Preventive Medicine Physicians' Role in Health Care Organizations' Pursuit of the Triple Aim.

CONTEXT: The Institute for Healthcare Improvement's Triple Aim is rooted in improving population health and therefore requires a focus on prevention as well as management of disease. Preventive medicine (PM) physicians are uniquely trained in clinical medicine as well as health care delivery and systems-based practice, thus potentially positioning them to lead population health and contribute to the Triple Aim. OBJECTIVE: The objectives of this study were to (1) describe PM physicians' contributions related to the Triple Aim and (2) describe PM physician satisfaction with these activities. DESIGN: A survey was administered to physicians graduating from a single Preventive Medicine Residency program between 1975 and 2015. Physicians were asked about work in 3 specific emerging areas that relate to the Triple Aim's focus on population health improvement: population health; health system transformation; and integration between primary care and public health. PM physicians were also asked about their job, career, and specialty satisfaction. RESULTS: Most respondents (74%) practiced population health, with the majority (63%) defining this as improving the health of the population at large versus for a defined clinical population (37%). Approximately half (59%) of PM physicians are involved in health system transformation leadership. Most respondents practice both public health and primary care, but only 32% report having had positions that involve integration of these activities. PM physicians reported high specialty satisfaction levels, particularly among those involved in population health and health care transformation. CONCLUSION: PM physicians already make substantial contributions to population health and lead work related to the Triple Aim. High satisfaction among PM physicians suggests that they can contribute to a stable and sustainable population health workforce.

Alignment of Preventive Medicine Physicians' Residency Training With Professional Needs.

Preventive medicine (PM) physicians promote population-based approaches to health care with training that emphasizes public health, epidemiology, and policy. PM physicians use these skills in varied, often nonclinical, practice settings. PM career diversity challenges educators when designing residency curricula. Input from PM physicians about workforce environments is needed to ensure that residency requirements match skills needed post-residency. Graduates of one PM residency were sent a cross-sectional survey in 2016. Questions included professional experience, importance of 18 Accreditation Council for Graduate Medical Education sub-competencies and 13 leadership/management skills to current position, and residency training adequacy in those sub-competencies/skills. Responses were rated on 3-point Likert scales. Analyses were completed in 2017. Pearson's chi-square tests examined relationships between position type (academic/government) and perception of competencies' importance and training adequacy. Eighty PM physicians responded (46%): 44% worked in academia and 25% in federal/state/local government. Half (53%) were PM board certified. A total of 88% completed clinical residency prior to PM. Thirteen of 18 competencies were important to work, and respondents felt well trained in 16 of 18 competencies. Respondents did not feel well trained in emergency preparedness and surveillance systems during residency and their opinions about the importance of these sub-competencies varied based on where they worked. Respondents rated all 13 leadership/management skills as important, but reported inadequate residency training. In conclusion, respondents rated most Accreditation Council for Graduate Medical Education sub-competencies as important to current work and felt well trained, indicating good alignment between residency training and professional needs. Respondents also reported leadership/management training deficiencies. PM residencies might consider incorporating formal leadership training into curricula.