The Population-Centered Medical Model: a method of practice for public health physicians

Abstract

Abstract Background Public Health Physicians (PHPs) in Canada occupy a liminal space between medicine and public health. Current practice frameworks for the care of individual patients by physicians do not account for the complexity of working with communities and populations for health. Similarly, frameworks for public health practice do not account for the roles and responsibilities of physicians in public health. A method of practice that outlines how public health physicians care for populations is vital for training and development of practice for this specialty group within medicine and public health. Methods Constructivist Grounded Theory methods were used in this study. Ethics approval was obtained through The Western University Health Sciences Research Ethics Board. Semi-structured interviews were conducted with eighteen (18) currently practicing PHPs across Canada. Data was analysed iteratively using constant comparison, multi-level coding, and memo writing. Thick description and reflexivity were employed to enhance rigour. Results The key finding is the elucidation of the Population-Centered Medical Model. In this empirically grounded model, PHPs bring values, knowledge and stances to their practice of Public Health Medicine. PHPs consider the population as patient, along with ethical obligations that flow from the physician to the population as a consequence. The process of caring for populations involves both diagnosis and intervention, with a focus on systems and prevention. It relies on knowledge sharing and relationship building between the physician and the population. Conclusions This is the first empirical model to describe the practice of PHPs. The model firmly grounds PHP practice in both medicine (diagnosis and intervention, the construction of a patient) and public health (focus on populations, systems and prevention). It also presents an opportunity to develop a general model of medical practice for n patients, where n can range between 1 and N. Key messages • The Population-Centered Medical Model is an empirically grounded model that describes the work of Public Health Physicians in Canada and grounds practice firmly in medicine and in public health. • Public Health Physicians consider populations as patients. They diagnose and intervene for health, with a focus on systems and prevention, by building relationships and sharing knowledge.