Combined M.D./M.P.H. Programs Give Future Physicians Individual, Population Perspectives, Say Educators

A new four-year doctor of medicine/master of public health, or M.D./M.P.H., program, sponsored by The University of Texas Health Science Center at San Antonio School of Medicine and The University of Texas Health Science Center at Houston School of Public Health, represents a happy marriage of health promotion and disease prevention that enables physicians to care for both individual patients and entire communities, according to family medicine educators. Students in the program say it has given them a broader medical perspective.

The program is described in an article in the April Texas Medicine. The combined, four-year program -- one of fewer than 10 in the country -- integrates medical and public health training so graduates can address population-based prevention and wellness issues more effectively, including such societal problems as obesity, diabetes, substance abuse and health disparities.

"In medically underserved regions like South Texas, in the face of rising national and local public health threats, well-trained public health and prevention-oriented physicians are needed urgently," the article's authors say. "A definite need exists for a four-year integrated dual-degree M.D./M.P.H. curriculum to close the training gap between medicine and public health."

One of the authors, Sharon Cooper, Ph.D., professor and regional dean of the University of Texas-Houston School of Public Health, San Antonio Regional Campus, told AAFP News Now in an e-mail interview that administrators do not know which specialties or subspecialties the 65 students in the new dual degree program -- which started in 2007-08 -- eventually will choose.

A fourth class of about 40 students has just been admitted, so it is too early to have data on whether the dual program is a good strategy for growing primary care physicians, she said. However, Cooper said the department of family and community medicine in the San Antonio medical school has a "clear public health orientation," with the largest concentration of faculty having these dual degrees.

"It seems to be the view of our students that all physicians -- from primary care to surgical subspecialties -- are better doctors when they keep population health and prevention in mind," she said. "We do think we will see a group of new physicians that will support and advocate for innovations, like the patient-centered medical home (or PCMH), that are especially relevant to family and community medicine."

Family physicians and family medicine educators speak highly of what the integration of medical and public health education brings to family medicine and primary care.

Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, told AAFP News Now that the dual programs are an excellent merging because they expand students' perspectives from the individual patient to the community.

"Public health brings prevention -- and to a certain extent, safety -- up to the community level, especially for those problems that affect large segments of the population," said Pugno, who pursued his public health training as a part-time student at Loma Linda University in Loma Linda, Calif., three years after completing his family medicine residency.

Wayne Dysinger, M.D., M.P.H., is director of the integrated family medicine/preventive medicine residency program at Loma Linda University. Its residents earn a master's degree in public health when they complete their four years of postgraduate training. He agrees with Pugno about the value of the combination.

"The overarching philosophy of the combined program is that a significant proportion of physicians are better off if they have strong population-based skills, as well as skills to take care of patients one-on-one," Dysinger said. Providing the added systems-based training equips physicians who have completed the dual degree program with an enhanced understanding of and ability to work with larger population groups, he added.

John Rogers, M.D., M.P.H., M.Ed., professor and interim chair of the department of family and community medicine at Baylor College of Medicine in Houston, said the program development and evaluation skills that are learned in an M.P.H. program are important in setting up and assessing a PCMH.

Moreover, he said, the M.P.H. enhances physicians' medical decision-making through statistical science that infuses day-to-day care and is used to evaluate preventive services. That can help physicians better judge, for example, a screening tool's effectiveness.

Rogers said public health training also teaches future physicians about the effects of social determinants of health, such as socioeconomic status and transportation and environmental issues, all of which "make you think about how you can be involved in a community rather than doing a Band-Aid (treatment) over and over and over."

Students in The University of Texas program say their studies in public health have opened their eyes to important health policy issues, such as the call for better access to care, the burden of uninsurance and the need for community health improvements.

Dana Brown, who is completing her first year in the program, told AAFP News Now that the public health training will allow her to help more people as a physician or as a physician-researcher who can influence health policy.

Brown, who hopes to enter a family medicine residency after she graduates in 2013, said the dual training has broadened her perspective and altered her approach to how she eventually will care for her patients. She especially likes epidemiology, she said. "It is critical to the health of a population to study, qualify and quantify those factors that affect health and well-being so effective interventions can be implemented."

Kirsten Newhams, who is completing her second year, said the combined program allows her to see the "bigger picture of medicine."

"With public health, I am learning to look at populations, trends and the economics of health," Newhams explained. "I have gained insight into the impact of the environment, occupation and policy on the health of populations and individuals."