Preventive medicine's equivalence problem

Influence of Preventive Medicine Residency Programs and Combined Master of Public Health Programs on Specialty Selection

INTRODUCTION

To determine medical school characteristics that may result in graduates entering the specialty of public health and general preventive medicine (PH&GPM), the authors conducted an analysis comparing the presence of affiliated preventive medicine residency programs and combined Master of Public Health degree programs with the likelihood of graduates entering the specialty of PH&GPM.

METHODS

Using data from the American Board of Preventive Medicine and publicly available information on medical schools and residencies, in spring 2022, the authors compared medical schools that produced PH&GPM physicians with the presence of a PH&GPM residency program, the presence of any preventive medicine residency (public health and general preventive medicine or occupational medicine or aerospace medicine), and the presence of a combined Doctor of Medicine‒Master of Public Health or Doctor of Osteopathic Medicine‒Master of Public Health program.

RESULTS

Between 2017 and 2021, there were 385 physicians newly board certified in PH&GPM, 210 medical schools, and 75 preventive medicine residencies. The 385 physicians graduated from 110 of the 210 medical schools. Analyses showed statistically significant associations between medical schools that graduated PH&GPM physicians and the presence of PH&GPM residencies (OR=3.74; 95% CI=1.61, 8.69), all preventive medicine residencies (OR=2.75; 95% CI=1.37, 5.51), and combined degree programs (OR=4.37; 95% CI=2.45, 7.79).

CONCLUSIONS

Because PH&GPM residency programs affiliated with medical schools are a significant factor associated with PH&GPM physicians obtaining board certification, such analyses may provide critical guidance in the utilization of resources intended to produce more physicians certified in this specialty.

Public Health and General Preventive Medicine Training: A National Survey

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Public Health/General Preventive Medicine is a diverse specialty with multiple career pathways.

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Preventive Medicine trainees are also diverse in their backgrounds.

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Clinical preventive medicine remains the top area of interest.

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Academia was the most common career goal for residents and graduates.

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Some Preventive Medicine trainees report difficulty in marketing themselves post-graduation.

Little is known about the current experiences of Public Health/General Preventive Medicine (PH/GPM) residents and graduates in the United States. This cross-sectional study of PH/GPM residents and graduates examined their knowledge of the field and career choices after graduation. We developed a questionnaire to address medical education, graduate medical training prior to Preventive Medicine (PM), current PM training, and post-graduation goals. Data was stratified by residency status (resident vs graduate), and board-eligibility (dual-eligible vs solely PH/GPM). Bivariate analysis of quantitative data was performed using Fisher’s test. Qualitative data were organized into themes and analyzed quantitatively. Of those invited to participate, a total of 153 (18.25%) PH/GPM residents and graduates responded to the survey. We found diversity in prior medical education/training among respondents. Overall, debt burden at the start of training was low compared to national trends. Compared to residents, a higher proportion of graduates were board-eligible in another specialty (p<0.001). Most respondents felt that their programs provided them with opportunities to acquire skills essential for a career in PM. Ninety-one percent of graduates were board-certified in PH/GPM. Respondents expressed a wide range of career interests, including government work and academia. Difficulty with marketing themselves as PM physicians was frequently cited as a reason for the difficulty in securing a PM job. The results inform the PM community with current trends in PH/GPM training and career obstacles faced by PM graduates.

The Supply and Distribution of the Preventive Medicine Physician Workforce

CONTEXT

Preventive medicine physicians work at the intersection of clinical medicine and public health. A previous report on the state of the preventive medicine workforce in 2000 revealed an ongoing decline in preventive medicine physicians and residents, but there have been few updates since.

OBJECTIVE

The purpose of this study was to describe trends in both the number of board-certified preventive medicine physicians and those physicians who self-designate preventive medicine as a primary or secondary specialty and examine the age, gender distribution, and geographic distribution of this workforce.

DESIGN

Analysis of the supply of preventive medicine physicians using data derived from board certification files of the American Board of Preventive Medicine and self-designation data from the American Medical Association Masterfile.

SETTING

The 50 US states and District of Columbia.

PARTICIPANTS

Board-certified and self-designated preventive medicine physicians in the United States.

MAIN OUTCOME MEASURES

Number, demographics, and location of preventive medicine physicians in United States.

RESULTS

From 1999 to 2018, the total number of physicians board certified in preventive medicine increased from 6091 to 9270; the number of self-identified preventive medicine physicians has generally decreased since 2000, with a leveling off in the past 4 years matching the trend of preventive medicine physicians per 100 000 population; there is a recent increase in women in the specialty; the practice locations of preventive medicine physicians do not match the US population in rural or micropolitan areas; and the average age of preventive medicine physicians is increasing.

CONCLUSIONS

The number of preventive medicine physicians is not likely to match population needs in the United States in the near term and beyond. Assessing the preventive medicine physician workforce in the United States is complicated by difficulties in defining the specialty and because less than half of self-designated preventive medicine physicians hold a board certification in the specialty.

Financing Preventive Medicine Graduate Medical Education

Financing US preventive medicine residency programs has been a persistently difficult issue. The unique nature of preventive medicine renders training more burdensome and costly than other specialties. This article describes the numerous and varied federal sources of Graduate Medical Education funding to outline available residency financing options for the specialty of preventive medicine. This information could be utilized by various preventive medicine organizations in their efforts to strengthen the specialty.

Core functions, knowledge bases and essential services: A proposed prescription for the evolution of the preventive medicine specialty

The pandemonium from the 2020 pandemic calls for a greater emphasis on prevention, public health and population health. Yet the role of preventive medicine specialists, ideally qualified to lead this charge, remains difficult to situate within the houses of medicine and public health. To overcome this challenge to its identity and evolve to better tackle novel and on-going public health and population health problems, the authors propose that the specialty of preventive medicine should assert 3 core functions within preventive care; expand and modernize its knowledge base; and enhance its residency training accordingly. The authors also propose 10 essential services, not otherwise systematically provided by other specialties, that the preventive medicine specialty can optimally fulfill as its unique contributions within medicine and public health.