Helping Physicians Look Upstream: Fifty Years of Training with the Preventive Medicine Residency

December 20, 2019

For the past 50 years, the University of Michigan's Preventive Medicine Residency (PMR) program has positively shaped the health of Michiganders and many others.

Housed in the School of Public Health, the PMR program began in 1969, had a brief hiatus in the 1990s when both the director and the field supervisor retired, then started up again in 2000 with an injection of energy and funding under the leadership of Matthew L. Boulton, senior associate dean for Global Public Health and professor of Epidemiology, Global Public Health, and Preventive Medicine at the School of Public Health.

Even Boulton, who recently stepped down as PMR director, has been surprised by the program’s recent successes. “Seeing three of our residents land medical directorships in local health departments within a few months of graduation—in Detroit and in Ingham and Washtenaw counties—was just incredible,” he said.

A PMR graduate from ten years ago, Ruta Sharangpani, is medical director of Wayne County, the largest jurisdiction in the state. “To have our residents as medical directors in these large, vital regions and all across Michigan—not only our new grads but people who graduated from the program many years ago—is a testament to the sustained success of the residency,” Boulton said.

Sustaining Success to Prevent Disease

The program is now in the hands of Laura Power, clinical assistant professor of Epidemiology and Internal Medicine at the School of Public Health, who succeeded Boulton when he stepped down as program director in the summer of 2019.

It stands out to Power how the PMR has provided not only high quality employees to a variety of organizations needing physicians trained to work in public health practice but consistently produces notable leaders across the state and the country. “Quite a few of our graduates are at local health departments, state health departments, at the Centers for Disease Control and Prevention (CDC), and in other federal positions. The PMR trains health leaders who are not only skilled in the science of preventive medicine but possess the interpersonal and organizational skills necessary to lead and the vision to inspire others to join them,” Power said.

Power is herself a PMR alum and prior to coming to Michigan for the residency was an infectious disease doctor and director of infection prevention at Henry Ford Health System. “My work at Henry Ford in infectious disease inspired me to study public health and epidemiology more formally,” Power said. “I wanted to understand the connection between the health system, the community, and governmental public health.”

Preventive medicine is so important, Power said, because it treats individual patients while also supporting population health. “We train our residents not only in clinical medical but in epidemiology and many other public health tools—from biostatistics to health behavior and education—to prevent disease from occurring,” Power said. “The focus on preventive rather than therapeutic interventions helps keep people free from infectious and chronic disease in the first place.”

Moving a clinical physician’s view “upstream” from the sources of disease also saves communities money. “Preventive medicine is much more cost effective than treating individual patients who have already become sick,” Boulton said. “Unfortunately, our country significantly under-invests in preventive medicine. The Patient Protection and Affordable Care Act (ACA)—the first real attempt to systematically incorporate prevention into our health care system—is being dismantled. Still, we have many tools at our disposal to move resources upstream so people stay healthier, and preventive medicine is a key one.”

Giving Back to Michigan

Using social epidemiology in clinical practice means understanding the social determinants of health—all of our living and working conditions, from neighborhood safety to food access to clean air and water—and how they can impact health.

A core component of the program is the broad variety of rotations residents must complete around the state, including working at a federally qualified health center in Jackson, Flint, or Detroit the entire time they are in the residency. “Our residents serve in local and state health departments and then spend time at Henry Ford learning about public health in health system contexts,” Power said. “These rotations help residents see possible career paths for themselves as they work through various settings, each of which gives them an opportunity to make a tremendous impact on population health around the state.”

Ultimately, residents come away with a deep understanding not only of clinical practice and the field of public health but of how health departments run internally. This is vital, since many of them will soon be managing personnel and overseeing annual budgets for large organizations.

Courtland Keteyian, a 2016 graduate who is now President and CEO of the Jackson Health Network, was on rotation in state government when the Flint water crisis occurred. “I experienced emergency response firsthand, and the learning from that event was invaluable. Protecting the public’s health requires much more than good science or sound policy—it requires execution and attention to every detail. It requires the ability to see problems at the highest level while never losing sight of the individuals each decision affects,” Keteyian said.

PMR faculty focus the program on capacity building because residents and many alumni are part of sustaining the basic public health services offered across the state of Michigan. “Our alumni go out and run entire local health jurisdictions, but not all doctors know how to run a health department,” Boulton said. “We need effective physician leaders who can improve the health of a community with their clinical and research knowledge, their managerial skills, and their ability to partner with health professionals and government leaders in a variety of roles.”

DuBois Bowman, dean of the School of Public Health and professor of Biostatistics, sees a bright future for a residency program whose graduates make such tremendous contributions to local and global health. “The ongoing positive impact the PMR program has on the Michigan community is made possible through the quality, leadership, and accomplishments of our incredible alumni, who have consistently given back to public health practice in the state of Michigan and beyond for 50 years,” Bowman said.

The Future of Preventive Medicine

Many of the PMR graduates who secure leadership posts outside the state of Michigan are actively serving in significant state and national positions.

From his decade of service as senior associate dean for Global Public Health and director of the Office of Global Public Health, Boulton knows that preventive medicine is not an either/or between domestic and global health. “Today, we see vaccine-related problems—like measles outbreaks—around the world, including in the US. We see the rise of chronic illnesses—like cancer and heart disease—internationally, including in the US. Preventive medicine training really prepares residents to serve in any context globally.”

Curi Kim, a 2006 graduate, serves at the intersection of domestic and global health—as director of the Division of Refugee Health within the Administration for Children and Families’ Office of Refugee Resettlement, part of the US Department of Health and Human Services. Kim says her work is “highly administrative but also requires that I see refugee health across the nation and in state and local contexts.”

Public health training taught Kim just how different health care is in each state, which prepared her for understanding and evaluating refugee health and access to services across the US. “All of my experiences in the PMR—including the breadth of practicums from local to state to national—prepared me perfectly for this federal role. I wouldn’t be where I am today without the skills and connections from my PMR training,” Kim said.

Many residents in the program are mid-career physicians looking for new tools to prevent the diseases they have become familiar with as clinicians. The intensive, hands-on experience they receive in the PMR “exposes residents to populations of high need but also helps provide services to those populations,” said Power.

And this combination of learning and service, Power said, is the centerpiece of the PMR’s success. “I want us to be seen as a strong partner for local and state health departments and to serve population health systems around the world in robust ways, even as we continue to train excellent preventive medicine physicians.”

• Interested in public health? Learn more here.
• Learn more about the Preventive Medicine Residency at Michigan Public Health.
• Read more stories about alumni, faculty, and students working on infectious diseases.
• Support research and engaged learning at the School of Public Health.

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Back row (l-r): Matthew Boulton, Laura Power, James Pierre, Jr., Shamik Dwivedi
Front row (l-r): Eden Wells, Ruta Sharangpani, Shawna Matzinger, Samantha Korycinski, Helene Fliegel}

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