The role of the medical health officer in British Columbia

The role of the Medical Health Officer (M.H.O.) in British Columbia is explored in this thesis, looking for consensus on the "job description." The evaluation of this brand of community physician is examined in a literature review which considers his function in the three countries of Britain, the United States and Canada. Some associated discussions of community health services in these countries is evident. Education of the Medical Health Officer is also explored as a necessary component in assuming this role description. The diversity of roles as engendered in the Canadian provinces is related to the legal and administrative position of the British Columbia Medical Health Officer. The study generally examines the level of consensus that has existed internationally and nationally on the role of the Medical Health Officer and specifically the level of consensus amongst British Columbia Medical Health Officers. A survey questionnaire was mailed to all provincial, regional and city Medical Health Officers in British Columbia to elucidate their opinions and ideas on what the job description entails and what they feel it should be. The response rate overall was seventeen out of twenty or eighty-five percent. Selection, education and experience of Medical Health Officers in British Columbia is examined in detail. Attitudes about the position and how it relates to the rest of the medical community are felt to be important aspects to integration of community medicine with the rest of medicine in general. The role description is divided mainly into Administration (Health Unit Director role) and Direct Services (Community Physician) role. The Health Officer (legislated officer role) is outlined as it occurs in British Columbia but this area is not pursued in detail because it could form the substance of a complete study in itself. The results indicated a lack of consensus on the role of the Medical Health Officer. In British Columbia the variable role is found to be more a function of personal preference and regional needs than a common set of procedures and practices. History revealed a constant reorganization and re-evaluation of Medical Health Officer functions accelerated by rapid technical, political and social changes. The need for a clearer role is questioned. The Medical Health Officer is felt to be a generalist, hopefully with the versatility to direct the "conflicting goals" of health systems into some kind of organizational sense. His broad outlook is felt to be an asset in this regard. Five main recommendations resulted from the study with respect to the British Columbia Medical Health Officer. These were: 1. re-evaluation of the educational program, periodically; 2. elimination of the marginally useful administrative functions of the Medical Health Officer by expansion of the Office Supervisor role; 3. re-evaluation'of the selection process for British Columbia Medical Health Officers; 4. establishment of closer formal liaison with "clinical medicine" via the BCMA to eliminate traditional barriers between the two groups and to expand the role of community medicine and; 5. requirements that assure new Medical Health Officers will obtain the F.R.C.P. qualifications to maintain equality and credibility with the clinical physicians. Finally, it is felt that there will be ongoing evaluation and assessment of the Medical Health Officer role without consensus ever being achievable or even desirable. This is not felt to alter his contribution to health systems. The question, "What level of consensus is there among British Columbia Medical Health Officers about their role?" has been answered. There is none.

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