Preventive Medicine's Identity Crisis.

What is preventive medicine? Specifically, what is the specialty of preventive medicine, and how should it best be described? The specialty of preventive medicine is poorly understood, not only by the medical profession and the general public, but even among some of its practitioners. Currently, there is no unifying, vernacular explanation of the specialty of preventive medicine, to its detriment. This paper presents the argument that preventive medicine is the medical specialty for public health, which should be the preferred identity for the specialty. The American Board of Preventive Medicine defines preventive medicine as “the specialty of medical practice that focuses on the health of individuals, communities, and defined populations.” The Board further separates its specialty into three categories “that emphasize different populations, environments, or practice settings: aerospace medicine, occupational medicine, and public health and general preventive medicine.” For the purposes of this paper, preventive medicine refers to the latter category, as the authors believe aerospace and occupational medicine are more naturally defined and do not suffer from the same identity crisis as general preventive medicine. Preventive medicine’s identity has been argued for many years among practitioners of the specialty, but not necessarily in the pages of this or any other journal. A review of the medical literature found no published articles in the past 35 years specifically addressing the best way to convey the specialty of preventive medicine in the U.S. Although published articles argue the need for public health physicians generally or preventive medicine physicians specifically, no articles have argued that preventive medicine should be advertised as the specialty of public health. Interestingly, the Accreditation Council for Graduate Medical Education lists preventive medicine as a “hospital-based specialty,” indicating that even the medical establishment does not have an appropriate context for categorizing the specialty. The mission statement of the American College of Preventive Medicine does not mention “public health.” The American Board of Preventive Medicine does not use the term “public health” in its explanation, noting instead that “Public Health and General Preventive Medicine” is one of its specialty areas, implying a distinct difference between public health and preventive medicine, when instead the two should be indistinguishable. Given the lack of systematic evidence on the definition of the specialty, the authors believe it would strongly benefit those practicing the specialty to engage in promoting a “brand” of the specialty for the benefit of the field, and that “brand” should be public health.