Public Health is a well known ‘alternative’ career for doctors as a small specialty (as per GMC description – less than 250 trainees) focusing on the bigger picture, that very few know how to get into.

Like most of the small specialties, as doctors, we have very limited, or no working experience within Public Health, although most of us will brush shoulders with it in the essence of our daily clinical practice.

For those who are in tune with the demands of the specialty, the application process is competitive with both medics and non-medics training in controversial parallel to become Public Health Consultants.

We catch up with Dr. Wikum Jayatunga, Public Health Registrar in a no-holds barred interview, to debunk the myths and uncertainties we hold about this career pathway including future career prospects, pay, the role of Local Authorities and big data.

What was your clinical background before Public Health (PH) Training and why did you apply?

I’m unusual in that I knew I had always wanted to go into Public Health training, so I entered the scheme after Foundation training. I first became interested in this career path following an intercalated BSc in Management during medical school. This opened my eyes to the potential of impacting health at a population level.

For my elective, I completed an internship with a management consultancy firm, working on health sector projects, and later completed a 4-month FY2 post in PH. This confirmed for me that I preferred the more strategic, ‘big-picture’ work to working in hospital medicine.

Describe a day in your life as a Public Health Registrar?

Registrars will work in so many different organisations during training that there is no typical day, and the variety is one of the best aspects of the work.

At the moment, I’m doing a Masters in Public Health which is one of the perks of the programme, getting to go back to Uni for a year. Before that I worked in health protection, responding to communicable disease outbreaks. And before that I was in Local Authority, where the focus is on health promotion and reducing health inequalities.

The day job for most placements will involve a mixture of reading and research, data analysis, report writing, presenting, debating and collaborating in meetings. A broad set of skills and knowledge is required, so being a generalist is an asset.

You’re given autonomy to manage your own time, so being a self-starter is essential.

Hours wise, it’s generally 9 to 5 with occasional busier periods, but most supervisors are quite flexible in how/when/where you work, as long as your projects are making progress, and you’re encouraged to go to conferences and training courses.

Health protection on call work is over the phone and usually minimal. After passing the (very difficult) membership exams, senior registrars can pursue a greater choice of placements, including universities, hospital trusts, think tanks, national institutions, and international placements.

What future career prospects are there after completing Public Health training?

The most common role for PH consultants is in Local Authorities, where the Director of Public Health is responsible for the health and wellbeing of the local population. Consultants in health protection work in regional Public Health England centres.

Increasingly, consultants are working for CCGs and acute hospital trusts, supporting commissioning and new models of care. Consultants also work in national organisations (PHE, DH, NHS) and some will experience a portfolio career, juggling multiple roles at the same time. Others may choose to leave the more typical tracks, for example, pursuing academic research careers at universities, or choosing to work internationally, in the third sector or private sector.

New areas of work in public health include sustainability and climate change, and ‘big data’ informatics and modelling.

Could you comment on the challenges and uncertainties of a career in public health?

Public health is certainly not immune to the difficulties currently facing the public sector.

The public health budget is facing year on year cuts which makes for an uncertain environment. Furthermore, the task is challenging given the funding shortfall across health and social care, but this makes for exciting work.

The public health profession is also more liable to health system reorganisation. For example, the recent switch from the NHS to local government means that we now work in a more inherently political environment (yet with more opportunities for upstream, cross-sectoral action).

Unlike in hospital medicine, Consultants wouldn’t expect to stay in the same job or workplace for their whole career.

At the moment I don’t worry too much about where I’ll end up, because it’s clear that public health skills are in demand. There will always be a role, somewhere in the system, for expertise and leadership in population health.

Can non-medics can also undertake Public Health training?

Historically, public health used to be a purely medical specialty like any other. But some time ago there was a recognition that public health is so broad and multidisciplinary in nature, that those without a medical degree would bring different skills to the table.

Despite lacking clinical experience, non-medics often have substantial prior experience of policy, advocacy, management or research. The very challenging membership exams (MFPH) have a wide syllabus and cover the various aspects of public health, ensuring that we’re all at a similar level on the fundamentals. The application process, job roles and training are exactly the same for non-medical registrars.

Medics are paid on the standard NHS doctors salary scale by central employment over the 5 years, while non-medics are paid on the Agenda for Change (AfC) scale.

The pay is broadly similar between medics and non-medics during training. Consultant salaries will vary based on the organisation and level of seniority, and there is more variability now compared to when public health was based fully in the NHS. Some consultants are transitioning to civil service and local authority scales, and this does seem to vary from place to place.

For more information on this, please check out the recruitment page

How does one best explore applying for training?

Working in PH is very different to all other medical specialties, and it can be a significant culture shock moving from hospital medicine to an office environment.

To understand what the job is like, get in touch with your Local Authority public health team or health protection team and organise a shadowing day.

For a longer experience, medical students can arrange a public health project whilst on elective, or post-FY2 during a year out.

One more thing to note: there’s a common misconception that having a long and impressive CV will increase your chances of selection, but the selection process is more based around general aptitude and demonstration of the qualities found in the person spec.

In my experience, they don’t look at your CV and they don’t look at publications, so those lacking prior public health experience shouldn’t be put off from applying. It’s also not uncommon to attempt multiple times before getting on the scheme.

Public Health are recruiting! – Check out their recruitment page for more information

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Charlotte Leigh

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