What Would a Structured Public Health Practitioner Education Look Like?

In the United States, if you want to become a physician, there is a structured way of going about it. You go to college to get an undergrad degree, preferably in some science field. From there, you apply to medical school after taking the MCAT. Once you get into a medical school, you do four years of it and then go into a residency program of some sort and of varying lengths based on what specialization you wish to pursue. At the end of that residency period, you can become board-certified in that specialization and you’re off to the races… Let’s not talk about the cost, though.

Sure, there are some people who take a less “traditional” route into becoming a physician and go get a master’s degree before medical school because they didn’t do too well in their undergrad program. Or they go to a medical school outside the United States and then come back and take a series of exams to get into a residency program here. (US-educated medical students take the same exams.) And then there are those crazy people who get a bachelor’s, then a master’s, then a doctorate, and then go to medical school because why the hell not?

To become a physician assistant, you go to school for a bachelor’s degree in some field and then you go to school to get a master’s degree in physician assistant studies. You can then practice as a PA in whatever field you like, but you have to do so under the supervision of a physician and in accordance with whatever laws your state has about licensure. And, to become a nurse, you go to either a two or four-year program. If you want to be more advanced in your nursing practice (and somewhat more independent), you go get a master’s. (Doctoral degrees for both PAs and nurses are available, especially if they want to teach at a high level.)

Yep. Someone has to teach you how to do this.

Of course, these are generalizations. Your mileage may vary slightly based on the program you enroll into. But what you should understand is that there is structure to these professions. There are specific programs that teach specific skills, and there are licensing boards that hold you accountable for your practice. Not so with public health practitioners.

If you want to be a public health practitioner, you can just get a job at a health department or some health agency and go from there. Sure, they require some level of education, but there have been plenty of times when I’ve run into people who have an education in something completely foreign to public health and then just kind of moved into the public health job for one reason or another.

Generally speaking, if you want to be an epidemiologist, you go get a bachelor’s degree in something and then get a master’s degree in epidemiology. Or you get a master’s degree in public health with some epidemiology courses thrown in there. Or you have a bachelor’s degree in something, a master’s degree in something, and then you go get a PhD (or DrPH) in epidemiology. (Though why would you want to get hired as an entry-level epidemiologist at a health department with all that debt from a doctoral degree?) This last option is mostly for academic/research epidemiologists. You know, the other kind of epidemiologist?

There just doesn’t seem to be a structure on how to become a public health practitioner. You can’t pull up one overarching plan on how to become one. It seems to me that it’s mostly just a matter of wanting to work at a health department and then asking people there what they did, and then just kind of doing the same thing they did. You know? Monkey see, monkey do?

My data are gone? Oy!

During the classes that I’ve served as a teaching assistant at that world-class, top-of-the-line school of public health, it has become very painfully clear to me that we are graduating a very big number of people who are ill-prepared to become public health practitioners. Sure, they can do logistic regressions like a boss, but they don’t know the first thing about how to investigate an outbreak. (Or they do know, but they only have the book knowledge — because they’ve been taught by an academic/research epidemiologist — when the real-life stuff is much more different.)

Even a high-ranking faculty member advised PhD students that they should look into working at a health department if they wanted to be assured of a job once they were done. Because of the cuts in research funding and the overcrowding of academic institutions, there aren’t many openings for research epidemiologists at academic institutions. However, he forgot to mention to them that their doctoral dissertations should relate to issues and public health problems seen by local and state health departments. Instead of the genetics of diabetes, they should look at the social determinants of diabetes, for example. Or how to intervene so people don’t get killed by poor food choices.

Chocolate will kill you, man!

Then again, I’ve also noticed that “public health practitioner” is not one of those sexy careers like “doctor” or “nurse.” You don’t see many television shows dedicated to PHPs. Heck, PHP is not even an acronym you’d associate with a public health practitioner. I mean, the last time television tried to do a show about epidemiologists, it was a farce. They had epidemiologists literally jumping off helicopters in order to stop an outbreak.

In the real world, the jobs that PHPs do are varied, but they certainly do not include running into a “hot zone” to physically save people. Yeah, we might go to a hospital to interview a case during an outbreak investigation, but we let the healthcare providers at that hospital take care of the patients. Or we might go to the scene of a major event, but victim rescue and transport is left up to the firefighters and EMS… You know, the experts?

What I would like to do in the next 10-20 years is to develop a structured program for PHPs at all levels. Want to be a sanitarian who checks restaurants and swimming pools for hygiene? Then here’s a program that will train you to be a sanitarian anywhere in the country. Want to be a public health nurse? Then here is a program that will train you after nursing school on what a public health nurse. Epidemiologist? Here’s a program to get you to be an entry-level epidemiologist, and here’s another for you to become a higher-level epidemiologist. Want to manage a disease investigation unit? Here’s a program for that.

You get the idea.

Instead of a school of public health that is only a graduate school (with a few courses open for undergraduates), my vision is that of a true school of public health that teaches the many different concepts of public health — and the basis of it all, epidemiology — to students of all levels. Such a school would be putting out PHPs ready to work at any level of the public health structure. They could be field investigators, sanitarians, public health nurses, epidemiologists, unit managers, division chiefs, and even state/territorial epidemiologists. They would all be prepared to work as PHPs, but — most importantly — they would be prepared to work with each other. And they would possess the latest knowledge on how to work in public health from all that cooperation and networking after they graduate.

It doesn’t hurt to dream, does it?