Profiles of Physicians Trained in Schools of Public Health ELENA PADILLA, PhD STEPHEN E. GOLDSTON, EdD, MSPH
The physician who graduates from a school of public health differs in many respects from a private practitioner. A profile of public health physicians is presented.
Introduction Unlike medical school education, internship, residency, and continuing medical education programs which are designed exclusively for physicians, the educational programs of schools of public health are addressed to multiple occupational groups. Persons representing more than 20 different occupations attend schools of public health and follow curricula which either overlap with or are identical to academic programs pursued by physicians during their public health training. The public health student population varies by backgrounds and levels of previous preparation, by career goals, and by enrollment in different degree programs. A wide choice of areas of major program concentration exists within the multidisciplinary framework of public health training. Physicians most frequently take a program leading to the MPH degree, which is the most commonly awarded degree among students graduating from a school of public health."2 In addition, physicians trained in schools of public health are generally employed in performing public health work functions after graduaDr. Padilla is Professor and Director, Health Planning, Policy, and Administration, Graduate School of Public Administration, New York University, New York, New York. Dr. Goldston is Coordinator for Primary Prevention Programs, Division of Special Mental Health Programs, National Institute of Mental Health, Rockville, Maryland 20852. The opinions expressed are those of the authors and not necessarily official positions of the National Institute of Mental Health, which funded this survey. The collaboration of the Professional Examination Service is acknowledged. This article was submitted for publication in April, 1972. 828 AJPH AUGUST, 1975, Vol. 65, No. 8
tion, usually in a governmental setting. Thus, within the scope of medical education and the utilization of medical and other professional health manpower, the training of physicians in schools of public health merits special study and is the focus of this paper. The flndings reported herein are excerpted from a research project conducted among recent American graduates from 11 accredited schools of public health in the continental United States.* A total of 4459 questionnaires were mailed in August-September, 1968, to American citizens who received master's degrees during 1961-1967; 3115 of the questionnaires returned (69.9 per cent) met usability criteria and were incorporated into the survey.3 Physicians comprised the largest primary professional group (604 or 19.4 per cent) in the surveyed population.t
Demographic and Educational Profiles At the time of the survey in 1968 over one-half of the physicians (55.6 per cent) were 31 to 40 years old. Only a few (5.0 per cent) were between 26 and 30 years old, which was the youngest age group where physicians were found. * Berkeley, Columbia, Harvard, Hopkins, Michigan, Minnesota, North Carolina, Pittsburgh, Tulane, UCLA, and Yale. t An additional 35 respondents or 1.1 per cent who reported themselves as psychiatrists were not included in this analysis of physician manpower. Thus, in effect, this article deals with nonpsychiatric physicians or 94.2 per cent of all of the physicians participating in the survey.
In the age group 41 to 50 years old were 28.7 per cent, and an additional 10.8 per cent were 51 years of age or over. On the whole, physicians as a group were younger than dentists, social workers, or nurses. Four of five of the physicians (81.5 per cent) were men, with the ratio of men to women being 4.6:1. Almost all of the physicians (97.7 per cent) had received their MD degrees prior to entering a school of public health. Also, almost two-thirds of them (62.4 per cent) had professional work experience in public health before their enrollment in a school of public health of which close to one-half (47.2 per cent) had from less than 1 year to 4 years of that type of experience. However, over one-third (35.6 per cent) had not had any public health experience. There were physicians among the graduates from each of the 11 schools and almost two-thirds of them (65.9 per cent) graduated from Berkeley (25.0 per cent), Harvard (23.3 per cent), and Hopkins (17.5 per cent). In addition, the highest percentages of respondents by primary profession from Harvard (62.4 per cent), Hopkins (58.9 per cent), Berkeley (29.4 per cent), and Columbia (16.7 per cent) were physicians. By contrast, only 2.5 per cent of the Minnesota graduates were physicians. Most physicians (94.7 per cent) obtained an MPH degree, this being by far the largest number to receive this degree in any professional group. While in a school of public health physicians had pursued more different specified major program areas (19 of 24) than any other professional group. Most frequently physicians reported majors in Administration or Practice of Public Health (23.5 per cent), Maternal and Child Health (16.9 per cent), Epidemiology (16.7 per cent), and Aviation Medicine (15.2 per cent). Physicians in turn comprised 95.8 per cent of all those who majored in Aviation Medicine, 55.8 per cent of those who majored in Epidemiology, 73.4 per cent of those who majored in Maternal and Child Health, and 29.2 per cent of those majoring in Administration or Practice of Public Health. Table 1 shows the major programs followed by physicians in schools of public health.
Occupational Profiles At the time of the survey, a large majority of the physicians (92.7 per cent) were working full-time and an additional small group (4.3 per cent) were working part-time. The unemployment rate was 2.3 per cent. Most physicians (97.1 per cent) were working in the health field. Over two-thirds of the employed physicians (67.0 per cent) identified some level of government as their principal source of income, 15.6 per cent identified the private sector, and 6.7 per cent noted other unspecified principal sources of income. One-half of all of the employed physicians (50.5 per cent) worked in a health setting or establishment, and over three-fourths of these (76.4 per cent) did not work in hospitals. Physicians also were not
TABLE 1-Major Programs Followed by Physicians Who Received a Master's Degree from a School of Public Health, 1961-1967 (in Rank Order) Major Programs Administration or Practice of Public Health Maternal and Child Health Epidemiology Aviation Medicine Occupational Health, Industrial Hygiene Medical Care and Hospital Administration, Administrative Medicine Tropical Medicine, Entomology, Parasitology International Health Biostatistics Environmental Health, Public Health Engineering, Sanitary Science Other Chronic Disease, Gerontology Mental Health, Administrative Psychiatry,
No.*
%
142 102 101 92 39 24
23.5
22 10 9 8
3.6 1.7 1.5 1.3
8 6 6
1.3 1.0 1.0
5 4 3 2 2 2 1
0.8 0.7 0.5 0.3 0.3 0.3 0.2 2.6
16.9 16.7 15.2 6.5 4.0
Community Psychiatry Population Studies, Family Planning, Demography Microbiology, Laboratory Public Health Physiological Hygiene, Environmental Medicine Health Education Nutrition, Biochemistry Radiation Health Behavioral Sciences Nonrespondents *
Total
=
16
604.
likely to work in welfare or social agencies (0.9 per cent), industry or business (2.9 per cent), schools (0.7 per cent), or a mental health setting (0.5 per cent). Only 4.6 per cent worked in a private practice setting. The influence of public health training on their professional activities was particularly noted by the tendency among physicians to work in the same area as that in which they had majored (70.0 per cent). Of the 172 physicians who were not working in the area of their major program, over one-fourth (27.9 per cent) were working in areas of administration and about another one-fourth (24.4 per cent) in unspecified other areas. Moreover, a plurality among the physicians (47.1 per cent) was not engaged in direct patient care as a function of their work. Physicians held the title of Public Health Physician more frequently than any other (35.3 per cent); however, this professional title was not exclusively held by physicians but to a lesser extent also by members of other primary professions. Other specific professional titles held by physicians were also held by members of other primary professions. By far the most frequently reported major professional roles discharged by physicians were in the executive-administrative areas (39.6 per cent); these roles were also reported by members of other professional groups although from currently available data it is not possible to identify whether any specific roles were discharged exclusively by physicians. In addition, 12.1 per cent of the physicians cited research roles, 11.1 per cent staff roles, 9.9 per cent consultative roles, 6.7 per cent instructional roles, PHYSICIAN PROFILES
829
2.0 per cent supervisory roles, and 9.6 per cent other unspecified roles. Except for 9.9 per cent and 1.7 per cent, respectively, of the physicians who considered their public health training "of little use" and "of no use at all" to their present work, the tendency was for physicians to assess their public health training as "highly useful" (49.0 per cent) and "useful" (37.3 per cent).
Conclusions 1. American physicians who received a master's degree from a school of public health between 1961 and 1967 were most likely to be male, to be between ages 31 and 40, to have attended Harvard, Hopkins, or Berkeley, and to have been awarded an MPH degree. 2. Most physicians had had professional experience in public health prior to enrollment in a school of public health, but close to one-half of them had from less than 1 year to 4 years of such experience, and over one-third had not had any public health work experience. 3. The largest numbers of physicians majored in Administration or Practice of Public Health, Maternal and Child Health, Epidemiology, and Aviation Medicine. 4. Physicians mainly worked in the same area as that in which they had majored in a school of public health and were employed in health settings, with two-thirds working in the public sector. 5. The most common title among physicians was
Public Health Physician, and the most common major roles that they held were executive-administrative; both the titles and roles held by physicians were also reported by members of other primary professions. These findings suggest a career model for physicians who have graduated from schools of public health which differs in many key respects from that of private medical practitioners.4 The central differences appear to be govemment employment, executive-administrative functions, less participation in direct patient care, and to some extent, the mix of professional titles and roles with members of other primary professions. The extent to which other professionals trained at schools of public health can perform the same tasks as physicians is an important area for study in improving the utilization of health manpower.
References 1. Troupin, J. L. American Public Health Association, Schools of Public Health in the United States and Canada, for the years ending June 1961-1970 (mimeographed annual reports). 2. Kane, R. L., and Weisbuch, J. B. The M.P.H.: Postgraduate Training or Remedial Medical Education? J. Med. Educ. 46:652-657, 1971. 3. Goldston, S. E., and Padilla, E. Mental Health Training and Public Health Manpower. U.S. Department of Health, Education, and Welfare, Publ. No. 72-9024. U.S. Government Printing Office, Washington, DC, 1972. 4. Medical Careers in Public Health. Milbank Mem. Fund Q. 44:2, Part I, 1966.
HEALTH EDUCATION SEMINAR SCHEDULED FOR SEPTEMBER Federal Region VII (Kansas, Iowa, Nebraska, Missouri) will hold a health education seminar September 29 and 30 and October 1, 1975, in Kansas City, MO. Each of the representative states will participate in the program: "Communications" (Kansas); "Behavior Modification" (Missouri); "Evaluation" (Iowa); and "Patient Education" (Nebraska). The National Bureau of Health Education will also be participating in the seminar. For further information, contact the Region VII office, Public Health Service, Kansas City, MO 64106, or any of the state directors of health.
830 AJPH AUGUST, 1975, Vol. 65, No. 8
The physician who graduates from a school of public health differs in many respects from a private practitioner. A profile of public health physicians is presented.
Introduction Unlike medical school education, internship, residency, and continuing medical education programs which are designed exclusively for physicians, the educational programs of schools of public health are addressed to multiple occupational groups. Persons representing more than 20 different occupations attend schools of public health and follow curricula which either overlap with or are identical to academic programs pursued by physicians during their public health training. The public health student population varies by backgrounds and levels of previous preparation, by career goals, and by enrollment in different degree programs. A wide choice of areas of major program concentration exists within the multidisciplinary framework of public health training. Physicians most frequently take a program leading to the MPH degree, which is the most commonly awarded degree among students graduating from a school of public health."2 In addition, physicians trained in schools of public health are generally employed in performing public health work functions after graduaDr. Padilla is Professor and Director, Health Planning, Policy, and Administration, Graduate School of Public Administration, New York University, New York, New York. Dr. Goldston is Coordinator for Primary Prevention Programs, Division of Special Mental Health Programs, National Institute of Mental Health, Rockville, Maryland 20852. The opinions expressed are those of the authors and not necessarily official positions of the National Institute of Mental Health, which funded this survey. The collaboration of the Professional Examination Service is acknowledged. This article was submitted for publication in April, 1972. 828 AJPH AUGUST, 1975, Vol. 65, No. 8
tion, usually in a governmental setting. Thus, within the scope of medical education and the utilization of medical and other professional health manpower, the training of physicians in schools of public health merits special study and is the focus of this paper. The flndings reported herein are excerpted from a research project conducted among recent American graduates from 11 accredited schools of public health in the continental United States.* A total of 4459 questionnaires were mailed in August-September, 1968, to American citizens who received master's degrees during 1961-1967; 3115 of the questionnaires returned (69.9 per cent) met usability criteria and were incorporated into the survey.3 Physicians comprised the largest primary professional group (604 or 19.4 per cent) in the surveyed population.t
Demographic and Educational Profiles At the time of the survey in 1968 over one-half of the physicians (55.6 per cent) were 31 to 40 years old. Only a few (5.0 per cent) were between 26 and 30 years old, which was the youngest age group where physicians were found. * Berkeley, Columbia, Harvard, Hopkins, Michigan, Minnesota, North Carolina, Pittsburgh, Tulane, UCLA, and Yale. t An additional 35 respondents or 1.1 per cent who reported themselves as psychiatrists were not included in this analysis of physician manpower. Thus, in effect, this article deals with nonpsychiatric physicians or 94.2 per cent of all of the physicians participating in the survey.
In the age group 41 to 50 years old were 28.7 per cent, and an additional 10.8 per cent were 51 years of age or over. On the whole, physicians as a group were younger than dentists, social workers, or nurses. Four of five of the physicians (81.5 per cent) were men, with the ratio of men to women being 4.6:1. Almost all of the physicians (97.7 per cent) had received their MD degrees prior to entering a school of public health. Also, almost two-thirds of them (62.4 per cent) had professional work experience in public health before their enrollment in a school of public health of which close to one-half (47.2 per cent) had from less than 1 year to 4 years of that type of experience. However, over one-third (35.6 per cent) had not had any public health experience. There were physicians among the graduates from each of the 11 schools and almost two-thirds of them (65.9 per cent) graduated from Berkeley (25.0 per cent), Harvard (23.3 per cent), and Hopkins (17.5 per cent). In addition, the highest percentages of respondents by primary profession from Harvard (62.4 per cent), Hopkins (58.9 per cent), Berkeley (29.4 per cent), and Columbia (16.7 per cent) were physicians. By contrast, only 2.5 per cent of the Minnesota graduates were physicians. Most physicians (94.7 per cent) obtained an MPH degree, this being by far the largest number to receive this degree in any professional group. While in a school of public health physicians had pursued more different specified major program areas (19 of 24) than any other professional group. Most frequently physicians reported majors in Administration or Practice of Public Health (23.5 per cent), Maternal and Child Health (16.9 per cent), Epidemiology (16.7 per cent), and Aviation Medicine (15.2 per cent). Physicians in turn comprised 95.8 per cent of all those who majored in Aviation Medicine, 55.8 per cent of those who majored in Epidemiology, 73.4 per cent of those who majored in Maternal and Child Health, and 29.2 per cent of those majoring in Administration or Practice of Public Health. Table 1 shows the major programs followed by physicians in schools of public health.
Occupational Profiles At the time of the survey, a large majority of the physicians (92.7 per cent) were working full-time and an additional small group (4.3 per cent) were working part-time. The unemployment rate was 2.3 per cent. Most physicians (97.1 per cent) were working in the health field. Over two-thirds of the employed physicians (67.0 per cent) identified some level of government as their principal source of income, 15.6 per cent identified the private sector, and 6.7 per cent noted other unspecified principal sources of income. One-half of all of the employed physicians (50.5 per cent) worked in a health setting or establishment, and over three-fourths of these (76.4 per cent) did not work in hospitals. Physicians also were not
TABLE 1-Major Programs Followed by Physicians Who Received a Master's Degree from a School of Public Health, 1961-1967 (in Rank Order) Major Programs Administration or Practice of Public Health Maternal and Child Health Epidemiology Aviation Medicine Occupational Health, Industrial Hygiene Medical Care and Hospital Administration, Administrative Medicine Tropical Medicine, Entomology, Parasitology International Health Biostatistics Environmental Health, Public Health Engineering, Sanitary Science Other Chronic Disease, Gerontology Mental Health, Administrative Psychiatry,
No.*
%
142 102 101 92 39 24
23.5
22 10 9 8
3.6 1.7 1.5 1.3
8 6 6
1.3 1.0 1.0
5 4 3 2 2 2 1
0.8 0.7 0.5 0.3 0.3 0.3 0.2 2.6
16.9 16.7 15.2 6.5 4.0
Community Psychiatry Population Studies, Family Planning, Demography Microbiology, Laboratory Public Health Physiological Hygiene, Environmental Medicine Health Education Nutrition, Biochemistry Radiation Health Behavioral Sciences Nonrespondents *
Total
=
16
604.
likely to work in welfare or social agencies (0.9 per cent), industry or business (2.9 per cent), schools (0.7 per cent), or a mental health setting (0.5 per cent). Only 4.6 per cent worked in a private practice setting. The influence of public health training on their professional activities was particularly noted by the tendency among physicians to work in the same area as that in which they had majored (70.0 per cent). Of the 172 physicians who were not working in the area of their major program, over one-fourth (27.9 per cent) were working in areas of administration and about another one-fourth (24.4 per cent) in unspecified other areas. Moreover, a plurality among the physicians (47.1 per cent) was not engaged in direct patient care as a function of their work. Physicians held the title of Public Health Physician more frequently than any other (35.3 per cent); however, this professional title was not exclusively held by physicians but to a lesser extent also by members of other primary professions. Other specific professional titles held by physicians were also held by members of other primary professions. By far the most frequently reported major professional roles discharged by physicians were in the executive-administrative areas (39.6 per cent); these roles were also reported by members of other professional groups although from currently available data it is not possible to identify whether any specific roles were discharged exclusively by physicians. In addition, 12.1 per cent of the physicians cited research roles, 11.1 per cent staff roles, 9.9 per cent consultative roles, 6.7 per cent instructional roles, PHYSICIAN PROFILES
829
2.0 per cent supervisory roles, and 9.6 per cent other unspecified roles. Except for 9.9 per cent and 1.7 per cent, respectively, of the physicians who considered their public health training "of little use" and "of no use at all" to their present work, the tendency was for physicians to assess their public health training as "highly useful" (49.0 per cent) and "useful" (37.3 per cent).
Conclusions 1. American physicians who received a master's degree from a school of public health between 1961 and 1967 were most likely to be male, to be between ages 31 and 40, to have attended Harvard, Hopkins, or Berkeley, and to have been awarded an MPH degree. 2. Most physicians had had professional experience in public health prior to enrollment in a school of public health, but close to one-half of them had from less than 1 year to 4 years of such experience, and over one-third had not had any public health work experience. 3. The largest numbers of physicians majored in Administration or Practice of Public Health, Maternal and Child Health, Epidemiology, and Aviation Medicine. 4. Physicians mainly worked in the same area as that in which they had majored in a school of public health and were employed in health settings, with two-thirds working in the public sector. 5. The most common title among physicians was
Public Health Physician, and the most common major roles that they held were executive-administrative; both the titles and roles held by physicians were also reported by members of other primary professions. These findings suggest a career model for physicians who have graduated from schools of public health which differs in many key respects from that of private medical practitioners.4 The central differences appear to be govemment employment, executive-administrative functions, less participation in direct patient care, and to some extent, the mix of professional titles and roles with members of other primary professions. The extent to which other professionals trained at schools of public health can perform the same tasks as physicians is an important area for study in improving the utilization of health manpower.
References 1. Troupin, J. L. American Public Health Association, Schools of Public Health in the United States and Canada, for the years ending June 1961-1970 (mimeographed annual reports). 2. Kane, R. L., and Weisbuch, J. B. The M.P.H.: Postgraduate Training or Remedial Medical Education? J. Med. Educ. 46:652-657, 1971. 3. Goldston, S. E., and Padilla, E. Mental Health Training and Public Health Manpower. U.S. Department of Health, Education, and Welfare, Publ. No. 72-9024. U.S. Government Printing Office, Washington, DC, 1972. 4. Medical Careers in Public Health. Milbank Mem. Fund Q. 44:2, Part I, 1966.
HEALTH EDUCATION SEMINAR SCHEDULED FOR SEPTEMBER Federal Region VII (Kansas, Iowa, Nebraska, Missouri) will hold a health education seminar September 29 and 30 and October 1, 1975, in Kansas City, MO. Each of the representative states will participate in the program: "Communications" (Kansas); "Behavior Modification" (Missouri); "Evaluation" (Iowa); and "Patient Education" (Nebraska). The National Bureau of Health Education will also be participating in the seminar. For further information, contact the Region VII office, Public Health Service, Kansas City, MO 64106, or any of the state directors of health.
830 AJPH AUGUST, 1975, Vol. 65, No. 8
