Preventive Medicine Physicians ARE Physician- Public Health Practitioners: An established academic medicine career track

M.A. "Tonette" Krousel Wood, MD, MSPH, FACPM
President, ACPM

The recent article in JAMA Forum, Physician-Public Health Practitioners—The Missing Academic Medicine Career Track¹ was music to my ears. As a Board-certified Preventive Medicine physician working in academic medicine, the article echoes decades of similar calls to address growing public health needs.

 
The COVID-19 pandemic illuminated the persistent health inequities and challenges that strained the medical and public health sectors, leading physicians to seek broader skillsets in population health. The great news—an Accreditation Council for Graduate Medical Education (ACGME) accredited infrastructure for training board-certified physicians to practice at the interface of medicine and public health has existed since 1946. However, the absence of this specialty in the article exemplifies the lack of visibility and funding for programs that train physicians to become leaders in community preparedness and health resilience.
 
Important facts:  

• There are 43 General Preventive Medicine/Public Health (GPM/PH) accredited residency training programs² which require clinical training, a masters in public health (MPH) or equivalent degree, and practice-based experiences in health departments, community and clinical settings
• Academic institutions with GPM/PH programs have strong partnerships with state and local health departments for rotations. 
• GPM/PH training provides competencies and credentials beyond a MPH   
• The American Board of Preventive Medicine provides board certification in GPM/PH³

Per the American Association of Medical Colleges more than two-thirds of applicants to GPH/PM programs are non-white,⁴ indicating an opportunity to build a medical profession more reflective of the diverse communities we serve.
 
Challenges for the specialty of GPM/PH are similar to those cited for population health departments:⁵ uncertain funding, limited exposure to GPM/PH in medical school; areas of overlapping focus; limited research portfolios; and insufficient ‘hard’ money to support infrastructure and growth. Paramount is the lack of funding for the residency training pipeline. Despite a 2007 Institute of Medicine report estimating a deficit of 10,000 public health physicians in the U.S.⁶, approximately half of the approved residency slots remain unfilled due to funding constraints.
 
Congress has the power to expand funding for GPM/PH programs via the Health Resources and Services Administration. Unlike many residency training programs, Preventive Medicine is not generally funded by the Centers for Medicaid and Medicare Services. This constricts the pipeline and diminishes visibility for GPM/PH. ACPM estimates that for $52 million, we could realize a robust pipeline to address population health needs in state, county, city and local health departments, in Federally Qualified Health Centers, in academic medical centers and health systems. Addressing pipeline issues and building an infrastructure resilient against ongoing and future public health crisis will require consistent support from our physician colleagues—join us in our advocacy efforts to fully fund this specialty. 
 
We thank the authors of the JAMA Health Forum article for highlighting a critical issue for both academic medicine and the health of our nation: the need for more physician-public health practitioners. ACPM is committed to advancing the specialty and improving health through evidence-based public health and preventive medicine.⁷ We welcome the opportunity to leverage our long-standing academic discipline and professional specialty of GPM/PH to accomplish this.

References—
 

1. Bibbins-Domingo K, Fernandez A. Physician–Public Health Practitioners—The Missing Academic Medicine Career Track. JAMA Health Forum. 2022;3(3):e220949. doi:10.1001/jamahealthforum.2022.0949

2. List of Programs By Specialty. Accreditation Council for Graduate Medical Education. Accessed April 19, 2022. https://apps.acgme-i.org/ads/Public/Reports/Report/1

3. Become Certified. American Board of Preventive Medicine. Accessed April 19, 2022. https://www.theabpm.org/become-certified/

4. American Association of Medical Colleges. (n.d.). Eras statistics. AAMC. Retrieved April 12, 2022, from https://www.aamc.org/data-reports/interactive-data/eras-statistics-data

5. Gourevitch MN, Curtis LH, Durkin MS, et al. The Emergence of Population Health in US Academic Medicine: A Qualitative Assessment. JAMA Netw Open. 2019;2(4):e192200. doi:10.1001/jamanetworkopen.2019.2200

6. Institute of Medicine (IOM). 2007. Training Physicians for Public Health Careers. Washington, DC: The National Academies Press.  

7. Kousel-Wood M. Presidential Address 2021—Back to the Future of Preventive Medicine, American Journal of Preventive Medicine, Volume 62, Issue 1, 2022, Pages 145-147, ISSN 0749-3797, https://doi.org/10.1016/j.amepre.2021.09.020.