Way back in the mid 20th century when I graduated from George Washington University with an MD degree I imagined that I had arrived.

I remember my classmates selecting different specialties and eventually going off to clinical training. I could not imagine doing anything other than clinical work, and perhaps dabbling in some clinical research.  Some of my friends were studying ‘epidemiology’ and a new field ‘public health’.  At that time, it mostly  was dedicated to ‘epidemics’, vaccinations, preventive medicine, and things that to me did not really involved patient care.

Turn the page, 50 or 60 years. This specialty has morphed into having an MPH (Masters in Public Health), and perhaps an MBA in health administration.  Previously these professionals had little to do with your clinical practice on a daily basis.  Now these people are the groundbreakers, movers and shakers throughout the medical world in which we all practice.

My school is now known as “George Washington University School of Medicine and Health Sciences.” The previous formal division of Medical Clinical pursuits from allied health and health business has become blurred at the educational level.  This blurring of distinction has also occurred in the clinical world with PAs. NPs, Advanced Degree nursing specialties and the like.

As a delayed and recent student of this field, and as a result of my blogging research I see that the topography has changed drastically.  Previously treated with disdain, MPHs, and MBAs, and MHAs increasingly have invaded our insular clinical world.  Many health reformers and policy makers delved deep into the social psychology of medical practice, medical group organization, quality measures, and even reimbursements.

All of this has evolved into an environment of MPHs having a huge influence on governmental policy makers.   Many MPHs have evolved into a new specialty of Political Influence.  Many practice medicine, not by treating patients or treating diseases, but by spreadsheets, algorithms, and formulating treating diseases from 40,000 feet … far removed from the implications of their edicts.

 

The flack is coming from we clinicians on the ground.

Gee, I wish I had gotten that MPH.

Gary Levin is a physician who blogs at Health Train Express.

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