As federal officials determine when and how to reopen the country, numerous public health experts fear that the United States is significantly short of the public health workers needed to mitigate another occurrence and properly perform contract tracing.
On April 8, 2020 JAMA published an editorial co-authored by Dr. Josh Sharfstein and Dr. Howard Bauchner proposing a public health response to the COVID-19 pandemic by electively suspending medical education for the medical students of the class of 2024 and implementing a National Service Program for interdisciplinary graduate students.
Dr. Jamar Slocum, on behalf of the Beyond Flexner Alliance, recently sat down with Dr. Josh Sharfstein, to discuss his recent editorial and its impact on medical education. Dr. Sharfstein is the current Vice Dean for Public Health Practice and Community Engagement for the Bloomberg School of Public Health and Director of the Bloomberg American Health Initiative. He previously served as Principal Deputy Commissioner of the U.S. Food and Drug Administration, Commissioner of Health for Baltimore City, and health policy advisor for Congressman Henry A. Waxman.
This discussion has been edited for length and clarity.
Medical Schools Do Need an Overhaul. Doctors need to be trained in public health, health equity, and social justice.
COVID-19 is laying bare society’s underlying structural inequities that increase the risk of exposure, infection, and death for minority and disadvantaged communities across the US. The pandemic is also disproportionately affecting healthcare workers, who continue to work despite insufficient personal protective equipment and further, face disciplinary actions for speaking out.
Despite these realities, Dr. Stanley Goldfarb in his April 13 commentary suggests “doctors should be trained in pandemics, not injustice,” and that “the medical profession should abandon the fantasy that physicians can be trained to solve the problems of poverty, food insecurity and racism.” Clinical care is estimated to account for only 10-20% of what ultimately impacts health outcomes. Social determinants of health – health behaviors, social and economic factors, and the physical environment – account for the other 80-90% (National Academy of Medicine). The attitude that physicians should focus solely on clinical care aims to disempower the profession and frankly, is dangerous.