HMS STATEMENT REGARDING PRIMARY CARE

July 16, 2009

A petition is being circulated regarding the current status of the HMS Division of Primary Care, which includes a request that the School renew its commitment to primary care.

It is important to understand that Harvard Medical School leadership shares the convictions of those who wrote and signed the petition and is deeply committed to primary care medicine and education at Harvard and to strengthening the state of primary care nationally. Throughout the years, and particularly during this difficult economic period, the School has repeatedly reaffirmed this commitment by regularly and significantly investing in primary care programs, such as primary care clerkships, mentoring and debt relief for MD students.

We also want to clarify potential misunderstandings regarding the broad HMS efforts in primary care on the one hand and the Division of Primary Care on the other. The Division of Primary Care has historically been administered by the Department of Ambulatory Care and Prevention (DACP). The DACP recently underwent an academic and organizational review that resulted in its being renamed the Department of Population Medicine to better reflect the faculty's core research and teaching activities. In addition, from a governance and administrative perspective, it was decided that the DACP would be formally housed within Harvard Pilgrim Health Care, the department's partner for many years.

As part of this review, HMS determined the need to reevaluate the Division of Primary Care's structure, leadership and ongoing funding support. HMS funding for the Division of Primary Care has been suspended until the review is complete, at which point we expect to have a much clearer vision of the most meaningful structure for the programs within the division and how they can be most effectively leveraged for primary care education and clinical training.

During this transition, it's important to consider the entire scope of the School's extensive and continuing activities and investment in primary-care medicine and education:

• Primary Care Clerkship. A major component of the HMS medical education program is the primary care clerkship. We invest significant resources to ensure that our students receive the best possible clinical training. Our investment in the clerkship is increasing by 30% this academic year to accommodate a larger number of medical students who will be required to take the course as part of the Principal Clinical Experience.


• Financial Aid. Even in these seriously resource-constrained times, the School continues to increase its financial aid budget in order to both ensure access to HMS for all students regardless of income and to help reduce the impact of medical student indebtedness on career choice -- a major issue for students considering careers in primary care medicine.
  
  The School's financial aid scholarship budget is $12.4 million, which represents 48% growth over the past two years. As you know, one of Dean Flier's first actions as HMS Dean was to invest approximately $2 million in a program to eliminate the expectation of contributions from low to middle income families to medical education costs.  This action alleviates medical debt for MD students and their families and helps free students to pursue careers in lower-paying areas of practice, including primary care. To further demonstrate this commitment to reducing debt, HMS provides debt relief in the form of loan forgiveness to graduating students planning to pursue traditionally lower-income fields.  Recently, HMS awarded more than $800,000 in loan forgiveness debt-relief funding to graduates of the Class of 2009; half of these awards were provided specifically to students planning to pursue careers in primary care.  HMS also offers a loan repayment assistance program to graduates with modest incomes and high debt-to-income levels upon entrance into practice. 


• Clinical Experiences. HMS provides many other opportunities for students to be involved in primary care settings in which they directly benefit from exceptional mentorship and training experiences as well as important patient interactions. These include:
  
  
  • the Family Van, a mobile clinic in which MD students see underserved patients in the community;
  
  
  • global-health delivery training experiences through programs developed by the School's Global Health and Social Medicine Department chaired by Paul Farmer (often in partnership with Partners in Health); and 
  
  
  • for our dental students, the dental clinic at Harvard School of Dental Medicine.
  
  
• Mentoring. The Mentored Clinical Casebook Project is a highly valued Harvard Medical School course in which first year MD students are matched with a clinician and paired with one of the clinician's patients. Each student shadows the patient for an entire year and works with the mentor to construct a casebook, chronicling the experience. Students are randomly assigned to mentors, except for those interested in primary care.  These students are matched deliberately with a primary care mentor so they may be exposed to the field early in their medical training as they begin to explore career choices.

Despite these efforts, we fully appreciate that many members of our community are disappointed with how the Division of Primary Care has been affected by the recent administrative and financial changes and the plan to review our needs in primary care education and mentorship. Dr. Harvey Katz has done an exemplary job shepherding this program, as attested to by many of his students and colleagues.

We look forward to partnering with HMS leaders in primary care as we shape the field's future at HMS.