Community Health

[astar44]

Hi all,

 

I'm hoping to learn a little bit more about prospects of a career in community health. what sort of opportunities are available to physicians after completing a CH residency? and what would be the advantage of doing a CH residency over just FP+MPH? Thank you

[A-Stark]

moo can answer better, but one obvious path is work as a medical officer of health for a local or regional (or provincial!) health unit. Tends to involve a lot of planning and meetings and reviews of literature, on anything from communicable disease surveillance and epidemiology to water and air quality. I don't think it matters whether you go through the CH residency vs. FP+MPH (or FP+CH as moo is doing). An MOH typically works 9-5 hours (usually closer to 8:30-5:30) and as a salaried administrative-level government employee faces no overhead and has excellent benefits. Call is from home and you essentially never have to "go in". If you have base training in something like FM, you can split your time to maintain clinical practice alongside public health.

[thebouque]

Sounds like an amazing career, but you gotta love epidemiology!

[moo]

moo can answer better, but one obvious path is work as a medical officer of health for a local or regional (or provincial!) health unit. Tends to involve a lot of planning and meetings and reviews of literature, on anything from communicable disease surveillance and epidemiology to water and air quality. I don't think it matters whether you go through the CH residency vs. FP+MPH (or FP+CH as moo is doing). An MOH typically works 9-5 hours (usually closer to 8:30-5:30) and as a salaried administrative-level government employee faces no overhead and has excellent benefits. Call is from home and you essentially never have to "go in". If you have base training in something like FM, you can split your time to maintain clinical practice alongside public health.

 

Pretty much nailed it on the head.

 

There are lots of other jobs other than the typical MOH job though. You can work for Workers Comp (job site visits, occasional clinical work, research, etc.), do academic research, work at the provincial disease control center doing public health practice and research, international work like my program director (goes to Uganda every few months, I may end up working out of Vancouver with an NIH grant to help China set up a HIV surveillance program--this would involve travel to China occasionally), and research and practice at the national/fed level (PHAC, CIHR, FNIH). You can always have a small private practice on the side as a family doc and I feel that training in public health makes you a much better physician and vice versa. A lot of it is drafting documents, research, meetings, dealing with the media, etc. so it's not for everyone, but it's very cerebral, you are always learning, collaborating with people other than pharmacists and nurses, and doing a lot of good.

[astar44]

Wow, thanks for the great responses guys! Sounds very interesting. Moo- can I ask you why you decided to do CH residency instead of just doing a MPH?? What extra doors will a CH residency open compared to having just done a FP+MPH?

[moo]

You can do FP + MPH, but your opportunities are more limited. If you want to be an MOH in a big city, you will need to be residency trained. (There are some MOHs in the city who are FP + Masters but nowadays you will not get hired without a residency... unless you want to go rural.) If you want to make public health your main career, you will need a residency. Almost all academic positions require the residency. If you want to just do some research on the side, with clinical work then yes, you could just get an MPH... I do know people at BC CDC who do a lot of clinical work (for ex, in the STI clinics), but also do some policy/research work but they were kind of grandfathered in to their positions. The residency just opens up more doors.

 

Bottom line is I love this specialty. It's so much fun every day to go to work and not have to feel pressured by having to see x number of patients to make the cash. (Incidentally I did moonlight for 3.5 hours tonight and ended up seeing 33 walk-ins... not that I wanted to but they kept on coming and I felt so pressured to see them all in a timely fashion. So different from my day job.) You do really important work and can publish lots. And best of all, being a public health physician makes you a better family doctor (there's a reason why for the past 2-3 years, the highest scoring person on the CCFP exam was also a community medicine resident).

[olecranon]

looking through the selection criteria though for community medicine it seems like you really need to have evidence that you know what community medicine is really about and it seems like you should really have a specific area of interest already and have done things to support that. For a lot of us its not easy as the most we can do is take some electives. They also want to know how a residency in CM will fit your career goals. Well for a lot of us we don't know what are career goals are. Short of wanting to be involved in public health in one way or another, many of us just don't know...

 

for example here is a cut and paste blurb from calgary's cm program on personal letters:

"A personal letter (maximum 750 words) is required, detailing your career goals, interests and experiences in Community Medicine/community health. Following this training, where do you expect to be? Doing what? How will this program prepare you to do this? Demonstrate your understanding of the specialty of Community Medicine. "

 

One of my main concerns though was job availability and moo has said that jobs tend to creep up here and there and from what I gathered shouldn't really be a problem even if you wanted to work in say vancouver. I do fear, however, having to spend a large proportion of time simply applying for grants etc in public health.

[A-Stark]

There are *always* openings for MOH's around the country, though not necessarily exactly where you want to be at a given time.

[jaegwon]

looking through the selection criteria though for community medicine it seems like you really need to have evidence that you know what community medicine is really about and it seems like you should really have a specific area of interest already and have done things to support that. For a lot of us its not easy as the most we can do is take some electives. They also want to know how a residency in CM will fit your career goals. Well for a lot of us we don't know what are career goals are. Short of wanting to be involved in public health in one way or another, many of us just don't know...

 

Well...you certainly do want to demonstrate to the interview committees that you know what CM/public health is, and have well-thought out reasons for choosing it, but I wouldn't agree that you need to have definite career goals or experiences in subspecialties in PH. Many residents don't have them when applying. Public health is such a broad field with so many opportunities that it is more than reasonable to wait until you gain more experience to make career decisions.

[moo]

looking through the selection criteria though for community medicine it seems like you really need to have evidence that you know what community medicine is really about and it seems like you should really have a specific area of interest already and have done things to support that. For a lot of us its not easy as the most we can do is take some electives. They also want to know how a residency in CM will fit your career goals. Well for a lot of us we don't know what are career goals are. Short of wanting to be involved in public health in one way or another, many of us just don't know...

 

for example here is a cut and paste blurb from calgary's cm program on personal letters:

"A personal letter (maximum 750 words) is required, detailing your career goals, interests and experiences in Community Medicine/community health. Following this training, where do you expect to be? Doing what? How will this program prepare you to do this? Demonstrate your understanding of the specialty of Community Medicine. "

 

One of my main concerns though was job availability and moo has said that jobs tend to creep up here and there and from what I gathered shouldn't really be a problem even if you wanted to work in say vancouver. I do fear, however, having to spend a large proportion of time simply applying for grants etc in public health.

 

But thats all specialties you're talking about. You can have an idea of what you want to do but by no means will anyone expect you to be committed to it. What we do look for in applicants are people who are genuinely interested in CM, know what the specialty is about, understand the types of jobs and career paths that you can take, and most of all, good people who are fun to work with. CM is not a competitive specialty but we do want people who won't just transfer out after a year because it was a backdoor to get into another residency program. Doing electives in CM is a good start.

 

As for jobs, I wouldnt worry too much about it. Many jobs are not advertised and things just pop up after you do rotations at certain places. As someone said, there are MOH jobs vacant across the country, and you just have to be flexible in your location, but even in big centers, there are usually jobs available.

[Sev]

I found information from the University of Alberta stating that Community Medicine Specialists make about $200 000 to $300 000 a year plus benefits. Is this salary range also accurate for other provinces, as well (e.g. BC, Ontario)?

 

Out of curiosity, do the PGY-3 and -4 (or whichever program-specific combination) salaries take into account MPH tuition fees, or do residents have to pay MPH tuition fees out of what they make?

[bearfuzz]

I don't know if this answers your question, but i'm pretty sure in the CM residency (now public health and preventive medicine) you have the option of completing 2 years of clinical work at the beginning of the 5 year residency i.e. you get the CCFP. This is not considered dropping out of one or the other.

 

This would be awesome to do public health and all the numerous benefits that come with that (if you enjoy that type of work) and also do a little clinical work on the side. Not to mention the moonlighting opportunities during residency.

 

However, i suspect it would be difficult to maintain part-time FM with full time PH activities. I'm pretty sure you can take some walk-in shifts and do a little here and there but I would rather do 20 hours or so at least but that's pushing some extra hours that may get a little tiring, but who knows.

 

I think moo will be able to answer your question better.

 

fuzz

[A-Stark]

It's not uncommon for medical officers of health to maintain clinical practices to varying degrees. Some don't do any clinical work, of course, but it depends more on the kind of training they have and what kind of career interests them.

[jaegwon]

Just out of curiosity, is there any flexibility in going between FM residency and CM residency and vica versa? if you do this, is it considered "dropping out" of a residency program, as it would be with someone switching from one specialty to the next?

 

If someone has an interest in community health and say, likes the idea of devoting some of their career time to developing public health policies but maintaining a family practice, would this be feasible at all?

 

Most MOH's do some work that is clinically-related (while on-call, communicable disease control, screening programs). But most people use the term 'clinical work' to mean actually seeing/laying hands on patients, and there are some relatively established options for public health related clinical work aside from a general family practice...e.g. travel medicine, STI clinic, TB related.

 

There is currently a fair bit of work going on within the field attempting to better define and advocate for the clinical competencies of PH (public health) medicine specialists. The role of the CCFP is not universally agreed upon and its presence in the various curriculums varies accordingly...some programs require the CCFP, others do not offer it, some give residents the choice of clinical route (basic clinical training year or CCFP).

 

Theoretically, there aren't really any fixed limits to what someone could do - basically you have to demonstrate to the college that you have received 'sufficient' training in an area during residency and then maintained competency afterwards. So if a public health resident has a particular clinic interest, they could attempt to build vertical training in that area into their residency training...setting a precedent is usually more difficult/risky than following the beaten path however...

 

(as mentioned by a previous poster, it is possible to practice public health and general family medicine, but it is very difficult to comprehensively do both (well)).

[moo]

Just out of curiosity, is there any flexibility in going between FM residency and CM residency and vica versa? if you do this, is it considered "dropping out" of a residency program, as it would be with someone switching from one specialty to the next?

 

If someone has an interest in community health and say, likes the idea of devoting some of their career time to developing public health policies but maintaining a family practice, would this be feasible at all?

 

I'm not sure what you mean by your first question. Generally if you graduate from med school and you do Public Health and Preventive Medicine (this is the new name of the specialty), most but not all, will do a CCFP. A lot of us, however, have practice family med for a number of years before going back. Some PH residents decide to drop out after their 2 year CCFP and go into private practice. Some come back, some don't. One of the PH people in my program did this--was in the PH program years ago, dropped out to do clinical work and then came back to finish the PH residency.

 

As for maintaining a family practice on the side... it all depends on how hard you want to work. I'm a resident right now but still maintain some semblance of a family practice. It's not easy, but it's doable if you're willing to put in some extra hours. Granted most family docs nowadays are available 2-3 days a week anyway, so the fact that I'm available most days of the week is pretty good for patients. The key is to not take on too many patients, so that you are accessible to them.

 

In general most PH docs do clinical work in relation to their specialty. SO if you are a specialist in TB, you might do some TB clinics. Or if you are a specialist in STI epidemiology and control, you may do some STI clinics.

[moo]

Hmm thanks for the response. To my understanding, if you hold a CCFP and an MPH, without actually having done a residency in community medicine, you probably aren't going to be holding down high-end positions or being involved in big projects, hence why I was wondering if you can maintain a practice w/ a little bit of community health work on the side.

 

You are right here. Most PH jobs nowadays (MOH jobs anyway) require a fellowship. Those who don't have it have been grandfathered in. There are some rural MOH jobs however, where an MPH (or equivalent) will suffice. But if you want career advancement or want to work in a big center, you will need a fellowship.

[moo]

That was my question. If you were in a Family medicine residency and decided you wanted to do CM, how easy is it to switch into the program granted there are spots available? Likewise, if you were in CM, has it been such that people have gotten their CCFP and decided they didn't want to do CM anymore and drop out? What amount of time do you have before you need to come back? What if you decide not to come back? Is permanently dropping out common?

 

It's very easy to switch. A common route is that people go out, do FM for a few years (or less) and then reapply for re-entry. There are usually a lot of re-entry positions available. At UBC, there are 1 or 2 re-entry spots a year specifically reserved for family docs.

 

There have also been many people who start out in CM, finish their CCFP and drop out, only to come back later (or not at all). There are no limits as to when you can come back. But of course, once you drop out, you're out of the program and free to work as you please. If you want to come back, you can re-apply as a re-entry like any other doctor.

[moo]

Thanks moo. That's really interesting. For some reason I remember reading about going from a 2yr to a 5yr residency can be complicated because of something to do with funding being attached to you, so going to a 5yr residency requires more funding than a 2yr residency. Good to see there is flexibility in this area.

 

Transferring between a 2 year and 5 year program is not as difficult as people make it seem, especially within the same school. I know many who've transferred from FM to other specialties. Ive also known many other speclialty residents transfer into FM. If there is room in the other specialty, it's usually doable (a resident dropped out, or transferred out, or they didn't fill in the first place). Aside from uber competitive specialties, usually it's not that difficult. Of course, I dont know how many who failed to transfer and wanted to... stats aren't available for that but anecdotally at least I hear it's very possible.

[Lactic Folly]

Where does the family medicine resident get their funding for the extra 3 years, if not from a specialty resident who is concomitantly transferring to FM, or from a spot that is taken from next year's cohort?

Once out, practicing physicians in ON can apply for re-entry positions which are funded separately.

In medical school, I was told the success rate for transferring in residency was about 50/50.

[moo]

Where does the family medicine resident get their funding for the extra 3 years, if not from a specialty resident who is concomitantly transferring to FM, or from a spot that is taken from next year's cohort?

Once out, practicing physicians in ON can apply for re-entry positions which are funded separately.

In medical school, I was told the success rate for transferring in residency was about 50/50.

 

It is usually from a resident who dropped out of the specialty residency or transferred out (either to FM or something else) or from any unmatched positions left over from CaRMS. From my experience, usually in the not so competitive specialties (IM, psych for example), there are usually spots either unmatched or because the program is so big, at least one or more resident has transferred out, leaving spots available for people to transfer in.

 

I don't know about the actual success rate for transferring in residency (no stats are available and anyone who quotes numbers is just BSing), but I can tell you it probably depends on the institution, and the specialty you're transferring into. I've heard of people transferring into derm, but it's probably very difficult. It really depends on what's available at the time and luck.