The HMS community gathered Wednesday, Nov. 3, to celebrate the planned launch of a Center for Primary Care geared toward transforming primary care education, research, and delivery systems.
Made possible by a $30 million anonymous gift, the center, which is without precedent in the United States, will have physical and virtual dimensions, serving as a docking point for students, residents, fellows, and faculty from across HMS and its affiliated teaching hospitals.
Spilling out of the Courtyard Café, the overflow crowd cheered the announcement Wednesday, as HMS Dean Jeffrey Flier, Harvard President Drew Gilpin Faust, and a luminous roster of primary care leaders celebrated the power of philanthropy and called for a renewed commitment to tackling the systemic challenges facing primary care.
Here are excerpts from their inspiring remarks.
‘Welcome to this extraordinary community celebration’
“Welcome to this extraordinary community celebration to launch what will henceforth be known as the Harvard Medical School Center for Primary Care, a center of excellence that will forge a new Harvard wide community, enhance primary care education and research at HMS, and play a critical role in facilitating our capacity to address the primary care crisis that our nation faces.
“It is also a tremendous honor for me to join with you to celebrate the power of philanthropy to transform society.
“I am excited because, as a diabetes researcher and physician, I have seen firsthand the difference that effective primary care can make in the health of individuals and communities, and the terrible cost of systemic failure to do so.
“I am also excited because this Center for Primary Care will both be a product of — and a catalyst for — the engine for innovation that at its heart is Harvard Medical School.”
— Jeffrey S. Flier, Dean, Harvard Medical School
‘Not just to celebrate’
Drew Gilpin Faust, President of Harvard University and Lincoln Professor of History, thanked the anonymous donor — “our absent angel” — whose $30 million gift made the Center possible.
“The issue of primary care is so much discussed in the context of American health care policy, global health and all our lives,” Faust said. “The issue is not just local, but global; not only intellectual, but also personal.”
Taking an historian’s tack, Faust noted milestones in the evolution of the current physician-shortage crisis in the United States, tracing the introduction of the term “primary care” to 1961, when experts first recognized the challenges that specialization was beginning to pose to primary care.
The new Primary Care Center at Harvard Medical School “proclaims and advances the significance of primary care around the world,” Faust said. “We are gathered not just to celebrate, but to dedicate ourselves to this cause of primary care.”
‘Think big’
“I would like to thank Dean Flier for his tremendous leadership and vision throughout this process, from thinking about who could best advance our efforts on the Primary Care Advisory Group to outlining the charge for this impressive group of individuals. From the start, the Dean encouraged the task Force to “think big”—and so they did!
“Dean Flier challenged the group to think deeply and seriously about a number of questions, questions involving how we could strengthen cross-institutional collaborations, better train tomorrow’s primary care leaders and elevate the visibility of our Primary Care effort at a national and international level — and what administrative structure would best promote the above aims?”
— Nancy Tarbell, HMS Dean for Academic and Clinical Affairs and C.C. Wang Professor of Radiation Oncology
‘Wonderful partners’
“As we talked to thought leaders in primary care throughout the HMS community and beyond, the names David Bates (right) and Russ Phillips (second from right) were unanimously recommended as the clear leaders for the HMS Task Force, the individuals best able to advise us on the future of primary care at HMS. Thank you Russ, thank you David.”
“I would want to express our gratitude and admiration for Primary Care Progress, a grass-roots group organized by Andrew Morris-Singer (left) and David Gellis (second from left). Primary Care Progress hosted a number of town meetings that drew together hundreds of people from throughout our community to consider recommendations for a path that would move us forward. They have been wonderful partners, and their passion for primary care is inspiring.”
— Dean Nancy Tarbell (not pictured)
‘Primary care in the U.S. is in crisis’
“Primary care in the U.S. is in crisis. Primary care providers are underpaid and over-worked, compared to other medical specialties. In part as a result, few medical students are going into primary care. Furthermore, the way that primary care is delivered needs to change. Many exciting experiments are going on around the country around primary care redesign, and the early results suggest that major improvements in costs and quality can be achieved when care is delivered differently. If the U.S. is to have better healthcare—care which is of higher quality at lower costs, primary care must play a central role, and primary care models will have to be different than those that we are using now.
“The Institute of Medicine’s ‘Crossing the Chasm’ report said: ‘Current care systems cannot do the job. Trying harder will not work. Changing systems will.’ But changing systems is very hard work, and it requires strong leadership. I believe this new Center will have the chance to provide some of that leadership, both through the Center itself and by engaging more people to get involved in this area — one of the great strengths of Harvard as an institution is that it brings some of the best minds in this country together.
“It would be presumptuous to believe that this Center will solve the problems we have in this area and we are not suggesting that, but we do believe that the Center will have the chance to contribute to the solutions.”
— David Bates, Professor in the Department of Health Policy and Management; Brigham and Women’s Hospital; and co-chair, Primary Care Advisory Group
‘We have more work to do’
“The gift that is giving rise to the Center is worthy of a wonderful celebration, as we are enjoying this evening. But we have more work to do. The new Center should be a hub with spokes that reach out to programs at our hospitals and our other clinical sites, including community health centers.
“MGH has taken the lead in helping to support the Stoeckle Center for Primary Care Innovation, which already offers exciting student programs. Each of our hospitals should have similar centers that offer innovative programs. Our medical centers, working with our community, should help raise funds to support new initiatives in primary care.
“And we should work to leverage the HMS gift in other ways, such as winning federal comparative effectiveness funds to support demonstration projects and research.”
“It has been a privilege for David and me to serve our community. Through the Harvard General Medicine Fellowship, we have collaborated across Harvard with general internists, pediatricians and meds-peds faculty. As co-chairs of the Advisory Group, we have also worked with members of the family medicine community. We have been continually impressed by the talent, vision and collegiality of our Harvard faculty. Your great talent makes us feel confident that we can be successful in meeting our very ambitious goal to help revitalize primary care, which will be central to improving our nation’s health.”
— Russell Phillips, Professor of Medicine; Chief, Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center; and co-chair, Primary Care Advisory Group
‘Recognize and seize these opportunities’
“I was one of the students who helped to circulate an open letter to the dean last year highlighting the tremendous opportunity Harvard has with respect to primary care, and I can’t convey how exciting this announcement is to all of us who engaged in that dialogue.
“Key to whether the revitalization of primary care in this country succeeds or flounders, I think, is whether my generation of students and trainees see in primary care these opportunities for leadership and innovation. There’s already a lot of exciting activity in this community, but a core mission of this new Center needs to be to ensure that students and residents recognize and seize those opportunities.
“Thank you Dean Flier for your leadership, and thank you to the primary care community for giving me so much to look forward to.”
— David Gellis ’10, intern, Brigham-Harvard Vanguard Primary Care Program, and co-founder, Primary Care Progress
‘Our community came together’
“It’s wonderful to see everyone here tonight. Everyone’s smiling. Now, this might just be me projecting but I think our smiles represent our personal and collective joy, our sense of accomplishment, our hopes, and perhaps most of all, our appreciation for the profound generosity that has made this center possible.
“One of the fundamental reasons we’re here today is because our community came together in an unprecedented way, across institutions, across disciplines and across generations first to draw attention to the need and opportunity for Harvard to take a leadership role with respect to primary care and then to work in close partnership with our deans to help define what that leadership could look like.”
— Andrew Morris-Singer ’07, intern, Brigham and Women’s Hospital, and co-founder, Primary Care Progress
‘Final pillar’
Dean for Medical Education Jules Dienstag described the School’s commitment to primary care education, which includes debt forgiveness and a weekly, 8-month primary care clerkship with a faculty preceptor.
“This is the longest and most sustained relationship that a student at Harvard has with a faculty member,” said Dienstag, the Carl W. Walter Professor of Medicine.
The launch of the Center for Primary Care will expand those opportunities just as the School implements the “final pillar” of curriculum reform: a faculty-mentored scholarly experience. “We expect that a substantial proportion of our students will choose to work with luminaries in the Center for Primary Care,” Dienstag said, “on projects that tackle novel and creative approaches to expanding and leveraging the medical workforce and extending it to meet the demands of primary care.”
Innovative approaches
Scholars at the new Center for Primary Care will work to improve the financing, organization and delivery of primary care, said Barbara McNeil, Ridley Watts Professor and head of the Department of Health Care Policy at HMS.
Supported by the center, health policy experts will pursue innovative approaches to improve the cost and quality of care, while integrating care across providers, she said. They will seek better ways to measure the quality of care, and explore how to ensure that primary care would not be compromised by a shift toward capitated pay.
Show of hands
When McNeil asked the audience whether they or anyone they knew worried about finding a primary care physician, hands shot up across the crowded room.
‘This is the perfect time for HMS to be taking the lead’
“I would like to start by noting that the Globe article about this remarkable gift said ‘many doctors consider primary care unglamorous and underpaid.’ Not after this! And by the way, you should have heard what they said about global health.
“So this is the perfect time for HMS to be taking the lead in educating and training the next generation of primary health care providers and innovators.
“We also need to give our students the skills and experience they’ll need to effect transformational health systems change — here and around the world.
“Primary care is the fundament of our work — and if we don’t get it right, we are not going be able to deliver quality care in this country or anywhere else.”
— Paul Farmer, Maude and Lillian Presley Professor of Global Health and Social Medicine; head of the Department of Global Health and Social Medicine; co-founder of Partners in Health; and UN Deputy Special Envoy for Haiti
The speakers
From left: Jules Dienstag, Barbara McNeil, David Gellis, Russell Phillips, Jeffrey Flier, Drew Gilpin Faust, Andrew Morris-Singer, Paul Farmer, Nancy Tarbell and David Bates
Photos by Suzanne Camarata
