Preventive medicine is practiced by all physicians and health care professionals to prevent further injury or progression of a disease or disorder. The American Board of Medical Specialties (ABMS) recognizes preventive medicine as a unique medical specialty which focuses on the health of individuals, communities and defined populations. The goal of preventive medicine is to protect, promote and maintain health and well-being and to prevent disease, disability and death (ACPM, 2017).
Preventive medicine specialists are licensed medical doctors (MD) or doctors of osteopathy (DO), who possess core competencies in biostatistics, epidemiology, environmental and occupational medicine, planning and evaluation of health services, management of health care organizations, research into causes of disease and injury in population groups, and the practice of prevention in clinical medicine (ACPM, 2017). These specialists must complete education and training to gain the skills needed to be successful. They are trained in medical, social, economic and behavioral sciences.
Most people see a doctor or physician when they have an illness or injury. Preventive medicine focuses on preventing illness and injury as opposed to treating these issues. Doctors in this medical specialty field work to develop and implement processes or procedures that will prevent people from becoming ill or injured.
Preventive Medicine Specialized Areas
There are three specialized areas within the field of preventive medicine, each with their own set of core knowledge, skills and competencies in different specialized population, environments or practice settings. The specialized areas are aerospace medicine, occupational medicine, and public health and general preventive medicine. Many preventive medicine specialists are board-certified in more than one specialty area, and some are certified in all three areas.
Aerospace Medicine
Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles (ACPM, 2017). Aerospace medicine specialists tend to work in remote, isolated or enclosed environments, which can cause physical and psychological stress to the specialist.
Occupational Medicine and Public Health
This preventive medicine specialty field focuses on employee or worker health and the associated physical, chemical, biological and social hazards or stressors in the work environment. Occupational medicine specialists analyze the associations between medical conditions and environmental workplace exposures, in addition to promoting health and safety practices and procedures.
Public Health and General Preventive Medicine
Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations (ACPM, 2017). These preventive medicine specialists combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings (ACPM, 2017).
Preventive Medicine Sub-specialties
The American Board of Preventive Medicine identifies four sub-specialty areas of this medical field: addiction medicine, clinical informatics, medical toxicology and undersea and hyperbaric medicine.
Addiction Medicine
Addiction Medicine is concerned with the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction, of those with substance-related health conditions, and of people who show unhealthy use of substances including nicotine, alcohol, prescription medications and other licit and illicit drugs (ABPM, 2017). These specialists also support family members who are affected by the patient’s addiction or substance abuse issues.
Clinical Informatics
Preventive medicine specialists who practice clinical informatics work with other medical and information technology professionals to analyze, design, implement and evaluate information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship (ABPM, 2017).
Clinical informatics combines knowledge of patient care with informatics tools to assess information and knowledge needs of healthcare professionals and patients; characterize, evaluate, and refine clinical processes; develop, implement, and refine clinical decision support systems; and lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems (ABPM, 2017).
Medical Toxicology
Medical toxicologists specialize in the prevention, evaluation, treatment, and monitoring of injury and illness from exposures to drugs and chemicals, as well as biological and radiological exposures. Medical toxicologists may work in clinical, academic, governmental, and public health settings, and provide poison control center leadership as well.
Undersea and Hyperbaric Medicine
Undersea and hyperbaric medicine specialists focus on the prevention of injury and illness due to exposure to environments in which the ambient pressure is increased, such as in diving or hyperbaric chamber exposure, and the therapeutic use of high environmental pressure and the delivery of oxygen under high pressure to treat disease (ABPM, 2017). The scope of the subspecialty emphasizes the occupational, environmental, safety, and clinical aspects of diving, hyperbaric chamber operations, compressed air work, and hyperbaric oxygen therapy.
What Does a Preventive Medicine Specialist Do?
A preventive medicine specialist may have a wide variety of duties and responsibilities. These doctors perform research to implement disease prevention tactics and decrease the occurrence of disability and the maintenance of overall patient health. Many preventive medicine specialists educate and train other medical staff to reduce the spread of infection, direct public health programs and determine the cause of certain disease outbreaks. In addition, they may provide education and training on health hazards and ways to reduce the risk of being injured or becoming ill.
There are many locations a preventive medicine specialist may be employed. They may work in a hospital, government agency or university, pharmaceutical company, or an aerospace medicine facility, in addition to many others.
Family History Evaluations
Family history is known to be a risk factor for many chronic diseases—including coronary heart disease, cancer, and diabetes—but it’s use in preventive medicine has been de-emphasized compared with modifiable risk factors such as smoking and diet (CDC, 2017). Although over 90% of Americans believe knowledge of their family history is important to their health, only a third of these people have documented their own family history.
Most common diseases result from the interactions of multiple genes with multiple environmental factors in complex patterns that, despite progress in sequencing the human genome, are unlikely to be understood fully in the near future (CDC, 2017). Although much is left unknown about the human genome, a family health history can provide similar data regarding the interactions of genetic, environmental and behavioral risk factors.
The Centers for Disease Control (CDC) (2017) has developed a Family History Public Health Initiative to emphasize the use of family history when assessing a patient’s risk for certain diseases in order to prevent the development of the disease or detect the disease in its early stages. At the center of this effort is a new Web-based family history tool for determining a person’s risk for common chronic diseases, and research activities to assess the validity and utility of using family health history as a public health strategy (CDC, 2017).
The History of Preventive Medicine in the United States
The concept of preventive medicine goes back to ancient times. Before the medical advances made during the World Wars, men were explaining disease and attempting to avoid illness (Springer, 2017). In surveying historical efforts to prevent communicable diseases and nutritional deficiency diseases three categories of prevention are apparent; (1) individual control over personal health through adherence to dietary and hygiene codes; (2) social control over health by means of isolating diseased individuals or protecting large groups of people from environmental dangers; (3) application of increased scientific understanding of disease (Becker, 1998).
The first annual meeting of the American Public Health Association (APHA) occurred in 1873, although it was an informal meeting of physicians. At the time, the goal of this meeting was to establish guidelines for increasing knowledge of hygiene and public health issues, including effective applications of sanitary principles and laws. During the inception of the APHA, there was no distinction made between public health and preventive medicine.
The APHA began implementing methods and recommendations to improve upon public health and sanitation practices. These methods included the following (Terris, 1973): (1) the education of the people; (2) the thorough education of the medical profession in sanitary science, and the reduction of that science to daily practice; (3) the professions of architecture, engineering, and allied departments of business must be educated in sanitary science; (4) the state must perform an important part in the application of sanitary knowledge; and (5) finally, the general government should within its appropriate sphere cooperate with state governments.
The main health concerns at the time included public instruction in sanitary science, principles of hospital hygiene, the relations of architecture and hygiene, heat as an element in sanitary climatology, the relation of city and country life to health and longevity, epidemics of cholera and yellow fever, vaccination against smallpox, principles and practice of quarantine, sanitary care of refuse, disinfection, water supply of cities, state and local sanitary organization, the necessity for a national sanitary bureau, and the need for a uniform system of registration of causes of death throughout the United States (Terris, 1973).
In 1897, bacteriology was incorporated into the sanitary sciences, mainly due to the work of Jenner and Pasteur as related to smallpox and rabies, respectively. Behring’s work with diphtheria and tetanus identification also contributed to the establishment of vaccines and bacteriology.
The APHA began to further research and analyze infectious disease control, including disinfection and fumigation, water purification, refuse disposal, isolation, the diagnosis of typhoid fever by Widal's blood reaction, studies in the etiology and prevention of typhoid fever, diphtheria, tuberculosis, and yellow fever, and the need for uniform and cooperative health laws (Terris, 1973).
In 1921, industrial hygiene was introduced, in addition to maternal and child health, including maternal mortality, the midwifery problem, prevention of rickets, undernourished school children, the hygiene of cardiac children, and school health supervision (Terris, 1973). Industrial hygiene involves the evaluation and recognition of hazards.
The APHA significantly expanded in 1947. At this time, fluoridation and other aspects of dental health, nutrition, health education and industrial hygiene issues were discussed, although this is not the reason for the expansion. The expansion of the APHA occurred when the American Public Health Association and the American Hospital Association decided that preventive and curative medicine could no longer remain separated both physically and functionally.
Six main functions of local health departments were established during this time: vital statistics, sanitation, communicable disease control, laboratory services, maternal and child health and health education (Terris, 2017). In 1950, these functions expanded and were redefined. Because of advances in controlling infectious disease, the preventive medicine field was able to expand to include prevention of the progression and complications of diseases, including disability and death.
The services provided by local health departments were redefined as: (1) recording and analysis of health date; (2) health education and information; (3) supervision and regulation; (4) provision of direct environmental health services; (5) administration of personal health services; (6) operation of health facilities; and (7) coordination of activities and resources (Terris, 2017).
Preventive Medicine Task Force
In 1984, the Public Health Service, part of the U.S. Department of Health and Human Services, established the USPSTF (US Public Service Task Force) to address a comprehensive set of clinical preventive services. The USPSTF was charged with systematically reviewing the scientific evidence for individual clinical preventive services and making recommendations for practitioners about what services should be routinely offered (Woolf and Adkins, 2001). By 1996, the enthusiasm for clinical practice guidelines and for evidence-based medicine had been tempered by a realization of their attendant practical and political challenges (Woolf and Adkins, 2001).
How to Become a Preventive Medicine Specialist
Extensive education and training is required in order to become a preventive medicine specialist. An undergraduate degree and completion of medical school are required to become a licensed specialist. Many aspiring preventive medicine specialists complete a master’s degree before medical school, in addition to completing a 2 to 4 -year residency program to receive more specialized training.
Undergraduate Degree
Although there is no specific requirement for the undergraduate degree major, many future preventive medicine specialists major in a science such as biology, chemistry or physics, while others may choose a social science such as sociology or psychology. A major in a science field will help prepare students for medical school and for the Medical College Admissions Test (MCAT) that must be passed in order to be accepted into an accredited medical school.
The Medical College Admission Test (MCAT) will be taken during the third year of undergraduate study. Medical school admission is extremely competitive, so a high MCAT score will help you stand out to the admissions board members. In addition, volunteering in a hospital or medical center is a great way to gain experience in the medical field, and it also looks good on a medical school application, as does participation in multiple extra-curricular activities.
Graduate Programs
Although a graduate degree is not required, some students choose to pursue a graduate degree in medicine or a medical field. This will also add to a medical school application, because the student has additional education and training in the medical field.
Medical School
Medical school typically consists of a four-year program. The first two years focus on classroom instruction in courses such as anatomy and physiology, biochemistry, pathology and pharmacology. The last two years includes hands-on clinical training under the supervision of a licensed physician performing general medicine evaluations and procedures. Hospital rotations may allow for experience in various specialized fields such as preventive medicine, pediatrics or surgery. A Doctorate of Medicine (M.D) is rewarded after successful completion of the 4-year medical school program.
Residency Program
Most practicing preventive medicine specialists completed at least two years of residency training, and some completed up to four years to receive additional specialized training in a specialty or sub-specialty field of preventive medicine. During a residency program, the preventive medicine specialist will evaluate patients or perform research while consulting with other licensed physicians.
A residency is required for board certification in specialized areas including general preventive medicine and public health, occupational medicine and aerospace medicine. According to ACPM (2017), there are currently 73 accredited Preventive Medicine residency training programs in the United States, with approximately 350 residents in each accredited program. This allows for individualized education and training.
Residency Training and Skills
Training during a residency program includes: application of biostatistical principles in methodology; recognition of epidemiological principles in methodology; planning, administration, and evaluation of health and medical programs and the evaluation of outcomes of health behavior and medical care;
Recognition, assessment, and control of environmental hazards to health, including those of occupational environments; recognition of the social, cultural, and behavioral factors in medicine; application and evaluation of primary, secondary, and tertiary prevention, with specificity of these skills varying between General Preventive Medicine, Occupational Medicine and Aerospace Medicine; and assessment of population and individual health needs (ACPM, 2017).
Residents must also successfully complete at least one year of clinical education that includes direct patient care in both inpatient and outpatient settings. Competency in the following fields must be demonstrated (ACPM, 2017): obtaining a comprehensive medical history; performing a comprehensive physical examination; assessing a patient’s medical conditions; making appropriate use of diagnostic studies and tests; integrating information to develop a differential diagnosis; and developing, implementing, and evaluating a treatment plan.
Some students obtain a Master’s degree in Public Health during their residency program, but all students will attend graduate-level courses in epidemiology, biostatistics, health services management and administration, environmental health and the behavioral aspects of science. Additional training includes didactics (teaching or education of preventive medicine), clinical training, research and public health.
Certification and Licensing
A preventive medicine specialist must be licensed in the state or region they choose to work in, although some states do not define licensure criteria for preventive medicine because they may not be involved in direct patient care. The American College of Preventive Medicine advocates that state medical boards develop licensure policies that recognize the vital impact of well-qualified physicians in settings outside of direct patient care including academic, research, government, public health, and physician leadership roles (ACPM, 2017).
Certification is optional, but it is highly recommended, particularly for doctors focusing on a sub-specialty field of preventive medicine. The ABPM is the certifying organization for preventive medicine specialists. To become certified, a specialist must pass an examination. Each specialty and sub-specialty areas have their own specific requirements for certification, although the categories are the same. Not only does certification demonstrate a preventive medicine specialist’s competency, it also provides a networking opportunity to coordinate with other physicians in the field.
To be eligible for certification, a preventive medicine specialist must meet clinical training, residency, graduate coursework, practice currency and additional requirements established in their respective specialty or sub-specialty field. Sub-specialties tend to have more extensive practice currency requirements, because additional training is required for these fields. Each specialty and sub-specialty has its own exam, but a specialist may take as many as exams as they like, and they can be certified in multiple specialty or sub-specialty fields.
Maintaining a ABPM certification requires continuing education and demonstration of competency in the preventive medicine field. It also requires taking the maintenance of certification (or MOC) exam. All ABPM diplomates must pass the cognitive exam prior to the expiration of their current certificate in order to recertify without a lapse (ABPM, 2017). Patient safety coursework and training is also required to maintain certification.
In addition to the education and training requirements, a preventive medicine specialist must maintain a good professional standing and maintain a license to practice in their respective state. As with any physician, professionals in this medical field must also uphold strict ethical and moral values as stated in their Hippocratic oath. This is also required to maintain certification and licensure.
Although this is a challenging medical field, it offers a wide variety of options and a flexible schedule. Whether you choose to have direct or indirect patient contact, you will greatly improve the quality of life by preventing illnesses and injuries. Many preventive medicine specialists are extremely satisfied with their career choice, regardless of if they work in a hospital, university, private practice or any other location.
Terris, Milton, M.D. Evolution of Public Health and Preventive Medicine in the United States. Journal of Public Health and Preventive Medicine. February, 1975, Vol. 65, No. 2.
Becker D.M. (1988) History of Preventive Medicine. In: Becker D.M., Gardner L.B. (eds) Prevention in Clinical Practice. Springer, Boston, MA
Woolf SH and Atkins D. The evolving role of prevention in health care: Contributions of the U.S. Preventive Services Task Force. Am J Prev Med 2001;20(3S):13-20
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