‘Why do an MPH?’ Motivations and intentions of physicians undertaking postgraduate public health training at the University of Cape Town

Abstract

BackgroundPublic health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH qualifications.ObjectivesThis study identifies their motivations and career intentions and explored MPH programme strengths and gaps in under- and post-graduate PH training.DesignA cross-sectional study using an online questionnaire was completed by physicians graduating with an MPH between 2000 and 2009 and those enrolled in the programme in 2010 at the University of Cape Town.ResultsNearly a quarter of MPH students were physicians. Of the 65 contactable physicians, 48% responded. They were mid-career physicians who wished to obtain research training (55%), who wished to gain broader perspectives on health (32%), and who used the MPH to advance careers (90%) as researchers, policy-makers, or managers. The MPH widened professional opportunities, with 62% changing jobs. They believed that inadequate undergraduate exposure should be remedied by applying PH approaches to clinical problems in community settings, which would increase the attractiveness of postgraduate PH training.ConclusionsThe MPH allows physicians to transition from pure clinical to research, policy and/or management work, preparing them to innovate changes for effective health systems, responsive to the health needs of populations. Limited local job options and incentives are important constraining factors. Advocacy for positions requiring qualifications and benchmarking exit competencies of programmes nationally may promote enrolment.

Motivations of South African physicians specialising in public health

“…However, it is concerning that most trained as physicians within the last 15 years, when SA educational reform adopted bio-psycho-social approaches to health [21]. Participants’ recommendations that PH should be integrated in clinical teaching, complemented by community exposures, research that ‘digs in the determinants of health’ coupled with health promotion, also emerged from other local research [22]. Such approaches need to be researched and evaluated locally.…”

Career Paths of Public Health Medicine Specialists in South Africa

“…A lengthy service experience and accompanying maturity, positions trainees to gain maximally from training programs, and prepares them to work in complex systems. Similar to an earlier study of physicians with MPHs (26), respondents in this study embarked on PHM training after substantial work experience (median 7 years vs. 8 for MPH physicians), and many already had PH or other graduate training prior to specialization. This accords with reports from NZ and the UK: in the UK, physicians began PH specialist training after an average 5 years of practice (24); and substantial practice experience is implied in a NZ study (30).…”

“…Overall, fewer specialists were women but this was the converse for recent graduates who were predominantly female. This may reflect the general feminization of the medical profession in South Africa over the past decade (24, 25) and of public health specifically, with more women entering specialist training (10) and women physicians increasingly completing MPHs (26). The feminization of medicine is an international phenomenon both for general medical training (27) and for public health training, for example in Italy (28).…”

The growth of Australian public health graduates and courses, 2001‐2018: implications for education and employment opportunities

“…The literature concerning why students enrol in MPHs is scarce. For example, Zweigenthal et al interviewed South African physicians who have enrolled in an MPH, finding skills acquisition and career change to be common considerations 16 . Given ambiguities between the purpose of undergraduate and postgraduate public health courses, 17 student motivations should be better understood, and their motivations should be in line with the purposes of the courses, which may be to broaden knowledge or to prepare students for a profession.…”