"If you really want to get good training in Primary Care, go to a state school," says second-year Harvard medical student Madeline Wilson '81.
Although Harvard Medical School may be the best place in the world for prospective neurobiologists and molecular engineers, it is playing a catch-up game in general medicine.
When Wilson returned to the U.S. to enroll in the Medical School in the fall of 1983 after two years of Peace Corps work in Liberia, she found that Harvard did not think the social problem of community health care was its worry.
"I don't believe Harvard Medical School believes its mission is to address that problem [community health care]," Wilson says.
Primary care, as opposed to specialty medicine, is the all-encompassing term for community and general health care, and, according to manpower experts, primary care physicians are needed to solve the pressing problems of medical maldistribution that arise when too many doctors go to places like Milton and too few go to South Boston.
For years doctors have decried the structural and financial disarray of modern medicine and one of its clear ramifications, the poor's inaccess to proper medical treatment.
"Substantial numbers of lower income people--not just in Boston, but in the nation--are having trouble. Substantial portions are not served," maintains the related School of Public Health (SPH)'s Director of the Community Health Improvement Program, J. Larry Brown.
Physicians are disappearing from depressed areas such as Mattapan and South Boston, and community health centers are folding--including one in Roxbury this year, SPH Dean of Students Helen Pommer says. "General Practitioners are a dying breed."
The maldistribution of health care and the related problem of a physician "glut"--an overabundance of doctors in some areas--came to light five years ago in a government report that predicted by 1990 that there would be an excess of physicians in almost every specialty at the expense of community and general medicine, Dean for Students and Alumni at Harvard Medical School Daniel D. Federman '49 says.
Despite this universally recognized need for more doctors in rural and inner city areas, Harvard Medical School has only indirectly addressed the problem of health care maldistribution, according to physicians there. The function of the Medical School is to educate students and to provide them with learning opportunities, not to pursue social goals, counters Federman.
"We don't give incentive bows to orient students to any particular path," he says. "We don't have any school program whose intent is to encourage students to practice in any one area."
Although recently the Medical School has revamped its curriculum and reasserted support for students interested in primary care, the school has not done enough to address the distribution problem, according to Dean of Students at the Medical School Myra B. Ramos.
"I think that a good many schools have more stringent requirements than we do, but we're catching up," Ramos says. "The school is increasingly recognizing the social context of medicine."
The creation of New Pathway--a radically new educational program emphasizing clinical studies--and a new core requirement in social medicine, both introduced with the class of 1989, have been steps in that direction.
Although New Pathway is more than just a primary care program, many of the students enrolled are strongly inclined towards community medicine, and the program itself fosters a concern for the individual patient, according to first-year participant Mari S. Miller. "There are quite a number who have interests in primary care. A lot are discovering how much they enjoy getting to know the patients," she says.