America must rebuild its public health workforce before the next pandemic
In this Nov. 19, 2020, photo, medical personnel prepare to treat a COVID-19 patient at Providence Holy Cross Medical Center in Los Angeles. A poll from the University of Chicago Harris School of Public Policy and The Associated Press-NORC Center for Public Affairs Research shows at least 7 in 10 Americans trust doctors, nurses and pharmacists to do what’s right for them and their families either most or all of the time.
Following the chaotic Speaker election, Congress now turns its attention toward key legislative priorities. Chief among these for both parties must be to ensure our health care system is equipped to prevent the next major pandemic.
Late last year, the Select Subcommittee on the Coronavirus Crisis released a final report on their investigation. Included in this report were 30 recommendations for preparing the United States to face future pandemics. The report, like many pandemic post-mortems, highlighted the need for physicians and public health workers trained in “surveillance and detection, risk communications, laboratory science, data systems and disease containment.”
While the congressional report is short on details on how exactly it seeks to train this workforce, what it, and many others, have overlooked is preventive medicine, a certified specialty of the American Board of Medical Specialties (ABMS) that meets those same competencies. Preventive medicine-trained physicians are exactly what our public health system needs, but nearly half of all residency slots go unfilled each year due to limited and uncertain funding.
As the new Congress settles into their seats, investment in the physician workforce trained in public health should be high on their priorities. During the pandemic, we heard story upon story of weak and fractured systems that were stretched beyond reason and capacity. Staffing levels and leadership could not keep up with the demand for information or contact tracing, let alone for managing other community needs such as supplies of masks, vaccines or emergency food and shelter. The healthcare and public health communities across this country were stretched to the breaking point.
While underappreciated before the pandemic, it is now clear that each health department needs adequate staff with requisite skills and training to ensure proper disease mitigation strategies, pandemic preparedness and response and recovery. They need leadership that 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 to do this is to invest in preventive medicine residency training. Preventive medicine physicians are trained specifically in the competencies needed to prevent and manage public health emergencies and response — biostatistics, risk communications, epidemiology and program and systems design and planning and conduct their training rotations in state and local health departments acquiring contextual experience to apply their skills.
Unlike other residency specialty programs of the ABMS that are funded by the Centers for Medicare and Medicaid Services (CMS), preventive medicine residents are funded by the Health Resources and Services Administration (HRSA) through direct grants that are competitive in nature. These grant resources over the past decade have remained flat for years despite awareness, outreach and numerous congressional requests, and continue to fund less than half of the available slots.
In 2007, the Institutes of Medicine stated that we needed over 23,000 public health physicians to be prepared to address the country’s population health needs. Today, we have approximately 2,700 boarded preventive medicine/public health physicians. Imagine the impact on lives if every health department across the country had access to these physicians at the start of the pandemic. And, imagine the future opportunities for improved mitigation strategies if we were able to properly build the pipeline of these important physicians trained in public health moving forward.
Billions of dollars have been allocated for health programs in the upcoming fiscal year, a small fraction of that should be allocated to the Health Resources and Services Administration to build up this important public health resource.
This funding would:
- Build a pipeline of preventive medicine physicians to meet the challenges our nation faces for chronic and infectious disease prevention, health equity and diversity.
- Strengthen the public health infrastructure across this county with additional skills among the already stretched public health department staff.
- Stabilize public health and preventive medicine residency positions at over 40 accredited preventive medicine residency training programs in the U.S.
- Enable more than 350 residents to be secured and supported as they conduct their specialty training to meet the nation’s clinical preventive needs.
- Contribute to the future of healthcare, as much of what influences health happens outside the walls of a 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 interactions of health and society, including the pervasive influence of structural racism and the social determinants leading to poor health.
In addition to training physicians with requisite skills, this field also attracts passionate physicians who reflect the communities they desire to serve. Two-thirds of physician applicants to preventive medicine residency programs self-report as coming from nonwhite communities. If our country genuinely wants public health physician leaders in each community with both the skills and lived experience to address population health needs, then this is a small ask for change.
The new Congress has the power to address one small investment that would have an immeasurable impact on the nation’s health by maximizing resources to build the public health workforce through preventive medicine physicians. This one important step forward would contribute to positive health outcomes for the nation.
Donna Grande is the chief executive officer of the American College of Preventive Medicine.