President's Column 1/8/10
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By Mark B. Johnson, MD, MPH, FACPM - ACPM President

Rodney Dangerfield was the American comedian who built his career on being a victim.  His signature lines were, "I don't get no respect," and "It's not easy bein' me."  He claimed he got no respect from his mother, his father, his wife, his children, his doctor, the Surgeon General, his priest, or his dog.  Nobody respected him.  He even maintained that the Fruit-of-the-Loom guys in his underwear laughed at him. 

His name has become a cliché.  Former Arkansas Governor Mike Huckabee was called the Rodney Dangerfield of the Republican Party during the last presidential campaign.  The natural gas industry has claimed it is the Rodney Dangerfield of fuels.  Skype has become the Rodney Dangerfield of telecommunications, and it seems to me that preventive medicine has at times considered itself to be the Rodney Dangerfield of medical specialties.  In our internal discussions and dialogues I have too often gotten the sense that the underlying line of argument is that "we don't get no respect."

Rodney Dangerfield is dead.  It is time to move on.  

Preventive medicine must shake off its perceived mantle of victimhood.  It is unhealthy and unwarranted.  While as victims we may think that we are morally right and are forever entitled to sympathy, victimhood carries with it a sense of helplessness and self-pity that can lead to feeling neither responsible nor accountable for our actions.  If we wish to be regarded with more respect, we must take on the responsibility of demonstrating that our medical specialty is worthy of that respect.

The American College of Preventive Medicine (ACPM) is currently involved in numerous activities that are having or have the potential of having a direct impact on the respect that is shown for our specialty.  Our advocacy and lobbying activities in Washington, D.C., have led to more talk about and support for preventive medicine and its potential than at any other time I can remember.  Through the diligent work of Paul Bonta and other ACPM staff and College members, the preventive medicine/public health training act amendment has been included in both the Senate and House versions of health care reform, which bodes well for its inclusion in a final bill.  This could lead to the greatest publicity for the merit of our medical specialty since the announcement of the polio vaccine.

Perhaps the greatest indicator of the respect preventive medicine is getting on Capitol Hill is the torrent of opinion pieces and letters to editors that have attacked it.  As I mentioned in the last President's Column, there have been pieces in the national and medical press with such titles as, "Preventive medicine doesn't work," "Preventive medicine does not reduce costs," "Can we please stop pretending that preventive medicine saves money?" and "Prevention will reduce medical costs: A persistent myth."  We have attempted to respond to each of these by clarifying for them the difference between a short term focus on cost savings and long term health care value.  The Achilles' heel of preventive medicine has long been the emphasis on the quarterly report in the private sector and the yearly budget summary in the public and not-for-profit sectors.  The perceived value of prevention will never reflect its true value in systems that are not capable of looking more than a few months or even a year into the future.

In light of the real or perceived threat to our medical specialty from accrediting and licensing bodies, the ACPM GME Committee, under the leadership of Wayne Dysinger, is taking a hard look at our residency program requirements.  In an attempt to ensure that we are not being rash or reactive, this committee is working on a deliberate response that endeavors to address the current training needs of our specialty without being encumbered by the historical rationales that led to our present requirements.   The committee members have been very active in carefully putting together a thoughtful document that accurately reflects the challenges and opportunities facing us today.

ACPM is also actively involved in "building a bigger boat" for preventive medicine.  We have partnered with MDVIP, Inc., a national network of over 310 physicians located in 28 states and the District of Columbia whose practices highlight preventive medicine and personalized healthcare.  This relationship has allowed ACPM to expand and fully implement Time Tools, our exclusive product line that offers clinical practitioners brief, yet authoritative guidance on today's most vexing health problems, emphasizing the preventive side of the continuum of health care.

Two new and evolving initiatives have broadened our outlook on the international health scene.  Johnson & Johnson, one of our Corporate Roundtable members, is expanding its operations in India, and has invited us to partner with them to provide expertise in the marketing of preventive health messages for the public as well as providing guidance in how to increase preventive medicine training for physicians in India.  By including two of our board officers on their advisory council, it looks like this may grow into a major initiative for ACPM, with truly worldwide implications. 

In addition to this, the Republic of Singapore is in the process of transforming its graduate medical education system from a more traditional British model to the American model based on the standards of the Accreditation Council for Graduate Medical Education (ACGME).  One of the first residencies that they want to establish in 2010 is preventive medicine.  The prominence of training in occupational health, chronic disease prevention and public health in our specialty matches well with the health care issues that the Ministry of Health in Singapore sees as priorities in its health plans.

While we may not be ready yet to take the smug approach of Stuart Smalley ("I'm good enough, I'm smart enough, and doggone it, people like me!"), we in preventive medicine have much for which we can be proud.  We are realistically reassessing our training needs.  We are reaching out to share our expertise with other practicing physicians.  We are making great progress in confirming the significance of our contributions in both the national and international arenas.  We are gaining respect.

Rodney Dangerfield is dead.  May he rest in peace. 


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