By Cristine Hall
Growing up in northeast San Fernando Valley, Andrea Bañuelos Mota wanted to be a doctor, but she didn’t know how. No one in her community had gone to medical school. When her brother passed away, a devastating loss for her family, she resolved to chart her own course.
“My brother’s passing showed me how social determinants of health can lead to difficult outcomes,” said Bañuelos Mota, who graduated this month with dual degrees, a doctor of medicine and a master’s of public health. “I had to take a step back and think about what it would mean to become a physician in this healthcare system, and I knew I needed to be a part of it.”
Bañuelos Mota is among a growing number of students pursuing a dual MD-MPH degree, a study from USC researchers shows. The number of students pursuing MD-MPH degrees increased 434 percent from 149 in 2010 to 796 in 2018, according to “Dual MD-MPH Degree Students in the United States: Moving the Medical Workforce Toward Population Health,” published in Public Health Reports by co-authors Jo Marie Reilly, MD, MPH, professor of clinical family medicine, and Michael R. Cousineau, DrPH, MPH, professor emeritus of preventive medicine, both at Keck School of Medicine of USC.
The rate of growth was greater than the increase in either the number of medical students (16 percent) or the number of MPH students (65 percent) alone. And MD–MPH students as a percentage of total MPH students more than tripled, from 1.1 percent in 2010 to 3.6 percent in 2018.
“The healthcare system is increasingly looking at what we call population health, the health of groups of people, and how we create better value for what we spend in medical care,” said Cousineau, co-author of the study and until recently the director of the MD-MPH Program at Keck School of Medicine of USC for eight years. “There’s growing interest at the policy level at how we can improve quality at a lower price and that means research, data, and behavioral interventions. Tomorrow’s physicians want skills in data and policy analysis, and population health. An MPH gives students a broader view of the healthcare system and skills they need to understand how we change system factors that affect people’s health.”
The study’s principal author, Reilly, added an MPH to her MD three years ago.
“This past year has brought about a bigger emphasis in looking at disparities in healthcare, particularly for people of color, and how to address that on a health global level,” said Reilly, vice chair of education in family medicine at the Keck School of Medicine of USC. “Being a clinician, I learned about one-on-one patient care. An MPH gave me an amplified look at systems of healthcare and things that don’t traditionally get taught in medical school.”
A multidisciplinary worldview
USC’s MD-MPH program formed 10 years ago and averages about 10 students a year. Students typically complete their MPH after their third of medical school and graduate in five years. Classes draw students from nursing, social work and journalism, in addition to MD and MPH candidates, giving students a multidisciplinary view of the world. As they complete their coursework, students gain work experience in 150-hour practicums, a requirement for the MPH, with local health departments, community-based researchers, health plans and other public health organizations, Cousineau said.
Cousineau has traveled with students to Sacramento for the annual Insure the Uninsured Project conference, which draws a diverse group of policymakers, providers and researchers to focus on advancing healthcare reform in California. Students are given an assignment to identify at least one legislator, make an appointment to speak with them about a bill, and then follow up as part of a mini-lobbying exercise.
MD-MPH candidates also must complete a capstone course. Three years ago, a class decided to address the issue of firearm violence by organizing a symposium, organizing everything from the food to the speakers. “It was a great example of how you do public health,” Cousineau said. This year’s capstone class focused on vaccine access for low-income and minority communities under the direction of Danica Liberman, MD MPH, associate professor of clinical pediatrics at Keck School of Medicine of USC.
The MD-MPH program has produced more than 100 graduates, many of whom remain in close touch with Cousineau, Reilly and other Population and Public Health Sciences faculty as they’ve moved on to pursue careers in academia, clinical care, managed healthcare plans, local health department, s the Center for Disease Control and Prevention, the World Health Organization and more.
An edge for Match Day
With a dual MD-MPH degree, graduates make strong candidates for residency programs, Reilly said. Their training gives them skills to take on leadership positions and develop programming for their residency institutions.
In March, the program celebrated a successful Match Day for graduates, including Bañuelos Mota. In her third year of medical school, while doing clinical rotations, Bañuelos Mota realized a medical degree wouldn’t be enough, and that she would need an MPH to understand how healthcare is delivered in this country.
“I had three goals with my MPH: to learn about different health insurances, to learn about health policies and how they influence health services, and to complete a research project,” said Bañuelos Mota, who will soon begin her residency at the Family Medicine program at UCLA Santa Monica Medical Center. “I wanted a strong foundation in statistical training to do future community-based research.”
Dual MD-MPH degrees may be the future for medical education. The University of Miami Miller School of Medicine in Florida only offers a dual degree MD-MPH program for its medical students.
Taking medicine one step further
Jodie Guller, who graduated with an MD-MPH this month, believes a dual MD-MPH degree makes the most sense for anyone looking to practice medicine with a holistic understanding of the many upstream factors influencing the health of individuals, families, and communities.
A summer research program in high school with an MD-PhD researcher sparked Guller’s interest in medicine. Her initial years in medical school opened her eyes to the need for a better foundational understanding of our healthcare system and the policies that impact people’s health.
“For me public health allows us to take it one step further and understand all the factors that influence the way people live their lives,” said Guller, who will complete her family medicine residency at Long Beach Memorial Hospital. “What do their neighborhoods look like? What are their education and employment opportunities? All these things impact people’s health immensely, and physicians who are taking care of patients need to have that broader understanding.”
Christine M. Plepys, MS, senior director of data analytics at the Association of Schools and Programs of Public Health, is co-author of the study with Reilly and Cousineau.