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Why is "Preventative" Medicine Disrespected?

In the April issue of the GME e-Letter we referenced a March 19 New York Times article on career choices of recent MD graduates in which a medical student said, "The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol. But there is not a lot of respect for doctors who do that because anyone can get into it."

In response, we received the following e-mail from Sharon K. Hull, MD, MPH, Associate Professor and Chair in the Department of Community Health Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy (NEOUCOM).

I would like to point out one issue I have with the comment by the medical student, as referenced in the GME e-Letter.

While I realize that this quote appeared in The New York Times, the attitude it represents is based on a fallacious argument. It is true that there is not a lot of respect for doctors who do "preventative (sic) stuff," but it is not because "anyone can get into it." Preventive medicine is a specialty fully recognized by the American Board of Medical Specialties, but it is the only specialty that does not receive federal funding for training programs. The number of residency programs in preventive medicine is declining at a time when the specialty is most needed by the nation, with rising rates of chronic disease and life expectancies perhaps declining for the first time in over a century.  Reimbursement for preventive services is very low, whether those services are provided by physicians specialty-trained in preventive medicine or by any other physician.  Perhaps these issues are the proximate cause for the lack of respect for prevention alluded to by this student.

It happens that past AMA President, Ron Davis, MD, is a board-certified preventive medicine physician, but the number of board-certified preventive medicine physicians nationwide is very small, and in some states, new regulations requiring "active clinical practice" in order to obtain a medical license are systematically calling into question whether the practice of preventive medicine is even really the practice of "medicine" at all. These facts, along with medical student perceptions such as that stated above, are "symptoms" of the lack of respect or foresight accorded to the specialty, and the AMA should take the lead at working to solve the "root cause" problems, including the lack of funding for training in preventive medicine, and low rates of reimbursement for preventive services for all physicians. Thes "root causes" (and not the idea that "anyone can get into it") work synergistically to prevent this much-needed specialty from being seen in a more positive light.