The role of a specialist in public health medicine and epidemiology

Public health includes the measures put in place by governments and institutions to prevent disease, improve the health of a population and promote life expectancy. There are four areas in public health:

1. Health protection: against environmental and biological factors.

2. Improving health: by acting on risk factors such as smoking / alcohol consumption and improving living conditions and hygiene.

3. Public health health: ensuring the accessibility and efficiency of health services.

4. Academic public health: includes the compilation of evidence in all areas of public health.

Public health consultants need skills in all four areas, but may choose to specialize in only one. Dental public health consultants direct and implement policies relating to dental services, nutrition and food.

They must be fully registered with the GDC, be on the GDC Dental Public Health Specialist List, and hold a Masters Degree in Dental Public Health.

Consultant epidemiologists are involved in the surveillance of infectious diseases and environmental risks. They must analyze and evaluate research and evidence from various sources to make recommendations and guidelines. They investigate epidemics, different interventions and the cost-effectiveness of each.

There are differences between the job of a public health consultant and that of an epidemiology consultant, but both involve leading and working in teams to roll out new policies. Public health consultants focus on creating intervention policies targeting specific demographics to promote well-being and increase life expectancy.

They need to evaluate existing programs and ensure that health services are cost-effective, safe and accessible. Inequalities in health care are addressed by public health consultants. Working with different organizations, managing staff, budgeting, training juniors and leading research projects is the daily life of public health consultants.

Consultant epidemiologists focus more on policies for the investigation, control and prevention of contagious diseases. They participate in planning the response to local epidemics and in evaluating the epidemiology of existing diseases. Advice to the public health sector and other organizations as well as research, training and auditing are part of the professional life of consultant epidemiologists (1).

According to Health Education England in 2017, around 70% of local authority public health consultants and just under 60% of public health directors were women (2).

Flexibility, leadership, communication, work under pressure, research, political awareness and respect for other cultures are important skills and qualities in the public health sector. Job opportunities are growing in public and global health for people who can analyze data and format it to develop guidelines and policies.

A typical week

It is difficult to give an example of a typical week in a career in public health due to the diversity of positions and jobs. It is rare for a person to keep the same job for their entire career in public health, as they will take on positions that are better suited to their interests and developments. University and multidisciplinary teamwork is expected in most positions.

Often, interns are required to be part of their local health protection rotational team.

The road to public health medicine and epidemiology

Unlike other specialties, the public health training program welcomes medical and non-medical graduates. Non-medical consultants will be registered with the UK Public Health Register, while medical consultants will be registered with the GMC.

Medical graduates who do not qualify for GMC enrollment will be listed in the UK Public Health Register. Public health training generally lasts 5 years.

Entry requirements for ST1 in public health include an MBBS degree (Bachelor of Medicine and Bachelor of Surgery) or a first degree (1st or 2: 1) or Masters / Doctorate. For trainees applying with a medical degree, full enrollment and license to practice from the GMC is required, as well as completion of a UK foundation program or two-year equivalent at the ‘foreigner.

Trainees without a medical degree or non-medical candidates, a minimum of 48 months of professional experience is required. 24 of those months must be in a field related to public health practice (3).

The above criteria may change every year, information can be found on

Health Education England – Specialized Training

There are two exams to become a member of the Faculty of Public Health (FPH). This is the Diploma Exam of the Faculty of Public Health (DFPH), formerly known as Part A of the exam.

The second is the Final Membership Examination (MFPH) / Objective Structured Public Health Examination (OSPHE), formerly known as Part B of the exam. DFPH is used to examine the understanding of the scientific basis of public health, success will lead to entry into diplomatic membership. MFPH / OSPHE examines trainees’ ability to integrate public health theory into practice.

Obtaining the MFPH leads to membership in the Faculty of Public Health. CCT is awarded upon joining MFPH (UK) and completion of approved training programs and positions (4)

Here is a training course for trainees with medical training:

There were 804 applications for 86 UK positions in 2019 for entry into ST1 Public Health Medicine. This makes the competition ratio the highest compared to all other specialties at 9.35 (6).

Due to the Public Health Entrance Competition, interested interns can attend conferences, apply for funding for research projects, and participate in quality improvement projects. Teaching and management experience is appreciated.

Medical interns can apply for internships in public health. At the student level, students can become members of public health societies at the university and undertake elective internships or work experience in a field related to public health.

Full-time training is available for interested interns.

Sub-specialties

There are no separate sub-specialties for public health medicine in the UK (7), although consultants may choose to focus on the public health area in which they wish to work. Research and academia are integral parts of a career in public health.

Earnings

Salaries for NHS consultants are the same for all specialties, but vary between Scotland (highest), England, Northern Ireland and Wales (lowest) and increase with service (up to 19 years). In 2020, the salary ranges go from £ 77,779 to £ 109,849. Salaries can be further improved with the NHS Excellence Awards.

As with any specialty, it is possible to improve NHS income through private practice. JRSM reported in 2008 that the total income of public health medicine consultants was £ 80,659, with NHS income being £ 66,427 and private practices earning £ 14,232, a ratio of 0.21. This is similar to general psychiatry (0.20) and hematology (0.20) but much weaker than orthopedics (1.4), plastic surgery (1.9) and many other specialties ( 8).

For more information on salaries in the NHS, feel free to consult The Complete Guide to NHS Pay.

Resources

The Royal Society of Public Health (RSPH) publishes three peer-reviewed journals. Public Health, A Public Health Perspective and Public Health in Practice. Public Health contains research articles and reviews. Perspectives in Public Health publishes opinion pieces as well as peer-reviewed research. Public health in practice contains research on the practical side of public health care delivery and the theory behind the problems in the field (9)

Sources of related jobs with BMJ Careers

More comprehensive guides by BMJ Careers

The references

1. Public health consultants and specialists [Internet]. Health careers. 2020 [cited 3 July 2020]. Available at: https://www.healthcareers.nhs.uk/explore-roles/public-health/roles-public-health/public-health-consultants-and-specialists

2. Rankin B, Speller T, Sasiak A. Capacity of public health specialists – results [Internet]. 2020 [cited 3 July 2020]. Available at: https://www.hee.nhs.uk/sites/default/files/documents/Public%20health%20specialist%20capacity%20-%20findings.pdf

3. Person specification 2020- Public health- ST1 [Internet]. 2020 [cited 1 July 2020]. Available at: https://specialtytraining.hee.nhs.uk/portals/1/Content/Person%20Specifications/Public%20Health/Public%20Health-%20ST1.pdf

4. The diploma (DFPH) and the final membership examination (MFPH) [Internet]. FPH. 2020 [cited 2 July 2020]. Available at: https://www.fph.org.uk/training-careers/the-diplomate-dfph-and-final-membership-examination-mfph/

5. Public health medicine course [Internet]. Gmc-fr.org. 2020 [cited 2 July 2020]. Available at: https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/public-health-medicine-curriculum

6. 2019 Specialties Recruitment Competition Ratios [Internet]. 2020 [cited 3 July 2020]. Available at: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf

7. Specialties, sub-specialties and progression through training from an international perspective [Internet]. 2020 [cited 2 July 2020]. Available at: https://www.gmc-uk.org/-/media/documents/specialties-subspecialties-and-progression-through-training—the-international-perspective-45500662.pdf

8. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D et al. Analysis of the NHS and private income of consultants in England in 2003/4. Journal of the Royal Society of Medicine. 2008; 101 (7): 372-380.

9. Our journals | Royal Society of Public Health of the United Kingdom [Internet]. Rsph.org.uk. 2020 [cited 3 July 2020]. Available at: https://www.rsph.org.uk/our-services/journals.html