Are you Pre-Med and trying to figure out what career in healthcare suits you? Are you trying to figure out whether your future holds medical school, PA school, nursing school, physical therapy school, research or another field of healthcare? If so, our SheMD Women In Healthcare Series is FOR YOU! Today we're talking about why you may want to consider a MPH or Masters in Public Health in addition to your MD or DO degree while in medical school. Student Doctor Shana Zucker is sharing why she chose to pursue an MPH.
I did not know that it would be the first patient that I ever saw which would lead me to pursuing a degree in public health. I was in high school, 16 years old, and knew in my heart that I was going to be a doctor. My incredible science teacher set me on this path when she advised me that observing a physician in action would help me understand the career path I had adamantly decided upon three years prior. She knew an emergency medicine physician at the small local hospital, and, dressed in formal attire and armed with the medical knowledge I acquired from Google-searching what I saw on popular television medical dramas, I headed into my first observing experience.
The population served by this hospital was relatively homogenous: white, upper-class, either families with children in school or elderly individuals, with very few in between, highly educated. The nurse reported to the attending I was shadowing that the family we were about to see had just had their power turned off and were hoping to get a doctor’s note to send to the company—not a standard predicament of this community. The physician shrugged, “Not every problem can be solved with a doctor’s note.” With that, he stood up, gestured with a nod for me to follow, and I filed behind him into the patient room.
The family before us did not meet the typical picture of North Shore suburbia in the Midwest. A father sat with his two children, a three-year-old girl and a five-year-old boy. In an oversized and discolored white t-shirt, the father looked stressed, while the siblings were playing. I did not yet have the words for it, but looking at this black family, the concepts of race, class, and privilege were developing in my mind. The doctor took a thorough history and examined the children: they each had no more than five insect bites that he concluded were from mosquitos. The father was relieved that it was not anything more serious, but explained “Doc, you gotta help us. We’ve been without A/C for three days.” In a Midwestern summer, where the temperature hangs in the upper 90s with heavy humidity, the lack of air conditioning could be suffocating.
I do not remember what the doctor said, but ultimately he excused himself, and when we returned to the desk, he began working on a letter to the gas company. I was surprised—perhaps too accustomed to watching cynical TV doctors—that he would change his mind. I asked why his opinion changed, and he explained, “It is my responsibility to treat everything that I can.”
This was my primer to the social determinants of health. Patients do not exist outside of their circumstances; to try to treat the condition and not the patient, the whole patient, with their story and context, is not only foolish but also simply ineffective. Sure, every person is unique, but the reality is that each identity that we bear also can categorize us, stratify us into risk groups. Prescribing treatment to two patients with the same symptoms, but of completely opposing socioeconomic classes, will not yield identical results, not because of the mysteries of the human body, but because of factors contributing to their environment, like being able to afford medication, or take as prescribed.
To me, the study of public health is an important way to view health using a different lens: both a social medicine approach, as well as a population-based approach. What I have enjoyed most about my pursuit of a masters of public health degree is the coursework in which I have been taught how to identify a population health problem, assess it appropriately, develop an intervention, and monitor and evaluate programs. Over the course of a semester, I completed a project writing a hypothetical grant proposal for a vaccine outreach program. In my particular MPH degree program, I am able to have a concentration in Global Community Health and Behavioral Sciences, which focuses on community-based interventions and impact, but I still have the opportunity to learn from the other concentrations, which involve the environment, policy and health systems structures, epidemiology, biostatistics, and tropical medicine.
Regardless of the field of medicine in which I ultimately specialize, I know that the skills I am gaining will be transferrable. I am going to be a doctor that works for the community, within the community. I am going to harness community health resources and form relationships with community partners. I am going to identify larger problems that impact my patients, and work with folks in and outside of the medical sphere to develop innovative solutions. In one of my courses, we completed a simulation in which teams of students were assigned various institutions—academic hospitals, community hospitals, various levels of government offices, non-for-profits—with differing priorities, and we had to come together to create a plan and budget to address a social need.
This is the type of applicable training that I see as the future of medicine: one in which we address both the physical cause of a patient’s symptoms, as well as the societal ones. What I love about public health is how vast it is, covering any content that threatens health and wellness on a large scale. By pursuing simultaneous degrees, I feel as if I can alternate between two different lenses: viewing an individual patient with my MD lens, and contextualizing the patient within a population with my MPH lens.
Not only does the MPH lens facilitate zooming out to a big picture view of a patient, but also encourages the same perspective shift in viewing the role of the physician in the context of the greater health problem. This enables an increasingly interdisciplinary approach to population health, involving allied health professions, community networks, and government infrastructure. I envision my future career in which I alternate between and synthesize these perspectives so that I can take into account patients’ individual symptoms as well as the greater social determinants of their health in their treatment, and develop programs to combat systemic issues to create enduring improvement.