Available Positions Known to AAPHP

Click Here for an Abstract of Dr. Nitzkin's August 2000, Survey, to be published in AJPM.

Job Market Action Plan.

Head Hunter Firms

       New World Healthcare Solutions, Inc

New Material from Nov 2000 AAPHP Board Meeting

A:  Resolutions prepared  for ACPM by Joel Nitzkin

B: Supporting Information to resolutions (A: Above)

 

Historical Material:  This proposed Job Market Action Plan is presented in the context of the AAPHP "Master Strategy", as Proposed November 27, and approved at our December 20, 1996, Conference Call Board Meeting. Please review and forward suggestions for change/update to the editors for inclusion in the next bulletin

Problem Statement
A. The job market for Public Health Physicians (PHPs) is no where near as large as it should be, and does not have the richness in quality offerings that it should include.
B. Many of the jobs that should be done by public health physicians, in both health care and public health systems, are done by non-physicians. Some are done by physicians without public health training--sometimes without any understanding of epidemiology or how it's principles should be applied.

Definitions

  1. Physician defined as licensed MD or DO.
  2. Public Health Training defined as formal education and certification to engage in group/population diagnosis and intervention/treatment--assessment, policy development and "assurance". Unless otherwise specified, such training shall be considered to be an MPH (or similar degree) and a Public Health Residency, or the functional equivalent thereof.
  3. Physicians with such training to be referred to as Public Health Physicians (PHPs), whether they consider themselves "public health", or "general preventive medicine".
  4. Public Health Work is defined as administrative and policy in nature, not clinical. Physicians who spend part of their time doing clinical work are considered to be part time PHPs and part time clinicians in the context of these definitions.

Potential Job Arenas

1. Public Health

2. Health Care Delivery,.

Detailed Perceptions of the Problem, in Public and Private Sectors

  1. In traditional public health (State and Local Health Department Directorships) non-physicians are frequently used because:
  1. They are less expensive.
  2. They are seen as more politically responsive.
  3. Attempts were made to hire a PHP, but none could be found.
  4. Those doing the hiring had no comprehension of a physician role outside a clinical setting.
  5. There is a common perception that physicians are poor administrators.
  1. In health care delivery, non-physicians are usually used because:
  1. The roles are defined as managerial or financial.
  2. Physicians are seen as managerially and financially inept.
  3. Those doing the hiring had no comprehension of a physician role outside a clinical setting.
  4. Social work administrators and health plan and health facility managers often see physicians as part of the problem, not part of the solution.

(For many of the jobs to be done, the cost using accounts and administrators is two to five times higher than it would be using PHPs).

C. In both public health and health care settings, physicians with little or no training in public health are used because:
  1. There are many more of them.
  2. If they are smart enough to do clinical medicine, they must be smart enough to do this "much simpler work".
  3. "Public Health" is still seen by many as the refugee for physicians unable to do clinical work.
  4. Most doing the hiring in both sectors have no comprehension of Public Health as a medical specialty with specialized training and skill--although most recognize an MPH as a ticket for admission to this field.
  5. There is no performance standard to measure the quality of work done by a physician in a public health role.
  6. Schools of Public Health are divorced from any form of Public Health Practice (most schools, most of the time, but this problem has been recognized, and practice opportunities are slowly evolving

D. Most of the "Problem" is in Tertiary Prevention - where there has been most of the recent growth and little penetration by PHPs. A list of Tertiary Prevention role is as follows:
  1. Demand Management
  2. Disease Management
  3. Utilization Review
  4. Quality Assurance
  5. Health Risk Assessment and Amelioration for populations at special risk (pregnant, diabetic, asthmatic, correctional infant or geriatric, indigent, etc.)
  6. Development of protocols, guidelines, baselines and benchmarks.

Other Problematic Issues, and Proposed Responses to Each of Them

A. No agreed upon concept of public health competency or specialization.

B. Lack of perception by PHPs and public health residency programs as to many of the jobs PHPs should be doing to pay their way through residency--doing public health rather than clinical work.

C. Certain topics that could substantially contribute to the success of PHP work that are currently taught in MPH or PHP training programs.

D, Serious problem with some physicians claiming public health expertise that they do not have, performing poorly, and adding to the lackluster reputation of the field -referred to at the Prevention'97 special interest session as "public health dilettantes". These individuals claim expertise they do not possess, but often get political appointments to highly placed positions, then perform poorly, further damaging the reputation of the specialty of Public Health and General Preventive Medicine.

E. No recognition in many job market arenas that there is such a thing as a specialty of Public Health and Preventive Medicine -- and that these physicians have specialized skills not offered by other physicians.

Recommended Corrective Measures (to Job Market Problem)

  1. Public Health and Preventive Medicine residency programs should play a lead role within each of their host institutions relative to public health program services at nearby state and local health departments, and in Demand Management, Disease Management, Outcomes Ascertainment, Quality Assurance and Utilization Review within their host academic medical centers and related payers and health plans. This health care delivery work should be framed as "tertiary prevention". Public Health and Preventive Medicine residents should earn their way through residency doing this public health related work, with faculty supervision, rather than the current pattern of doing clinical work to earn their way through residency. This would provide valuable training for the residents and demonstrate the value of physicians with public health training doing this work.
  2. Redefine the specialty for purposes of more clearly articulating the competencies offered -- from "General Preventive Medicine and Public Health" to "Public Health, Preventive and Population Medicine" (PHPPM) The term "Public Health Physician" should be defined as a physician, who has specialized training and experience in group/population diagnosis and intervention/treatment.
    1. The problem(s) and interventions could be preventive, therapeutic, related to health care costs, or any combination thereof.
    2. The PHPPM role is administrative in nature. It can be within health departments, managed care plans and other public and private settings.
    3. Many, if not most, PHPs also see patients. These physicians, in the context of this definition, do part time public health work, and part time clinical work.
  1. Proposed (informal) Subspecialty Structure

1. Nature of work -- the first of two dimensions describing specialization

2. By nature of competency -- the second of two dimensions describing specialization

  1. Proposed Focus on Tertiary Prevention
  1. In training programs -- move resident support from primarily clinical to primarily administrative -- doing tertiary prevention work.
  2. In MPH programs - introduce new material on tertiary prevention, and the ways in which epidemiologic principles can be applied to these issues.
  3. When dealing with potential employers - state our skills in terms of services they wish to purchase (with major focus on health care cost containment).
  1. Proposed Articulation of Justification for Focus on Tertiary Prevention
    1. The cost of health care delivery has skyrocketed out of control. Much of the cost is wasted on services which are not needed or are harmful. Public health skills are required to figure out how to reduce these costs without compromising the health of the people being served.

    2. 2. Unfortunately, from a public health perspective, much needed medical care is not being delivered. Infant and adult immunization, prenatal care and cancer screening re excellent examples. From a public health perspective, the issue is considered more care vs less care, but should be looked at as the right care to the right client at the right time. Even more important, from a public health perspective, are community preventive services intended to deal with tobacco use, diet, exercise, safety, etc.

  2. Quackery is a serious problem with preventive health services, and there are many parties, both well-meaning and otherwise, that propose dietary supplements, devices and other items that may be unproven, worthless or harmful. Sorting the helpful from the worthless and harmful is often difficult. This sorting, in turn, requires public health skills.
  3. Proposed Solutions (external to specialty):

1. Objectives of this Marketing Effort

2. Marketing Work To Be Done

Generate and pass resolutions through public health related national organizations in support of the specialty in general, PHPs, and Boards of Health (this is highest immediate priority) AAPHP, AMA, NACCHO, ASTHO, ACPM, ATPM, The National Association of Boards of Health, and other organizations co-sponsoring the annual Prevention Meetings.

Generate and pass these same resolutions through national organizations representing actual and potential employers

1. Governmental:

2. Academic and health care delivery:

Other Points from Prevention'97 Job Market Special Interest Section Meeting and AAPHP Brainstorming Session on this Topic: