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Editorial

HRSA's Investment in Preventive Medicine

Jung, Paul MD, MPH, FACPM; Russell, Sophia DM, MBA, RN, NE-BC

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Journal of Public Health Management and Practice: May/June 2021 - Volume 27 - Issue - p S113-S115
doi: 10.1097/PHH.0000000000001291
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The medical specialty of preventive medicine is unique for a number of reasons—it is the only medical specialty that requires training in both direct patient care and population health,1 it is the only specialty for which Congress has appropriated a specific line of funding for residency training,2 and it is one of the smallest and least recognized specialties within modern medicine.3,4 And yet, as health organizations, including federal agencies, move toward measuring and improving population health,5 and as the COVID-19 pandemic exposes problems within health care and the public health infrastructure,6 the specialty of preventive medicine is probably more important now than ever before.

With support of then-US Surgeon General Leonard Scheele, the American Board of Preventive Medicine incorporated in 1948 and began certifying preventive medicine specialists shortly thereafter.7 Surgeon General Scheele went on to indicate that qualifications for officers within the US Public Health Service “include not only the basic professional skills of its officers, but also special know-how in public health and preventive medicine....”8(p39) Since these auspicious origins, preventive medicine physicians have assumed an exclusive role in health care, one with dual capabilities in individual patient care combined with population health (Figure).

FIGURE
FIGURE:
The Unique Role of the Preventive Medicine Specialist

Three distinct core specialties encompass preventive medicine: aerospace medicine, occupational medicine, and public health and general preventive medicine. Although each may appear different, they are united in their training and practice of population health.

Preventive Medicine Training and Practice

While many specialties focus on a specific organ system or disease, such as cardiology or oncology, the specialty of preventive medicine is designed, by training and practice, to focus on populations. In addition to clinical training in direct patient care, preventive medicine residents obtain training in epidemiology, biostatistics, health services administration, environmental health sciences, and social and behavioral sciences, followed by intensive practicum training in supervised practical experience in population health based on the “essential public health services.”1 No other specialty requires such training, with the vast majority of specialties requiring none of the essential public health services in their training at all.9

Preventive medicine specialists stand out in their ability to address complex health needs of a population through multidimensional assessments and programs utilizing their unique training. It is a true “meta-specialty” that addresses a patient's clinical issues as well as the underlying environmental-, population-, and community-level causes of those diseases and conditions. Preventive medicine can be considered as the one specialty that is specifically designed to assess the need for clinical prevention programs for a given population, the proper method of implementing and deploying such prevention programs, and the best way to conduct assessments to determine the success of these programs.

HRSA and Preventive Medicine

The Health Resources and Services Administration (HRSA) has managed congressional appropriations for the specialty's training through its Preventive Medicine Program since 1983.10 HRSA funding allows preventive medicine residency training to align with the goals of the agency. Specifically, the specialty of preventive medicine falls squarely within HRSA Strategic Plan Goal 3: Achieve Health Equity and Enhance Population Health.11 Preventive medicine is situated to address these goals by leveraging community partnerships and stakeholder collaboration to achieve health equity and enhance population health and by promoting health and disease prevention across populations, providers, and communities. The HRSA Preventive Medicine Program exists within the agency's Bureau of Health Workforce, and the program aligns with the Bureau's priorities of access, supply, distribution, and quality.12

In addition to aligning training with agency priorities, HRSA can promote efforts to characterize, support, and promote the specialty. For example, in just the last few years:

  • The HRSA National Center for Health Workforce Analysis commissioned the Carolina Health Workforce Research Center, part of the University of North Carolina at Chapel Hill, to conduct a review of preventive medicine physicians in the United States, providing a snapshot of the specialty within the US physician workforce.13
  • The HRSA Bureau of Health Workforce, Division of Medicine and Dentistry, held the first-ever preventive medicine stakeholder meeting in November 2019 to address the future of the specialty. Presentations by the Accreditation Council for Graduate Medical Education, the American College of Preventive Medicine, National Association of County and City Health Officials, Association of State and Territorial Health Officials, and the de Beaumont Foundation were followed by robust roundtable discussions on careers for preventive medicine physicians, measures of success for residency programs, and the structure and function of residency training programs.14
  • HRSA's Federal Office of Rural Health Policy included preventive medicine in the eligible specialties for its 2020 Rural Residency Program Development (RRPD) program to support the development of new residency programs in rural areas.15 The RRPD program provides start-up funds to help new residency programs with training in rural areas to achieve accreditation and develop sustainable funding, and the inclusion of preventive medicine demonstrates the importance of the specialty in rural America.16
  • Finally, preventive medicine physicians have recently been appointed to 2 HRSA advisory committees, the Council on Graduate Medical Education17 and the Advisory Committee on Training in Primary Care Medicine and Dentistry,18 indicating the importance of the specialty to HRSA's work.

HRSA-Funded Residency Program Activities

The projects collected in this supplement demonstrate the importance of the specialty in light of HRSA's priorities by providing a glimpse into some of the activity undertaken by preventive medicine residents in programs funded by HRSA. From bread and butter public health issues such as vaping and e-cigarettes to the modern plagues of the opioid epidemic and COVID-19; from systematic descriptions of the occupational medicine subspecialty to addressing population health in rural America; from clinical quality improvement assessments to the specialty's role in health systems: the training of preventive medicine residents is exemplified in the work published herein. There is ample evidence that the graduates of HRSA-sponsored preventive medicine residency programs are ready and capable of incorporating medical care and population health into health departments, health centers, and the health system writ large.

The future of the specialty of preventive medicine remains strong, and HRSA will continue to manage Congress' valuable financial support for the specialty to ensure that it remains viable and relevant for the future.

References

1. Accreditation Council on Graduate Medical Education. ACGME program requirements for graduate medical education in preventive medicine. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/380_PreventiveMedicine_2020.pdf?ver=2020-06-30-144631-400. Accessed September 13, 2020.
2. Jung P, Lushniak BD. Financing preventive medicine graduate medical education. J. Public Health Manag. Pract. 2021;27(3 Suppl):S206–S210.
3. AMA physicians by TOPS. AMA physicians report created 9/11/2020 8:30:03 am. https://www.med-pub.com/mms/web/AMA-SpecialtyByTOPS.pdf. Accessed September 13, 2020.
4. Salive ME, Parkinson MD. Preventive medicine residents: a national survey. Am J Prev Med. 1991;7(6):445–449.
5. Kassler WJ, Tomoyasu N, Conway PH. Beyond a traditional payer—CMS's role in improving population health. N Engl J Med. 2015;372(2):109–111.
6. Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19—implications for the health care system. N Engl J Med. 2020;383(15):1483–1488.
7. Ring AR. History of the American Board of Preventive Medicine. Am J Prev Med. 2002;22(4):296–319.
8. Scheele LA. Military medicine and the U.S. Public Health Service. Mil Surg. 1954;114(1):37–40.
9. Jung P, Lushniak BD. Preventive medicine's identity crisis. Am J Prev Med. 2017;52(3):e85–e89.
10. Lane DS, Varma AA. The postgraduate education of physicians in preventive medicine. Am J Prev Med. 1986;2(4):216–219.
11. Health Resources and Services Administration. Strategic plan FY 2019-2022. https://www.hrsa.gov/about/strategic-plan/index.html. Published February 2019. Accessed September 13, 2020.
12. Health Resources and Services Administration. Bureau of Health Workforce. https://www.hrsa.gov/about/organization/bureaus/bhw/index.html. Published May 2020. Accessed September 13, 2020.
13. Ricketts TC, Porterfield DS, Miller RL, Fraher EP. The Supply and Distribution of the Preventive Medicine Physician Workforce. J Public Health Manag Pract. 2021 May/Jun;27(Suppl 2), HRSA Investment in Public Health: S116–S122.
14. Health Resources and Services Administration. Future of Preventive Medicine Stakeholder Meeting Summary Report. Rockville, MD: Health Resources and Services Administration; 2019.
15. Health Resources and Services Administration. Rural residency planning and development program. Announcement number: HRSA-20-107. https://www.hrsa.gov/grants/find-funding/hrsa-20-107. Accessed September 13, 2020.
16. Jung P, Warne DK. Integrating the preventive medicine specialty in the rural and Tribal public health workforce. Prev Med. 2020;139:106187.
17. Bureau of Health Workforce, Health Resources and Services Administration. Department of Health and Human Services. Council on Graduate Medical Education (COGME) members. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/graduate-medical-edu/cogme-members_0.pdf. Accessed September 13, 2020.
18. Health Resources and Services Administration. Department of Health and Human Services. Advisory Committee on Training in Primary Care Medicine and Dentistry members. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/primarycare-dentist/actpcmd-roster.pdf. Accessed September 13, 2020.
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