Halt in primary care division funding causes stirs at Harvard
More than 500 medical students, doctors, and professors have signed a petition urging Harvard Medical School to restore funding for its Division of Primary Care, cuts the school says reflects a reorganization and not a retrenchment from its commitment to primary care medicine and education.
"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 petition says.
The division had been embedded in the Department of Ambulatory Care and Prevention, a partnership with Harvard Pilgrim Health Care. But after that department moved over to the health plan as of July 1, Harvard's side of the endeavor, which was devoted to research and education, eliminated funding for the division in the renamed Department of Population Medicine.
The division and its programs, which include a speakers series and a mentoring program that matched students with practicing primary care physicians, will be evaluated in the fall and housed where they fit best, Dr. Nancy Tarbell, dean for academic and clinical programs, said. Its budget was about $200,000.
"Ultimately, my hope is it will be at least stable and I hope it grows. We'll see what make sense," she said. "This is a tricky time. We try to be very fiscally responsible."
Dr. David Himmelstein, a faculty member who practices internal medicine at Cambridge Health Alliance and signed the petition, said suspending the division for the next academic year is symbolically important.
"Basically what it says is the medical school doesn't have any academic units that are devoted to primary care," he said. "It's part of the clear message delivered to students that primary care is not something for a Harvard person to strive for."
In a statement sent to members of the medical school community, Harvard emphasizes its efforts to bolster primary care, a specialty suffering from a shortage of new doctors that is blamed in part on lower pay. It cites a primary care clerkship, clinical experience, and mentoring for students.
Both the petition and the statement highlight a loan-forgiveness program created to encourage students to choose primary care.
"But loan forgiveness can only be one component of a multi-pronged strategy to boost student interest in primary care," the petition says.
Dr. Jules Dienstag, dean of medical education at the medical school, said he agrees.
"Our commitment to enhancing primary care is totally unrelated to a narrow issue of organization and leadership structure of the [primary care] division," he said.
Comment
Permalink
E-mail
This is absurd. The closest thing this medical system has to preventive care is Primary care. And that, within this system, is poorly designed at best. The ONLY way to restructure the failed medical system we have is to focus on PREVENTION.
Unfortunately, prevention isn't expensive, nor does it place the doctor at the pinnacle of the health care paradigm. Therefore, the AMA will not put it's considerable self-interested clout behind it. It is the AMA, along with it's brothers, the pharmaceutical industry, the food industry and the politicians which have created this parasite of tremendous appetite. To allow the undermining of the one, albeit small, nod to people NOT becoming sick and dependent on it, is just a reflection of their true evil.
A $200,000 budget for a division of primary care?? That is not a commitment - it's lip service. If Harvard were serious about primary care, they would take several million dollars from their endowment and start an academic department of family medicine. The main problem is that family medicine and primary care internal medicine are simply not reimbursed like invasive cardiology, radiology and surgical subspecialties. If the government and insurers ever take primary care seriously with adequate reimbursements this discussion would not take place. There would be adequate funds available.
The primary care physician shortage seriously threatens the quality of healthcare US citizens receive now and for the future. Primary care has become endangered with only 2% of medical students stating they plan to work in primary care internal medicine. In many parts of the country, patients cannot find a primary care doctor. While we know that impossible administrative hassles and poor reimbursement from health insurance companies, Medicare's fee schedule, time pressures, inadequate resources, and medical school loans contribute significantly to the diminishing number of primary care physicians, what educational interventions can we introduce in medical schools and residency programs to encourage more trainees to go into primary care specialties (internal medicine, pediatrics, and family practice)?
Harvard Medical School (HMS) should create and nurture a strong and growing primary care department and fund it well. Such a commitment on the part of HMS is essential, and would be wise, given the focus on primary care and prevention with Healthcare Reform. Healthcare Reform bills before Congress recognize the primary care crisis, and provide various provisions to address the shortage. HMS would do well to be aware of this and take it seriously. Although HMS has not had any genuine commitment to primary care in the past, HMS could become a leader in this area, both on an educational level and a national policy level, if they chose to.
At present, 731 people have signed the petition, and more sign every day.
Part of the petition states:
“As members of the Harvard Medical School community, we request that the administration renew its commitment to primary care and present a detailed action plan for expanding institutional support despite this budget cut.
”In doing so we believe Harvard should reaffirm the following guiding principles:
• Leadership in primary care research and education is central to Harvard’s mission as the nation’s premier academic medical institution.
• Institutional support for collaboration is critical to leveraging the primary care-related research and education activities across Harvard-affiliated institutions.
• Harvard should support initiatives to train future leaders and innovators in primary care.
• Harvard must continue to expand loan forgiveness initiatives that encourage students to pursue primary care specialties.
• Harvard must actively support national efforts that make primary care central to a reformed health care system.
• The administration should solicit and implement proposals from the HMS community that support the above goals.”
Many members of the Harvard Medical School community have signed the petition including Harvard Medical School professors and other faculty, Department Chairs, Division Chiefs, Program Directors, residents, medical students, Harvard physicians, alumni, former faculty, affiliated health professionals, and others. This is a clear mandate to Harvard Medical School to make a true commitment to Primary Care.
This blogger might want to review your comment before posting it.
Contributors
blogger
Boston Globe Health and Science staff:
browse this blog
by categoryrelated links