Faculty Council Vice Chair Martin Samuels and Dean for Academic and Clinical Affairs Nancy Tarbell chaired the meeting in Dean Jeffery S. Flier’s absence.
Tarbell called the meeting to order and introduced HMS Dean of Resource Development Susan Rapple, who made a presentation on endowed professorships. Briefly outlining the history of philanthropy at HMS, Rapple displayed a map of the HMS Quadrangle and profiled major donors who have named buildings and contributed to endowed professorships. The Office of Resource Development organizes more than 100 donor meetings and holds more than 50 events every year, she added, and answered questions during the ensuing discussion.
Tarbell then introduced Andrew Ellner and Russell Phillips, interim co-chairs of the HMS Center for Primary Care. Ellner and Phillips gave a brief history of the primary care movement, displaying a slide that charted the growth in salaries in medical specialties from 1994 to 2004 and showed that salaries for the primary care specialties—primary care, pediatrics and geriatrics—increased at a rate significantly lower than that for other specialties. Ellner noted that salary potential has an impact on medical students’ and residents’ choice of specialty. The Center for Primary Care may sponsor projects to look at potential changes in reimbursement systems that could alter current salary disparities, Phillips said.
Phillips then gave a brief overview of the HMS Center for Primary Care. Support for primary care became visible across the HMS community in 2009, he said, when funding was decreased. As a result, Dean Flier convened the Primary Care Advisory Group (PCAG), headed by David Bates, Ellner and Phillips, to develop recommendations for the role HMS might play in shaping the future of primary care. The PCAG worked closely with the Primary Care Working Group and held a number of town hall meetings. Following the submission of PCAG’s report, which recommended innovations in primary care research and education, Dean Flier secured a $30 million gift from an anonymous donor to establish the center.
According to Phillips, interim leadership for the center is working to establish physical and virtual space for students and faculty. Dean Flier is chairing a search committee to find a nationally recognized director.
The goals of the Primary Care Center, Phillips said, are to promote innovation, foster a stronger and more collaborative primary care community, and advance the dialogue about health care in this country. The center will focus upon three areas: building community and fostering discourse; a program for primary care education; and a program for primary care policy and innovation research. Phillips reviewed the center’s governance structure and metrics that will be used to measure success.
During the ensuing discussion, Ellner explained that while he hopes the center will expose trainees to the advocacy process, advocacy for salaries will not be a main focus. He noted that salaries are just one part of a complex system and that the culture needs change if primary care is to be valued as the foundation of health care delivery.
The Center for Primary Care may help eliminate a stigma at Harvard attached to internists, Jo Shapiro suggested. She added that the decline in the number of medical school graduates going into obstetrics/gynecology may be related to the rise in professional liability litigation. She suggested that the center reach out to specialists who teach primary care.
Jordan Smoller inquired about the problem of physician burnout. According to Ellner, this is a key issue, one that could be addressed through innovation in care delivery. He expressed the opinion that much of the work now done by primary care physicians could be carried out by other allied health providers.
Robert D’Amato commented that the recent Kraft gift to Partners HealthCare System removes financial disincentives for physicians interested in going into primary care. Phillips said that Center for Primary Care interim leaders will meet with Partners leadership to discuss the program.
When the question of whether the center would provide any sort of repayment program for student loans arose, Tarbell noted that there were programs at HMS dedicated to loan repayment and that the center’s goal was to maximize synergies among existing programs. Tarbell speculated that the Center for Primary Care may need to better mentor and educate students about existing programs.
Ruth Tuomala recommended that the center interface with pediatrics, geriatrics, obstetrics/gynecology and family medicine. She suggested that, if the center were going to become a leader in primary care, HMS would need to consider creating a department of family medicine.
Helen Shields suggested that center leaders look at creating new partnerships with baby-boomer patients. Phillips said that they hoped to engage patients through initiatives such as crowd-sourcing. Ellner commented that the Center for Primary Care will convene conferences and symposia, starting at the local level, and will reach out to other schools at Harvard to identify ways to engage the Harvard community.
When asked whether there were provisions in place to recruit under-represented minorities to center programs, Ellner noted that this was indeed part of the strategic planning now underway. He welcomed recommendations of candidates for the director position.
Tarbell adjourned the meeting.
