“What is that?” I was sitting in the emergency room during my emergency medicine rotation, chatting with my attending when he had asked me what residency program I was in. I told him I was actually doing two: family medicine and preventive medicine. Family medicine he had heard of, but preventive medicine? Only a confused look. And he is not the only one. In medical school, there was no specialty advisor for preventive medicine. In a class of about 227 students, I was the only one who matched into a preventive medicine residency. And honestly, that is not surprising. According to the American College of Preventive Medicine (ACPM), there are only about 3,000 board-certified preventive medicine doctors in the United States, less than 0.5 percent of the U.S. physician workforce. So, we are used to it. We just grin and bear the confused looks and go about our work; it is not a specialty we chose for the notoriety.
But what is it exactly that we do? A residency in general preventive medicine and public health (GPMR) combines the practice of both clinical medicine and public health, typically leading to the completion of a master’s degree in public health during training. This blend of training uniquely prepares graduates of these programs to fill extremely important roles that are often invisible to the general public; graduates of my own program have gone on to fill roles as leaders and medical directors in county health departments, federally qualified community health centers, managed care organizations, the Indian Health Service, and correctional health, to name only a few. Many more are active in teaching residents, doing research at the NIH or NIAID, and developing policy at the local, state, and federal levels.
Although it does not come with much fanfare, the impact GPMR graduates can make is huge, because when it comes to public health, the numbers are huge. Take, for example, the work of Dr. Howard Sobel, a graduate of the GMPR at Johns Hopkins School of Public Health, who worked for the World Health Organization directing their immunization program in the Philippines from 2003 to 2010. An estimated 18,000 lives were saved as a result of a 2004 measles vaccination campaign organized with his strategic leadership during this time.
If there is a single group of specialists specifically trained to help navigate our complex political, social, and economic landscape and most prepared to lead health care in the United States, it is preventive medicine physicians. And that is why we have to speak up. Because preventive medicine residencies are starting to disappear.
Times are hard for the field of public health. Recently, members of our program were pulled into a private meeting and informed that there would be no incoming cohort of preventive medicine residents. They were taking a “pause.” And unfortunately, this is not without precedent: Of the approximately 350 GMPR spots allotted by the Accreditation Council on Graduate Medical Education, there are only about 100 preventive medicine graduates every year, largely due to funding issues. Discussions with leadership cited significant funding shortfalls due to fewer international students being able to attend the school of public health and budget cuts to research grants as reasons the program could not be supported this year. Unfortunately, this is not unique: While other medical residency programs are funded by CMS, the majority of GPMR programs are funded through HRSA grants, but currently the funding is only sufficient to cover about 50 residents. For the other approximately 50 residents that matriculate each year, programs rely on funding from research grants, institutional support, and state funding, which is less reliable and insufficient.
Unfortunately, we cannot help but fear that things are not going to get better. We fear that our specialty may end entirely. But our nation cannot afford to let our training pipeline disappear. Preventive medicine physicians are the key to improving health care in the U.S. They are the backbone that helps keep us all afloat, from one-on-one patient interactions in clinic up to caring for our communities at the city, county, state, and federal level, they protect the health of Americans everywhere. Be it managing infectious disease outbreaks, building policies that improve health equity instead of reinforcing inequity, shifting our health care toward prevention instead of sick-care, or improving maternal and infant mortality, our nation relies on preventive medicine physician leaders, and it is in desperate need of more of them.
It would only cost an additional $48 million to fully fund every one of the remaining 300 allotted GPMR training spots across the nation, more than doubling the number of preventive medicine physicians entering the workforce each year. To some, that might sound like a lot. But when compared to the cost of preventable disease, disability, and loss of American lives that preventive medicine physicians stop, it is nothing. The United States of America can afford to pay for our training. But it cannot afford our absence.
Jacob Player is a family medicine resident.
