AAFP to Harvard Medical School: Reaffirm Support for Primary Care

The AAFP and the Massachusetts AFP are expressing their "concern and dismay" about Harvard Medical School's recent elimination of funding for its Division of Primary Care. In an Aug. 5 letter to Harvard Medical School Dean Jeffrey Flier, M.D., the two organizations ask the Boston-based medical school to "reaffirm its commitment to primary care."

The letter, signed by AAFP President Ted Epperly, M.D., of Boise, Idaho, and Massachusetts AFP President Dennis Dimitri, M.D., of Worcester, calls the funding elimination a "particularly unfortunate action for one of the nation's leading medical schools to take at a time when this country is facing a crisis in primary care." The letter further raises concerns about what the school's action means for access to health care in Massachusetts, which passed a universal health insurance plan in 2006 that requires all residents to have coverage.

Since the enactment of that legislation, the state has experienced a severe shortage of primary care physicians.

"At a time when Harvard Medical School can become part of the solution to the health care issues of the Commonwealth of Massachusetts, it's decided to turn its back and walk away from the people of the state," Epperly said in an interview with AAFP News Now.

According to a July 16 statement by the school, the Department of Ambulatory Care and Prevention, which administers the Division of Primary Care, recently underwent an academic and organizational review, that led to a "need to reevaluate the Division of Primary Care's structure, leadership and ongoing funding support." Funding for the division has been suspended until the review is completed.

Although Flier was not available to comment, the statement says that the medical school remains "deeply committed" to primary care medicine and education. It lists Harvard's primary care clerkship, financial aid and loan forgiveness programs; clinical training experiences; and mentoring project as examples of that commitment.

Not surprisingly, the suspension of funding, which amounted to about $200,000 a year, sparked an outcry among medical students, residents, faculty and others.

In a petition to Flier, the groups said they are "deeply concerned" about the loss of funding for the primary care division. "Such a budget cut seems at odds with both increased national recognition of the crisis in primary care and encouraging signs of late that Harvard acknowledges its responsibility to help address this crisis."

The petitioners praised the school's loan forgiveness program, but said it can be only "one component of a multi-pronged strategy to boost student interest in primary care." They asked the administration to "renew its commitment to primary care and present a detailed action plan for expanding institutional support despite this budget cut."

The electronic petition has been signed by more than 1,160 people to date, including physicians in academic and clinical medicine, Harvard alumni, medical students and residents.

Not only should Harvard reinstate the primary care division's funding, Epperly told AAFP News Now, the school should create its own department of family medicine.
"Medical schools are good at training a workforce that is good for medical schools, teaching hospitals and academic health centers in general," Epperly said. "But they are failing to meet the physician workforce needs of the communities and regions they serve."

The organizations' letter reiterates that sentiment, noting that the evidence clearly shows health care reform in the United States cannot succeed "unless we reverse the escalating flight of medical students away from primary care careers."

"As one if the nation' premier academic medical institutions, Harvard should be actively supporting those initiatives that contribute to the training of future leaders and innovators in primary care," the letter states.