Preventive medicine: notes toward an agenda for change.

Preventive medicine is an exciting specialty that is often blocked in its progress by internal conflicts and external obstacles. We can all change this state of affairs. I present and compare definitions of important terms to clarify the discussion. Structural problems of the specialty include, among others, fragmentary representation, unfocused academic departments, lack of control over professionalization, and specialty identification, particularly with respect to occupational medicine. A set of suggested solutions to these problems include these actions: (1) federate the leading organizations into a coalition for organizational strength, without sacrificing their individual identities; (2) define the core content of the specialty once and for all by the mechanism of consensus-driven competency-based learning objectives; (3) build stronger bridges to clinical specialties other than family medicine, particularly to internal medicine; (4) restructure academic departments to form a preventive medicine unit as such, encouraging health care research and community medicine to connect principally with family medicine departments; (5) rethink specialty certification, including a model defining a knowledge and skills set in defined modules, which would be combined in various ways to support flexible specialty certification; and (6) integrate occupational medicine with preventive medicine generally by exploring issues of common interest and building closer institutional ties when the opportunity arises. These and other ideas might be discussed by the leadership of the principal public health and prevention organizations at a "summit" meeting, but some group must take the initiative to champion the cause. Medical Subject Headings (MeSH): preventive medicine, future, definitions, specialty certification, community medicine, population medicine.