Almost 16 months after Harvard Medical School, or HMS, defunded its primary care division and sparked an outcry from students, faculty and primary care clinicians, the AAFP and other primary care leaders are applauding the school's recent launch of a new $30 million Center for Primary Care.
AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, told AAFP News Now that it is significant that one of the nation's leading medical schools has taken steps to revitalize and expand its focus on primary care education and training.
"I applaud Harvard for recognizing that their decision over a year ago was not the right decision. To have Harvard appreciate and value primary care is very important," Goertz said.
Thomas Bodenheimer, M.D., M.P.H., adjunct professor of family and community medicine at the University of California-San Francisco and co-director of its Center for Excellence in Primary Care, said Harvard's new center is a step in the right direction.
Listen to an AAFP News Now audio interview (7:32-minute MP3 file; About Downloading) with Brian Blank, a member of the grassroots advocacy group that pushed for Harvard Medical School to recommit to the importance of primary care education and research.
"We still need to narrow the primary care-specialty income gap and make primary care less stressful for primary care physicians. But changing the culture in medical schools to be less toxic to primary care is something that the Harvard center could begin to address," said Bodenheimer, who received his medical degree from Harvard.
In an Oct. 28 news release, the medical school described the new Center for Primary Care -- the result of a $30 million anonymous gift -- as "a center of excellence geared toward transforming primary care education, research and delivery systems." In addition, the school said the center will be a "physical and intellectual docking point" for students, residents, fellows and faculty.
"This new center will more effectively position HMS to develop programs and train leaders in primary care and health systems research, education and policy," said HMS Dean Jeffrey Flier, M.D, in the news release.
"The center will also contribute to innovation in primary care delivery, which we expect to have a transformative, global impact," he added.
According to the news release, the new center will focus on three broad areas of primary care education and investigation.
- Medical education: The center will reinforce students' exposure to educational offerings in primary care systems. It also will help students who have a particular interest in primary care to identify and receive funding for opportunities in education, research and practice improvement.
- Local, national and international leadership: The center will have a director identified by a national search who will occupy an endowed chair. He or she will have a primary academic home in the HMS departments of Health Care Policy and/or Global Health & Social Medicine and a secondary appointment in a Harvard teaching hospital. The center also will bring together experts for discussion, symposia and collaboration and will play a key role in promoting discourse among primary care clinicians, divisions and centers within HMS-affiliated teaching hospitals, as well as in affiliated community health centers and other practice networks.
- Primary care delivery and innovation research: The center will provide a new academic home with substantial funding for primary care scholarship, particularly in the area of health care policy and primary care delivery system innovation.
Primary care leaders credit the grassroots advocacy efforts of Primary Care Progress(primarycareprogress.org), a nonprofit organization made up of students, trainees and clinicians, for helping to bring about the new center. Primary Care Progress organized a series of town hall meetings that brought together hundreds of members of the Harvard primary care community to discuss how Harvard could strengthen its commitment to primary care.
The Primary Care Advisory Group's, or PCAG's, report to Harvard Medical School, or HMS, included a number of recommendations regarding family medicine. The report came at the behest of HMS Dean Jeffrey Flier, M.D., who established the PCAG and charged it with advising him on the state of primary care at the school.
According to the report's executive summary, the group notes that Harvard is among "a minority of U.S. medical schools that do not explicitly include family medicine or require a family medicine rotation for medical students."
The PCAG, however, is "highly supportive" of family medicine and believes it should be included within the new Center for Primary Care. Recommendations include that HMS
- consider encouraging the recruitment of family medicine faculty across HMS clinical affiliates to serve as more visible clinical and academic role models for HMS students, with at least one family medicine faculty member included as core faculty in the new center;
- develop a process to examine the role of family medicine at the school and nationally;
- determine a process for academic appointments and promotion of current and future faculty in family medicine;
- integrate and expand the roles of family medicine faculty in course offerings; and
- ensure that all recommendations relating to primary care faculty include family medicine.
Primary Care Progress collaborated with HMS' Primary Care Advisory Group, or PCAG, a body comprising faculty members, administrators, residents and medical school students. Flier established PCAG last year to advise him about the state of primary care at Harvard and develop a report that includes recommendations for expanding the role of family medicine and family medicine faculty and for exploring the patient-centered medical home model of practice.
"It would be very important for Harvard to give family medicine a place" in the new Center for Primary Care, Bodenheimer said. "Harvard has not paid attention to the enormous contribution family medicine has made to our population."
In August 2009, the AAFP asked Harvard to reaffirm its support for primary care at a time when severe shortages of primary care physicians were anticipated. In a joint letter to HMS, the AAFP and the Massachusetts AFP expressed their "concern and dismay" about the school's elimination of funding for its primary care division.
The letter followed HMS' July 16 statement(web.med.harvard.edu) that the school's department of ambulatory care and prevention, which administered the primary care division, had undergone an academic and organizational review. HMS subsequently suspended funding for the division, which amounted to about $200,000 a year.
The suspension sparked an outcry among medical students, residents, faculty and others. They sent a petition(www.petitiononline.com) to the HMS dean that questioned the budget cut in the midst of a primary care crisis and asked the school's administration for an action plan to expand institutional support for primary care.