Today, the current health care ecosystem is broken and in need of an overhaul. To start, this country’s high cost of health care is not sustainable, preventing millions of Americans from accessing important health care services. The recent ruling will only exacerbate this to remove requirements for preventive screenings from the Affordable Care Act. Further, there are vast omissions of care provided to individuals in historically marginalized communities. These inexcusable health inequities in care have caused disproportionate rates of preventable chronic conditions like diabetes and heart disease among communities of color.
The solution to these problems has to start at the table where decisions about our health care system are made, and physicians must be seated at the table.
If the U.S. Congress truly wants to fix the broken health care infrastructure, they would allocate a small portion of the trillion-dollar budget towards building a pipeline of public health-trained preventive medicine physicians. Recently, the Select Subcommittee on the Coronavirus Crisis highlighted the need for physicians and public health workers trained in “surveillance and detection, risk communications, laboratory science, data systems, and disease containment” to prepare for future pandemics; it seems cavalier to bypass funding decisions for the very individuals uniquely trained to meet this need.
For decades, physicians — particularly preventive medicine physicians — have been put on the sidelines of investments and not invited to many tables where solutions are being discussed and structured at the hospital, in public health, and across the overall health care ecosystem. Physicians are working on the frontlines of care — managing the downstream impact of decisions made by judges, public officials, and others who, while well-intentioned, do not understand the complexities of how care is delivered. Preventive medicine physicians can help bridge that gap through the duality of their training and roles they serve at the intersection of both clinical care and public health.
Their training in health systems thinking and their experience in public health are key assets for addressing the numerous challenges and for identifying strategies and interventions that will fix a broken infrastructure. The lack of awareness and overall arrogance of many seem to imply that someone other than physicians trained uniquely for the needs of today can offer solutions.
As I have said in other public forums, imagine a system where properly trained public health physicians were leading solutions across this country at both hospital and health department levels. Imagine integrating population health approaches and systems thinking into the mess we all experienced through the pandemic. It could have been different if the right people were both on the proverbial bus and driving it forward.
As our country’s population continues to grow and human life expectancy is stalling, the practice of medicine is a prime target for legislative change, which ultimately impacts patient care and the nation’s overall health.
Physicians are respected members of society, have an expansive knowledge of disease processes and health care delivery to patients, and are naturally patient advocates. Preventive medicine-trained physicians bring forward additional assets in epidemiology and systems thinking, having gained on-the-job training in public health departments that give them a unique perspective from their other medical specialty colleagues. Physician leaders are primed to help shape federal advocacy and to continue to preserve the best interests and dignity of all patients and citizens of this country.
Giving public health-trained physicians a seat at the table is an ethical imperative and a “practical matter” that the collective of elected officials and those in “power” should consider. Invite preventive medicine-trained physicians to the table and hear plausible and possible solutions to address this broken system.
Donna Grande is CEO, American College of Preventive Medicine.