|
Publications
Reports
Resource Papers
Meetings
News & Events
About COGME
Members & Staff
Useful Links
Site Index
Home
|
Summary
of Resource Paper Compendium
Update on the Physician Workforce
August 2000
1
2
3
Page 4
C. "PHYSICIANS IN THE PUBLIC HEALTH WORKFORCE"
by Jerilyn K. Glass, M.D., Ph.D.
The author documents a decline over the past several decades in the percentage of physicians engaged in public health/preventive medicine activities and presents a case for (a) reversal of the decline and (b) the need for more current data. The decline can be inferred from a number of different data sets of varying time periods:
- Shortly after schools of public health were first accredited (1946-47), the majority of students admitted for Masters degrees in public health were physicians (61%). By 1965-66, the percentage had shrunk to 23%, by 1978-79 to 11%.
- Data from the AMA Masterfile indicate that the percentage of active specialty-classified physicians who self-designated in preventive medicine underwent a similar 50% decline between the mid 60's and late 70's, from 3.2% in 1963 to 1.6% in 1978.
- More recent data from the AMA's Physician Characteristics and Distribution in the U.S. indicate a comparable decline in the percentage of physicians self-designating in aerospace medicine, general preventive medicine, occupational medicine, or public health, from 2.3% in 1970 to 0.9% in 1997.
Noting that physicians have traditionally been leaders in the country's public health movement, the author cites data which indicate this may no longer be the case. Only about a third of full-time local health department executives currently have a medical degree, with the percentage varying by the size of the jurisdiction served. In jurisdictions serving populations of under 250,000, full-time physician executives are a distinct minority. Given today's societal health needs and the need for informed leadership in matters of population health and preventive medicine, the author underscores the importance of physicians with specialized training in public health competencies.
On the issue of data, the author notes that comprehensive, in-depth data on physicians in the public health workforce are currently in short supply. Citing a number of useful studies in the field-in particular, a 1999 survey of public health personnel in the State of Texas, headed by Dr. Virginia Kennedy7-she recommends an in-depth enumeration study be conducted across several States, utilizing a research approach similar to that employed by Dr. Kennedy, to explore the functions that public health physicians perform. She proposes the study utilize the expertise and data collection capabilities of the Health Resources and Services Administration's regional workforce centers, and that it involve a number of other governmental and professional organizations as well.
A second major set of recommendations dealt with the issue of funding support. The author recommends:
- Increasing Title VII funding of residency programs, currently averaging between $1.6 and 2.0 million a year, to support greater numbers of preventive medicine residents and faculty, as well as increased faculty development in these residency programs.
- Including preventive medicine residency training in Medicare's GME financing system in recognition that promotion of preventive medicine and population health is relevant to the health care of the Medicare population.
- Extending eligibility for National Health Service Corps (NHSC) scholarships to preventive medicine residents.
REFERENCES
1 COGME. Tenth Report: Physician Distribution and Health Care Challenges in Rural and Inner-City Areas, February 1998.
2 COGME. Fourteenth Report: COGME Physician Workforce Policies: Recent Developments and Recurring Challenges in Meeting National Goals, March 1999.
3 COGME. Eighth Report: Patient Care Physician Supply and Requirements: Testing COGME Recommendations, November 1996.
4 Vector Research, Incorporated. Integrated Requirements Model, Version 3.0 Technical Report, October 22, 1999.
5 Bureau of Health Professions. Report on Primary Care Workforce Projections. Council on Graduate Medical Education and National Advisory Council on Nursing Education and Practice, December 1995.
6 Makuc, et al. The Use of Health Service Areas for Measuring Provider Availability. The Journal of Rural Health, 7(4), Supplemental, pp. 347-356.
7 Kennedy, V.C., et al. Public Health Workforce Information: A State-Level Study. Journal of Public Health Management and Practice, 5(3), pp. 10-19.
1
2
3
Page 4
|
