Mel Minarik Ph.D., MPH, FACHELecturer
1. Can you provide a brief overview of the health administration field and how it relates to public health?
The area that we work in is health administration, policy and health policy administration. Health policy is the big picture of how the health system works, how it is structured and its incentives. Repealing the Affordable Care Act is all policy, for example. However, from a big picture someone creates policy and the administration piece is how you implement it. Some people are more policy focused and bigger picture whereas the administration piece is reacting to that policy and how do we go about implementing it. I teach them both — My practical experience is in the administration and my academic experience is grounded in policy. Administration is the back-end and going back upstream is where policy is.
2. Which parts of the UNR curriculum are especially relevant for students interested in health administration or advancing their careers in health administration?
Both areas – whether policy or administration – are very helpful to students in health administration. Depending on where a student is in their career they may be more on the policy side (how to create a policy with regulation or implementation) or they may be a director of an organization and take what is in front of them and implement it operationally. Sometimes, there isn’t a choice in how it is implemented and sometimes a policy is presented and the team has the freedom to make it happen as long as they meet the expected outcomes.
Students who advance their careers in MPH are going to be in policy or administration or both. CHS 755, Health Policy and Administration, is rooted in policy and in that course they actually get to create a health policy for whatever they are interested in. That policy project requires the student to do all the steps of what they would do in a workplace. This gives them the opportunity to try it out and see if it’s something they are a good fit for.
Example: A student I had last spring had an experience with his then pregnant wife where she was experiencing some complications with her pregnancy. She needed to be taken to the ER to be treated. They ended up waiting for over 10 hours to been seen. As an MPH student he goes to the financial counselor at the ER and asked about an estimate for the cost of the visit. When he received the bill in the mail a month later the bill was 4 times as expensive as the estimate he was given at the ER.
When it came time to do his policy project, he decided to propose an app that would interact with the hospital system updating the patient, or a patient’s loved one, would be updated on a minute-by-minute basis the costs they were incurring in the hospital. He felt that would alleviate the added stress a lot of people feel in this situation.
Some of the steps that need to be addressed in creating a policy include:
1. Research the literature to get context and background on the topic
2. Propose a unique solution to something happening in the realm of public health and explain why that solution would improve the health of the system
3. Describe the interest groups that would be for and against the idea
4. Explain how they would implement and regulate the policy
5. Explain who they would have to get the policy approved by
6. Explain if it is democratic or republican philosophy
7. Lay out next steps for implementation
The student dove deep into this idea but when he brought the idea to the class there were a lot of reasons why it couldn’t work, namely the fact that nobody’s CMS system could support it. The discussion was really helpful because the class collectively was able to go through and explain what he didn’t know context wise to help explain the health care system. In 10 years this may be something the system would be ready for, but that’s ok because he went through the steps and the entire class learned so much.
Students may come up with a policy idea that makes a lot of sense but part of the reason it won’t work is because the interest groups are so powerful. I.e. smoking in Nevada: The casinos were too powerful to pass “no smoking” in casinos.
Students have to learn all the factors of whether policy is good or bad and all the challenges. There are powerful interest groups at play who may want it to happen or don’t want it to happen.
There are courses on the administration side like CHS 756: Organization Behavior in Health Sciences, which teaches soft skills and focuses on leadership, and CHS 759: Health Services Finance, covers budgeting and finance and how you manage the resources with hard, analytical data.
3. What experience do UNR faculty have in health administration? How could this benefit students?
UNR has several health administration faculty, a few of which are just coming on board. We have faculty whose experience is on the policy side and others are more focused on the administration side; our dean, Trudy Larson, being one of them. It is a matter of finding the balance between us. In many respects we see the world differently. It’s hard to cross over and implement policy in pharmacy and home health agency, but someone may know a whole lot more about policy.
We talk each other’s language and there is overlap in our knowledge but not completely. Trudy has had various experience in managing Northern Nevada HOPES in Reno. There are a few faculty from the College of Business and Economics because administration is all about knowing health but also understanding business and being able to apply those principles to public health. You have to be able to speak to both elements of the workforce. If I am a health administrator I need to understand business but also talk to health. It is a multidisciplinary group that allows for a lot of interesting conversations from right brain and left brain perspectives.
I have a master of public health in health services management from UCLA. At the time the degree only required two public health classes so I don’t have a real deep background of public health, even with the degree. I have learned so much working with MPH faculty and the academic perspective has balanced out my understanding. What is really important to understand (and something I wasn’t as aware of when I was working as a public health practitioner) is that it is always about what population you are working with whether talking about the health of the people who work for you, the health of the population you serve or the population of an outbreak area. The bottom line is that it is the same framework just working with different populations and different interventions.
4. What traits or skills are important for a successful health administrator? How does the UNR-MPH program help improve those skills?
An interest in professional development is necessary to enter a graduate program or to move up in an organization. An MPH can be an asset whether you’re looking for a higher level job or looking to pursue a different type of job. An MPH will teach you the skills and competencies you won’t get in a bachelor’s degree. UNR expects students to comprehend evidence-based information, more than they would understand with a bachelor’s degree alone, and look towards the future. If individuals aren’t prepared to work with a toolbox of new tools that will allow them to be comfortable with change then a graduate degree would be challenging. A graduate degree is about looking at disruption and finding different and better ways of doing things.
In the traditional MPH program if you are focusing on epidemiology and social behavioral health you won’t be taking the budgeting and leadership classes. When UNR completed the most recent workforce survey that was one thing employers said they needed their employees to know. It wasn’t just leaders of organization but also MPH candidates, employers, managers, leaders and former students all said this is what they were missing – leadership and finance skills.
5. What advice would you provide to an MPH student interested in furthering their career?
If a student is interested in health administration and policy it is important that they get some experience as an undergraduate before they begin an MPH program or else the content of the classes may seem too theoretical for them. Not having this context in a professional program could prove to be a problem for a student. It will be a much better experience if they can sit in a lecture and say I just had that or saw that last week. Students who come straight out of undergrad who don’t have base knowledge tend to feel overwhelmed by the material.
Having context to understand what is going on is hugely important. Create some time in your schedule to volunteer or get unpaid internships otherwise you may feel lost. Students who come into the program with that work experience are much further ahead of the game.