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. 2000 Jul 8;321(7253):112.

Career development in public health

Doctors should lead public health departments

Sarah Taylor 1, Charles Saunders 1
PMCID: PMC1127731  PMID: 10950529

Editor—McPherson's letter exemplifies the problem inherent in the demedicalisation of public health medicine.1 Of course the quality of the training available to non-medical public health workers needs to be improved. So do career and pay structures to recruit and retain those highly skilled individuals from a variety of specialties who make up the public health team, particularly public health infection control nurses, who are in extremely short supply.

A broad range of skills is required to make public health teams function properly in the real world. Different members of the team bring different knowledge and skills, and these are not readily interchangeable.

But McPherson trivialises what medical training is. A medical degree is much more than studying the illness of individuals. Most courses are designed to enable prospective doctors to do their jobs, which means they will deal compassionately with sick and well people, understand and treat illness as a social and individual phenomenon, and work with others in teams. The breadth of the scientific and social compass of medical training mirrors the range of additional skills needed if we are to be effective improvers of the public's health. Doctors who work in public health build on this foundation and develop sufficient competence in most of the skills needed in any public health team either to lead specific areas of work or to understand what others will contribute. No other discipline in the team can do this, but this kind of understanding is essential for its proper leadership. This is why we believe that doctors should lead public health departments.

References

BMJ. 2000 Jul 8;321(7253):112.

Career choice in public health should be less restricted

Surinder Bakhshi 1

Editor—McPherson supports careers in public health without a glass ceiling and promises availability of excellence in training in public health for those without a medical degree.1-1 Why is formal training in public health necessary for a career in public health? The tools that a director of public health needs in order to manage the health of the population are, in principle, no different from those required by a director of social services, a senior civil servant, or the chief executive of a public body.

The restrictive career choice in public health has, like all restrictive practices, distorted and skewed public health in the country. Practitioners in public health medicine would find it difficult—looking at death rates from heart disease and cancer—to justify the monopoly of their specialty in improving the health of the population. The dismal picture may not be their fault, but it does require alternative solutions. The United Kingdom compares unfavourably with other European countries, where there is less emphasis on the medically oriented practice of public health.

Removing the glass ceiling will attract candidates of the highest calibre, including doctors. An unfettered pay structure outside the NHS pay scale will reward achievement. As McPherson states, the excellently medically trained public health doctors have nothing to fear from competition.

Change is painful. The BMA has a duty to protect the interests of its members. It should not do so from a narrow perspective. Saving Lives: Our Healthier Nation presents an opportunity to improve dramatically the health of the population.1-2 We should seize this opportunity with both hands.

References

  • 1-1.McPherson K. Removing barriers to career development in public health. BMJ. 2000;320:448. . (12 February.) [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Secretary of State for Health. Saving lives: our healthier nation. London: Stationery Office; 1999. . (Cm 4386.) [Google Scholar]

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