Preventive Medicine Physicians Are
Uniquely Trained To Serve Patients and
Communities
Physicians board-certified in
preventive medicine, a recognized
specialty for over fifty years, are the
only medical specialists trained in
both clinical medicine and public health.
Preventive medicine physicians receive
training in biostatistics, epidemiology,
environmental health, and health services
administration. They gain critical
knowledge in population & community
health issues, disease & injury
prevention, disease surveillance &
outbreak investigation, and public health
research. They are employed in hospitals,
private practice, state & local health
departments, health maintenance
organizations, community and migrant
health centers, industrial sites,
occupational health centers, academic
centers, the military, and other Federal
government agencies.
Preventive Medicine Physicians Lead
Communities in the Fight Against
Bioterrorism
The critical skills needed to
effectively respond to bioterrorism
include: surveillance; management of and
differentiation between hoaxes and true
bioterrorism threats; understanding of the
use of microbes and toxins in biological
warfare; knowledge of health-related human
behavior, disease prevention,
post-exposure prophylaxis, and treatment
of illness; credibility with and trust of
health care providers, news media, and the
general public; ability to effectively
ration medications and other health
resources for the greatest benefit; and
ability to manage and integrate the
resources of health care institutions,
social service agencies, public safety
workers, and private and voluntary
organizations. While
many of these skills are not emphasized in
medical school or clinical residencies,
they are the skills at the heart of
preventive medicine training and public
health practice.
Many of the
public health leaders who were most
visible during the aftermath of the 9/11
attacks and during the anthrax crises are
physicians trained in preventive medicine.
Some examples of
the role ACPM members play in bioterrorism
preparedness and response:
- Gary Goldbaum, MD, MPH, is the
Incident Commander for the Public
Health Emergency Operations Center in
Seattle, Washington. Dr. Goldbaum’s
preventive medicine training and
public health experience have prepared
him to deal with the health
consequences of disasters, natural or
man-made. He understands the role of
government agencies, the effect of
diseases and altered environments on
large populations, and how to
coordinate available resources.
- Royce Moser, Jr., MD, MPH, is
Professor and Director of the Rocky
Mountain Center for Occupational and
Environmental Health at the University
of Utah School of Medicine. He has
spent much of his 23 years in the U.S.
Air Force coordinating and teaching
disaster planning and response. This
included Medical Officer Special
Weapons Defense (NBC), NORAD, and
developing medical responses to
chemical or biological agent
exposures. His teachings have
emphasized the critical role public
health and preventive medicine
physicians play in detecting covert
attacks and in distinguishing between
real and hoax events.
- Jennifer K. Brennan MD, MPH, with
Northwest Center for Public Health
Practice, develops bioterrorism
training curricula for four different
target groups: primary care
clinicians, public health
professionals, emergency
first-responders, and
businesses/general public. Her
preventive medicine training, with
both its public health and clinical
components, has provided her with a
broad understanding of bioterrorism
preparedness and response, how each of
the above-mentioned target groups fits
into the system, and how to mobilize
each group to be able to function
appropriately in the system.
There is a Growing Shortage of
Preventive Medicine Specialists
In today’s uncertain environment, the
tools of preventive medicine are growing
in importance. Yet, the number of
physicians training in preventive medicine
is eroding. Preventive medicine residency
programs struggle for basic funding,
resulting in too few training slots to
meet the real need.
- There currently are only 6,000
physicians certified in the specialty
of preventive medicine in the United
States.
- The federal Council of Graduate
Medical Education (COGME) notes that
"…the number of physicians in
public health/preventive medicine is
steadily decreasing" and
recommends increased support for
residency training in public health
and preventive medicine.
- Preventive medicine training
programs have not received a
significant funding increase since
1986; meaning that the number of
training slots funded each year has
eroded over time. Because most
preventive medicine residencies are
based in the community—not in
hospitals—very few programs are
eligible for Medicare Graduate Medical
Education (GME) funding.
- Between 1995 and 2000, the number of
residents enrolled in all preventive
medicine training programs declined
10% primarily due to lack of
funding for residency positions.
- The number of preventive medicine
residency programs decreased from 90
in 1999 to 85 in 2002, with an
additional two programs slated to
close in 2002, mostly because of
inadequate funding levels.
Bottom Line: A Strong Public Health
System Requires A Strong Preventive
Medicine Workforce
The terrorist acts of recent months
have thrust public health into the
forefront of the nation’s consciousness.
Congress has already begun to infuse
hundreds of millions of dollars into the
public health system to shore up the
nation’s disaster response capacity.
These are welcome developments. The ACPM
applauds greater investment in disaster
planning, information technology,
laboratory capacity, and drug and vaccine
stockpiles.
However, any efforts to strengthen the
public health infrastructure and disaster
response capability must include measures
to strengthen the existing training
programs that help produce public health
leaders. According to William L. Roper,
MD, MPH, Dean, School of Public Health,
The University of North Carolina at Chapel
Hill , "Investing
in public health preparedness and response
without supporting public health and
preventive medicine training programs is
like building a sophisticated fleet of
fighter jets without training the pilots
to fly them."
The proportion of U.S. physicians who
self-identified as practicing preventive
medicine decreased from 2.3% in 1970 to
0.9% in 1998. If the proportion of
preventive medicine physicians needed was
constant (and a case can be made that the
need is in fact growing), 17,595
preventive medicine physicians should be
practicing today, suggesting a deficit of
10,710. The ACPM believes $22.2 million
annually, adjusted yearly for inflation,
is necessary to meet the need for training
physicians in preventive medicine. Stable
funding at this level would provide
training for 720 preventive medicine
residents per year, compared to the
current average of 424.
___________________________________________
Glass, JK. Physicians in
the Public Health Workforce. Council of
Graduate Medical Education. Update on the
Physician Workforce. Rockville, MD:
Council on Graduate Medical Education,
2000: 41-55.
American College of Preventive
Medicine. Building Our Nation’s
Preventive Medicine Workforce: A Report of
the ACPM Preventive Medicine Residency
Funding Task Force. ACPM, November 2000:
p. 2.
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