What's preventing more prevention? Barriers to development at academic medical centers.
OBJECTIVE
To determine the views of leaders in academic medicine concerning the need for programs in preventive medicine (PM) and the prevailing barriers to program development.


METHODS
Structured interviews.


METHODS
Medical schools of the United States.


METHODS
90% of deans and chairpersons of departments of medicine and preventive medicine.


METHODS
None.


RESULTS
91% considered academic PM underdeveloped and 100% considered their own programs average or worse. Identified barriers to development included funding constraints, academic partiality to biomedicine, inadequate quality of preventive medicine research and faculty, public preferences for technologic care, and organization of academic medical centers (AMCs). While 80% perceived a shortage of able PM faculty and 60% considered PM research quality to be inadequate, only 12% of PM units gave research training high priority. While 95% of respondents held that AMCs should develop community programs and 75% identified social problems as a cause of chronic diseases, 65% agreed that community programs are not considered scholarly. Only 23% of PM units gave community service high priority.


CONCLUSIONS
A policy contradiction exists: academic leadership agreed on the problems and needed changes in PM, yet the problems were often attributed to nonacademic sources, particularly finding and public preferences, and current academic practices commonly fail to address recognized developmental barriers within academic institutions. A chain of barriers is apparent. Breaking the chain may require a change in our understanding of the role of prevention.
Gottlieb
L K
LK
Department of Medicine, Stanford University School of Medicine, CA.
Holman
H R
HR
D001291:Attitude of Health Personnel; D004501:Education, Medical / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D011315:Preventive Medicine / Q000191:economics* / Q000193:education*; D012106:Research; D012577:Schools, Medical / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States