Preventive medicine is at risk in Trump’s budget plan
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At a time when greater focus should be placed on the prevention of chronic diseases and injuries that drive up health care spending, lead to millions of lives lost and create significant productivity loss to our economy, it is deeply concerning that President Trump’s budget proposes to eliminate large portions of critical prevention funding.

One of the most concerning cuts is the elimination of the sole source of federal support for our nation’s Preventive Medicine Residency training programs. The budget proposal, which targets funding at the Health Resources and Services Administration (HRSA), comes at a time when we should be expanding — not shrinking — the training of disease prevention and health promotion physicians.   

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Preventive medicine specialists focus not only on the health of communities, targeting specific high risk and vulnerable populations but also on individuals. They apply their skills to prevent and reduce the impact of disease and encourage healthier lifestyle choices.

They often train and serve in underserved areas and practice at the community and population level to identify and treat the root causes of ill-health. Their work spans areas from decreasing acute and chronic illnesses, including diabetes, heart disease and respiratory illnesses, to addressing public health preparedness and emergencies such as the Zika virus, disaster preparedness and the growing opioid epidemic.

In addition, these same skills are critical to supporting our nation’s health system transformation efforts.  The move to a more efficient, value-based health system focused on better population health outcomes is accelerated and amplified by applying appropriate population health management skills core to preventive medicine physicians.

At a time when half of the population is afflicted with at least one chronic condition, we must start at the top with public health initiatives that reach the greatest number of citizens possible. America faces an alarming increase in chronic diseases – especially due to obesity – including heart disease, stroke, type 2 diabetes and some cancers.

Though preventable, chronic diseases threaten to overwhelm our health care system. About half of all Americans adults have one or more chronic conditions, according to the Centers for Disease Control and Prevention, and one in four adults have two or more. Direct medical costs for chronic diseases and conditions exceed $750 billion annually. Research shows that half of these chronic diseases could be preventable, at least.

The return on investment from preventing these conditions is high. Based on current trends, by 2023, chronic disease cases will increase by 42 percent, to 230 million, costing $4.2 trillion in treatment and lost economic output. Reducing our ability to prevent and reduce obesity through cutting preventive medicine funding will thus add far more costs to our nations’ ever growing debt.

Why is the preventive medicine specialty particularly vulnerable with this budget proposal?  Since preventive medicine residents train in community-based settings rather than in the traditional teaching hospital, Medicare and Medicaid do not support the cost of their graduate medical education as with all other clinical specialties.  At a time when applications to preventive medicine residency training programs are on the rise due to added emphasis on population health in medical school, the sole source of federal support for these resident positions is now under attack.

The president’s budget will do irreparable harm to the preventive medicine training pipeline, send a signal to our young physicians in training that prevention should be deemphasized and increase our future health care costs adding risk to our nation’s health and economy.

The National Academy of Medicine (formally known as the Institute of Medicine), recommended adding the capacity to train at least an additional 400 public health and preventive medicine residents per year.  Funding to increase the number of residents to meet this workforce gap has been inadequate and further compromised by a cut to HRSA’s preventive medicine residency training line-item in the Fiscal Year 2017 budget. 

As a result several programs have been forced to turn away residents who were planning to start their residency training on July 1. 

This is tragic.

 As a national asset poised to help reduce future disease, health costs and improve our nation’s key performance indicators, preventive medicine residents deserve stable and sustainable funding and the full support of our federal government as other medical specialties.

Without physicians trained to address and prevent these increasingly high-risk conditions, patients will suffer, our national economic competitiveness will further erode and health systems will continue to strain under the weight of costly and preventable diseases.

Dr. Robert Carr, MD, MPH, FACPM, is president of The American College of Preventive Medicine. He is a professor and director of the Executive Master’s program in Health Systems Administration at Georgetown University. Follow him on Twitter @ACPM_HQ.


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