Harvard's Big Heart for Primary Care

Harvard Medical School sure knows how to make itself look good. This week's news is loaded with reports and accolades for Harvard's new initiative to support primary care.


But Harvard's record on funding for primary care research and education is actually pretty terrible. 


Harvard Medical School educates very few primary care doctors every year - only 10% of their 2009 class went into front line medical care, and that's the lowest rate of the region's medical schools. By contrast, the University of Massachusetts graduated 39% into primary care in 2009.

Also, Harvard's recent history of funding for primary care initiatives is dismal. Just a little over a year ago, Harvard made news for eliminating funding for its primary care division. This action caused a stir just as the nation was gearing up for a vote on health reform. We now know that health reform included several provisions that will shift massive amounts of new funding to primary care research, education and practice.

This new effort is welcome, but it is not funded by the generosity of Harvard's big heart, or even by a small dose of creativity. It's the direct result of hindsight on health reform. HMS now sees major new funding streams coming down the pike through accountable care organizations (ACOs) and through new initiatives in training of primary care doctors. 

The upshot of this? If you are a primary care center in Massachusetts and you see opportunities for growth as a result of reform, you're on the right track. Community Health Centers, for instance, stand to grow substantially. But these centers must beware of competition from the 800 pound gorilla. Harvard is positioning itself to gobble up as much as possible of the region's anticipated new primary care dollars.

Nurse Practitioners Push for an Expanded Role in Primary Care

Check out this interesting article about the push by nurses for an expanded role in primary care: http://www.bit.ly/dg7TSL. And check out this review of studies that compares advanced nursing care with physician-directed primary care: http://www.bit.ly/choFHP.

The nutshell? Advanced nursing care is often as good or better than care from a physician. And it costs less.

Although lower cost care is often equally as good or even better for the patient, there are few incentives in place to choose lower cost and lower intensity alternatives. People who are very sick may prefer to modify or even limit the intensity of the health care they receive. But everything in our system - and nearly everyone - points patients toward higher intensity.

This isn't exactly any one's fault. The whole system has us on a treadmill toward higher spending and higher-intensity care. Many insurers and health providers find themselves struggling to keep revenues high, which means the default choice is a physician over a nurse practitioner, a hospital over a community health center and a hi-tech over a low-tech intervention.

Just a little food for thought.