Family Medicine Vital Signs

by German Ellsworth, MPH; Clinton Wadley, BS; Jacob Prunuske, MD, MSPH; and Jessica Greenwood, MD, MSPH

Many physicians attain graduate public health as a component of their careers. The decision to pursue higher education in public health is varied and often uniquely personal. However, whether they recognize it or not, those who achieve a public health degree on some level acknowledge the words of Hippocrates: “protecting and developing health must rank even above that of restoring it when it is impaired.”

We questioned how Utah family physicians with public health training utilize a public health degree in their medical career.   Our goal was to (1) estimate the prevalence of Utah family medicine physicians with graduate public health training and (2) describe how these physicians utilize their public health training.

We performed an anonymous, IRB approved, cross-sectional survey utilizing the University of Utah’s web-based management E-survey system.

Of 804 surveyed members of the UAFP, 84 responded to the survey (10%).  Fourteen (17%) of respondents completed a graduate public health degree.

Reasons for pursing public health training included (most common first) to practice community/population health, augment future training or employment application, perform research, assist with administration responsibilities and augment teaching. Times when graduate degree was attained were: after residency (43%), before medical school (29%), during medical school (14%) or during residency (14%).

Most (64%), reported using their graduate level public health degree after graduation in various capacities including: graduate education (67%); public policy (44%); research (44%); medical student clerkship director (33%); residency director (22%); and continuous quality improvement, public health director and clinical health applications (each 11 %). Current utilization included graduate education (67%); research (55%): public policy (44%); medical student clerkship director, residency director, and clinical health applications (22%); and continuous quality improvement (11%).

Our survey suggests that 17% of UAFP members have obtained a graduate public health degree and most have used and continue to use (64%) of their public health skills in their career. Utah family physicians with graduate public health degrees are more likely to work as salaried physicians in an academic setting. Compared to their colleagues without public health degrees, they spend less time in a clinical care setting and more time on graduate-level education, research, public policy, and administration.

Our survey results were similar to other published studies regarding graduate level public education among physicians. In 1994 Gensheimer et al surveyed medical students and physicians enrolled in the Harvard School of Public Health and found the most frequent reason for pursuing public health was the potential to benefit the community and to make an impact on society.  Most planned careers in public health,  and occupation and environmental health.

In 1998, Rosenberg surveyed a self-selected sub-set of medical students from Columbia University. The respondents indicated that interests in health policy, international health, and clinical prevention motivated their pursuit of public health.

Krousel-Wood et al published a study of all Tulane University School of Medicine alumni that graduated from 1985 – 1997 with and without an MPH degree. They found that graduates with an MPH were more likely to have completed a primary care residency, obtain employment in an academic institution or government agency, and practice public health.  These medical school graduates were also more likely to conduct, publish and present research.

These results may be useful in advising medical students and residents who seek advice on when and whether or not to seek formal public health education. This study is limited to the State of Utah, which may impact its generalizability. Our response rate (10%) should also be considered when critically evaluating our survey results.  It may also be that physicians with public health degrees responded to the survey at a higher rate than those without graduate degrees.