In recent years physicians have become increasingly involved in the decision-making and policy-making processes in hospitals and other health service organizations. Consequently, there is a growing awareness of the need for specialized education programs for physicians who have managerial responsibilities. While education programs in management for physicians have been available in Britain and the United States for a number of years, relatively few programs have existed in Canada. Typically, physicians who have assumed administrative positions either within the medical staff organization or within the hospital's management structure have received no formal training in management. This article examines reasons for the increased demand for management education for physicians in Canada, specific needs of physicians in the area of management education, and the assessment of needs for management education programs.
Public health emergency planning includes a consideration of public health human resource requirements. We addressed the hypothetical question: How many public health physicians could Canada mobilize in the event of a public health emergency?
We used the 2004 National Physician Survey (NPS) to estimate the number of public health physicians in Canada. Using weighting to account for non-response, we estimated the numbers and population estimates of public health physicians who were active versus 'in reserve'. We explored the impact of using diverse definitions of public health physician based upon NPS questions on professional activity, self-reported degrees and certifications, and physician database classifications.
Of all Canadian physicians, an estimated 769 (1.3%) are qualified to practice public health by virtue of degrees and certifications relevant to public health, of whom 367 (48%) also report active 'community medicine/public health' practice. Even among Canada's 382 Community Medicine specialists, only 60% report active public health practice.
The estimation of the size of Canada's public health physician workforce is currently limited by the lack of a clear definition and appropriate monitoring. It appears that, even with a reserve public health physician workforce that would almost double its numbers, Canada's available workforce is only 40% of projected requirements. Public health emergency preparedness planning exercises should clearly delineate public health physician roles and needs, and action should be taken accordingly to enhance the numbers of Canadian public health physicians and their capacity to meet these requirements.
In addition to establishing Canadian federal institutions for public health to work in cooperation with provincial and local health authorities, the infrastructure of public health for the future depends on a multi-disciplinary and well-prepared workforce. Traditionally, Canada trained its public health workforce in schools of public health (or hygiene), but in recent decades this has been carried out in departments and centres primarily within medical faculties. Recent public health crises in Canada have led to some new federal institutions and reorganization of public health activities as well as other reforms. This commentary proposes re-examination of the context of public health workforce training and especially for schools of public health as independent faculties within universities as in the United States or, as developed more recently in Europe, semi-independent schools within medical faculties. The multi-disciplinary nature of public health professionals and the complex challenges of the "New Public Health" call for a new debate on this vital issue of public health workforce development. Public health needs a new image and higher profile of training, research and service to meet provincial and national needs, based on international standards of accreditation and recognition.
Notes
Comment In: Can J Public Health. 2006 May-Jun;97(3):251-416827419
This concluding article comments on what we learned from the conference, what we still need to know, and what we need to do now. It describes what participants said about the impact of the conference and the follow-up steps that have been taken so far. In terms of what we learned, there was agreement on the importance of culture in understanding literacy and health literacy; the importance of context; the integral relationship between literacy and health literacy and the concept of "empowerment;" the value of efforts to improve health through literacy and health literacy; and the need for collaboration. We need more and better information on how our various efforts are working; the cost of low literacy; the links between health, education, and lifelong learning; the needs and strengths of Aboriginal people, and the perspectives of Francophone and ethnocultural groups. Specific topics worthy of pursuit are suggested. They are followed by a list of recommendations from the conference related to focussing on language and culture, and to building best practices, knowledge, and healthy public policy. The paper presents some findings from the conference evaluation, which suggests that the conference met its goals. It concludes by reporting on actions that have been taken to implement the conference recommendations, including the establishment of a Health Literacy Expert Committee and the submission of several funding proposals.
Different sets of competencies in public health, global health and research have recently emerged, including the Core Competencies for Public Health in Canada (CCPHC). Within this context, we believe it is important to articulate competencies for globalhealth practitioners-educators and researchers that are in addition to those outlined in the CCPHC. In global health, we require knowledge and skills regarding: north-south power dynamics, linkages between local and global health problems, and the roles of international organizations. We must be able to work responsibly in low-resource settings, foster self-determination in a world rife with power differentials, and engage in dialogue with stakeholders globally. Skills in cross-cultural communication and the ability to critically self-reflect on one's own social location within the global context are essential. Those in global health must be committed to improving health equity through global systems changes and be willing to be mentored and to mentor others across borders. We call for dialogue on these competencies and for development of ways to assess both their demonstration in academic settings and their performance in global health practice and research.
Bridging the gap in population health for rural and Aboriginal communities: a needs assessment of public health training for rural primary care physicians.
The literature identifies significant inequalities in the health status of rural and Aboriginal populations, compared with the general population. Providing rural primary care physicians with public health skills could help address this issue since the patterns of mortality and morbidity suggest that prevention and health promotion play an important role. However, we were unable to identify any community needs assessment for such professionals with dual skills that had been performed in Canada.
We conducted key informant interviews and focus groups in 3 rural and Aboriginal communities in British Columbia (chosen through purposive sampling). We analyzed transcripts following standard qualitative iterative methodologies to extract themes and for discussing content.
There was broad support for a program to train primary care physicians in public health. The characteristics identified as necessary in such a physician included a long-term commitment to the community with partnership building, advocacy, communication and cultural sensitivity skills. The communities we studied identified some priority challenges, most notably that the current remuneration structure does not support physicians engaging in public health or research.
There is great potential and support for the training of rural primary care practitioners in public health to improve population health and engage communities in this process.
The success of efforts to prevent continued transmission of the human immunodeficiency virus (HIV) and to increase compliance with HIV prophylactic interventions among homosexual and bisexual men will depend in part on health care professionals' understanding of and ability to establish linkages with these men. In order to recruit men into a research project and an educational program, staff at the Pitt Men's Study, an epidemiological investigation of HIV infection, developed a process described here as "brokering," which was based on community organizing and marketing principles. Brokering is a dynamic process by which researchers and public health professionals exchange goods and services with formal and informal leaders of the gay community in order to establish strong, long-term linkages. To date, this process yielded 2,989 homosexual and bisexual recruits into the study, which began in 1983. After 8 years, 79% of those still alive continue to return for follow-up. While recruitment techniques will need to vary from city to city, the importance of establishing linkages with the local indigenous leadership remains of major importance.
