After a chaotic speaker election, Congress is now turning its attention to key legislative priorities. Chief among these, for both parties, must be ensuring that our healthcare system is equipped to prevent the next major pandemic.
Late last year, a special subcommittee on the coronavirus crisis released a final report on their investigation. The report contains 30 recommendations to help the United States prepare for future pandemics. Like many post-pandemic analyses, the report highlights the need for physicians and public health workers trained in “surveillance and testing, risk communication, laboratory science, data systems, and disease control.”
While the congressional report doesn’t detail how exactly it trains this force, it and many others ignore preventive medicine, an American Board of Medical Specialties (ABMS) certified specialty that fits these same competencies. Physicians trained in preventive medicine are exactly what our public health system needs, yet with limited and uncertain funding, nearly half of all residency positions go unfilled each year.
As the new Congress takes office, investing in a workforce of physicians trained in public health should be their top priority. During the pandemic, we’ve heard story after story of fragile and broken systems beyond reason and capacity. Staffing levels and leadership cannot keep up with the demand for information or contact tracing, let alone manage other community needs such as masks, vaccines or the provision of emergency food and shelter. The health care and public health community in this country is on the verge of collapse.
While underappreciated prior to the pandemic, it is now clear that every health sector needs sufficient staff with the necessary skills and training to ensure appropriate disease mitigation strategies, pandemic preparedness, response and recovery . They need leadership who can understand clinical needs and communicate with hospital and healthcare leaders to organize population approaches to disease mitigation. They also need physicians who represent and understand the communities they serve.
One way is to invest in residency training in preventive medicine. Preventive medicine physicians receive specialized training in the competencies needed to prevent and manage public health emergencies and respond – biostatistics, risk communication, epidemiology, and program and systems design and planning – and are trained in state and local health departments Rotate, gain relevant experience to apply their intellectual skills.
Unlike ABMS’s other residency specialty programs funded by the Centers for Medicare and Medicaid Services (CMS), the Preventive Medicine residency is funded by the Health Resources and Services Administration (HRSA) through competitive direct grants. Despite awareness, outreach, and numerous congressional requests, these grant resources over the past decade have remained constant over the years and continue to fund less than half of the available places.
In 2007, the Institute of Medicine stated that we need more than 23,000 public health physicians ready to meet the nation’s population health needs. Today, we have approximately 2,700 boarding preventive medicine/public health physicians. Imagine the impact on lives if every health department in the country had access to these doctors at the start of the pandemic. And, if we can get this pipeline of vital physicians trained in public health right, imagine the opportunities for improved mitigation strategies in the future.
Billions of dollars have been allocated to health programs in the upcoming fiscal year, a small portion of which should go to the Health Resources and Services Administration to build this vital public health resource.
This funding will:
- Build a pipeline of preventive medicine physicians to address our nation’s challenges in chronic and infectious disease prevention, health equity, and diversity.
- Add skills to the already stretched public health department workforce and strengthen the county’s public health infrastructure.
- Steady public health and preventive medicine residency positions in more than 40 accredited preventive medicine residency programs in the U.S.
- More than 350 residents were assured and supported in their professional training to meet the nation’s clinical prevention needs.
- Contribute to the future of healthcare as many factors that affect health happen outside of the doctor’s office. Preventive medicine physicians are trained to work at the intersection of clinical care and public health and are uniquely positioned to understand the complex interplay of health and society, including the pervasive impact of structural racism and social decisions that lead to poor health factor.
In addition to training physicians with the necessary skills, the field attracts passionate physicians who reflect the communities they wish to serve. Two-thirds of applicants to preventive medicine residency programs reported coming from non-white communities. If our country really wants public health physician leaders in every community to have the skills and life experience to address the health needs of the population, then this is just one small change.
The new Congress has the power to build the public health workforce by maximizing resources from preventive medicine physicians, addressing a small investment that will have an immeasurable impact on the nation’s health. This important step forward will help deliver positive health outcomes for the nation.
Donna Grande is CEO of the American Academy of Preventive Medicine.