Issue
Despite being recognized as an underdeveloped national resource and in shortage for many years, the Preventive Medicine residency (PMR) training pipeline is shrinking.¹ Training program and residency graduate numbers are rapidly declining at a time of unprecedented national, state, and community need for properly trained physicians in public health and disaster preparedness, prevention-oriented practices and quality improvement; mostly due to lack of funding.

ACPM recognizes residency training and board-certification in Preventive Medicine as the gold standard of competency for public health physicians.ACPM advocates for the expansion of PMR programs to meet the growing need for public health physicians.

Background
The health challenges of the 21^st century, including the increasing burden of chronic diseases, persistent and emerging infectious diseases, and disaster response, require the medical and public health communities to work in concert.Preventive Medicine is the only medical specialty recognized by the American Board of Medical Specialties that requires all of its physicians to receive training in both clinical care and public health.This makes Preventive Medicine physicians uniquely suited for these roles.

Unfortunately, the supply of Preventive Medicine physicians is shrinking.In 2011 there were 310 Preventive Medicine residents in training at 72 programs, compared with 410 residents training at 85 programs 10 years prior.^2,4

The largest contributor to the decrease in the number of Preventive Medicine residents training is inadequate funding due to the current reimbursement structure.Physicians training in Preventive Medicine are the only medical residents whose graduate medical education (GME) costs are not supported by Medicare, Medicaid or other third party insurers, because training occurs outside hospital-based settings and therefore is not financed by GME payments to hospitals.

The Institute of Medicine (IOM) recognizes the shortage of Preventive Medicine physicians and in its 2007 report, "Training Physicians for Public Health Careers,” called for expanded training capacity to graduate a minimum of an additional 400 residents each year.In addition, the report recommends that this expansion should be supported by federal general education funds that are not linked to the provision of clinical medical services.

Status
In response to ACPM advocacy efforts, 17 PMR training programs are currently receiving federal support to help offset the costs of training residents.In 2010, the Health Resources and Services Administration (HRSA) provided $9.5 million to 17 PMR training programs that included $7 million secured through the American Recovery and Reinvestment Act of 2009 and $2.5 million in FY 2010 HRSA appropriations to support the "preventive medicine and public health” line-item.ACPM has urged that Congress provide HRSA with $10 million in FY 2012 base-line funding to expand support for PMR training programs.

1.IOM ( Institute of Medicine). 2007.Training physicians for publichealth careers. Washington, DC: The National Academies Press.

2. Lane D. A threat to the public health workforce: evidence from trends in preventive medicine certification and training. Am J Prev Med 2000;18:87-96.

3. Graduate Medical Education National Advisory Committee. Summary Report of the Graduate Medical Education National Advisory Committee to the Secretary. US Health and Human Services, Health Resources and Services Administration, 1980.

4. Accreditation Council for Graduate Medical Education. Number of Accredited Programs by Academic Year. Available at: http://www.acgme.org/adspublic/reports/accredited_programs.asp?accredited=1. Accessed July 15, 2011.

5. Council on Graduate Medical Education First Report of the Council. US Health

and Human Services, Health Resources and Services Administration, 1988.

6. Council on Graduate Medical Education Fourth Report to Congress and the Department of Health and Human Services Secretary. Recommendations to Improve Access to Health Care Through Physician Workforce Reform. US Health and Human Services, Health Resources and Services Administration, 1994.

7. Council on Graduate Medical Education Sixth Report. Managed Health Care: Implications for the Physician Workforce and Medical Education. US Health and Human Services, Health Resources and Services Administration, 1995.

8. Council on Graduate Medical Education Resource Paper Compendium. Update on the physician workforce: Physicians in the public health workforce. US Health and Human Services, Health Resources and Services Administration, 2000.