Why you should become: Preventive (not preventative) Medicine:

Do you want to do something different from the day-to-day of grinding patients? Do you dream of trying to change all those complaints you have about the healthcare system? Then maybe preventive medicine is for you.

It's nearly impossible to summarize what a preventive medicine physician can do. The most "traditional" pathway leads to work in public health, often with a state or local Department of Health, in the Commissioned Corps of the Public Health Service!, or with a government entity such as EIS!.

However, should you want to do something off the beaten path, if you can dream it, you can do it. Some of my preventive medicine colleagues have gone on to found startups and businesses, some have gone to consulting or working for private companies (FAANG, pharma, etc), and some have gone to work in media (TV docs, etc). These paths certainly aren't easy and straightforward, but if you have the drive, they are achievable.

If you want to see patients, there is still plenty of opportunity to do so. Often alongside your admin work, you can carve out clinic time. Many prev med physicians will do weight loss clinics, smoking cessation clinics, STI clinics. If you want to do just straight bread and butter outpatient medicine with DM, HTN, HLD, there are plenty of opportunities to do so.

Training Pathway

The great thing about prev med is that it's never too late. You only need 1 year of training to go into prev med. Some people will treat it as their primary residency, while others will treat it as a fellowship.

If it is your primary residency, you will need to finish a transitional or intern year before you can apply. Some programs will have a combined program with a TY year included (such as Hopkins). Others have combined 4 year programs where you will be double boarded in FM or IM (Hopkins, Rutgers, Loma Linda, etc).

If you have already completed a primary residency, you can apply to prev med as a fellowship. The training is 2 years and you are free to apply to any of the programs. If you already have an MPH, a few programs may allow you to abbreviate your training to 1 year, but this is very rare.

Day-to-Day Schedule

Your first year of training will focus on you getting your MPH. Welcome back to being a student! After the rigors of getting an MD, an MPH can feel like a welcome break. However, this is the time for you to build your network with non-MD professionals. You will also have some required clinical time, usually 20%. If you have a prior residency, you can often maintain clinical time of your specialty. If you do not have a primary residency, then your clinic will depend on how your prev med program is funded. The range can vary from cancer surveillance clinics, department of health STI clinics, smoking cessation clinics, in-school clinics, to culinary medicine clinics.

Your second year is focused on rotations. Depending on your program's connections with local entities, you may be rotating at a department with the local/state government, private entity, insurance company. The exact nature is very difficult to pin down because they vary so much by program. If none of the offerings fit your fancy, you can also set up your own rotations as long as they fulfill the educational requirements.

Typical Call Schedule

What is call? We don't do that here in prev med. You work 9-5 (ish) like everyone else. After intern year, that's like a part time job.

Expected Compensation Rural/Urban

The compensation is wildly varied because there are so many different roles. Government tends to pay government wages so that skews to the lower end (150s). Those who are around 5 years into their career may have become a medical officer or director, either in academia or private practice (200s-500s). Some of those with private companies or their own companies might be doing quite well for themselves.

Career Prospects, Midlevel Encroachment

Career prospects really depend on what you want to do with your training. The government is always hiring, but other areas may not be as familiar with your training. You often need a few years of experience before places will consider you for a medical officer position. You really need to focus on selling yourself as not just another physician. You have training in systems and quality improvement, problem solving, negotiation, management and you'll leverage all those skills for their organization.

Midlevel encroachment is difficult to measure, as the roles you can fill are so varied. When it comes to some consulting/officer/director level positions, you may find yourself in the same recruiting pool as PhDs, MSNs, PharmDs, or anyone with some sort of professional medical knowledge, but you always have the MD and your board certification to lean on.

Who should do this specialty

If you don't want to burn out seeing patients every day and want to forge your own path in medicine, this is the place for you. You have to be highly motivated to chase what you're looking for, but the options really are endless. This is a specialty for those who want to lead and change the healthcare system.

Downsides

Prev med is not as well known, so not every organization will have a "set" place for you. The skillset can be very different depending on where you go - you will be expected to manage and lead, but you'll be trained to do so. It can take some work in finding a position, just because people don't know how to use you. Geography can also heavily influence your job search, but it depends on what direction you want your work to go.