Careers in Medicine: Health Policy
A NextGen Pathways in Medicine Article
From an Interview with Josh Sharfstein, M.D., Baltimore City Health Department
Josh Sharfstein, M.D.
Throughout the history of medicine in America, the realms of medicine and public health have often been at odds with one another, and to this day, there is still considerable tension. In one camp, there are the physicians who primarily advocate an approach to mitigating the burden of disease through the aggressive treatment of individuals (such as through the use of pharmaceutical drugs, procedures, and other medical treatments). In the other camp, there are public health professionals who primarily advocate an approach that emphasizes disease prevention (such as through sanitation, health education, lifestyle change, and other preventative measures). Traditionally, the medical camp has often "captured" the majority of federal and non-government funds dedicated to the improvement of health care, leaving preventive efforts with fewer resources. Nonetheless, a physician working in public health can play a pivotal role in bridging the gap between these two fields in an effort to drive changes in health policy. Dr. Josh Sharfstein of the Baltimore City Health Department is one such physician aiming to improve health care through policy.
"In public health, physicians can assume a wide range of roles: from leading the organization to being a team member [addressing issues in] school health, environmental health, maternal and child health, public health preparedness, etc." Physicians working at the policy level of public health interact extensively with other physicians, lawyers, and policymakers on a daily basis. Building strong roots in the targeted community is also very important to public health initiatives. Collaboration is vital to all public health efforts: "We typically work in alliance with other health groups. Occasionally, we are at odds with legislators who take positions contrary to public health."
Although physicians who focus primarily on health policy or research have "little direct patient care responsibility," Dr. Sharfstein asserts that "public health is a great opportunity to put medical knowledge to work for the health of a population." On the other hand, other physicians engaged in public health work on a clinical level have extensive patient contact as they aim to provide high quality care on par with mainstream health care [See "Careers—Clinics for Underserved Communities" in our next issue -- Ed.]. Public health on a clinical level typically involves clinical service directed toward improving the health of specific segments of the population that might fall through the cracks of mainstream health care.
There is substantial flexibility in the involvement of physicians in public health and health policy. Some physicians choose to stay in a single program for most of their careers, while others move from one program to the next to spread their contributions. Dr. Sharfstein recommends that young physicians interested in policy should seek jobs in local, regional, or national health departments, or otherwise find ways of cooperating with health departments from a clinical or academic setting. While a Masters in Public Health (M.P.H.) is not required for public health work, it does provide useful background knowledge and skills for analyzing and interpreting population data.
According to Dr. Sharfstein, physicians working in the public health sector should have excellent interpersonal skills and a desire to make a difference in a community. "If you want to make a difference for an entire community at a time, consider public health." 
Lester Leung is the founder of the Next Generation and a member of the Harvard College Class of 2006.
Josh Sharfstein, M.D. is a pediatrician who has worked with the WHO, FDA, Massachusetts Department of Public Health, and Boston Medical Center, and is an aide to Congressmen Harry Waxmen for HIV/AIDS and discrimination policy issues.