The editors of the Washington Post urge us to start thinking seriously about the next pandemic. Here’s what they would like done:
A high priority is to build the equivalent of national early warning radar for disease. Genomic sequencing makes it feasible to rapidly identify pathogens and send up a flare, as South Africa did with the emergence of omicron. A viral and bacterial surveillance network will provide a clear picture of threats and more time to respond properly.
Next, we must invest in people. Even before the pandemic, turnover was high among state public health officials, and once the crisis set in, state and local workforces became exhausted and burned out. Dr. Walensky said the workforce needs more than just money: “We need to train it. We need to make public health an attractive workforce to enter.†Public health workers have been at the front line of bitter political debates about vaccine and mask mandates, too often subject to toxic public threats and political interference. At the same time, they must redouble efforts to earn the public’s trust with clear, transparent communications and overcome the deleterious impact of misinformation and disinformation. The CDC needs to get out of its ivory tower and play a more direct and urgent role in addressing the public.
Data is the lifeblood of public health. The CDC and states have suffered for years with antiquated systems. In an unpredictable pandemic, this is a serious liability to decision-making. Dr. Walensky promised to make upgrades a priority. “The pipes have to connect,†she said.
I wish they would connect the dots for me. I don’t see how any of those measures, whether in isolation or together, would mitigate the risk of a future pandemic. COVID-19 was completely sequenced by the Chinese no later than January 10, 2020. Since then the virus has spread from China to every country in the world and killed more than 5 million people. In the case they cite sequencing the omicron variant did exactly nothing to halt its spread.
Invest in people? We’ve been investing in people for a half century or more. I suspect that issue is more that we’re investing in the wrong people. In most states public health officials are required to be medical doctors. As has been pointed out “thinking like doctors” is part of the problem rather than the solution. My experience has been that medical doctors are peculiarly unsuited to manage groups consisting of varied professionals. They’re not trained for it and the motivations that lead to med school generally don’t include a desire or the personal skills to manage physicians let alone non-physicians. Managing professionals is generally understood to be a tricky matter and med school doesn’t prepare you for it.
And then there’s data. Government organizations are peculiarly unsuited to applying cutting edge information technology. For one thing they are almost always standards-based and standards are inherently retrospective. You only need consider the federal government’s many information technology debacles of the last dozen years to recognize that.
I don’t have any advice for dealing with the next pandemic. All I can suggest is that the editors try again.
” They’re not trained for it ”
Who is? I dont think any profession really gets training as part of their regular education that prepares them for managing disparate groups of professionals. Some get prepared for handling the finances. Some read management theory but they arent really prepared for the real thing. (Engineers certainly arent trained to manage people and the run of the mill engineer will suck at it but those who develop the skills to manage over their careers often make really good managers/leaders.)
You will need some people with medical background. At the local level you will need to replace a lot of public health people who have left. They arent really managing lots of professionals. At higher levels what you need are people with medical knowledge providing opinions but you need other people to make the final decisions factoring in medical and non-medical factors.
We need to put in place an infrastructure and maintain it. There will be another pandemic. Instead someone will want to cut budgets and PPE wont be maintained and the pandemic team will be disbursed.
Steve
“I wish they would connect the dots for me.” Indeed.
“In the case they cite sequencing the omicron variant did exactly nothing to halt its spread.”
Among a number of other ineffective policy initiatives.
“As has been pointed out “thinking like doctors†is part of the problem rather than the solution. My experience has been that medical doctors are peculiarly unsuited to manage groups consisting of varied professionals.”
Said another way “thinking like narrow, but perhaps very talented, specialists.” And prima donnas to boot. I think steve is correct that few specialists are trained in management. And further, at the end of the day management is an apprenticeship profession. But I note the word Dave used – “peculiarly.” Doctors are generally arrogant, especially the surgeons, and generally not suited temperamentally to management. (Ever seen a well run health care practice? Its more like the DMV.) Its a widely acknowledged issue. steve points out engineers. True, but a rather larger fraction matriculate. The IT guys are the worst.
This all said, any particular individual can escape the issue. There is an old saw: make it or sell it, but don’t count it. Fine. But you better have an appreciation for measuring financial performance (and an attendant nose for funny business), and raising capital. Shorter: manage your career to be a generalist and move about to gain experience. In defense of doctors, they simply have no chance. Hence…..
“And then there’s data.”
Heh. As I’ve commented before, and as steve basically rejected, I have a friend in the belly of the beast at Johns Hopkins. She has maintained all along that the data are so suspect as to send chills down your spine. Not that politicians and bureaucracies might influence things. (snicker)
I agree. But except in very rare circumstances professional staff should be doing what their professional training trains them for. They shouldn’t be formulating policy or administering policy—they should be consulted in formulating policy and administering policy which is quite different. Physicians from top to bottom contributes to management problems, high costs, and higher personnel loss rates.
I dont really know of any hospitals. medical entities of any size that are run top to bottom by physicians. Seems like a straw man to me. It would be too costly to put docs in lower level admin positions. What really happens is that nurses tend to gravitate to those positions to lower and mid management is dominated by nurses and people who have some sort of admin degree.
I dont think being an MD means that you cannot have any management or leadership skills. Im not really sure why they should be less likely to have those skills than say lawyers. There are arrogant people in every profession and in medicine over the last 10-20 years being able to work in a team has ben heavily emphasized. We now get rid of people who are arrogant. Also, there is some advantage I think to having your admin consist of at least some people who actually understand what you do.
“She has maintained all along that the data are so suspect as to send chills down your spine.”
Then she should publish. In my estimation Hopkins is now a second tier institution living off of its reputation (one of my former fellow residents is now a chair there) but they still have a lot of good people so if she had good data they would support her. To be honest I am pretty tired of people who just cast vague aspersions or claim to have special knowledge that only they have noticed, one among thousands of other doctors, nurses or whatever.
Steve
I was referring to the federal and, to some extent, state and local public health agencies. In most states MDs are required to manage such organizations. The head of the CDC is a doc; so is her deputy. If you look at its organizational chart, it’s filled with docs. My experience is that is very much the norm for the federal government. The designated head of the FDA is a doc; the acting head is a doc; the deputy is a doc.
Sure it’s possible. But the skills that make a good manager don’t get you through pre-med, don’t help you on the MCATs, don’t get you into medical school, and don’t get you a good residency. Furthermore, I doubt that 1 in 1,000 physicians pursued the practice of medicine so they could manage doctors. Certainly, no pre-med I’ve ever known gave that indication.