Reflections on 5 Years of Transforming Primary Care

On October 20, 2016, the Center for Primary Care celebrated five years of excellence in primary care. Held at the Harvard Club of Boston, the 5th Year Anniversary Gala was a moment for the Harvard primary care community to commemorate the Center’s work across HMS and the greater Boston community. Though the Center’s achievements are well known to many, it is impossible to understand its significance and the magnitude of its journey without first understanding its origin.

In 2009, facing a difficult budget crisis, Harvard Medical School administrators elected to defund the school’s Division of Primary Care and Ambulatory Prevention. At the time, the division was primarily an administrative entity with an unclear organizational role and seemed a reasonable target for cost-cutting measures. Unbeknownst to the administration, the HMS primary care community interpreted the move as a statement about the value of primary care at Harvard, though it had not been intended as such.

According to Andrew Morris-Singer, MD ’07, then a resident in Internal Medicine at Brigham and Women’s Hospital, this reinforced a deeply held sense that there was no place for primary care at HMS. “At the time,” said Dr. Morris-Singer, “it wasn’t really fun being in primary care or interested in primary care at Harvard. You kind of felt alone.” The primary care practitioners in the community had long lamented the lack of primary care-related institutional development and leadership. In the wake of the division’s defunding, some even considered leaving HMS altogether.

In this setting, faculty, residents, and medical students passionate about primary care gathered in a series of town hall meetings to express their discontent. These difficult conversations strengthened a sense of community among attendees. As the meetings grew in size, the community quickly realized an opportunity to transform the building momentum into lasting change at HMS.  In response to the concerns voiced by the primary care community, Jeffery Flier, MD, then Dean of the Faculty of Medicine, commissioned a task force to assess the landscape and chart a path forward. Later, an anonymous donor learned of the task force’s efforts, was compelled by the group’s vision, and committed to a $30 million founding gift – and the Center was born.

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The Center set out five years ago with a simple yet lofty mission: to transform primary care. Since then, the Center community has pursued that aim with a specific emphasis on research, education, and primary care innovation. According to Andy Ellner, AB ’97, MD ’04 and Co-Director of the Center for Primary Care, the Center began its work with a deliberate focus on leadership in the local community. A video recapping the Center’s work celebrated its creation of a Primary Care Collaborative across 28 practices in the greater Boston area, which has impacted care for more than 300,000 patients.

A series of awards granted to members of the community demonstrated the breadth of activities the Center has engaged in. Among the seven honorees, Barbara Ogur, MD received the Innovation in Medical Education Award for her pioneering work in developing a longitudinal patient-centered model of clinical medical education that has been replicated nationally and internationally. Exemplifying the Center’s commitment to innovation in primary care, the founders of Sherbit Health received the Innovation in Primary Care Award for their development of a personal data analytics tool that helps providers harness technology to help patients maintain health-promoting behaviors through coaching, action plans, and preventative alerts.

One of the most consistent themes of the night – and of the Center’s work overall – was a celebration of students’ contributions to the Center for Primary Care. During his address to the gala audience, Dr. Morris-Singer recounted a deliberate effort to recruit medical students at the time of the Center’s founding based on a belief that students are “the core of movement building.” As Dr. Russ Phillips, Director of the Center of Primary Care recalled, students were initially invited to participate via a Student Advisory Committee, but they insisted that they not just serve as advisors – they wanted to lead. The Student Advisory Committee was promptly renamed the Student Leadership Committee, and students have remained integral to the primary care movement at Harvard.

In five years, the Student Leadership Committee (SLC) has grown from 12 to 37 members. Demonstrating the inter-professional collaboration required for the future of primary care, the SLC includes students from Harvard Medical School, Harvard School of Dental Medicine, and the Massachusetts General Hospital Institute of Health Professions. SLC subcommittees have been developed to focus on issues of medical education, advocacy, community engagement, innovations in health care delivery, and communications and narrative medicine. Through the Center, students have consistently been engaged in producing original research. Student poster presentations at the anniversary celebration ranged from topics such as implementing a mindfulness and meditation curriculum at Nashua Street Jail to predicting high emergency department utilization for patients in a student-run primary care clinic.

Students have also been instrumental in shifting the broader institutional landscape at HMS. During her remarks, Lydia Flier, MD ’16 and former Student Leadership Committee member, spoke of the student leadership efforts that have helped move the institution towards creating an institutional home for Family Medicine. She also spoke of how the SLC effort to involve senior medical students as near-peer educators resulted in the creation of a new medical education elective course in the HMS curriculum.

Looking back, Dr. Flier reflected on her experience of applying to Harvard Medical School as a student interested in primary care. “I wanted a medical school experience with a reputation for strong primary care exposure,” she said. “In 2010, that was not Harvard.”

Despite the institution’s illustrious legacy as a world-leading training center, studying at HMS was a discouraging prospect for aspiring leaders in primary care. The advent of the Center for Primary Care has created a new reality. While deciding between offers from competitive medical schools, current first-year student Mugda Joshi ’20 believed the Center’s presence ensured that she’d find a community at Harvard that values primary care. Said Joshi, “I felt like I’d be able to find mentors, support, and like-minded peers.” The Center proved a deciding factor in her decision to attend HMS.

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The 5th Year Anniversary Gala was a moment for reflection but also an opportunity to look to the future. As changes in the health care system continue to pressure primary care providers to do more with less, there is an ever-increasing need for innovation and opportunity for leadership – objectives for which the Center is naturally suited. In May, Dean Jeffrey Flier announced that Harvard Medical School had received a $10 million gift to advance the work of the Center for Primary Care from the same anonymous donor whose $30 million gift established the Center in 2010.

Dean Flier, who oversaw the Center’s founding and championed its development until his retirement in 2016, expressed confidence that it will continue to be a center of gravity for education and cross-institutional thinking across the Harvard medical community. In outlining his vision for the Center’s future from his perspective as Director, Dr. Russ Phillips described a goal of positioning the Center as the primary resource for those interested in innovation in primary care around the world.

Years ago, the Harvard primary care community gathered in those first town hall meetings feeling like a community without a home. At the 5th Year Anniversary Gala, that same community gathered with a deep sense of belonging, a thriving entity that has established a legacy of leadership. Dr. Ellner remarked that the night felt like a bar mitzvah, and in many ways it was just that: a celebration of the Center’s coming of age, with bright hopes for a long, fruitful future.

Elorm F. Avakame is a fourth-year MD/Master’s in Public Policy Candidate at Harvard Medical School and the Harvard John F. Kennedy School of Government. He is a Sheila C. Johnson Leadership Fellow at the Harvard Kennedy School’s Center for Public Leadership. Elorm aspires to a career in primary care pediatrics and plans to care for adolescents in his home city of Philadelphia.