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This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Speechwriting
Subseries:
Laura Schiller: Events, Meetings 5/98 - 7/98
OA/ID Number:
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Folder Title:
[Harvard Medical School - 6/4/98][Folder 1][2]
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DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. resume
Address (Partial) Phone No. (Partial) (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Speechwriting (Laura Schiller: Events, Meetings 5/98-7/98)
OA/Box Number: 24611
FOLDER TITLE:
[Harvard Medical School - 6/4/98][Folder 1][2]
2006-1733-F
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b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
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JUN-02-1998 16:58
HMS ALUMNI OFFICE
617 432 1560 P.01
HARVARD MEDICAL ALUMNI ASSOCIATION
5
CO
25 SHATTUCK STREET
BOSTON, MASSACHUSETTS 02115
(617) 432-1560
FAX (617) 432-3366
OFFICE OF THE DIRECTOR
Please forward to Ms. Laura Schiller
Dear Ms. Schiller:
Here are the responses from our graduates who might be called upon by the First Lady:
Coming to hear the First Lady:
Dr. Maria Alexander Bridges
Dr. Kenneth Roland Bridges
Dr. Dewayne Pursley
Dr. Steven Weinberger
Dr. Frank Lepreau
Dr. Orah Platt
Dr. Martha Tracy
Dr. William Chin (most probably)
Dr. Marshall Wolf (most probably)
Dr. Alison May (most probably)
Definitely not coming:
Dr. Eric Chivian
Dr. Judah Folkman (will be in Helsinki and very much regrets he won't be there)
Dr. David Ho
Sincerely,
Km KmKen Nora N. Nercessian, Ph.D.
Executive Director of Alumni Relations
TOTAL P.01
MAY-22-1998 17:04
HMS ALUMNI OFFICE
617
432
1560
P.02
MARIA ALEXANDER BRIDGES (HMS Class of 1980) and Kenneth Roland Bridges
(HMS class of 1976); both are African-Americans. Dr. Maria Alexander Bridges conducts
basic laboratory research in reproduction and Diabetes; Dr. Kenneth Bridges is a researcher
in the mechanisms underlying blood diseases.
WILLIAM W. CHIN is an Asian-American who graduated Harvard Medical School in
1972. He conducts research in how hormones work and works toward the development
of clinical genetics in an adult population and "translate" advances in the genetic basis of
disease to the bedside in the areas of diagnosis and treatment.
JUDAH FOLKMAN, a graduate of 1957, teaches pediatric surgery and cell biology; in
research, he is credited with truly novel approaches to the treatment of cancer.
MARSHALL WOLF, who graduated HMS in 1963, is a physician and is recognized a
teacher excellence. He is a teacher of young men and women in residency training.
ERIC CHIVIAN graduated HMS in 1968 is a psychiatrist who is the founder and director
of the Center for Health and the Global Environment at Harvard Medical School. He was
co-founder of the Society of International Physicians for the Prevention of Nuclear War.
Received the Nobel Prize in 1985.
STEPHEN WEINBERGER graduated in 1973. He is involved in patient care, teaching
and research. His research is in the area of critical care and pulmonary disease.
MARTHA TRACY graduated in 1973 is an oncologist who devotes 100% of her time to
patient care. She is a private pilot who uses her flying peripherally for medicine--lifeline
flights, flying doctors, etc.
ORAH PLATT graduated in 1973 and is the Master of one of the academic societies at
Harvard Medical School. She is a leader in research of sickle cell disease.
ALLYSON G. MAY graduated in 1991. She is an African-American who has recently
completed her residency training and has joined a practice that serves the underserved
populations in the inner city in Boston, working through the Healthcare for the Homeless
Program and the community health center.
DAVID HO is an Asian-American who graduated in 1978, and is a member of the
Committee of 100, a Chinese-American leadership Organization. He is a leader in the
research and science of AIDS. He was cited as Man of the Year in Time Magazine (1996).
DEWAYNE PURSLEY is an African American who graduate in 1982. He is a well-
known neonatologist, a teacher, physician and researcher and widely known for his
outstanding clinical care and dedicated teaching in neonatal health services research.
FRANK LEPREAU graduated in 1938. He has worked in Haiti, rural Appalachia, and
currently, although retired, works with AIDS and Rehab patients in Providence, RI. He
was, before retirement, Professor of Medicine at Brown University.
TOTAL P.02
MAY-21-1998 17:02
HMS
617 432 3912
P.18
OATH OF THE CLASS OF 1998
HARVARD MEDICAL SCHOOL - HARVARD SCHOOL OF DENTAL MEDICINE
Prepared by the Oath Committee of the Class of 1998
Ratified by the Class on 14 May 1998
'Please read Physician or Dentist as appropriate
Dean:
Members of the Class of 1998, please rise.
I now invite you. as a class, to affirm your commitment to the profession of
Medicine or Dentistry and to articulate the ideals and principles that will
guide you in the years ahead.
Class:
Today, in the presence of family, friends, teachers, and colleagues,
I dedicate myself to the profession of Medicine.
I pledge myself,to the service of humanity.
I will use my skills to care for all in need, without bias and with openness of spirit.
.
The health of my patients will be my first concern.
I VOW to hold sacred the bond between doctor and patient.
I will hold in confidence all that my patients entrust to me.
I will strive to alleviate suffering.
I will respect the dignity and autonomy of my patients in living and in dying. @
As a Physician/Dentist¹, 1 recognize my duty to society.
I will work to promote health and to prevent disease. I will advocate for the
welfare of my community.
Even under duress, I will not use my knowledge or my skills against humanity.
I will acknowledge my limitations and my mistakes so that I may learn from them.
To uphold these responsibilities, I will maintain my own well-being and the
well-being of those close to me.
I will promote the integrity of the practice of Medicine.
In the tradition of my profession, I honor all who teach me this Art.
Through honest and respectful collaboration with my colleagues, I will uphold
the highest standards in the service of patients.
I will seek new knowledge, reexamine ideas and practices of the past, and teach
what I have learned.
Above all, the health of my patients will be my first concern.
This Oath I take freely and upon my honor.
05/21/98
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JAMA 100 Years Ago
March 19, 1898
FATALITY FOLLOWING A CONTROVERSY
BETWEEN TWO MEDICAL MEN,
A letter from the University of Bonn
them to the argumentum baculinum for
recites a tragedy following a difference
the adjustment of technical disputes must
between surgeons. An armed encounter
be an altogether exceptional occur-
between members of the medical profes-
rence. Complaints are often heard of the
sion at this the close of the nineteenth cen-
overcrowding of the medical profession
tury was certainly not to be anticipated,
on the other side of the channel, but of
but the old saying that it is always the
all the depletory methods the slaying of
unexpected which arrives has once more
one's confrère is surely the least philo-
been verified. It is only too true that a
sophic. A duel at the present day is an
duel was recently fought at Bonn, the
anachronism. As a mode of settling sci-
combatants being both medical practi-
entific controversy it is not only out of
tioners, and most unfortunately one of
date, but also about the most illogic pro-
them met with his death from a penetrat-
cedure conceivable. Killing an opponent
ing wound of the thorax. It seems that
does not prove the survivor's case; while
two of the assistants of a surgical clinic
the gratification of an ignoble feeling of
named Reusing and Fischer, had a vio-
personal resentment is dearly pur-
lent altercation over a professional mat-
chased at the expense of life-long re-
ter, the former accusing his colleague of
morse. The principals in a duel are blame-
malpractice in the conduct of an opera-
worthy, but for them there are excuses,
tion, and as apparently there was no older
seeing that most human beings are more
and wiser person at hand to pour oil on
or less passionate by nature. For the sec-
the troubled waters a hostile meeting en-
onds, generally speaking, there is abso-
sued, with the above mentioned deplor-
lutely nothing to be said. They are sim-
www.ama-assi http://www.ama-asst
Your access to the world of medicine.
able result. That duels should still sur-
ply the abettors of a crime in which they
vive on the Continent, especially in
run no bodily risk, and it is against them
military circles is perhaps not to be won-
that retributive justice should be mainly
dered at under the existing regime, but
directed. If seconds would only consider
happily the vast majority of medical men
the heinousness of their position, there
of all nationalities are the possessors of
would soon be an end of dueling.
well balanced minds, and recourse among
JAMA. 1898;30:690
Edited by Brian P. Pace, MA, Assistant Editor.
American Medical Association
Physicians dedicated to the health of America
JAMA, March 18, 1998-Vol 279, No. 11
JAMA 100 Years Ago 832 e
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Becoming
A Physician
Development of Values and
Attitudes in Medicine
Edited by:
Eileen C. Shapiro
Leah M. Lowenstein, M.D., D.Phil,
Ballinger Publishing Company Cambridge, Massachusetts
A Subsidiary of Harper & Row, Publishers, Inc.
05/21/98
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Chapter 13
The Federal Government's
Physician Manpower Policies
Eli Ginzberg, Ph.
Professional socialization of physicians today occurs in an
environment of increasing federal involvement in and regu-
lation of the selection, training, and practice options of
physicians. The background of this federal involvement is explored
in this chapter.
THE HISTORICAL CONTEXT
As the United States approaches the end of the twentieth century,
it is important to remember the long-term relations between Ameri-
can medicine and the federal government that existed from World
War I until after World War II. The 1920s were the heyday of con-
servatism, the era of Harding, Coolidge, and Hoover. Governmental
officials in Washington were deeply committed to the belief: "the
less government, the better." The American Medical Association
(AMA) was able to operate with little or no challenge from gov-
emment, consumer, or pressure groups; regulation or legislation
intended to affect directly the numbers, training, or allocation of
physician manpower was no part of the federal agenda. Even in the
more radical days of Franklin D. Roosevelt, the President was suf-
ficiently respectful of the power and prestige of the AMA to exclude
health from his Social Security bill, During the New Deal, the AMA
was allowed, even encouraged, to play the dominant role in deter-
mining public policy issues related to physicians. The purpose of the
present chapter is to explain those post-World War II events that have
worked to alter the government's posture toward physician man-
261
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262 Public Policy
The Federal Govel
power issues which, in turn, provides the societal context for the pro-
The National Institute of M
fessional socialization of physicians.
thority to train personnel, bec
The relationship between the government and medicine was first
expansion of the nation's poc
challenged shortly before the outbreak of World War II when Demo-
congressional concern with "II
crats in Congress unsuccessfully sought the passage of a national
cialty and geographic location,
health insurance bill. In the late 1940s President Truman supported
1950s through the 1960s the N
a second attempt, which also failed. Determined to find some way to
eral practitioners, pediatricians
improve the health care received by the American people, Mr. Tru-
specialists qualify as psychiatri
man then appointed what came to be known as the Magnuson
support was the continuing ac
Commission, named after its chairman, which issued its report
mental hospitals. However, the
shortly before Truman left office. The commission recommended a
newly minted psychiatrists esta
larger role for the government in increasing the supply of health re-
affluent with psychoanalytic te
sources, sponsoring research, and financing selected aspects of health
able to provide basic care for pa
services. Further, the commission advocated that Congress act with
During the 1950s, initiatives
new and sustained vigor to bring the potentialities of modern medi-
ily limited to increasingly liber
cine to all Americans. A specific recommendation to a sympathetic
of research, and this increased
Congress was that federal funding be provided to assist medical
the infusion of new resources i:
schools, many of which were hard pressed financially. The reasoning
however, took a more active IC
underlying the recommendations of the Magnuson Commission can
considerably more income to S]
be briefly summarized: American medicine had achieved many out-
and with a rapid rise in the bir
standing results in the treatment of battle casualties in World War II.
mand for obstetrical and pedia
These achievements, along with important advances in chemother-
sicians became a matter of C
apy, convinced commission members that with these additional re-
communities. Moreover, larger
sources at its command, an expanded and improved health care
uates sought entrance to medica
system would yield major additional benefits to the American peo-
to build new medical schools, a
ple. The commissioners also recognized that the nation's medical
ened nor encouraged by the AM
schools faced a difficult financial future, that research would require
medicine continued to control
large additional funding, and that many poor and near poor needed
undergraduate medical educatio
help in gaining access to the health services system.
trol but a modest rate of expans
The commission had sought a middle ground between the conser-
As described in the previous
vatism of the AMA, which preferred a "hands-off" governmental
growing number of communitie
policy concerning medicine, and the growing belief in Washington
in attracting and retaining phy
that Americans were being deprived of important health services be-
growing areas could not find a
cause of the attitudes and power of organized medicine. Nonetheless,
appointment without a long W
the AMA successfully opposed the commission's recommendation of
pressure on Congress to interve
financial aid to medical schools, although the AMA did refrain from
cians. The AMA was accused of
lobbying against congressional efforts to make such funds available
supply and thus maintain high
through expanded support for biomedical research. Thus, through
was finally willing to act.
this indirect approach, the federal government paid for the advanced
In 1963, federal funds becan
training of numerous researchers and, by paying indirect costs on
tion of new medical schools. Se
research contracts, Congress made substantial funds available to the
pansion of existing schools foll
health science centers of those universities that competed success-
purposes to schools in financial
fully for research grants and contracts.
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The Federal Government's Physician Manpower Policies 263
the societal context for the pro-
The National Institute of Mental Health (NIMH), which had au-
thority to train personnel, became a major force in the substantial
imment and medicine was first
expansion of the nation's pool of psychiatrists. In light of recent
k of World War II when Demo-
congressional concern with "maldistribution of physicians" by spe-
ght the passage of a national
cialty and geographic location, it is interesting to note that from the
Os President Truman supported
1950s through the 1960s the NIMH made liberal grants to help gen-
etermined to find some way to
eral practitioners, pediatricians, internists, and even some surgical
the American people, Mr. Tru-
specialists qualify as psychiatrists. The ostensible rationale for such
be known as the Magnuson
support was the continuing acute shortage of psychiatrists in state
man, which issued its report
mental hospitals. However, their training completed, most of these
e commission recommended a
newly minted psychiatrists established private practices to treat the
easing the supply of health re-
affluent with psychoanalytic techniques, and in fact were not avail-
ncing selected aspects of health
able to provide basic care for patients in state mental institutions.
located that Congress act with
During the 1950s, initiatives in federal health policy were primar-
potentialities of modern medi-
ily limited to increasingly liberal support for a broadened spectrum
mmendation to a sympathetic
of research, and this increased support contributed substantially to
be provided to assist medical
the infusion of new resources into U.S. medical schools. The states,
ssed financially. The reasoning
however, took a more active role. With the American public having
he Magnuson Commission can
considerably more income to spend, with medicine able to do more,
licine had achieved many out-
and with a rapid rise in the birth rate (reflected in an increased de-
ittle casualties in World War II.
mand for obstetrical and pediatric services), the "shortage" of phy-
rtant advances in chemother-
sicians became a matter of concern to an increasing number of
that with these additional re-
communities. Moreover, larger numbers of young male college grad-
ed and improved health care
uates sought entrance to medical schools. Hence several states moved
benefits to the American peo-
to build new medical schools, a development that was neither threat-
:ed that the nation's medical
ened nor encouraged by the AMA. However, as in the past, organized
re, that research would require
medicine continued to control accreditation of institutions providing
y poor and near poor needed
undergraduate medical education, thus assuring not only quality con-
ices system.
trol but a modest rate of expansion.
le ground between the conser-
As described in the previous chapter, as the decade progressed a
a "hands-off" governmental
growing number of communities and groups experienced difficulties
growing belief in Washington
in attracting and retaining physicians. Many individuals in rapidly
important health services be-
growing areas could not find a physician who would give them an
anized medicine. Nonetheless,
appointment without a long waiting time. The result was increased
mission's recommendation of
pressure on Congress to intervene and enlarge the supply of physi-
igh the AMA did refrain from
cians. The AMA was accused of practices that worked to contain the
to make such funds available
supply and thus maintain high incomes for its members. Congress
dical research. Thus, through
was finally willing to act.
rnment paid for the advanced
In 1963, federal funds became available to assist in the construc-
by paying indirect costs on
tion of new medical schools. Seriatim, funds were voted for the ex-
stantial funds available to the
pansion of existing schools followed by special grants for operating
sities that competed success-
purposes to schools in financial distress. And by the late 1960s, gov-
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264 Public Policy
The Federal Gover
emmental involvement took the next crucial step of making funds
cialists and subspecialists and t
available to medical schools willing to expand their enrollments.
physicians to attend to the gel
To place these acts in perspective, it is important to remember
experience of the United King
that several commissions and taskforces had studied the adequacy of
guideline entered the debate; pl
the nation's supply of physicians and without exception had argued
less than 50 percent of all physic
in favor of an expanded role by the federal government to increase
The new actions of 1971 we)
the rate at which the supply was being enlarged. Nonetheless, until
the Nixon Administration deci
the early 1960s, the AMA saw no reason for such an enlargement of
shortage of 50,000 physicians h
the role of the federal government, which had not previously played
why the federal government shc
a direct role in financing the production of physician manpower.
cation. Why not encourage the
According to the AMA, there was no compelling reason for the ini-
cover full costs; why not simp.
tiation of such policies. But by the mid-1960s the AMA, faced with
cessful applicants from low-inc
the threat of Medicare and other, in their view, undesirable innova-
questions for a conservative ad
tions, decided to contest no longer the argument that the community
received a proper hearing either
needed more doctors. After this concession, the AMA ceased its tena-
of the Democrat-controlled Co
cious fight against federal funding for medical education.
Congress were not convinced t)
In the early 1950s, the failure of national health insurance legisla-
could be resolved satisfactorily
tion to be enacted had led the Magnuson Commission to recommend
vention. After much wranglin
the alternative strategy of expanding resources as the second best
Health Professions Education A
approach to strengthening the health care system. By the mid-1960s,
was passed. This legislation It
in the face of growing concern that the promises of biomedical re-
federal interest in physician dis
search were not being fulfilled, federal funds had begun to be shifted
trol over inflow of foreign med
from research to services. This shift became more rapid after the en-
ernmental support to the med
actment of Medicare and Medicaid. Moreover, the passage of the
available to U.S. citizens pursu
Medicare and Medicaid legislation gave encouragement to advocates
Further, this legislation effectiv
of supply expansion. How could the health services that Congress
notice that if they did not colle
had just promised the American people be delivered in the face of a
tribution of residencies in prin
shortage of 50,000 physicians, a figure reported with authority by
1980, they would face specific a
the nation's senior health officials? Congress crossed the skirmish
This last stipulation was not a
line and opened the federal treasury for the direct training of physi-
already had been met by the tir
cian manpower, convinced that the promised services could be pro-
ever, the congressional directive 1
vided only by adding to the pool of physician manpower.
for U.S. citizens studying abroa
In 1971, Congress increased its involvement in the production of
settled the following year by a :
physician manpower by regularizing its contributions through capi-
fering" with the admission proce
tation (grants to medical schools based on the number of medical
The new controls of the inflo
students enrolled) and at the same time making funds available for
pact. Since the days of Hitler, wh
the residency training of family care physicians. By these two ac-
and Austrian physicians came to
tions, Congress affirmed the national interest in health manpower
there had been a continuing but
and carved an additional role for itself in the financing of residency
surmounted sizable hurdles in F
training.
obtain a license. These refugee I
The background for the latter action stemmed from a growing be-
European medical schools wher
lief by many observers in and out of government and the profession
was not greatly different from
that U.S. medicine was weighted too heavily in the direction of spe-
changes in U.S. immigration sta
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The Federal Government's Physician Manpower Policies 265
t crucial step of making funds
cialists and subspecialists and that there were too few primary care
expand their enrollments.
physicians to attend to the general ills of patients. Drawing on the
; it is important to remember
experience of the United Kingdom and Canada, a new statistical
ces had studied the adequacy of
guideline entered the debate; primary care physicians should not be
I without exception had argued
less than 50 percent of all physicians.
federal government to increase
The new actions of 1971 were hardly on the statute books before
ng enlarged. Nonetheless, until
the Nixon Administration decided that since the long-proclaimed
ason for such an enlargement of
shortage of 50,000 physicians had disappeared, there was no reason
which had not previously played
why the federal government should continue to finance medical edu-
iction of physician manpower.
cation. Why not encourage the medical schools to raise tuition to
) compelling reason for the ini-
cover full costs; why not simply offer adequate loan funds to suc-
nid-1960s the AMA, faced with
cessful applicants from low-income homes? These were reasonable
their view, undesirable innova-
questions for a conservative administration to raise but they never
e argument that the community
received a proper hearing either in the public domain or in the halls
ession, the AMA ceased its tena-
of the Democrat-controlled Congress. Moreover, the public and the
medical education.
Congress were not convinced that national health manpower issues
national health insurance legisla-
could be resolved satisfactorily without further governmental inter-
son Commission to recommend
vention. After much wrangling between Senate and House, the
g resources as the second best
Health Professions Education Assistance Act of 1976 (PL 94-484)
care system. By the mid-1960s,
was passed. This legislation reconfirmed capitation, strengthened
the promises of biomedical re-
federal interest in physician distribution, provided for tighter con-
al funds had begun to be shifted
trol over inflow of foreign medical graduates (FMGs), and tied gov-
became more rapid after the en-
emmental support to the medical schools' making limited spaces
Moreover, the passage of the
available to U.S. citizens pursuing their medical education abroad.
ve encouragement to advocates
Further, this legislation effectively placed health science centers on
e health services that Congress
notice that if they did not collectively meet the required 50:50 dis-
ple be delivered in the face of a
tribution of residencies in primary care to those in specialties by
ure reported with authority by
1980, they would face specific quotas, institution by institution.
Congress crossed the skirmish
This last stipulation was not a real threat since the quota for 1980
for the direct training of physi-
already had been met by the time the legislation became law. How-
promised services could be pro-
ever, the congressional directive to the medical schools to make room
hysician manpower.
for U.S. citizens studying abroad set off a major altercation that was
volvement in the production of
settled the following year by a semiretreat by Congress from "inter-
its contributions through capi-
fering" with the admission process of medical schools.
ised on the number of medical
The new controls of the inflow of FMGs, however, had major im-
time making funds available for
pact. Since the days of Hitler, when considerable numbers of German
e physicians. By these two ac-
and Austrian physicians came to the United States, and up to 1965,
al interest in health manpower
there had been a continuing but not large inflow of FMGs who had
elf in the financing of residency
surmounted sizable hurdles in passing the examinations required to
obtain a license. These refugee physicians were usually graduates of
ion stemmed from a growing be-
European medical schools where the substance of instruction often
E government and the profession
was not greatly different from that of the United States. In 1965,
) heavily in the direction of spe-
changes in U.S. immigration statutes prompted a sizable inflow of
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266 Public Policy
The Federal GOVE
physicians from Asia and other parts of the world where medical edu-
(HEW) policy papers dealing
cation was considerably different from that in the United States. Be-
points of this review are summa
cause of the uncontrolled expansion of residencies that could not be
Between 1978 and 1990, th
filled by graduates from U.S. medical schools alone, these FMGs
the United States will increas
were welcomed by many hospitals that otherwise would have been
which is likely to prove the hi,
significantly understaffed. In fact, some hospitals on the East Coast
deral laws and regulations are
undertook annual recruiting missions abroad. By the early 1970s, the
medical graduates is not effect
number of foreign medical students who entered the country-most
will be even higher.
of whom remained in the United States to practice-equaled in num-
ber the output of U.S. medical schools. Widespread complaints by
Apparently, the federal go
this trend. Evidence indicates
American physicians and patients occurred about the professional in-
tions still face difficulties in ga
adequacy of many foreign medical graduates. The situation clearly
larly private care. It is difficult
warranted attention.
ably on an administration's S
To summarize, in the fourteen-year period from 1963 to 1977
government restrict the numbe
Congress used federal money and other means to make an impact on
probably will not be politicall:
the medical educational establishment in the following ways, to:
to reduce the size of new class
prove feasible is governmental
Recognize a national interest in medical education
programs to assure that accele
Expand enrollments and facilities
physicians is not encouraged.
Help schools in financial distress with operating support
Reduced earnings and less fr
pursue a specialty are possible
Tie federal assistance to specific increases in enrollments
This could make medicine a I
Subsidize residency training in fields determined to be in short
and thereby result in a decrea
supply
However, at present there are
Interdict the continued inflow of large numbers of FMGs
seeking admission to medical
rollments probably will not dro
Establish individual and collective goals on admissions to medical
6,000 U.S. citizens currently st
school and/or residency training as a condition for financial sup-
sorbed, along with later expatr
port
tem, thus further swelling the st
Improve geographic distribution by providing for loan forgiveness
One must also attend to the
which are also in a position to i
In addition, Congress supported the training of physician extend-
Added pressures on state legis]
ers, encouraged the enrollment of minorities, made available special
places for their children, citizer
loan funds, established the National Health Service Corps, and devel-
munities anticipating the econ
oped other initiatives. This abbreviated history points up a decade of
panded medical school would bi
frenetic activity in which the federal government felt called upon to
Several forces operate to con
intervene increasingly to shape and reshape the supply and distribu-
likely to be effective is the cha
tion of physician manpower.
and the length of commitmen
practice of medicine. An averag
CURRENT TRENDS, 1978
in the annual hours of work t
realm of possibility. If that OCC
In June 1978 a special ad hoc panel of the Institute of Medicine met
will be considerably improved.
to review a series of Department of Health, Education, and Welfare
centage of the profession and
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The Federal Government's Physician Manpower Policies 267
of the world where medical edu-
(HEW) policy papers dealing with physician manpower. The major
n that in the United States. Be-
points of this review are summarized below.
of residencies that could not be
Between 1978 and 1990, the ratio of physicians to population in
:al schools alone, these FMGs
the United States will increase by one-third to 235 per 100,000,
at otherwise would have been
which is likely to prove the highest in the world. If the present fed-
ne hospitals on the East Coast
deral laws and regulations are modified so that the inflow of foreign
abroad. By the early 1970s, the
medical graduates is not effectively slowed, in twelve years this ratio
who entered the country-most
will be even higher.
es to practice-equaled in num-
Apparently, the federal government cannot do much to deflect
ols. Widespread complaints by
this trend. Evidence indicates that sizable rural and urban popula-
urred about the professional in-
tions still face difficulties in gaining access to medical care, particu-
raduates. The situation clearly
larly private care. It is difficult to see how Congress would act favor-
ably on an administration's suggestion, if it were made, that the
ar period from 1963 to 1977
government restrict the numbers of physicians in medical school. It
er means to make an impact on
probably will not be politically feasible to use capitation payments
in the following ways, to:
to reduce the size of new classes entering medical school. What may
prove feasible is governmental review of its incentive and support
dical education
programs to assure that accelerated growth of the supply of future
physicians is not encouraged.
ith operating support
Reduced earnings and less freedom of choice for the individual to
pursue a specialty are possible outcomes of future federal policies.
creases in enrollments
This could make medicine a less attractive field in the near future
ilds determined to be in short
and thereby result in a decrease in the numbers seeking to enter.
However, at present there are so many more qualified candidates
arge numbers of FMGs
seeking admission to medical school than places available that en-
rollments probably will not drop. Moreover, it is expected that some
goals on admissions to medical
6,000 U.S. citizens currently studying abroad will eventually be ab-
$ a condition for financial sup-
sorbed, along with later expatriates, into the American medical sys-
tern, thus further swelling the supply.
providing for loan forgiveness
One must also attend to the continuing role of state governments,
which are also in a position to affect the future supply of physicians.
e training of physician extend-
Added pressures on state legislators continue from parents seeking
norities, made available special
places for their children, citizens seeking improved access, and com-
Health Service Corps, and devel-
munities anticipating the economic stimulation that a new or ex-
d history points up a decade of
panded medical school would bring.
government felt called upon to
Several forces operate to contain the rate of growth. The one most
shape the supply and distribu-
likely to be effective is the change that will come in the work year
and the length of commitment of the individual physician to the
practice of medicine. An average decline of 15 percent to 20 percent
in the annual hours of work by physicians by 1990 is within the
realm of possibility. If that occurs, the demand-supply relationship
of the Institute of Medicine met
will be considerably improved. With women comprising a larger per-
Health, Education, and Welfare
centage of the profession and with more physicians practicing in
05/21/98
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268 Public Policy
The Federal Gover
groups or in salaried positions, a coming reduction in work hours
uent bodies that established the
seems likely.
it would be an error, in my vie
However, if physicians are able to control their earnings and there-
empt the CCME from playing
by earn the same income for less time, the manpower position may
judgment of the recent General
look more advantageous than it really is. A rapid increase in the ratio
The government has a legitin
of physicians to population may well lead to acceleration in the total
cies and has some leverage at
costs of operating the health care system. The federal government
bursement for the care of hospit
will then regret its involvement in expanding the supply of physi-
difficulty in determining what
cians, and may be forced to supplement ever larger portions of the
and the adequacy of reimburser
annual health bill.
may be seen in the following
In the second arena in which the federal government is increas-
encourage the training of an ac
ingly involved-that of "maldistribution" by specialty-there is an
sicians, the complex issue of re
absence of any agreement among "experts" in the assessment both
vices (to open more training sl.
of the existent situation and the optimal one. Enthusiasts for more
the same time, the question o
"primary care physicians" believe that most of the malfunctioning
schedules could in fact be tran
of the present system could be alleviated by the training of more pri-
specialty and subspecialty res:
mary care physicians. They believe that primary care physicians
Both undertakings are fraught
could treat most patients (70 to 80 percent), control referrals, inter-
ated with the issue of whether
dict the unnecessary use of hospitalization and high technology,
ence the geographic distributio
move health care in the direction of preventive services, and under-
whether the government shoul
gird still other positive developments.
tice of physicians in underserve
However, it must be noted that there is no agreement on the defi-
physicians away from surplus a)
nition of a primary care physician, no clarity as to how current
An effective policy must be
modes of practice can be modified to give primary care physicians
data it is impossible for the fe
larger roles, and most importantly, little sensitivity to the fact that
criteria for areas assumed to I
many consumers may not agree that it is preferable for them to be
base does not currently exist a
treated in the first instance by a primary care physician. Moreover,
its establishment. For example
there is no reliable data about how active physicians now divide their
York City has one of the high
time among patients requiring primary care, specialty care, and sub-
world. But the New York Cit
specialty care. In the absence of such data the protagonists are deal-
ported a considerable number
ing with ideology, not reality. While it may be possible to support
which there is no physician in F
the contention that there is a surplus of surgeons or neurosurgeons,
It is possible that the fede
it surely does not follow that such a generalization could be substan-
urban areas by facilitating the I
tiated for all specialties or for the maldistribution of specialists. Thus
the use of reimbursement poli
the subject remains so elusive that sensible social intervention is hard
zation of facilities, and other
to design, and even harder to implement.
willing to practice in or close
Nevertheless, there is some basis for believing that the approach
reasonable.
whereby specialty boards approve residency programs solely by ref-
Problems concerning the da
erence to standards of quality is in need of modification. The govern-
hold true for governmental ir
ment, particularly in the embodiment of HEW, has been trying to
areas of surplus. "Surplus" ar
involve the Coordinating Council for Medical Education (CCME) in
physicians, and it may strain 1
such modification of procedures, in concert with representatives of
if established members of the
the public and with the freedom to act independently of the constit-
to relocate. Perhaps the best II
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The Federal Government's Physician Manpower Policies 269
ing reduction in work hours
uent bodies that established the CCME. The outcome is unclear, but
it would be an error, in my view, for the federal government to pre-
ntrol their earnings and there-
empt the CCME from playing a more active role. This is also the
the manpower position may
judgment of the recent General Accounting Office (GAO) report.
5. A rapid increase in the ratio
The government has a legitimate interest in the matter of residen-
ad to acceleration in the total
cies and has some leverage at its disposal via the methods of reim-
tem. The federal government
bursement for the care of hospitalized Medicaid patients. One critical
panding the supply of physi-
difficulty in determining what goals the government should pursue,
nt ever larger portions of the
and the adequacy of reimbursement levers to accomplish those goals,
may be seen in the following example. If the government were to
ederal government is increas-
encourage the training of an additional number of primary care phy-
on" by specialty-there is an
sicians, the complex issue of reimbursement for ambulatory care ser-
perts" in the assessment both
vices (to open more training slots) would need to be confronted. At
nal one, Enthusiasts for more
the same time, the question of whether changes in reimbursement
t most of the malfunctioning
schedules could in fact be translated into cutbacks in the number of
ed by the training of more pri-
specialty and subspecialty residencies would need to be explored.
that primary care physicians
Both undertakings are fraught with difficulty and are closely associ-
reent), control referrals, inter-
ated with the issue of whether the federal government should influ-
zation and high technology,
ence the geographic distribution of physicians and, more specifically,
reventive services, and under-
whether the government should encourage the settlement and prac-
tice of physicians in underserved areas and exercise pressures to draw
e is no agreement on the defi-
physicians away from surplus areas.
10 clarity as to how current
An effective policy must be based on reliable data. Without such
give primary care physicians
data it is impossible for the federal authorities to establish objective
tle sensitivity to the fact that
criteria for areas assumed to be in shortage or surplus. Such a data
t is preferable for them to be
base does not currently exist and there are significant difficulties to
ary care physician. Moreover,
its establishment. For example, the borough of Manhattan in New
ve physicians now divide their
York City has one of the highest physician to resident ratios in the
care, specialty care, and sub-
world. But the New York City Department of Health recently re-
data the protagonists are deal-
ported a considerable number of census tracts within the borough in
it may be possible to support
which there is no physician in private practice.
of surgeons or neurosurgeons,
It is possible that the federal government can assist underserved
neralization could be substan-
urban areas by facilitating the growth of new practice modes through
istribution of specialists. Thus
the use of reimbursement policies for ambulatory care, the moderni-
ible social intervention is hard
zation of facilities, and other forms of assistance. Physicians may be
t.
willing to practice in or close to ghetto areas if the conditions are
r believing that the approach
reasonable.
lency programs solely by ref-
Problems concerning the data base and criteria for assessment also
1 of modification. The govern-
hold true for governmental interdiction of physicians practicing in
of HEW, has been trying to
areas of surplus. "Surplus" areas might be short of certain types of
Medical Education (CCME) in
physicians, and it may strain the limits of governmental intervention
oncert with representatives of
if established members of the profession were uprooted and forced
independently of the constit-
to relocate. Perhaps the best method would be the offer of monetary
05/21/98
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270 Public Policy
The Federal Gove
and other inducements to new physicians to establish practices else-
tion, usually without repaying
where. Another possible method would be simply to place certain
be that the government can no
locations "off limits" to new entrants. However, this would solidify
need to examine how well t
the advantages of the established group and run against federal ef-
whether they accept or balk
forts, like those of the Federal Trade Commission, to reduce the
more complain to Congress tha
monopoly power now available for physicians.
as well be performed by paran
As is true of many new ideas in health manpower policy, it is hard
ducing or eliminating their oblig
to design a federal effort that could contribute to the redistribution
Difficulty also arises from th
of physicians at a bearable cost. Once one recognizes that all such
ernment to control the assignr
efforts are likely to be confronted by unanticipated (and negative)
program will succeed will be er
consequences, the ground for action becomes more tenuous.
eral agencies are able to elicit t
During most of the past decade, the government has been engaged
health departments, Health S
in supporting the training of physician extenders. Evidence of large-
schools that are likely to be t
scale increases in the supply of physicians questions the necessity of
how they could be better ser
continued government support of these extender programs, and the
tralized procedure is the possi
answer hinges on issues of scale and utility. The scale of federal con-
The onus would fall on feder:
tributions is relatively small; most extenders are trained without
might be jeopardized.
federal assistance. Evidence indicates that many extenders serve
Another major concern is th
population groups that have difficulty in attracting and retaining
cine. Even before the Bakke d
physicians. Because it is expected that such difficulties for certain
against such recruitment. Altl
urban and rural groups will continue, it would be a mistake to elim-
exceed those of pre-affirmative
inate federal support now. More experimentation is needed to deter-
clining rapidly. There is little
mine the optimal use of extenders. However, the coming "surplus"
major federal intervention.
of physicians argues against any expansion of federal support while
One possible federal effort W
continuing experimentation argues for maintenance of present effort.
minority enrollments to increa
Experimentation requires the production of new supplies and some
norities by a threat of loss of
modification of reimbursement mechanisms. At present it appears
make more funds available to
financially unwise to set extenders free to be reimbursed for their
and improved outreach progran
services on a fee-for-service basis. On the other hand, more flexibility
admission years. A third effor
could be achieved in their utilization if urban, like rural, clinics were
available to help selected min<
reimbursed for services rendered by extenders. Another suggestion is
fully as professional researcher
that the government monitor continued increases in the supply of
school faculty largely are develo
extenders as compared to increases in the output of physicians. If
The continuing financial dif
the comparison indicates a weakening demand for extenders, federal
School of Medicine (largely a ft
support could be reduced or eliminated.
ing hospital) raise the issue of
The presumption that within the next five years the federal gov-
port not only for Meharry but
ernment will have a substantial pool of new graduates entering the
for other minority groups such
National Health Service Corps-that is, graduates forced to accept
The federal government is hard
assignments in underserved areas as a way of working off their in-
from a major source of supply
debtedness to the nation-may be incorrect. Thus far, states and
want to review the basis for its
philanthropic foundations have had little success in extracting service
from being asked to finance n
from those whose education they financed. Somehow the potentially
the United States sees gains fro
indentured have managed to extricate themselves from their obliga-
above the present 5 to 6 perc
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The Federal Government's Physician Manpower Policies 271
ins to establish practices else-
tion, usually without repaying the money advanced to them. It may
d be simply to place certain
be that the government can now enforce the obligation. But we will
However, this would solidify
need to examine how well the early graduates are assigned and
up and run against federal ef-
whether they accept or balk at their posts. If several hundred or
: Commission, to reduce the
more complain to Congress that they are doing work that could just
sicians.
as well be performed by paramedics, they may again succeed in re-
th manpower policy, it is hard
ducing or eliminating their obligation.
intribute to the redistribution
Difficulty also arises from the dubious capacity of the federal gov-
: one recognizes that all such
ernment to control the assignment process. The likelihood that the
unanticipated (and negative)
program will succeed will be enhanced if those in the pertinent fed-
comes more tenuous.
eral agencies are able to elicit the active cooperation of state or local
government has been engaged
health departments, Health Service Agencies, or selected medical
extenders. Evidence of large-
schools that are likely to be best informed about local needs and
ans questions the necessity of
how they could be better served. The clear risk to such a decen-
e extender programs, and the
tralized procedure is the possibility of error by the intermediaries.
ility. The scale of federal con-
The onus would fall on federal shoulders, and the entire program
ktenders are trained without
might be jeopardized.
that many extenders serve
Another major concern is the recruitment of minorities into medi-
y in attracting and retaining
cine, Even before the Bakke decision, signs were indicating a trend
t such difficulties for certain
against such recruitment. Although present minority enrollments
it would be a mistake to elim-
exceed those of pre-affirmative action years, such enrollments are de-
imentation is needed to deter-
clining rapidly. There is little likelihood of reversal unless there is
owever, the coming "surplus"
major federal intervention.
ision of federal support while
One possible federal effort would be to pressure schools with low
maintenance of present effort.
minority enrollments to increase their efforts at recruitment of mi-
ion of new supplies and some
norities by a threat of loss of federal monies. Another would be to
anisms. At present it appears
make more funds available to assist schools to undertake expanded
ee to be reimbursed for their
and improved outreach programs and remedial education in the pre-
he other hand, more flexibility
admission years. A third effort would be to make special funding
f urban, like rural, clinics were
available to help selected minority students compete more success-
tenders. Another suggestion is
fully as professional researchers, a pool from which future medical
ed increases in the supply of
school faculty largely are developed.
1 the output of physicians. If
The continuing financial difficulties of Meharry Medical College
demand for extenders, federal
School of Medicine (largely a function of the difficulties of its teach-
1.
ing hospital) raise the issue of federal policy toward continuing sup-
ext five years the federal gov-
port not only for Meharry but also for financing medical education
of new graduates entering the
for other minority groups such as Chicanos and Native Americans.
S, graduates forced to accept
The federal government is hardly in a position to withdraw support
way of working off their in-
from a major source of supply of black physicians, although it may
ncorrect. Thus far, states and
want to review the basis for its support of Meharry to protect itself
tle success in extracting service
from being asked to finance new medical schools for minorities. If
iced. Somehow the potentially
the United States sees gains from increasing the proportion of blacks
themselves from their obliga-
above the present 5 to 6 percent of enrollees in medical school, it
05/21/98
13:11
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272 Public Policy
will have to take action along multiple fronts since the medical estab-
lishment, left to its own devices, seems to be in partial retreat.
Placing this forecast alongside our recapitulation of the recent
past leads to the conclusion that the federal government can more
readily intervene than it can accomplish the goals at which its inter-
vention is aimed. Accordingly, in my view, a cautionary stance to-
Index
ward future interventions in physician manpower may be the better
part of wisdom.
REFERENCES
Department of Health, Education, and Welfare. August 1978. A Report to
the President and Congress on the Status of Health Professions Personnel in the
United States, Publication No. 78-93 (HRA).
Ginzberg, E. 1978. "How Much Will U.S. Medicine Change in the Decade
Ahead?" Annals of Internal Medicine 89, 4 (October).
- 1978. Health Manpower and Health Policy. Montclair, N.J.: Allan-
held, Osmun and Co.
Graduate Medical Education National Advisory Committee Staff Papers,
Academic culture, 24, 42, 45
DHEW, HRA 78-10. "Physician Manpower Requirements."
Academic medicine, 6, 63-64, 98,
HRD-77-92. May 16, 1978. "Are Enough Physicians of the Right Types
140, 151, 250. See also Research,
Trained in the U.S.?"
as career choice
Rogers, D.E. 1978. American Medicine: Challenge for the 1980s. Cambridge,
Adaptation. See also Coping mecha-
nisms
Mass.: Ballinger Publishing Co.
effect of pediatric internship on,
Waitzkin, H. 1978. "A Marxist View of Medical Care." Annals of Internal
113-14, 119, 121, 128-31, 136
Medicine 89: 264-278. (Bibliography of 260 items.)
for stress, x, 88-91, 201-12
Admission. See also Selection
criteria for, 82, 84-85
and data collection for career
choice, 56-57, 62-68, 76-78
and federal government, 265-67
and stress in medical school, XX,
83-88
Adorno, T.W., 28
Adsett, C., 204-205
Adult socialization, 10, 37-46
Advisors, 129, 142-43, 145, 147-50,
156-58
Allport, Gordon, 27
Aloia, J.F., and Jonas, E., 116, 132
Alpert, J.J., 115
and Charney, E., 169
Ambulatory care, 38, 117, 164-69,
254-55, 258, 269
American Academy of Family
Practice, 56
American Academy of Pediatrics,
100
American Board of Family Practice,
56
American Board of Internal Medi-
cine, 97, 101
05/21/98
13:03
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002/016
JAMA 100 Years Ago
April 2, 1898
NEW SECRET ORDER FOR PHYSICIANS.
The Mystic Order of Disciples of Asculapius, is being organized by Frank C. Hoyt,
M.D., superintendent of the Iowa Hospital for the Insane, Clarinda, Iowa. It is
designed to work in conjunction with medical societies, and in no way supplant them,
and the enterprise is fraternal, not commercial in character. Full information can be
obtained by addressing Dr. Hoyt.
JAMA. 1898;30:808
April 9, 1898
TREATMENT OF IMPETIGO WITH FRANKLINIZATION.
Fourteen cases rapidly cured with "electric effluvation" are reported by Doumer
Some things
and Levezier of Lille, all children from six months to 12 years of age, accompanied by
marked improvement in the appetite and health. The seances were repeated three
improve with age.
times a week, lasting ten minutes each time, two to eight being generally required,
and a machine powerful enough to emit sparks eight centimeters in length-Sem.
Méd., February 9.
JAMA. 1898:30:866
But you need a new
April 16, 1898
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IRREGULAR HOURS AND SMALL PAY.
every year.
The stranger remarked: "I think I can tell what your business is." "What?" "Night
watch." "No, friend, you are mistaken; they can go to sleep on their beat and they
Don't let the word "generics" in the
draw their wages regularly." "Well, then you're a fireman, ain't you?" "Worse than
title fool you. This highly specialized
that; no such regular pay or sleep for me." "Well, what are you then?" "Why, I'm a
doctor; one of those unfortunate fellows who are called up so often that they don't
reference provides complete prescrib-
know night from day, excepting when they get out of town, and never draw their pay
ing and pricing information on virtually
while they are away, either."
every brand and generic prescription
JAMA. 1898;30:933
medication on the market today.
April 23, 1898
With more than 24,000 listings -
BOARD OF HEALTH CAN NOT RESTRICT MODE OF LAYING FLOOR.
many new this year - it's the most
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New Jersey gives boards of health power to adopt ordinances; to regulate plumb-
available from any source.
ing and ventilation and secure the sanitary condition of all buildings; to regulate the
keeping of all kinds of animals and the accumulation of offal; and to abate any nuisance
in any place. But notwithstanding this the supreme court of that State holds, Feb. 21,
Prescribe with confidence. Order today!
1898, in State VS. Board of Health, that the board of health of Asbury Park had no
power to restrict the owners of a stable to the mode of laying a stable floor prescribed
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sorting to any other method which would secure the sanitary condition of the stable,
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though by departing from the prescribed method they took the risk of creating a nui-
sance. If the stable was a nuisance, the owners must be prosecuted for maintaining
Available February 1998
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Satisfaction guaranteed
JAMA. 1898;30:998
or return within 30 days
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April 30, 1898
New!
CONNECTION BETWEEN NASAL AFFECTIONS AND PSYCHIATRY.
C. Ziem urges a more active treatment for certain mental disturbances, and traces
Call 800 621-8335.
the connection between them and nasal troubles, especially affections of the acces-
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brain. His communication in the Monats. f. Ohr. k., 1897, 11 and 12, describes his own
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personal experience with scientific candor and accuracy, and is a convincing plea in
favor of the alleged connection.-Cbl. f. Chir., March 12.
American Medical Association
JAMA. 1898;30:1050
Physicians dedicated to the health of America
STATE
Edited by Brian P. Pace, MA, Assistant Editor.
978 JAMA, April 1, 1998-Vol 279, No. 13
JAMA 100 Years Ago
Harvard Medical School Facts and Figures
http://www.hms.harvard.edu/about/facts.html#buildings.
145
Number of Students Enrolled for the PhD in the Division of Medical Sciences, Fall 1997
500
Continuing Education
Courses offered: 206
New courses: 38
Attendees: 38,426
States represented: 50
Countries represented: 63
Countway Library
Library
The Countway Library [http://www.med.harvard.edu/countway/] comprises the Harvard Medical School
and Boston Medical Libraries
Housed in the Countway Library Building
Volumes: 608,900
Monographs: 203,000
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Special Collections
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Multiple databases for on-line services
More than 2 million files downloaded from Countway Library site monthly
Nobel Laureates
Nobel Laureates
George Minot, 1934, Medicine and Physiology
Research on liver treatment of the anemias (with Murphy)
William P. Murphy, 1934, Medicine and Physiology
Diabetes and diseases of the blood (with Minot)
Fritz A. Lipmann, 1953, Medicine and Physiology
Identified coenzyme A and discovered basic principles in understanding of proteins
John F. Enders, 1954, Medicine and Physiology
Application of tissue-culture methods in developing a polio virus, the ingredient of the polio vaccine
(with Robbins and Weller)
3 of 4
05/19/98 13:01:25
Harvard Medical School Facts and Figures
http://www.hms.harvard.edu/about/tfacts.html#buildings.
Frederick C. Robbins,* 1954, Medicine and Physiology
Application of tissue-culture methods to the study of viral diseases (with Enders and Weller)
Thomas H. Weller, 1954, Medicine and Physiology
Application of tissue-culture methods to the study of viral diseases (with Enders and Robbins)
Georg von Bekesy, 1961, Medicine and Physiology
Discovered the traveling wave while researching how the ear responds to sound waves
James D. Watson, 1962, Medicine and Physiology
Described the structure of DNA
Konrad E. Bloch, 1964, Medicine and Physiology
Studied the pattern of reactions involved in the biosynthesis of cholesterol and fatty acids
George Wald, 1967, Medicine and Physiology
Research on the biochemistry of vision
Baruj Benacerraf, 1980, Medicine and Physiology
Discovered that disease-fighting ability is passed on genetically, although the immune-response gene
varies from person to person
David Hubel, 1981, Medicine
Research on information-processing in the visual system (with Wiesel)
Torsten Wiesel, 1981, Medicine
Research on information-processing in the visual system (with Hubel)
Bernard Lown, Herbert Abrams, Eric Chivian, and James Muller, 1985, Peace
Cofounders, with Evgueni Chazov, Leonid Ilyin, and Mikhail Kuzin from the Soviet Union, of the
International Physicians for the Prevention of Nuclear War
Joseph E. Murray, 1990, Medicine
Developed new procedures for organ transplant (with E. Donnall Thomas, formerly of the University of
Washington)
'Robbins was awarded the Nobel Prize for work done while a member of the Harvard Faculty. When the
award was made, he was a member of the faculty of Western Reserve University.
About HMS I Education & Admissions I Research I Administration & Faculty
Harvard Medical Web
Last Updated: October 16, 1997
4 of 4
05/19/98 13:01:26
Harvard Medical School: A History and Background
http://www.hms.harvard.edu/about/intro.html
Introduction to Harvard Medical School
Harvard Medical School is one of the world's preeminent institutions in medical education and research.
The breadth and depth of its scientific and clinical disciplines are unsurpassed. The School has more
than 8,000 faculty and 17 affiliated facilities.
At the core of the Medical School are its educational and research programs. The student body is
composed of 650 men and women in the MD program; 440 students in the PhD program; and 145 in the
joint MD-PhD programs, part of which is sponsored in collaboration with MIT. For its medical students,
Harvard has inaugurated the/New Pathway curriculum, a problem-solving, case-method approach to
NEW
learning, offering the opportunity to come in contact with patient cases early in their studies.
PATHWAY
The Medical School has nine departments in basic- and social-science disciplines: Cell Biology,
Biological Chemistry and Molecular Pharmacology, Genetics, Microbiology and Molecular Genetics,
Neurobiology, and Pathology, and the Departments of Ambulatory Care and Prevention, Health Care
Policy, and Social Medicine. In 1992, a new state-of-the-art research building was dedicated to house
Neurobiology, Genetics, and Pathology. With this new building, virtually all of the Medical School's
research and educational facilities have been renovated or newly constructed in the last eight years.
Most of the heads of the above departments have been appointed within the past five years. In turn, they
are in the process of recruiting exceptionally strong, world-class faculty members to enhance and expand
the current complement of faculty. The Medical School is the largest of Harvard's graduate faculties and
has traditionally been a trend-setter for many University-wide initiatives.
last updated on September 19, 1997
About HMS Education & Admissions I Research| Faculty & Administration
Harvard Medical Web
1 of 1
05/19/98 13:00:47
Harvard Medical School Facts and Figures
http://www.hms.harvard.edu/about/facts.html#buildings
Leadership, Buildings, & Departments
Dean, Harvard Medical School
Joseph B. Martin, MD, PhD
Dean, Harvard School of Dental Medicine
R. Bruce Donoff, DMD, MD
Medical School Established
1782
Buildings on Campus
Main quadrangle, opened 1906
Harvard School of Dental Medicine, 1867
Vanderbilt Hall (Student Residence), 1927
Francis A. Countway Library, 1965
Laboratory for Human Reproduction and Reproductive Biology, 1972
Seeley G. Mudd Building, 1977
Medical Education Center, 1987, Named for Daniel C. Tosteson, 1997
Warren Alpert Building, 1992
Goldenson Building Renovations, 1994
Harvard Institutes of Medicine, 1996
Departments
Ambulatory Care and Prevention
Biological Chemistry and Molecular Pharmacology
Cell Biology
Genetics
Health Care Policy
Microbiology and Molecular Genetics
Neurobiology
Pathology
Social Medicine
44 hospital-based clinical departments
New England Regional Primate Research Center
Affiliated Hospitals & Research Institutions
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Cambridge Hospital
Center for Blood Research
Children's Hospital
Dana-Farber Cancer Institute
Harvard Pilgrim Health Care
Joslin Diabetes Center
Judge Baker Children's Center
McLean Hospital
Massachusetts Eye and Ear Infirmary
Massachusetts General Hospital
Massachusetts Mental Health Center
Mount Auburn Hospital
Schepens Eye Research Institute
Spaulding Rehabilitation Hospital
Veterans Administration Medical Center (Brockton/West Roxbury)
Financial Figures
Financial Summary
Budget Fiscal Year 1997)
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Harvard Medical School Facts and Figures
http://www.hms.harvard.edu/about/facts.html/buildings
$241,000,000
Endowments
June 1997: $1,235,000,000
Professorships: 193
First Gift
In 1772, Ezekiel Hersey established two professorships in Anatomy and Physic (Medicine) at the
yet-to-be established Medical School
Gifts Fiscal Year 1997
For current use: $19,223,000
For capital:
Endowment: $16,087,000
Loan funds: $338,000
Total gifts: $35,648,000
Research and Training Dollars 1997
U.S. government direct and indirect: $92,463,000
Private funding direct and indirect: $62,782,000
Total: $155,245,000
Financial Aid Fiscal Year 1996-1997
Average scholarship: $12,908
Unit loan: $20,000
Percentage of students receiving financial aid: 71.4
Number of students graduating with loans: 126
Average loan debt on graduation: $73,339
Range of debt (Class of 1996): $5,700-$162,000
Average Cost 1996-1997
$40,900, including tuition of $25,200
People in Education
Faculty
Over 2,800 senior faculty (assistant, associate, and full professors) -- over 80% have full-time
appointments
Faculty Instructors
Over 4,600 full-time and part-time
Trainees
Over 5,000 residents, interns and postdoctoral fellows
Living Alumni
8,600 from classes 1917-1997
Students
165 entering freshman annually
First-Year Class Entered in 1996
Applicants: 3,956
Matriculants: 76 men, 88 Women
Under-represented minorities: 30
First-year students from 27 states and 7 countries
Number of Students Enrolled in MD-PhD Program, Fall 1997
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Harvard Medical School Facts and Figures
http://www.hms.harvard.edu/about/facts.html#financial
Leadership, Buildings, & Departments
Dean, Harvard Medical School
Joseph B. Martin, MD, PhD
Dean, Harvard School of Dental Medicine
R. Bruce Donoff, DMD, MD
Medical School Established
1782
Buildings on Campus
Main quadrangle, opened 1906
Harvard School of Dental Medicine, 1867
Vanderbilt Hall (Student Residence), 1927
Francis A. Countway Library, 1965
Laboratory for Human Reproduction and Reproductive Biology, 1972
Seeley G. Mudd Building, 1977
Medical Education Center, 1987, Named for Daniel C. Tosteson, 1997
Warren Alpert Building, 1992
Goldenson Building Renovations, 1994
Harvard Institutes of Medicine, 1996
Departments
Ambulatory Care and Prevention
Biological Chemistry and Molecular Pharmacology
Cell Biology
Genetics
Health Care Policy
Microbiology and Molecular Genetics
Neurobiology
Pathology
Social Medicine
44 hospital-based clinical departments
New England Regional Primate Research Center
Affiliated Hospitals & Research Institutions
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Cambridge Hospital
Center for Blood Research
Children's Hospital
Dana-Farber Cancer Institute
Harvard Pilgrim Health Care
Joslin Diabetes Center
Judge Baker Children's Center
McLean Hospital
Massachusetts Eye and Ear Infirmary
Massachusetts General Hospital
Massachusetts Mental Health Center
Mount Auburn Hospital
Schepens Eye Research Institute
Spaulding Rehabilitation Hospital
Veterans Administration Medical Center (Brockton/West Roxbury)
Financial Figures
Financial Summary
Budget Fiscal Year 1997)
1 of 4
05/19/98 13:01:37
Harvard Medical School Facts and Figures
http://www.hms.harvard.edu/about/facts.html#financia
$241,000,000
Endowments
June 1997: $1,235,000,000
Professorships: 193
First Gift
In 1772, Ezekiel Hersey established two professorships in Anatomy and Physic (Medicine) at the
yet-to-be established Medical School
Gifts Fiscal Year 1997
For current use: $19,223,000
For capital:
Endowment: $16,087,000
Loan funds: $338,000
Total gifts: $35,648,000
Research and Training Dollars 1997
U.S. government direct and indirect: $92,463,000
Private funding direct and indirect: $62,782,000
Total: $155,245,000
Financial Aid Fiscal Year 1996-1997
Average scholarship: $12,908
Unit loan: $20,000
Percentage of students receiving financial aid: 71.4
Number of students graduating with loans: 126
Average loan debt on graduation: $73,339
Range of debt (Class of 1996): $5,700-$162,000
Average Cost 1996-1997
$40,900, including tuition of $25,200
People in Education
Faculty
Over 2,800 senior faculty (assistant, associate, and full professors) -- over 80% have full-time
appointments
Faculty Instructors
Over 4,600 full-time and part-time
Trainees
Over 5,000 residents, interns and postdoctoral fellows
Living Alumni
8,600 from classes 1917-1997
Students
165 entering freshman annually
First-Year Class Entered in 1996
Applicants: 3,956
Matriculants: 76 men, 88 Women
Under-represented minorities: 30
First-year students from 27 states and 7 countries
Number of Students Enrolled in MD-PhD Program, Fall 1997
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Harvard Medical School Facts and Figures
http://www.hms.harvard.edu/about/facts.html#financial
145
Number of Students Enrolled for the PhD in the Division of Medical Sciences, Fall 1997
500
Continuing Education
Courses offered: 206
New courses: 38
Attendees: 38,426
States represented: 50
Countries represented: 63
Countway Library
Library
The Countway Library [http://www.med.harvard.edu/countway/] comprises the Harvard Medical School
and Boston Medical Libraries
Housed in the Countway Library Building
Volumes: 608,900
Monographs: 203,000
Serials: 3,971
Rare books: More than 25,000
Special Collections
History of medicine (810 incunabula)
European books printed 16th-19th centuries
English books published 1475-1800
American books 1668-1870, especially New England imprints and Bostoniana
14th century medical Hebraica and Judaica
Manuscripts and archives, especially of New England origin
National archive of medical illustration
Warren Collection of early books in the history of medicine
World famous collection of medical medals and portraits
Users per day
1,000
Journal pages copied per year
5 million
Multiple databases for on-line services
More than 2 million files downloaded from Countway Library site monthly
Nobel Laureates
Nobel Laureates
George Minot, 1934, Medicine and Physiology
Research on liver treatment of the anemias (with Murphy)
William P. Murphy, 1934, Medicine and Physiology
Diabetes and diseases of the blood (with Minot)
Fritz A. Lipmann, 1953, Medicine and Physiology
Identified coenzyme A and discovered basic principles in understanding of proteins
John F. Enders, 1954, Medicine and Physiology
Application of tissue-culture methods in developing a polio virus, the ingredient of the polio vaccine
(with Robbins and Weller)
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Harvard Medical School Facts and Figures
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Frederick C. Robbins,* 1954, Medicine and Physiology
Application of tissue-culture methods to the study of viral diseases (with Enders and Weller)
Thomas H. Weller, 1954, Medicine and Physiology
Application of tissue-culture methods to the study of viral diseases (with Enders and Robbins)
Georg von Bekesy, 1961, Medicine and Physiology
Discovered the traveling wave while researching how the ear responds to sound waves
James D. Watson, 1962, Medicine and Physiology
Described the structure of DNA
Konrad E. Bloch, 1964, Medicine and Physiology
Studied the pattern of reactions involved in the biosynthesis of cholesterol and fatty acids
George Wald, 1967, Medicine and Physiology
Research on the biochemistry of vision
Baruj Benacerraf, 1980, Medicine and Physiology
Discovered that disease-fighting ability is passed on genetically, although the immune-response gene
varies from person to person
David Hubel, 1981, Medicine
Research on information-processing in the visual system (with Wiesel)
Torsten Wiesel, 1981, Medicine
Research on information-processing in the visual system (with Hubel)
Bernard Lown, Herbert Abrams, Eric Chivian, and James Muller, 1985, Peace
Cofounders, with Evgueni Chazov, Leonid Ilyin, and Mikhail Kuzin from the Soviet Union, of the
International Physicians for the Prevention of Nuclear War
Joseph E. Murray, 1990, Medicine
Developed new procedures for organ transplant (with E. Donnall Thomas, formerly of the University of
Washington)
Robbins was awarded the Nobel Prize for work done while a member of the Harvard Faculty. When the
award was made, he was a member of the faculty of Western Reserve University.
About HMS I Education & Admissions I Research I Administration & Faculty
Harvard Medical Web
Last Updated: October 16, 1997
4 of 4
05/19/98 13:01:38
News, Facts & Access
http://www.med.harvard.edu/news.html
Harvard Medical Web
NEWS, FACTS & MAPS
NEWS
Press Releases
Harvard Medical School and Harvard School of Dental Medicine
Media Relations
Harvard Medical School and Harvard School of Dental Medicine
Harvard Medical School Affiliated Teaching Hospitals and Research
Institutes
FACTS
The Harvard Medical Community
The Harvard medical community is a complex group of schools, hospitals and
research institutions in which the Harvard University Faculty of Medicine
conduct research, educate future physicians and scientists, and provide
state-of-the-art patient care.
The Harvard Faculty of Medicine work at the 1906 marble quadrangle that
houses the administration of Harvard Medical School and six basic science
departments and two social science and policy departments. The faculty also
work in an additional 42 clinical departments based at the 17 affiliated
hospitals and research institutions that are connected through the charter of
the Harvard Medical Center. The faculty also work at the Harvard School of
Dental Medicine in a building adjoining the quadrangle.
Each of the institutions maintains various degrees of autonomy, though a
number are now linked through two large health care systems Partners and
CareGroup, and all come together for the academic missions of teaching and
research. This far-flung faculty produces an incredible depth and breadth in
its ability to conduct cutting-edge research and to create innovations in
medical education, with basic and clinical research and education occurring at
most sites.
MAPS & DIRECTIONS
Directions to Harvard Medical School
Harvard Medical School Quadrangle
Longwood Medical Area
Public Transit
Back to Harvard Medical Web
last updated on February 23, 1998
1 of 1
05/19/98 11:53:20
Harvard Medical Center Network Maps
http://www.hmcnet.harvard.edu/txtmap.html
Harvard Medical Center
Network
HMC index About the HMC Network I Residency/Fellowship Search
Clinical Departments I Preclinical Departments Affiliate sites Affiliate sites by
discipline
Harvard Medical School Clinical Departments [top]
Ambulatory Care
Anaesthesia
Dermatology
Medicine
Neurology
OB/GYN
Opthamology
Orthopedics
Otolaryngology
Pathology
Pediatrics
Physical Medicine and Rehabilitation
Psychiatry
Radiology
Radiation Oncology
Surgery
Harvard Medical School Preclinical Departments [top]
Biological Chemistry & Molecular Pharmacolgy
Cell Biology
Genetics
Health Care Policy
Microbiology and Molecular Genetics
Pathology
Social Medicine
Affiliate Homepages [top]
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Brockton/West Roxbury Veterans Administration Medical Center
Cambridge Hospital
Center for Blood Research
Children's Hospital
Dana Farber Cancer Institute
Harvard Medical School
Harvard Pilgrim Health Care
Harvard University
Joslin Diabetes Center
Judge Baker Center
Massachusetts Eye and Ear Institute
Massachusetts General Hospital
1 of 4
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Harvard Medical Center Network Maps
http://www.hmcnet.harvard.edu/txtmap.html
McLean Hospital
Mount Auburn Hospital
Schepens Eye Institute
Spaulding Rehabilitation Hospital
Affiliate Sites (by clinical discipline) [top]
Ambulatory Care
Beth Israel Deaconess Medical Center
Harvard Community Health Care
Joslin Diabetes Center
Anesthesia
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Children's Hospital
Massachusetts Eye and Ear Institute
Massachusetts General Hospital
Dermatology
Beth Israel Medical Center
Brigham and Women's Hospital
Medicine
Brigham and Women's Hospital
Cambridge Hospital
Children's Hospital
Massachusetts General Hospital
Neurology
Beth Israel Deaconess Medical Center
Brigham and Women's Hosptial
Children's Hospital
Harvard Medical School
Massachusetts General Hospital
Schepens Eye Research Institute
OB/GYN
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Children's Hospital
Joslin Diabetes Center Gynecology services
Joslin Diabetes Center Pregnancy services
Massachusetts General Hospital
Opthamology
Children's Hospital
Joslin Diabetes Center
Massachusetts Eye and Ear Institute
2 of 4
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Harvard Medical Center Network Maps
http://www.hmcnet.harvard.edu/txtmap.htm.
Orthopedic Surgery
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Children's Hospital
Massachusetts General Hospital
Otolaryngology
Beth Israel Deaconess Medical Center
Children's Hosptial
Massachusetts Eye and Ear Institute
Pathology
Center for Blood Research
Harvard Medical School
Beth Israel Deaconess Medical School
Brigham and Women's Hospital
Children's Hospital
Massachusetts General Hospital
Pediatrics
Children's Hospital
Joslin Diabetes Center
Massachusetts General Hospital
Physical Medicine and Rehabilitation
Beth Israel Deaconess Medical Center
Spaulding Rehabilitation Hospital
Psychiatry
Beth Israel Deaconess Medical Center
Cambridge Hospital
Children's Hospital
Joslin Diabetes Center
McLean Hospital
Massachusetts General Hospital
Radiology
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Children's Hospital
Massachusetts Eye and Ear Institute
Massachusetts General Hospital
Radiation Oncology
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Children's Hospital
Massachusetts General Hospital
Surgery
3 of 4
05/19/98 11:55:57
Harvard Medical Center Network Maps
http://www.hmcnet.harvard.edu/txtmap.html
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Children's Hospital
Search for a Residency or Fellowship [top]
If you have additions or corrections to these maps, please contact
[email protected]
Last modified: 3/3/98
top I Harvard Medical Center Network index
4 of 4
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Harvard Medical School: Important Dates
http://www.harvard.edu/academics/catalogs/medical/calendars.htm.
Harvard Medical School Course Catalog
GENERAL
Harvard Medical School
INFORMATION
Calendars for Academic Year 1997-98
About HMS
Programs of study
General
Academic policies
Year I, Cannon, Castle, Holmes, & Peabody Societies
Year II, Cannon, Castle, Holmes, & Peabody Societies
Clinical Rotations July 1997 - June 1998
COURSE LISTINGS
Index
Preclinical - Year I
Preclinical - Year II
General Calendar
HST Courses
Clinical
AUGUST 1997
Epidemiology
Social Medicine
25
Mon
CCHP* Year II classes begin
26/27
Wed/Thur
Core Clerkships
USMLE** Step II Examination
Advanced
Biomedical
SEPTEMBER
Electives
1
Mon
HMS-Division of
Labor Day - no classes
Medical Sciences
2/3
Tue/Wed
HMS (all societies) Year I Registration & Orientation
Courses
2
Tue
HST Year II classes begin
3
Wed
HST Year I Orientation Luncheon
3
Wed
MIT classes begin
OTHER WEB SITES
4
Thur
Year I classes begin
Harvard Medical
OCTOBER
Web
Harvard University
13
Mon
Columbus Day - no classes
14/15
Tues/Wed
USMLE Step I Examination
NOVEMBER
11
Tue
Veterans Day - no classes
27-29 Thur-Sun
Thanksgiving recess
DECEMBER
12
Fri
HST classes end
15-19
Mon-Thur
MIT final exam period
15-19
Mon-Thur
HST final exam period
19
Fri
HST winter recess begins
22
Mon
CCHP Winter recess begins
JANUARY 1998
3
Thurs
CCHP Classes resume
5
Mon
MIT independent activities begin
5
Mon
HST January classes begin
12
Mon
M.L. King Day - no classes
30
Fri
HST January classes end
FEBRUARY
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Harvard Medical School: Important Dates
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2
Mon
MIT Registration Day
2
Mon
HST spring classes begin
16
Mon
Presidents Day - no classes
MARCH
3/4
Tue/Wed
USMLE Step II Examination
12
Thur
PM HST Forum (Test)
23-27
Mon-Sun
CCHP and HST Spring recess
APRIL
20
Mon
Holiday at MIT only (Patriot's Day)
21
Thur
PM Soma Weiss Assembly
MAY
15
Fri
HST classes end
18-22
Mon-Fri
MIT final exam period
18-22
Mon-Fri
HST final exam period
22
Fri
CCHP Year II classes end
25
Mon
Memorial Day - no classes
JUNE
3
Wed
HST Commencement
4
Thur
Harvard Commencement
5
Fri
MIT Commencement
9/10
Tue/Wed
USMLE Step I Examination
19
Fri
CCHP Year I classes end
* Cannon/Castle/Holmes/Peabody Societies (New Pathway program)
** United States Medical Licensing Examination
*** Harvard - MIT Health Sciences and Technology Program
Year I: Cannon, Castle, Holmes, & Peabody Societies
Orientation:
Tue - Wed, Sept 2-3
Human Body: IN 701.0
All mornings: Thu, Sept 4 - Tue, Oct 28
HB Final Exam: Tue, Oct 28
Holiday: Mon, Oct 13
Chem Biol Cell: IN 711.0
All mornings: Wed, Oct 29 - Fri, Dec 12
CBC Final Exam: Fri, Dec 12
Holidays: Tue, Nov 11 & Nov 27 - 28
Integrated Human Physiology: IN 712.0
All mornings: Mon, Dec 15 - Wed, Feb 11
HP Final Exam: Wed, Feb 11
Winter Recess: Mon, Dec 22 - Fri, Jan 2
Holiday: Mon, Jan 19
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Harvard Medical School: Important Dates
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Pharmacology: IN 705.0
All mornings: Thu, Feb 12 - Thu, Mar 12
Pharm Final Exam: Thu, Mar 12
Holiday: Mon, Feb 16
Genetics, Embryology, Reproduction: IN 703.0
All mornings: Fri, Mar 13 - Tue, April 28
GER Final Exam: Tue, April 28
Immunology, Microbiology & Infectious Disease: IN 704.0
All mornings: Wed, Apr 29 - Fri, June 19*
One Afternoon Session: TBA
IMD Final Exam: Tue, June 23
Holiday: Mon, May 25
*HMS Commencement: Thu, June 4
Clinical Epidemiology & Social Medicine
Fall Semester:
Tue afternoons: Sept 9 - Dec 16
Thu afternoons: Sept 11 - Dec 18
Spring Semester:
Tue afternoons: Feb 3 - Mar 17 & Mar 31 - May 12
Thu afternoons: Feb 5 - Mar 19 & Apr 2 - May 21*
Holiday: Thu: Nov 27
*Soma Weiss Research Day: Thu, PM - No Classes
Patient/Doctor I: IN 709.JA
Fall Semester:
Mon afternoons: Sept 8 - Dec 15
Wed afternoons: Sept 10 - Dec 17 (Wed, Nov 26-No Class)
Spring Semester:
Mon afternoons: Jan 5 - Mar 16 & Mar 30 - June 8
Wed afternoons: Jan 7 - Mar 18 & Apr 1 - June 10
Holidays:
Mon: Oct 13, Jan 19, Feb 16, May 25
Wed: Nov 26-No Class
Assessment: Spring dates TBA
Recess:
Winter: Dec 22, 1997 - Jan 2, 1998
Spring: Mar 23, 1998 - Mar 27, 1998
Academic Year I ends Tuesday, June 23, 1998
Year II (1997 - 1998) Cannon, Castle, Holmes, & Peabody
Societies
Human Nervous System & Behavior: IN 707.0
All mornings: Mon, Aug 25 - Tue, Oct 21
HNSB Mid-Block Exam: TBA
HNSB Final Exam: Mon & Tue, Oct 20 & 21
Holidays: Mon, Sept 1 & Mon, Oct 13
Pathology: IN 714.0
All mornings: Wed, Oct 22 - Fri, Nov 14
Pathology Final Exam: Fri, Nov 14
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Holiday: Tue, Nov 11
Human Systems: IN 708.0
Mon - Fri mornings: Mon, Nov 17 - Fri, Jan 30
Mon/Tue/Thu/Fri mornings: Mon, Feb 2 - Fri, Apr 3
Tue/Thu/Fri mornings: Tue, Apr 7 - Fri, May 22
Holidays:
Nov 27&28
Jan 19
Feb 16
Winter Recess
Dec 22 - Jan 2
Spring Recess
March 23 - March 27
Human Systems Sections:
Module I (Dermatology/Respiratory/Cardiovascular/Hematology)
Mon, Nov 17, 1997 - Mon, Feb 9, 1998
Module II
(Gastroenterology/Musculoskeletal/Renal/Endocrine/Reproductive)
Tues, Feb 10, 1998 - Fri, May 22, 1998
Behavioral Science (Psychopathology): PS 700M.J
Fall Semester (Cannon, Castle, Holmes & Peabody Students):
Tue afternoons: Sept 2 - Dec 9
Thu afternoons: Sept 4 - Dec 11
Spring Semester (HST Students):
Tuesday Afternoons: Feb 3 - Mar 17 & Apr 7 - May 12
Preventive Medicine/Nutrition: PM 711.0
Spring Semester:
Tue afternoons: Jan 13 - Mar 17 & Apr 7 - Apr 28
Patient/Doctor II
Wednesday Afternoons: Sept 3 - Dec 17 & Jan 7 - Jan 28
All day Wednesday: Feb 4 - Apr 1
All day Monday & Wednesday: Apr 6 - May 20
No Classes: Wed, Nov 26
OSCE April 6, 8, & 10
Recess:
Winter: Dec 22, 1997 - Jan 2, 1998
Spring: Mar 23, 1998 - Mar 27, 1998
Academic Year II ends Friday, May 22, 1998
Clinical Rotation Dates
July 1997 - June 1998
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Harvard Medical School: Important Dates
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Last day
Rotation
Rotation Dates
to drop
July
July 7 - Aug 3
May 1
August
Aug 4 - Aug 31
June 1
USMLE Step II Exam:
Aug 26-27, 1997
Registration deadline for this exam
is May 28, 1997
September
Sept 1 - Sept 28
July 1
October
Sept 29 - Oct 26
August 1
USMLE Step I Exam:
Oct 14-15, 1997
Registration deadline for this exam
is July 17, 1997
November
Oct 27 - Nov 23
Sept 1
December
Nov 24 - Dec 21
Oct 1
Recess
Dec 22 - Jan 4
January
Jan 5 - Feb 1
Nov 1
February
Feb 2 - - Mar 1
Dec 1
March
Mar 2 - Mar 29
Jan 1
USMLE Step I Exam:
Mar 3-4, 1998
Registration deadline for this exam
is Dec 5, 1997
Recess
Mar 30 - Apr 5
April
Apr 6 - May 3
Feb 1
May
May 4 - May 31
Mar 1
June
June 1 - June 28
Apr 1
Commencement
June 4, 1998
USMLE Step I Exam:
June 9-10, 1998
Registration deadline for this exam is
(Tentative)
Mar 13, 1998 (Tentative)
Recess
June 29 - July 5
Students doing clinical rotations should check with the course director
regarding holiday time off.
*Last Day to Drop:This is the last day to drop one month clerkships only;
Three month clerkships are set and cannot be changed.
Back to Academic Policies
5 of 5
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MAY-12-1998 11:31
HMS-DEAN'S OFFICE
617 432 3907 P.02
1
Joseph B. Martin
Open Doors Address
HARVARD MEDICAL SCHOOL
Dean's
11.
On Sept. 2, the first day of Orientation Week, Dean Joseph Martin
welcomed first-year students at a reception outside the
all
administration building. The ceremony marked the opening of the
building's traditionally locked doors onio the Quad, a gesture the
Speech-
Letter to the Commissions
dean explained in his remarks, which are excerpted below.
Main
A warm welcome to each and every one of you. I welcome you as
Community
new members to the Harvard Medical community, 168 medical
students and 32 dental medicine students.
Seruice
In saying "community," I mean something much broader than that
bounded by this marble quadrangle.
I want to take just a few minutes this afternoon to discuss the
many layers of community that have, as of today, become integral to
your life. And I want to caution that you may occasionally lose sight
of these over the next four years as you immerse yourselves in the
study of medicine and dentistry.
I want to describe the community of medicine at Harvard in the
context of the broader Harvard Medical community, the alumni who
have come before you, and the faculty, residents, and postdocs at our
17 affiliated teaching hospitals and research institutions.
You are here bccause among medical and dental schools, Harvard
is unsurpassed. You came here because you expect the best
education possible in a community of distinguished scholars,
teachers, scientists, and clinicians.
I also want to spend a few moments thinking about another
community that will bc important to you over the years, one that you
may have trouble keeping sight of while you're here. This
community is our neighbors-the community on nearby Mission Hill,
the community of greater Boston, the U.S., and, indeed, the whole
world. These communities are the raison d'être of your new
profession.
Through your experiences here, you will have the opportunity to
become leaders in your profession-physicians and scientists who
make sure the profession stays true to its commitment to improve the
well-being of all our communities.
Although I officially started my tenure as dean of the Harvard
Faculty of Medicine on July 1, I join with you today in fully entering
this community. I have heard stories about your superlative
achievements before arriving here, and it is a privilege to be
rejoining the Harvard Medical community with you today.
As a symbol of my commitment to go with you through your
transition into the medical profession, I want to announce today that
these front doors of HMS-doors that, for decades, have been locked
to you until your graduation day-will be open to you now every day.
Well. at least every Monday through Friday from 9 to 5.
The opening of these doors is symbolic: it represents my priorities
for Harvard Medical School. We in this building will be open and
accessible to all our communities; at the same time, we will be
looking for ways we can be of assistance-to our students seeking
knowledge, our affiliates seeking collaboration, or a neighborhood
health clinic seeking another pair of hands
1 of 2
5/12/98 12:19 PM
MAY-12-1998 11:32
HMS-DEAN'S OFFICE
617 432 3907 P.03
Prior to my leaving San Francisco for Boston, I was invited to
comment on the future of medical education. At that time I said:
"Our most important task right now is to make the communities
around us aware of what we do in the academic centers. The public
is very interested in biomedical research; health and science still get
on the evening news regularly. But I don't think the public
understands how science leads to the advances that people are
interested in, and how science is threatened right now."
Then I closed, saying, "We need to open our doors and
communicate that the work we are doing is for everybody."
Now, with these doors open, during my tenure here, community
outreach and service will remain an individual choice but will be a
mandate for HMS as an institution.
There is one last aspect of responsibility to community that I
would like to address. It is something that underlies everything that
you have heard today, and that is ethics, the foundation of our
medical profession.
So to conclude: as you become immersed in your first year of
medical or dental school, periodically take time to think about how
you interact with all your communities, the Harvard Medical
community, the community of doctors and dentists, and our
neighboring communities-in Boston, across the U.S., and around the
globe.
Carefully consider ways that you can take your membership in the
Harvard Medical community as an opportunity to become leaders in
using the science and the art of medicine to make all our
communities better.
As a result, you will become better members of the medical and
dental profession.
-Joseph B. Martin
last updated on October 9, 1997
About HMSI Education & Admissions I Researchi Administration & Faculty
Harvard Medical Web
2 of 2
5/12/98 12:19 PM
MAY-29-1998 11:31
HMS-DEAN'S OFFICE
617 432 3907
P.01
Harvard Medical School
OFFICE OF THE DEAN OF THE FACULTY OF MEDICINE
25 SHATTUCK STREET
BOSTON, MASSACHUSETTS 02115
TELEPHONE: (617) 432-1501
FACSIMILE: (617) 432-3907
VIA FACSIMILE
To:
Michael
Facsimile:
202-456-6244
From:
Gloria M. Lacap
Office of the Dean of the Faculty of Medicine
Telephone:
617-432-3792
Facsimile:
617-432-3665
Re:
Student Speakers at Graduation on June 4, 1998
Date:
29 May 1998
# Pages (incl. cover sheet):
2
MAY-12-1998 11:32
HMS-DEAN'S OFFICE
617 432 3907
P.04
OSEPH B. MAR' 'IN
Dean's priorites Spach
SEVEN PRIORITIES FOR HARVARD MEDICAL SCHOOL
I will now list-and briefly discuss with you-the seven priorities
that shape my vision for Harvard Medical School in the coming
years.
My first priority is to maintain and strengthen the basic science
departments. My passion for science, and the great importance I
place on the quality of scientific work, led me to spend a full day in
each of the basic science departments this past summer. I was
thoroughly impressed with the intellectual ability and enthusiasm of
the faculty, the ample laboratory facilities, and the groundbreaking
research being done in each department.
To ensure that the pursuit of fundamental truth continues to
flourish here at the Medical School, I am committed to preserving
what is best about our basic science departments-the unsurpassed
intellectual capital of the faculty; the freedom, and the means, to
follow wherever the quest of pure knowledge leads-while at the
MAY-12-1998 11:32
HMS-DEAN'S OFFICE
617 432 3907 P.05
S me time introducing changes that I believe wi I make our
departments even better.
One way I hope to strengthen the basic science enterprise here is by
fostering closer collaboration between departments, including,
where appropriate, joint recruitment and shared resources. Science
that is increasingly interdisciplinary calls for new thinking in terms
of recruitment, and I believe that cross-departmental appointments
may lead to increased scientific collaboration and to a shared vision
among leaders in research.
My second priority is to improve the sometimes fractured
institutional relationships between Harvard Medical School
and its affiliated institutions.
MA-12-1998 11:33
0 e of the first steps I have taken to ccompl sh this is to
establish a physical presence at each of the major affiliates.
This presence will take the form of satellite offices-or
embassies, as I like to think of them-that will serve as a direct
resource for faculty and students, and where I will hold office
hours each month.
The first of these satellite offices opened at MGH in October,
the office at Brigham & Women's this month. The Beth Israel
Deaconess Institute office will open in December, and the office
at Children's Hospital in January.
As I mentioned a moment ago with regard to basic science
departments, I plan to encourage and facilitate joint recruitment
and dual appointments between the Quad and the affiliates. I
believe this cross-cutting approach will help to draw the entire
Harvard medical community closer together in the crucial effort to
build bridges between basic science and clinical practice.
MAY-12-1998 11.33
My third priority is to cultiv te d versity in all its forms. Let me
make it clear that diversity here at Harvard Medical School is not
an issue of fairness, but of quality-the quality of our educational
programs and the quality of care in our medical community. The
ethnic and cultural diversity of our medical students, faculty, and
staff-or the lack thereof-contributes directly to the quality and
scope of research, education, and patient care that is practiced here.
A more diverse and culturally representative medical community
practices higher quality medicine, the better to serve the larger
community.
I am proud of the minority representation we have currently
achieved in the student body. We need to continue our efforts to
attract and encourage the best minority students, particularly in
light of the Supreme Court's ruling this week upholding
California's proposition 209, and the distressing news from the
Association of American Medical Colleges that minority
applications to medical schools nationwide decreased 8.4 percent
last year.
MAY-12-1998 11:33
HMS-DEAN'S OFFICE
617 432 3907 P.08
In addition, we need to see a corresponding increase in the number
of underrepresented minority students in our residency programs
and on our faculty.
Another concern is the advancement of women. Although progress
has been made-as shown by a new student population of 50%
women-that there are still areas, such as the promotion of women
faculty members and staff, where more work needs to be done.
With these challenges in mind, I have charged William Silen, the
Dean for Faculty Development and Diversity, with the task of
coordinating all diversity programs throughout the Harvard
medical community.
Medical education is my fourth priority. I am impressed with the
results of the New Pathway-the innovative approach to medical
education introduced by my distinguished predecessor, Dan
Tosteson. But even the New Pathway will run the risk of premature
aging if it fails to keep pace with the rapid changes in today's health
care environment.
MAY-12-1998 11:33
HMS-DEAN'S OFFICE
617 432 3907
P.09
Our Ph.D. and M.D./Ph.D. programs represent another traditional
strength that we must carefully nurture. In recent years, the Ph.D.
program in the Division of Medical Sciences has been expanded and
reorganized to great effect. But severe cuts in Federal aid threaten
the program. And even more serious financial problems plague the
combined M.D./Ph.D. program, which trains scientists to bridge the
gap between basic and clinical research. Now, more than ever, we
cannot afford to watch our support erode in these areas.
My fifth priority is to enhance and optimize the use of information
technology here at Harvard Medical School, particularly in the
areas of educational, research, and administrative computing
The sixth priority is community and public service, which is an
integral part of a complete medical education and an activity of
incalculable value within the Harvard medical community, the city,
the nation, and the world at large. I applaud the efforts of our
students who undertake public service projects, and encourage all of
our students to serve the larger community in some way.
MAY-12-1998 11:34
HMS-DEAN'S OFFICE
617 432 3907 P.10
On a wider scale, Harvard Medical International marshals the
resources of the Faculty of Medicine, the affiliates, and selected
external partners in an effort to promote quality healthcare
worldwide.
Finally, number seven among my priorities must be resource
development. For all of our efforts to succeed, resources are
essential.
Although I have given you only a broad outline, I hope it has left
you with a sense of the direction, or rather directions, in which I
plan to take Harvard Medical School during my tenure as Dean.
For me, these seven points will serve as reminders of the core values
we strive to sustain, and as guideposts to assess our progress in the
coming years towards the important goals they represent.
Thank you very much. I will now take any questions you may have.
TOTAL P.10
MAY.20.1998
3:03PM
HMS PUBLIC AFFAIRS (617)432-0446
NO.730
P.2
PROGRAM
INTRODUCTION AND WELCOME
Allison Sarah Bryant and
Samuel Clayton Somers
Co-Moderators
STUDENT ADDRESSES
Kelly A. Cook
"The Fabric of Life"
Tokunbo Kemi Babagberni
"On Call"
Rev. Anthony Lamar Mitchell
"What I. Really Learned in Medical School"
ADDRESS
First Lady Hillary Rodham Clinton,
Commencement Address
CLASS PRESENTATIONS AND CONFERRAL OF DEGREES
Harvard School of Dental Medicine
R Bruce Donoff, DMD, MD.
Dean, Harvard School of Dental Medicine
Harvard Medical School
Joseph B. Martin, MD, PhD
Dean of the Faculty of Medicine, Harvard Medical School
ADMINISTRATION OF THE OATH OF THE CLASS OF 1998
So that everyone may see, please remain seated during the entire program.
Photographs are to be taken from your seat. Thank you.
4th, inleresting student
wincen. veryacture- -
had baby durny 4th
year- worked with
me on Family Jan ^
(information a Hached)
Harvard Medical School
ES
Oliver Wendell Holmes Society
Daniel A. Goodenough, Ph.D., Master
(617) 432-2156
Fax: (617) 432-2500
Medical Education Center
260 Longwood Avenue
Boston, Massachusetts 02115
DEAN'S LETTER FOR VICTORIA ANGELA MCGHEE SMITH
NOVEMBER 1, 1997
Dear Colleague:
It is our pleasure to write this Dean's Letter for Victoria McGhee Smith, who is applying for residency training
in Family Medicine. Vicki received her B.A. from Yale University summa cum laude in Near Eastern Languages and
Civilization in 1990. At Yale, Vicki was elected ФВК and received Distinction in Near East Languages. In addition to
her academic work, she worked as a Healthworker in the Women's Health Services and was a volunteer at Yale-New
Haven Hospital. She originally planned to develop a career as a diplomat, but after spending some time observing life at
the American embassy in Cairo decided to pursue other interests. After graduation from Yale, Vicki worked as a teacher
in California as part of the Teach for America Program, teaching 4th and 5th grade in Ingelwood, CA. In 1992, Vicki
enrolled at El Camino College to complete her pre-medical courses, earning the General Chemistry McQuerry Award for
Distinction in Chemistry. While at El Camino, she also worked half time, coordinating a computer lab for vocational and
technical students, acting as tutor in both computing and math skills and serving as an Independent Study Coordinator for
a basic skills program. She managed also to find time to volunteer as a Medical Assistant at Clinica Para Las Americas,
and keep herself fluent in Spanish.
Since matriculating at the Harvard Medical School, Vicki has been an energetic and engaged student. She has
been a Member of the Multicultural Fellows Committee and co-chair of the Third World Caucus (TWC). With her
colleagues, she engineered the TWC weekend a program at HMS for accepted underrepresented minority students which
was a terrific success. In the summer of 1995, Vicki joined the Urban Health Project, working for the Family Van
developing activities for Mattapan youth with funds she was awarded for a grant she had written. She also counseled
adolescent mothers about contraception and STDs at the Brookside Community Health Center. During the past year, she
has been the Chair of the Family Practice Interest Group. During her first year, Vicki also worked as a Research
Assistant in the Department of Adolescent Medicine at Children's Hospital, Boston. In addition to performing literature
searches, she wrote a chapter on adolescent pregnancy and childbearing for a textbook on adolescent gynecology edited
by Dr. Jean Emans. In her second year, Vicki worked as a research assistant for the Beth Israel WELL Program (Women
Enjoying Longer Lives), an outreach educational program to minority women of middle age. As a member of the
Massachusetts Academy of Family Physicians' Medical School Cooperative Committee, Vicki worked on a project to
educate medical students about the field of Family Practice, and helped develop a conference about Family Practice for
medical students held at Tufts Medical School. In recognition of her outstanding achievements in community work,
Vicki was selected by the W.K. Kellogg Foundation to receive their Community Based Training Fellowship for 1997.
Additional honors include election to the Aesculapian Club, the Linnane Scholarship and the AAUW Selected
Professions Fellowship.
During her basic science studies of the first two years, Vicki's tutors praised her keen intellect, superb
interpersonal skills, and good understanding of the course material. "Vicki excelled in her ability to relate the clinical
perspectives to the cases. She consistently was able to focus on the relevant issued and successfully help the group reach
an understanding of the practical aspects of medical problems which arose in the body." "Vicki was clearly the leader of
the tutorial, both with her good will and her interest in pursuing the case to its depths. She was not dominating, but
encouraged everyone to participate. In the best group of tutorial students in my eight years of teaching, she was only a
slight first among equals, but with no inclination to be more, and was invaluable in helping the shy members. Her study
habits are good and her knowledge increased during the course substantially."
0150560434:Smith, Victoria Angela; Personal Statement Page I
Victoria Angela McGhee Smith
I entered Harvard Medical School in the fall of 1994 wanting to become a Family Practice
physician. Experiences as a teacher and as a medical assistant in low-cost health clinics shaped this
decision.
Vignette #1:
"Good afternoon, Mrs. Gaston. This is Ms. McGhee (my maiden name), Dasmont's teacher I'd
like to know if I could stop by and speak with you and your husband this week."
A sharp intake of breath crosses the phone lines.
"What did Dasmont do wrong? Is he going to be suspended?"
"Dasmont hasn't done anything wrong. I just want to discuss his progress with you and hear your
concerns about his education."
Like Mrs Gaston, most of the parents that I called responded with alarm to my suggestion of a
home visit. I decided to embark upon a home visitation campaign as I recognized that to successfully
teach each of my students I could not view my classroom as existing in a vacuum. My home visits
helped me to better understand the myriad of forces at work in my students' lives which encouraged or
discouraged them from learning. Just as important was the creation of a team spirit with myself, the
parents or guardians, and the student working together for a common goal.
Vignette #2:
"The first thing on today's agenda is a discussion of the following problem. Many of our patients
are
returning to us reinfected with a sexually transmitted disease that we have successfully treated Does
anyone have any suggestions as to how to deal with this issue?" queried the medical director of
Women's Health Services (WHS), a low-cost health center for women in which I worked as a
healthworker during my sophomore and senior years of college.
After a long discussion, it was decided that WHS would treat the male partners of their patients.
The rationale behind that decision was that there were few to no low-cost health care options for men in
the New Haven area to have their sexually transmitted diseases treated and if WHS truly cared
about its female patients it had to care for their male partners.
My teaching experience and experiences in community health centers like WHS demonstrated to
me the interdependence of individuals and the families and communities. I also realized that I tend to
think of problems in a holistic fashion. Even before entering medical school, Family Practice seemed to
me to be the medical specialty that thought about a patient's health in a way that expands beyond the
individual to his/her family and environment
My clinical rotations in medical school as well as my extracurricular activities have merely served
to
confirm the fit of Family Practice for me. One particular patient encounter during my pediatrics rotation
exemplifies my interest in Family Practice. One night in the pediatric emergency room I was asked to
evaluate an intoxicated 15 year old Latina female brought in by her mother and maternal grandmother
Jasmine's mother did not know that her daughter drank. Upon discovering Jasmine drunk, she rushed
her to the hospital to have her stomach pumped. After interviewing Mrs. Cortes and Jasmine
separately, it became clear that Jasmine's drinking was in response to the breakup of her parents'
marriage as well as conflicts with her mother concerning her need for independence. Meanwhile, her
mother was struggling with the fact that her "little girl" had become an adolescent and was scared that
Jasmine was associating with teens who would lead her to substance abuse and sexual exploration.
Fortunately, my intern gave me the opportunity to spend one hour with Jasmine and her mother trying to
begin the process of resolving some of the many conflicts between this mother and daughter That night
I experienced the joys and frustrations of working with a family and became further convinced that my
future lies in a career in Family Practice.
My career goals after residency are to obtain more training in Preventive Medicine and Public
0150560434 Smith, Victoria Angela; Personal Statement - Page 2
Health and work as a family physician in a medically underserved area. I hope to work in or create a
comprehensive community health center that attends to the multiplicity of needs of the community it
serves. A truly comprehensive health center addresses not only the physical and medical needs of its
patients but also seeks to work on emotional, educational, financial, and spiritual concerns of a
community. As a Family Practice physician, I look forward to the challenge of practicing medicine
among the medically underserved in the United States and abroad.
The Family Van
Mission Statement:
In 1988 the death rate for infants in the United States was 10 per 1,000 births;
in Boston, infants died at more than twice that rate. A case-by-case study examined the
factors that led to 144 of the infant deaths in Boston in 1990 and 1991 Researchers
found three major themes running through the stories that the mothers of these infants
told Over 70 percent of these cases were plagued by insufficient tracking and linkages
within the health care system. Sixty percent of the women had unplanned pregnancies.
Over 30 percent reported that negative interactions with providers led to negative
feelings about health care. And, more than 16 percent of the women were homeless
some time during their pregnancy.
In 1992, The Family Van, a collaboration among six neighborhood health
centers, state and local agencies, and the Beth Israel Hospital, began to bring its unique
combination of community expertise and health care resources into the neighborhoods
that experienced the highest rates of infant mortality Each day, The Family Van parks
at a predetermined corner in one of six Boston neighborhoods. The program offers
pregnancy testing, reproductive health counseling, nutrition counseling, and personalized
referrals to over 100 local programs dealing with such issues as HIV/AIDS, free
medical care, homelessness, violence prevention, and drug rehabilitation.
The Family Van seeks to be part of the communities it serves. We do this by
design, ideology, and atmosphere. Each collaborator provides staff for the Van who are
selected to meet the needs of the particular communities served. Community roots and
language skills are all considered essential to the success of the program.
The issue for most of our clients is not simply insurance or transportation,
it is, broadly speaking, a sense that institutions designed to serve them are
unwelcoming or even hostile. It is the unease of the outsider looking into a fast-
paced world that cannot hear their whole story or begin to address the holes that
a lifetime of deprivation has created in the ability to manage the business of life.
Ideologically, we believe that better health outcomes are more readily achieved
through sharing information and resources than by access to medical intervention. A
study of over 9,000 women nationwide found that better birth outcomes were linked
more tightly to positive informational exchanges between women and health care
providers than they were to the use of extensive diagnostic procedures. The Family
Van provides an atmosphere where women, men and teens can exchange information
and learn about the city resources that are dedicated to address their needs.
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Permanent Address
Current Address
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Education
Harvard Medical School, Boston, Massachusetts
M.D. Candidate
1993-98
Texas A&M University, College Station, Texas
B.A. Cell and Molecular Biology, Magna Cum Laude
1989-93
Honors
Medical School
Ciba-Geigy Outstanding Community Service Award
1995
Albert Schweitzer Urban Health Fellowship
1995
College
Barry M. Goldwater Science Scholarship
1990-93
Texas A&M University Scholar
1990-93
Texas A&M President's Endowed Scholar
1989-93
Texas A&M Brown-Rudder Outstanding Senior Student Award
1993
Phi Kappa Phi Outstanding Junior Award
1992
Texas A&M Thomas S. Gathright Scholar Award
1991
Texas A&M Buck Weirus Spirit Award
1991
Community
Co-Director of Resources International
1996-1997
Service
a non-profit organization that sends medical equipment
to clinics and hospitals in the United States and abroad.
M.D. Anderson Cancer Hospital-Camp Star Trials Counselor
1990,91,93,95
Mentorship Program - Place of Promise, Dorchester, MA
1994-97
Volunteer at Brookside Community Health Clinic
1994-96
Created Spanish/English Well Child Program
Oakwood Middle School Tutorial Program
1989-91
Big Brother/Big Sister Program
1989-90
International
Medical Experience in Viacha, Bolivia
Fall 1997
Experience
Worked at Alalay Orphanage with Street Children
in El Alto,Bolivia
Summer 1997
Student at Institute of Bilingual and Multicultural Studies,
Cuernavaca, Mexico
August 1995
Medical Experience at Hospital Vozandes in Shell, Ecuador
Summer 1994
Western Amazon Jungle
Student at Universidad de las Americas, Puebla, México
Summer 1993
L.T. Jordan Institute for International Awareness
1992-93
Director of Living Abroad in England Program at Texas A&M
International Peace Camp in the Republic of Serbia
August 1992
Quaker United Nation Summer School, Geneva, Switzerland
July 1992
Kings College London - Reciprocal Exchange Program
1991-92
Activities
Park Street Church Sunday Night Leadership Team
1996-97
Park Street Church Choir
1993
University of London Chorus
1991-92
The Octaves - Men's Singing Octet
1989-90
Languages
English, Taiwanese, Spanish
Interests
Tennis, Running, Singing, Traveling, Cooking, Hermeneutics, Social Justice
PAGE
2
5TH STORY of Level 1 printed in FULL format.
Copyright 1998 The New York Times Company
The New York Times
May 18, 1998, Monday, Late Edition - Final
SECTION: Section A; Page 10; Column 6; National Desk
LENGTH: 747 words
HEADLINE: More Children Go Uninsured Despite Status For Medicaid
BYLINE: By ROBERT PEAR
DATELINE: WASHINGTON, May 17
BODY:
A new Federal study finds that 4.7 million children far more than previously
estimated are eligible for Medicaid but are not enrolled in the program and
have no health insurance benefits.
The finding means that two of every five uninsured children in the United
States could have coverage through Medicaid, which provides comprehensive health
benefits, if they or their parents would just apply for it.
The study, published today in the journal Health Affairs, said 21.2 million
children ages 18 or younger were eligible for Medicaid, the Federal-state
program for low-income people. But, it said, 22 percent of them were not in
Medicaid or any other public or private health insurance program.
The White House had estimated that three million children were eligible for
Medicaid but not enrolled. And in January, President Clinton ordered the
Department of Health and Human Services to locate such children and sign them
up.
Mr. Clinton has repeatedly proposed new health programs for children and has
often complained that the number of uninsured Americans is increasing because of
Congress's failure to enact his proposals for universal coverage in 1994. But
the study suggests that the Government and low-income families have not made
full use of the existing Medicaid program, which has been revised by Congress
over the last decade to expand eligibility.
The main author of the new report, Thomas M. Selden, who is an economist at
the Federal Agency for Health Care Policy and Research, a unit of the Public
Health Service, said, "Over all, we estimate that 4.7 million children age 18
and under were uninsured despite being eligible for Medicaid." They represent 39
percent of uninsured children, a group that numbers 12 million.
Mr. Selden said he and his colleagues at the Public Health Service had
identified "a much larger group of Medicaid-eligible but uninsured children than
has previously been known to exist.' Earlier studies focused on children ages 10
and younger and did not consider all the children who might benefit from recent
state expansions of the Medicaid program, Mr. Selden said.
Changes in Medicaid since the late 1980's have nearly doubled the number of
eligible children, the study found. The changes were pushed through Congress
PAGE
3
The New York Times, May 18, 1998
by Senator John H. Chafee, Republican of Rhode Island, and Representative Henry
A. Waxman, Democrat of California.
Children who received cash assistance through the old welfare program, Aid to
Families With Dependent Children, were automatically enrolled in Medicaid. But
the new study found that teen-agers and children who became eligible for
Medicaid because of recent program expansions were less likely to be enrolled.
These families "may have been less aware of their Medicaid eligibility, given
that they were ineligible for cash assistance," the study said. In addition, it
suggested, "such families may have resided in neighborhoods with lower
Medicaid prevalence, which might have reduced their awareness of the program and
perhaps increased their sense of stigma" associated with Medicaid. The study
also makes these points:
*Of the 4.7 million children who are eligible for Medicaid but not enrolled
in the program, 3.3 million are younger than age 13, and 1.4 million are between
ages 13 and 18.
*Young children eligible for Medicaid are more likely than older children to
be enrolled in the program.
*Sweeping changes in welfare policy made by the Federal Government and the
states in the last few years could inadvertently increase the number of
uninsured children. The new laws impose time limits and other restrictions on
welfare benefits. Many children may still be eligible for Medicaid after they
lose cash assistance, but they and their parents may have to make special
efforts to get such health benefits.
Another study in the same issue of Health Affairs documents changes in
insurance coverage of mental health care. The proportion of insured workers with
mental health benefits has increased in recent years, the study says, but the
benefits have become less generous as insurers impose stricter limits on the use
of mental health services and charge higher co-payments.
Health maintenance organizations and other managed-care plans generally
impose such limits, and the number of Americans in such health plans has soared
in the last decade, said one of the authors, Gail A. Jensen, an expert on
employee benefits at Wayne State University, in Detroit.
LANGUAGE: ENGLISH
LOAD-DATE: May 18, 1998
About the Harvard Medical Area
http://www.hsdm.med.harvard.edu/pages/history.htm
" an 10ST
About Harvard School of Dental Medicine
Harvard College opened in Cambridge, Massachusetts, in 1636 with an enrollment of 12 students
and one Master to teach all subjects. Its mission was to educate the religious and intellectual leaders
of the newly settled New England colonies. Expanding its size and extending its geographical
boundaries during the 19th century, the College added graduate and professional schools which now
number ten. Three of these are located in the Harvard Medical Area: the School of Dental Medicine,
the Medical School, and the School of Public Health. The Medical Area also includes some of the
worlds Finest affliated teaching and research hospitals. Today Harvard is one of the worlds
outstanding universities with a total graduate and undergraduate enrollment of approximately 18,000
degree candidates. Its mission, however, has remained essentially the same though considerably
broadened in scope: to educate the leaders of our complex international society.
Harvard University, with its beautiful Georgian architecture and deeply rooted academic
traditions, has maintained a strong link with its New England past. But the makeup of its student
population has broadened from one dominated by students from the Northeastern United States to one
attracting a wide representation from throughout the United States and from over 100 countries.
Within its ranks can be found some of the worlds most gifted students and productive scholars.
HARVARD SCHOOL OF DENTAL MEDICINE
The Frst university-based dental school in the country, Harvard Dental School was founded in
1867. It was also the Frst to be established in close affliation with a medical school (Harvard Medical
School) and to make the full scholarly and scientiFc resources of a university available to dental
education.
In 1940, under President James B. Conant, the School was reorganized as Harvard School of
Dental Medicine to place stronger emphasis on the biological basis of oral medicine and to institute
multidisciplinary programs of dental research. A unique feature of the curriculum placed dental
students in joint classes with medical students for two years of basic science and pathophysiology and
for an introduction to clinical medicine on the wards of Harvard teaching hospitals and in community
health centers.
In 1957, the School of Dental Medicine was awarded National Institute of Dental Research
training grant funding and began to expand and enhance its postdoctoral educational programs,
combining advanced clinical and biomedical research training for dentists planning careers in
academic dentistry. Several postdoctoral programs were developed under the leadership of former
dean, Dr. Paul Goldhaber. These include a four-year Doctor of Medical Sciences in Oral Biology
program; a Fve- and six-year Oral and Maxillofacial Surgery/MD/General Surgery program; and a
group of three- and four-year, joint-degree programs combining advanced clinical training and
research in health-care systems, health policy or biomedical sciences.
HARVARD MEDICAL SCHOOL
Harvard Medical School, the third to be established in the United States, opened in 1782. From its
beginnings in a basement with a faculty of three, to its present status as the worlds pre-eminent
institution in medical education and research, it has grown to a complex network of clinical and
preclinical departments, laboratories and afFliated hospitals, a full- and part-time faculty of almost
3,000 and a student body of over 800 men and women. At the core of Harvard Medical School is its
effort to combine growth with excellence in medical education, patient care, and scientiFc
investigation.
HARVARD SCHOOL OF PUBLIC HEALTH
Harvard School of Public Health is the youngest of the three professional schools in the Harvard
1 of 2
05/20/98 14:49:48
About the Harvard Medical Area
http://www.hsdm.med.harvard.edu/pages/history.htm
Medical Area. The primary mission of the School of Public Health is to carry out teaching and
research aimed at improving the health of population groups throughout the world. The School
emphasizes not only the development and implementation of disease prevention and treatment
programs, but also the planning and management of the systems that are involved in the delivery of
health services in this country and abroad.
2 of 2
05/20/98 14:49:48
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6TH STORY of Level 1 printed in FULL format.
Copyright 1995 Information Access Company,
a Thomson Corporation Company
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Harvard Medical School Health Publications Group
Harvard Health Letter
November 1, 1995
SECTION: No. 1, Vol. 21; ISSN: 1052-1577
LENGTH: 943 words
HEADLINE: MILESTONES: Health Letter Celebrates 20 Years
BODY:
Years ago people didn't think twice about bending over for a shot, even if
they hadn't been told what was in the syringe or how it might help. Today, no
self-respecting doctor or patient would be satisfied with such an encounter.
In 1975, when the first issue of the Harvard Health Letter was published,
people were just beginning to question the absolute authority of doctors and to
demand a more active role in their own care. The new publication was the
brainchild of Timothy Johnson, a Harvard physician who went on to become medical
editor for ABC News, and Stephen E. Goldfinger, faculty dean for continuing
education at Harvard Medical School and now editor in chief of the Health
Letter.
Dr. Johnson envisioned a newsletter that would use Harvard's tremendous
resources to bring state-of-the-art medical information to the general public,
much as continuing education courses do for physicians. This proposal struck a
chord with Dr. Goldfinger, who already felt that old-fashioned paternalistic
medicine, in which the doctor's word was law, was not the best approach for
patients.
A skeptical era
The consumer activism that took hold in the 1960s set the stage for the
Health Letter. Just as Ralph Nader's shocking revelations about automobile
safety made people more demanding of car makers, scandalous news had undermined
public trust in the medical establishment. In 1973, for example, people read
about government doctors who had left African-American participants in a
syphilis experiment untreated for years and about physicians who sterilized
mentally retarded girls against their will.
It was a tumultuous time. New diagnostic tools and treatments were
proliferating, hospitals were getting larger and more intimidating, and doctors
had been taught that educating patients was less important than ordering the
right test and deciding which drug to use. On television people saw doctors and
patients disagreeing about which operation for breast cancer was best, but had
no way of evaluating what they heard.
And who could they trust? In 1973 the American Hospital Association (AHA)
released a document called a Patient's Bill of Rights which appeared to promise
the kind of humanistic care people really wanted. Then the AHA disappointed many
people when it told hospitals that implementing the edict was voluntary.
PAGE
56
Harvard Health Letter November 1, 1995
No wonder consumers were beginning to feel that hospitals and clinics, like
car dealerships, were places where they were truly on their own. The founders of
the Health Letter felt that they could address these concerns, at least in some
modest way. "We wanted to empower people to make better lifestyle and preventive
medicine choices, Dr. Johnson recalled, "and we wanted them to understand
better what was happening to them when they entered the health care system. "
A growth process
Dr. Johnson expected that large corporations would purchase multiple copies
of this new publication, then distribute it as part of a corporate health and
fitness program. For the first couple of years, this marketing approach reached
about 20,000 readers. Once magazines and newspapers began writing about the
newsletter, originally a four-page monthly called the Harvard Medical School
Health Letter, individual subscriptions caught on. By the time the Health Letter
celebrated its eighth birthday, it was reaching about 300,000 people.
William Ira Bennett, another Harvard physician who now divides his time
between magazine editing and the practice of psychiatry, steered the newsletter
through most of the 1980s. An unprecedented explosion in biomedical knowledge
made it harder than ever for doctors and patients to stay current, and the
Health Letter used its insider's view to stay ahead of the curve. It grew from
six to eight pages, added staff to meet the demands of an increasingly
sophisticated readership, changed its appearance, and shortened its name. It was
also during this era that dozens of similar publications, started by medical
schools and universities across the nation, began following in its footsteps.
A closer look
In recent years, the Health Letter has added quarterly special supplements
that tackle major medical topics or take an in-depth look at the quality, cost,
or availability of health care. For each of the past four years, the Harvard
Medical School faculty members who serve on the advisory board have worked with
us to rank the 10 most important advances in medical research reported during
the previous 12 months. This exercise helps readers (and editors, too) step back
and take the long view.
The Health Letter continues to evolve in both form and content, and future
subscribers may have the option of reading it on their computer screens. Still,
Dr. Bennett is struck by how true the Health Letter has remained to its original
mission. Every month it brings timely and accurate information to readers in an
understandable and useful form, and it still relies on the resources of Harvard
Medical School to do this.
Articles reflect the contributions of writers, Health Letter editors, and
Harvard faculty. They are reviewed before publication by the advisory board and
other expert consultants who generously donate their time and knowledge.
This issue marks the beginning of the Health Letter's third decade of
publication--a milestone that its founders never expected to celebrate when they
pasted up those early issues in a tiny office at the medical school. What has
given this publication such longevity, of course, is the loyalty of our
subscribers. Thank you for being our life force.
PAGE 57
Harvard Health Letter November 1, 1995
--PATRICIA THOMAS
COPYRIGHT 1995 President and Fellows of Harvard College
LANGUAGE: ENGLISH
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LOAD-DATE: January 06, 1996
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48
3RD STORY of Level 1 printed in FULL format.
Copyright 1997 Information Access Company,
a Thomson Corporation Company
IAC (SM) Newsletter Database (TM)
Faulkner & Gray, Inc.
Medicine & Health
interesting
May 5, 1997
SECTION: No. 18, Vol. 51; ISSN: 1047-8892
article
LENGTH: 2597 words
HEADLINE: Managed Care Brings Danger and Opportunity for Research
BODY:
The transformation of the health care marketplace by managed care presents
both challenges and opportunities for clinical research. As academic medical
centers (AMCs) restructure themselves to compete more effectively in an
aggressively bottom-line-oriented environment, it remains unclear how research
activities will be sustained in the future that historically have been supported
by clinical revenues to a degree that remains the subject of debate.
In a paper published in Health Affairs in Fall 1996, Robert E. Mechanic and
Allen Dobson of The Lewin Group concluded "that managed care has had a limited
impact on clinical research so far, but that economic forces affecting AMCs may
dramatically alter the future research environment." An informal survey by the
National Institute of Allergy and Infectious Diseases (NIAID) of the impact of
managed care on its research grantees found that most of them could be described
as "the worried well"--not yet feeling any negative effects but concerned about
what the future may hold.
At the same time, a consensus is developing that the growing influence of
managed care over the clinical research agenda could be a boon for
populationbased research and research that focuses on disease prevention,
clinical effectiveness, and outcomes.
"It will be increasingly possible to tap populations for clinical research
that you couldn't tap before," " said Merwyn R. Greenlick, former director of
Kaiser Permanente's Center for Health Research in Portland, Oregon, and chair of
the department of public health and preventive medicine at Oregon Health
Sciences University. "The potential is quite enormous."
The emergence of a strong managed care sector "constitutes some special
opportunities for clinical research that really haven't been there before,' said
Tom Inui, MD, chair of the department of ambulatory care and prevention at
Harvard Medical School and national director of Health of the Public, which
promotes population-oriented research at AMCs. "While there's a lot of pain
involved in the restructuring, there are important scientific reasons why we
need to move in this direction if we want to maximize the value of the research
product for the public," Inui says Central to the debate about the impact of
managed care on clinical research is what David A. Burnett of the Illinois-based
University HealthSystem Consortium (UHC) has described as "the intricate web of
relationships that exists across and within the clinical and research components
of AMCs." Persistent skepticism by some outside observers about the extent to
which AMCs' clinical revenues are being squeezed by managed care as well as
PAGE
49
Medicine & Health May 5, 1997
the extent to which those revenues have been used to support clinical research
has pressured AMCs to document these effects more precisely.
By the Numbers
Both UHC and the Association of American Medical Colleges (AAMC) have made
efforts to supply the objective data that is needed. Burnett reported in the
Fall 1996 issue of Health Affairs that a UHC analysis of financial data for its
70 AMC members, found effects that vary with market maturity; and "that when
health care markets move from Stage 3 (provider consolidation) to Stage 4
(managed competition), managed care has a dramatic impact on AMC hospitals."
Between 1991 and 1994, "hospitals in Stage 2 (loose framework) and Stage 3
markets experienced increases of 10.8 percent and 9.4 percent in net hospital
revenue per discharge, respectively. During the same time, hospitals in markets
that had moved into Stage 4 experienced a 7.2 percent decrease in net hospital
revenue per discharge.' In 1995 UHC tentatively identified 13 member markets at
Stage 4 compared with only one (Minneapolis) in 1993-94.
In a study published in Academic Medicine in March 1996, Robert F. Jones and
Susan C. Sanderson of AAMC estimated that 28 cents of every dollar of revenue
generated by medical schools' faculty practice plans (FPPs) supported academic
programs. Generalizing to all medical schools on the basis of data from 60
institutions, they estimated that FPPs provided $ 2.4 billion in support for
teaching and research activities in fiscal year 1993 arid that $ 816 million of
this amount supported faculty research while the balance supported education and
other academic programs.
A November 1996 report by a AAMC task force on medical school financing found
that aggregate medical school revenues, including revenues from FPPs, continued
to increase through 1994-95, although the rate of increase has slowed. The task
force attributed the increase to several factors, including more complete
reporting of FPP revenues and an increase in clinical effort by faculty members.
Average FPP revenues per clinical faculty member have remained flat in
constant dollar terms since 1992, the task force concluded. Moreover, medical
schools in areas of high HMO penetration saw their FPP margins decline from 20
percent in 1991 to 9 percent in 1995. Over the same period, FPP margins at
medical schools in areas of low HMO penetration remained relatively constant at
between 10 and 14 percent.
Critics note that because no two medical schools do their financial
accounting in the same way, uniform data on which to base these analyses are
sparse. The AAMC task force acknowledges that the financial data schools are
required to report provides limited information about changes in discretionary
revenues over time. "The lack of these data or of other measures of financial
health commonly used in industry, such as marginal cash flow, liquidity, and
access to capital, presents a major obstacle to responsive policy formulation."
Among public medical schools, reliance on clinical cross-subsidies may depend
on the level of state support received. A financial analysis conducted by Penn
State College of Medicine found that 60 percent of the college's budget comes
from clinical income. In 1994-95, the college received $ 4.5 million in state
support--less than any of the nation's 75 public medical schools. The median
level of state support was $ 36.7 million.
PAGE
50
Medicine & Health May 5, 1997
Another 21 percent of the Penn State medical college's budget came from
external research grants. However, C. McCollister Evarts, dean of the medical
college, reckons that grants cover at most 90 percent of the cost of sustaining
the college's research programs.
There are many reasons why external grants do not cover the entire cost of an
institution's research enterprise, according to Samuel Silverstein, chair of the
physiology department at Columbia University School of Medicine. Laboratory
equipment and staff must be maintained continually, whereas grants provide
funding for fixed periods of time.
Because of the high level of competition for research grants (roughly one in
five National Institutes of Health grant applications receives funding), even
the most distinguished investigators can find themselves temporarily without
external funding, said Silverstein. "Even Nobel laureates have grant problems at
times. In addition, external funders usually will not pay for the collection of
preliminary data, even though investigators need such data to support a research
grant application.
"AMCs feel that they are victims of unfair competition," said David
Blumenthal, MD, head of the health policy unit at Massachusetts General Hospital
and a professor at Harvard Medical School, at a recent National Institutes of
Health-sponsored conference on managed care and clinical research. Blumenthal
expressed what many associated with AMCs probably feel: When forced to compete
solely on the basis of price with institutions that do not bear the
responsibility (and costs) of research, education as well as patient care, they
are at a disadvantage.
In addition, AMCs provide about half of all indigent medical care in the
United States--a responsibility that often represents a heavy financial burden.
Survival Strategies
A February 1997 article in the Journal of the American Medical Association by
John I. Gallin, MD, director of the NIH Clinical Center, and Helen L. Smits, MD,
formerly with the Health Care Financing Administration, describes a variety of
management strategies common to AMCs that are successfully coping with the
changed health care delivery environment.
Prominent among these strategies are replacing traditional academic,
consensus-based management structures with streamlined corporate-style
leadership models that permit quick, decisive action; aggressively pursuing more
efficient purchasing and contracting arrangements; investing heavily in
information systems that enable precise tracking of costs and revenues for
clinical services, research, and education; affiliating with managed care plans
or setting up their own; and setting up clinical research institutes intended to
generate revenue by conducting clinical trials for the pharmaceutical and
biotechnology industries.
Among other advantages, alliances with managed care organizations offer AMCs
access to patients in remote, outpatient, and ambulatory care settings where
many health care services that used to require hospital admission are now being
provided.
PAGE
51
Medicine & Health May 5, 1997
A subset of managed care plans, predominantly not-for-profit groupand staff
model health maintenance organizations, have a history of involvement in
clinical research that stretches back to the 1950s. Some of the earliest
randomized controlled trials of routine mammography to detect breast cancer were
conducted by the Health Insurance Plan of Greater New York in the 1960s and
1970s.
Edward H. Wagner, MD, is director of the Center for Health Studies and the
MacCell Institute for Healthcare Innovation at Group Health Cooperative (GHC) of
Puget Sound and chair of the HMO Research Network, a group of HMO-based research
centers formed in 1996. In addition to GHC, network members include Harvard
Pilgrim Health Care, Henry Ford Health System, and several Kaiser Permanente
regional divisions. HMO Research Network members currently hold NIH research
grants and contracts worth an estimated $ 25 million a year.
The HMO research setting "is characterized by a large defined population,
good computerized health data on every member of that population, and a high
interest in prevention and primary care, said Wagner. Because of those
characteristics, HMO-based research centers tend to do population-based
epidemiologic and health services research that focuses on disease prevention
and on common health problems encountered in primary care practice.
Wagner is currently spending about half of his time on a fellowship jointly
sponsored by the National Institutes of Health and the American Association of
Health Plans, working on how to increase managed care organizations'
participation in NIH clinical studies.
Large defined populations and good computerized health data are precisely the
characteristics of managed care organizations that make them attractive to
people like Lawrence Deyton, MD, acting director of extramural research at
NIAID.
For example, Deyton said, to learn how effective a new vaccine is or how to
make the best clinical use of a new medication (such as the new protease
inhibitors in AIDS treatment) "requires a study that would need tens of
thousands of patients and cost NIH millions of dollars." For NIH to collaborate
on such a study with a large managed care organization that had a unified
patient database could be mutually beneficial, said Deyton.
"Managed care organizations want to know how to deliver the best quality care
most efficiently. That's of interest to NIH, too. You can also learn a lot about
mechanisms of action and disease processes from those kinds of trials, so you
get two bangs for the buck."
Lost In Translation?
While many in clinical research agree that a greater emphasis on clinical
effectiveness research is overdue, they worry that the shift will come at the
expense of research that endeavors to translate advances in basic science into
improvements in patient care. "Translational" research is essential to moving
clinical innovations into practice, said Blumenthal, but this type of
research--by definition somewhat speculative--has relied the most on
cross-subsidies for support.
PAGE
52
Medicine & Health May 5, 1997
Roger Meyer, MD, senior consultant on clinical research for AAMC, draws an
analogy with the practice of "carving out" coverage of mental health and other
specialty services. "To the degree that you carve out clinical trials and
outcomes research, you are disconnecting what has been an iterative process of
scientific advancement. II
Meyer also notes that clinical trials and outcomes research are more likely
than translational research to ultimately be profitable. "If you carve out
whatever profitability there is, AMCs will be left to bear "the costs
associate. d with knowledge development."
Another fear is that, as faculty members spend more time on clinical work to
generate income, they will not have the time to devote to research--or they may
be discouraged from devoting time to research because it reduces their clinical
productivity.
From managed care's perspective, these concerns may or may not be valid, but
they don't alter the fact that health care payers are no longer willing to pay
the premium that AMCs have traditionally charged for their clinical services. A
recent study commissioned by the American Association of Health Plans, for
example, found that while capitated health plans pay major teaching hospitals
about $ 1,000 per discharge more than they pay non-teaching hospitals, capitated
plans pay such hospitals $ 2,200 less per case than private fee-for-service
insurance does. "AMCs don't seem to understand the pressure we are under from
the people who buy Our Services,' said Wagner. "Raising premiums is just not an
option in many marketplaces."
Greenlick, who has lived on both sides of the divide between managed care and
academic medicine for 30 years, said that AMCs are now paying the price for
their failure to explicitly account for the costs of research in the past. "I
don't think it's appropriate to finance clinical research out of patient care
dollars,' he said. "That's not the same as running an efficient practice, making
a profit, and using that profit explicitly to support research and education.
That's the direction AMCs are trying to take now, and that should have come 25
years ago."
The next two to three years represent an important transition period for AMCs
that may set the course for the future of clinical research in the United
States. Two prospective studies supported by the Commonwealth Fund may provide
significant insights into how both AMCs and their individual faculty members
adapt to a radically different environment.
Blumenthal is leading a study that focuses on how AMC faculty members are
affected by the swirl of change occurring around them. Through surveys to be
conducted three years apart, he is endeavoring to quantify changes in how
faculty members allocate their time among research, teaching, and clinical work
and the extent to which their research budgets are funded by internal rather
than external sources.
Institutional change is the focus of an AAMC study that is using data
collected from a "sentinel" network of 14 AMCs around the country. Paul Griner,
MD, who heads the AAMC's Center for the Assessment and Management of Change in
Academic Medicine, said: "We hope to identify creative approaches that AMCs are
taking to respond to the challenges they face. Eleanor Mayfield, Silver
Spring MD
PAGE 53
Medicine & Health May 5, 1997
COPYRIGHT 1997 Faulkner & Gray
LANGUAGE: ENGLISH
IAC-ACC-NO: 03657754 ND
LOAD-DATE: May 19, 1997
38TH STORY of Level 1 printed in FULL format.
Copyright 1998 Globe Newspaper Company
The Boston Globe
Articleabant
January 18, 1998, Sunday, City Edition
SECTION: ECONOMY; Pg. C1
LENGTH: 2397 words
It
is
HEADLINE: A doctor's heart, CEO's skill;
Partners Healthcare chief's passion is driving force behind firm's success;
first
2 pages
EXECUTIVE FOCUS / SAMUEL O. THIER
BYLINE: By Kimberly Blanton, Globe Staff
BODY:
Samuel O. Thier has transformed even the Sunday crossword puzzle into a
competitive sport - racing with his sister to finish first. And he revels in a
good controversy: From the helm of the Institute of Medicine in Washington a
decade ago, he lobbed politically explosive reports on AIDS and breast cancer at
Capitol Hill.
But if the chief executive of Partners Healthcare System Inc. has a singular
passion, it is neither competition nor politics. It is medicine.
That passion, sparked as a boy while accompanying his physician father on
house calls in his Brooklyn neighborhood, is still stoked, once a month, when
Dr. Thier makes rounds at Massachusetts General Hospital, where he once served
as chief resident.
Partners Healthcare - operator of Massachusetts General and Brigham and
Women's Hospital - is thriving under the doctor's care.
Thier, whose career as an executive is guided by his experience as a
physician, has successfully engineered the unwieldy 1994 merger of two of the
nation's most prestigious academic teaching institutions, Mass. General and the
Brigham. He has done SO using a combination of supreme self-confidence - some
say intimidation - a wicked sense of humor from which few are spared, and a
clear vision of what he wants to achieve.
In the four years since he joined Partners, its fund-raising. hospital
admissions, and spending on treatment of the uninsured have all risen, Mass.
General and the Brigham consistently have pulled in more National Institutes of
Health grants for medical research than any other US hospital, as they have for
more than a decade.
"He is a doctor and he has an interest in medicine - much more SO than any
other hospital administrators," said philanthropist Melvin Nessel, who gave $ 10
million last year to Mass. General for a cancer center after his wife received
treatment there. "If it hadn't been for Dr. Thier, I would not have made this
gift."
But Thier, who reluctantly left his perch as president of Brandeis University
to commandeer the hospital merger, has also used Partners as a platform from
which to promote a much bigger agenda: protecting medical research and
PAGE
42
The Boston Globe, January 18, 1998
teaching, the soul of the US health care system, from the menacing financial
pressures of managed care and federal budget cuts.
"I didn't need any more chevrons, Thier said in a recent interview as he
explained why he left Brandeis to join Partners. "The reason I'm back in this is
I don't like what's happening in medicine."
Thier, 60, is much sought after as a super-administrator - in recent years he
received overtures from at least three prestigious universities. That was hardly
true when he finished medical school at a university with a modest reputation,
State University of New York in Syracuse.
A stellar student, Thier was 16 when he finished high school at James Madison
High in Brooklyn, launching pad for luminaries such as US Supreme Court Justice
Ruth Bader Ginsburg, Nobel laureate in economics Robert Solow, and actor Martin
Landau. He went on to Cornell University and graduated first in his 1960 class
at medical school by age 21.
Despite these distinctions, he was an underdog in competing for a residency
at Mass. General against graduates of Harvard University and other top-drawer
medical schools. But the marginal candidate impressed skeptical committee
members during his interview, launching into a cocky monologue on hemophilia -
he had happened to read about the blood disorder the day before in the library
of another hospital while waiting for an interview.
Thier's acceptance was no fluke: He was selected to the prestigious post of
chief resident in his final year of training and scored highest on the national
boards for internal medicine.
Working with Mass. General's best and brightest in the 1960s provided an
intellectual challenge unlike any Thier had experienced since his late-night
debates as a child with his father. And it opened doors for Thier - he was
recruited for academic postings at the University of Pennsylvania's medical
school and then Yale and the National Academy of Sciences in Washington - and
created a debt he said he is now repaying. When Mass. General called, Thier
said, "it was like having your family say you've got to come home and help. What
are you going to say? 'No'?"
Commitment to free care
What becomes obvious to anyone who spends time with Thier is that he really
does give a damn about the quality of care given to the more than 1 million
patients treated at Partners' hospitals every year. Thier has boosted the budget
for community health programs. He is "committed with every fiber of his being"
to free care for those unable to pay, said Matt Fishman, community health
director at Partners.
And he is fascinated by complex medical cases, which present the type of
diagnostic mystery Thier loves to solve. On a recent December morning, Thier,
crowded into a small office at Mass. General with residents and students, delved
into details of a case of an elderly man with a liver abscess. (It was later
found to be caused by a leaky intestine.)
Thier clearly enjoyed the role of teaching, punctuating the discussion with
medical jokes. When told the patient had diagnosed himself as having
PAGE
43
The Boston Globe, January 18, 1998
"molecular ice" caused by living on the bitter cold North Shore, Thier shot
back, "Sounds like Kurt Vonnegut." His sharp wit is just as often aimed at
himself. Squinting at an X-ray of a man's bowel, Thier laughed, "Once you get to
trifocals there is no proper distance."
In the patient's room, Thier's edge softens as he leans over the bed, asking
questions about his drinking habits, his bowel movements, his golf game. The
patient plays golf with a group of men - all over age 80. "Someone has to
remember where the ball went," Thier quips. Before leaving the patient's room,
Thier offers some comforting words and encouragement.
It is classic Dr. Thier.
Defies stereotypes
Partners' physicians and executives have found their boss cannot be
pigeon-holded. He can be intimidating, colleagues and underlings say, and then
turn on the charm.
Ellen Zane, who came to Partners from Quincy Hospital to take on the
formidable job of building, from the ground up, a network of 1,000 physicians
linked to Partners and its hospitals, said Thier never wavered in his support.
The job "would've been impossible without his incredibly deep, sincere,
forthright support," said Zane.
He can be a withering intellectual opponent.
Under the pressures of Partners, his biggest career challenge yet, Thier's
impatience flares with those who don't keep pace with his racing thoughts or
meet his perfectionist demands. "Every time I leave a meeting with him, I feel
talked down to. It's not something that's a secret in this industry," said one
health care executive. Yet Thier once surprised a Partners executive by calling
to thank him for challenging him in a meeting. The executive had lost the
argument.
As chairman of the department of internal medicine at Yale from 1975 to 1985,
he was called "Fear Thier" and "Syncope Sam" - syncope is a medical term for
fainting, which is what one Yale medical student did under questioning by Thier
about a patient.
"He's very aggressive and very charismatic," said Dr. Norman Marieb, a
professor at the Yale New Haven Hospital. "When he wants something he goes after
it and doesn't pull any punches. He's honest. He's fair. But he's very direct.
There are some people who shake a little bit at that."
Thier's loyalty and high expectations, said another colleague, means "You
don't want to let Sam down. He has a unique ability to instill that."
Underneath Thier's sturdy intellect and a driving ambition is a man as
devoted to the women in his life as he was to the Brooklyn Dodgers baseball team
as a boy until they broke his heart by losing to the New York Giants in the 1951
pennant race. His daughters - one an environmentalist, one an intellectual
property attorney, and one a medical journal editor - call him often for career
advice. He is proud of his wife's own professional accomplishments. Paula Thier
was membership coordinator for the National Trust for Historic Preservation
PAGE
44
The Boston Globe, January 18, 1998
during their years in Washington, before moving to the Chestnut Hill section of
Newton. "People would look at me and say, 'Are you Paula Thier's husband?' "
Thier says, grinning.
Thier and a friend once acted as yentas, matching up his colleague at Yale
with her recently divorced girlfriend. Thier enthusiastically agreed to fly to
San Francisco to dine with the couple and "encourage them and make sure he took
her to a fancy place, recalled Thier's friend and co-conspirator, Barbara J.
Culliton. The matchmaking scheme worked: The couple married.
The Washington years
At Partners, Thier is using political skills honed during years in
Washington. The registered Independent arrived in Washington and allied himself
with Senator Ted Kennedy, the senior Democratic senator from Massachusetts, C.
Everett Koop, the former US surgeon general, and others. He put the obscure
Institute of Medicine, the medical research arm of the National Academy of
Sciences, on the political map. According to a 1987 article in The Wall Street
Journal, "When Institute of Medicine Speaks, People Listen."
His agency's reports became known in Congress as the gold standard of precise
and unbiased analysis. A seminal 1986 report on AIDS riveted lawmakers'
attention to the dimensions of the public health issue for the first time.
Another report spotlighted the absence of breast cancer research by the National
Institutes of Health. "Sam Thier put his finger on it," said Nick Littlefield,
Kennedy's former chief counsel. "It was like a bomb went off in Washington.
In any job, Thier has an unerring sense of how to fix a problem. When asked
to join Brandeis in 1992, a secular, Jewish-sponsored university, to
reinvigorate its flagging finances and burnish its reputation, Thier, who is
Jewish, thought, simply, "I can fix this." Quoting playwright Goethe during his
inauguration speech at Brandeis, Thier said, "You must labor to possess that
which you have inherited."
Fix it he did. During a brief tenure at Brandeis, he repaired what one
professor called its "inferiority complex" by lifting faculty morale and putting
the university on sounder financial footing. "Sam is clearly a leader,' said
Jehuda Reinharz, Brandeis's current president.
Partners has given Thier a new platform from which to again influence
national health care policy.
When Congress, debating the budget last year, eyed federal funds used by
hospitals to subsidize faculty and research, Thier mobilized his cohorts at
teaching hospitals around the country and successfully blocked the cuts, arguing
reductions would devastate important medical research.
Thier has been just as good at negotiating office politics and merging Mass.
General and the Brigham, with their star-studded rosters of physicians. He has
been fearless about making unpopular decisions, such as reducing the numbers in
the hospitals' joint residency program; the cuts meant longer hours and bigger
patient loads for staff physicians. Thier "stepped into a snakepit," said Dr.
Martin Solomon, a prominent physician at Beth Israel Deaconess who knows him. He
"prevented them from cutting each other's throats."
PAGE
45
The Boston Globe, January 18, 1998
The decision to merge Mass. General and Brigham and Women's, made before
Thier joined the system, rocked the health care world. But Thier was left to
field criticism inside Boston's medical community thats has shrunk, according to
the consulting firm Coopers & Lybrand.
Thier has another view: Partners's business strategy is key to protecting the
hospitals' tradition of pioneering surgery and medical research, which includes
the first use of ether as an anesthetic during surgery in the United States and
the world's first organ transplant.
Because of the high costs and the relatively small revenue generated by
teaching and research, academic medical systems are costly to operate. Financial
pressures on teaching hospitals have increased in recent years amid cost-cutting
by insurers and reductions in federal reimbursements for Medicare and Medicaid
patients by Congress.
To husband cash for teaching and research, Thier has slashed $ 180 million
from Partners' budget, which was $ 2.1 billion last year. Thier was ruthless in
merging administrative staffs of both hospitals, though he has coddled medical
staff and barely merged clinical operations.
The Mass. General-Brigham merger was an experiment that put Partners in the
vanguard of academic medical centers in a battle against insurance companies
squeezing them to provide health care services at lower and lower cost. Thier
has further bolstered Partners's clout with insurers by building, to date, an
844-physician network that can refer patients to its hospitals.
"The point I want to make is there isn't anything remotely close to" the
stature of the two academic medical centers in New England, Thier said. "And we
have to maintain that.
1:
Occupation: Chief executive, Partners Healthcare System Inc., operator of
Massachusetts General, Brigham and Women's, and McLean hospitals; North Shore
Health System; and Spaulding Rehabilitation Hospital.
Born: June 23, 1937, Brooklyn, N.Y.
Family: Wife, Paula Thier, and daughters, Audrey, Stephanie, and Sara.
Medical school: State University of N.Y., Syracuse, 1960.
Biggest accomplishment: Chief resident at Mass. General.
Childhood memory: The Brooklyn Dodgers loss to the New York Giants in 1951
pennant.
Weekend activities: Tennis with anyone and Boston Celtics games with
grandchildren.
Literary leanings: British playwright Richard Brinsley Sheridan.
2: Partners Healthcare System under Thier
PAGE
46
The Boston Globe, January 18, 1998
1995 1996 1997 Fund-raising $ 37.9m $ 51.1m $ 59.0m Market share1 NA 14.97%
15.28%2 Spending on uninsured patients $ 93.1m $ 104.2m $ 107.0m2 Research
funding3 $ 326.1m $ 339.1m $ 354.4m
1 Mass. General/Brigham share of acute-care hospital admissions in Eastern
Massachusetts
2 Estimate
3 Research funding from National Institutes of Health and other sources. NA
not available SOURCE: Partners Healthcare System Inc. and Coopers & Lybrand
GLOBE STAFF CHART
GRAPHIC: CHART PHOTO, 1. Partners CEO Samuel O. Thier visits with patient Donald
Monell, 80, of Gloucester. Thier still makes rounds once a month at Mass.
General Hospital, where he once served as chief resident. / GLOBE STAFF
PHOTO/PAM BERRY 2. Dr. Thier: "The reason I'm back in this is I don't like
what's happening in medicine." GLOBE STAFF PHOTO/PAM BERRY
LANGUAGE: ENGLISH
LOAD-DATE: January 22, 1998

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    "ocrText": "FOIA Number:\n2006-1733-F\nFOIA\nMARKER\nThis is not a textual record. This is used as an\nadministrative marker by the William J. Clinton\nPresidential Library Staff.\nCollection/Record Group:\nClinton Presidential Records\nSubgroup/Office of Origin:\nFirst Lady's Office\nSeries/Staff Member:\nSpeechwriting\nSubseries:\nLaura Schiller: Events, Meetings 5/98 - 7/98\nOA/ID Number:\n24611\nFolderID:\nFolder Title:\n[Harvard Medical School - 6/4/98][Folder 1][2]\nStack:\nRow:\nSection:\nShelf:\nPosition:\nS\n60\n7\n8\n2\nWithdrawal/Redaction Sheet\nClinton Library\nDOCUMENT NO.\nSUBJECT/TITLE\nDATE\nRESTRICTION\nAND TYPE\n001. resume\nAddress (Partial) Phone No. (Partial) (1 page)\nn.d.\nP6/b(6)\nCOLLECTION:\nClinton Presidential Records\nFirst Lady's Office\nSpeechwriting (Laura Schiller: Events, Meetings 5/98-7/98)\nOA/Box Number: 24611\nFOLDER TITLE:\n[Harvard Medical School - 6/4/98][Folder 1][2]\n2006-1733-F\nbm701\nRESTRICTION CODES\nPresidential Records Act - |44 U.S.C. 2204(a)]\nFreedom of Information Act - [5 U.S.C. 552(b)]\nP1 National Security Classified Information [(a)(1) of the PRAJ\nb(1) National security classified information [(b)(1) of the FOIA]\nP2 Relating to the appointment to Federal office [(a)(2) of the PRA]\nb(2) Release would disclose internal personnel rules and practices of\nP3 Release would violate a Federal statute |(a)(3) of the PRA]\nan agency [(b)(2) of the FOIA]\nP4 Release would disclose trade secrets or confidential commercial or\nb(3) Release would violate a Federal statute |(b)(3) of the FOIA]\nfinancial information [(a)(4) of the PRA]\nb(4) Release would disclose trade secrets or confidential or financial\nP5 Release would disclose confidential advice between the President\ninformation [(b)(4) of the FOIA]\nand his advisors, or between such advisors [a)(5) of the PRA\nb(6) Release would constitute a clearly unwarranted invasion of\nP6 Release would constitute a clearly unwarranted invasion of\npersonal privacy [(b)(6) of the FOIA]\npersonal privacy [(a)(6) of the PRA]\nb(7) Release would disclose information compiled for law enforcement\npurposes |(b)(7) of the FOIA]\nC. Closed in accordance with restrictions contained in donor's deed\nb(8) Release would disclose information concerning the regulation of\nof gift.\nfinancial institutions |(b)(8) of the FOIA]\nPRM. Personal record misfile defined in accordance with 44 U.S.C.\nb(9) Release would disclose geological or geophysical information\n2201(3).\nconcerning wells |(b)(9) of the FOIA]\nRR. Document will be reviewed upon request.\nJUN-02-1998 16:58\nHMS ALUMNI OFFICE\n617 432 1560 P.01\nHARVARD MEDICAL ALUMNI ASSOCIATION\n5\nCO\n25 SHATTUCK STREET\nBOSTON, MASSACHUSETTS 02115\n(617) 432-1560\nFAX (617) 432-3366\nOFFICE OF THE DIRECTOR\nPlease forward to Ms. Laura Schiller\nDear Ms. Schiller:\nHere are the responses from our graduates who might be called upon by the First Lady:\nComing to hear the First Lady:\nDr. Maria Alexander Bridges\nDr. Kenneth Roland Bridges\nDr. Dewayne Pursley\nDr. Steven Weinberger\nDr. Frank Lepreau\nDr. Orah Platt\nDr. Martha Tracy\nDr. William Chin (most probably)\nDr. Marshall Wolf (most probably)\nDr. Alison May (most probably)\nDefinitely not coming:\nDr. Eric Chivian\nDr. Judah Folkman (will be in Helsinki and very much regrets he won't be there)\nDr. David Ho\nSincerely,\nKm KmKen Nora N. Nercessian, Ph.D.\nExecutive Director of Alumni Relations\nTOTAL P.01\nMAY-22-1998 17:04\nHMS ALUMNI OFFICE\n617\n432\n1560\nP.02\nMARIA ALEXANDER BRIDGES (HMS Class of 1980) and Kenneth Roland Bridges\n(HMS class of 1976); both are African-Americans. Dr. Maria Alexander Bridges conducts\nbasic laboratory research in reproduction and Diabetes; Dr. Kenneth Bridges is a researcher\nin the mechanisms underlying blood diseases.\nWILLIAM W. CHIN is an Asian-American who graduated Harvard Medical School in\n1972. He conducts research in how hormones work and works toward the development\nof clinical genetics in an adult population and \"translate\" advances in the genetic basis of\ndisease to the bedside in the areas of diagnosis and treatment.\nJUDAH FOLKMAN, a graduate of 1957, teaches pediatric surgery and cell biology; in\nresearch, he is credited with truly novel approaches to the treatment of cancer.\nMARSHALL WOLF, who graduated HMS in 1963, is a physician and is recognized a\nteacher excellence. He is a teacher of young men and women in residency training.\nERIC CHIVIAN graduated HMS in 1968 is a psychiatrist who is the founder and director\nof the Center for Health and the Global Environment at Harvard Medical School. He was\nco-founder of the Society of International Physicians for the Prevention of Nuclear War.\nReceived the Nobel Prize in 1985.\nSTEPHEN WEINBERGER graduated in 1973. He is involved in patient care, teaching\nand research. His research is in the area of critical care and pulmonary disease.\nMARTHA TRACY graduated in 1973 is an oncologist who devotes 100% of her time to\npatient care. She is a private pilot who uses her flying peripherally for medicine--lifeline\nflights, flying doctors, etc.\nORAH PLATT graduated in 1973 and is the Master of one of the academic societies at\nHarvard Medical School. She is a leader in research of sickle cell disease.\nALLYSON G. MAY graduated in 1991. She is an African-American who has recently\ncompleted her residency training and has joined a practice that serves the underserved\npopulations in the inner city in Boston, working through the Healthcare for the Homeless\nProgram and the community health center.\nDAVID HO is an Asian-American who graduated in 1978, and is a member of the\nCommittee of 100, a Chinese-American leadership Organization. He is a leader in the\nresearch and science of AIDS. He was cited as Man of the Year in Time Magazine (1996).\nDEWAYNE PURSLEY is an African American who graduate in 1982. He is a well-\nknown neonatologist, a teacher, physician and researcher and widely known for his\noutstanding clinical care and dedicated teaching in neonatal health services research.\nFRANK LEPREAU graduated in 1938. He has worked in Haiti, rural Appalachia, and\ncurrently, although retired, works with AIDS and Rehab patients in Providence, RI. He\nwas, before retirement, Professor of Medicine at Brown University.\nTOTAL P.02\nMAY-21-1998 17:02\nHMS\n617 432 3912\nP.18\nOATH OF THE CLASS OF 1998\nHARVARD MEDICAL SCHOOL - HARVARD SCHOOL OF DENTAL MEDICINE\nPrepared by the Oath Committee of the Class of 1998\nRatified by the Class on 14 May 1998\n'Please read Physician or Dentist as appropriate\nDean:\nMembers of the Class of 1998, please rise.\nI now invite you. as a class, to affirm your commitment to the profession of\nMedicine or Dentistry and to articulate the ideals and principles that will\nguide you in the years ahead.\nClass:\nToday, in the presence of family, friends, teachers, and colleagues,\nI dedicate myself to the profession of Medicine.\nI pledge myself,to the service of humanity.\nI will use my skills to care for all in need, without bias and with openness of spirit.\n.\nThe health of my patients will be my first concern.\nI VOW to hold sacred the bond between doctor and patient.\nI will hold in confidence all that my patients entrust to me.\nI will strive to alleviate suffering.\nI will respect the dignity and autonomy of my patients in living and in dying. @\nAs a Physician/Dentist¹, 1 recognize my duty to society.\nI will work to promote health and to prevent disease. I will advocate for the\nwelfare of my community.\nEven under duress, I will not use my knowledge or my skills against humanity.\nI will acknowledge my limitations and my mistakes so that I may learn from them.\nTo uphold these responsibilities, I will maintain my own well-being and the\nwell-being of those close to me.\nI will promote the integrity of the practice of Medicine.\nIn the tradition of my profession, I honor all who teach me this Art.\nThrough honest and respectful collaboration with my colleagues, I will uphold\nthe highest standards in the service of patients.\nI will seek new knowledge, reexamine ideas and practices of the past, and teach\nwhat I have learned.\nAbove all, the health of my patients will be my first concern.\nThis Oath I take freely and upon my honor.\n05/21/98\n13:03\n301 402 0338\n003/016\nJAMA 100 Years Ago\nMarch 19, 1898\nFATALITY FOLLOWING A CONTROVERSY\nBETWEEN TWO MEDICAL MEN,\nA letter from the University of Bonn\nthem to the argumentum baculinum for\nrecites a tragedy following a difference\nthe adjustment of technical disputes must\nbetween surgeons. An armed encounter\nbe an altogether exceptional occur-\nbetween members of the medical profes-\nrence. Complaints are often heard of the\nsion at this the close of the nineteenth cen-\novercrowding of the medical profession\ntury was certainly not to be anticipated,\non the other side of the channel, but of\nbut the old saying that it is always the\nall the depletory methods the slaying of\nunexpected which arrives has once more\none's confrère is surely the least philo-\nbeen verified. It is only too true that a\nsophic. A duel at the present day is an\nduel was recently fought at Bonn, the\nanachronism. As a mode of settling sci-\ncombatants being both medical practi-\nentific controversy it is not only out of\ntioners, and most unfortunately one of\ndate, but also about the most illogic pro-\nthem met with his death from a penetrat-\ncedure conceivable. Killing an opponent\ning wound of the thorax. It seems that\ndoes not prove the survivor's case; while\ntwo of the assistants of a surgical clinic\nthe gratification of an ignoble feeling of\nnamed Reusing and Fischer, had a vio-\npersonal resentment is dearly pur-\nlent altercation over a professional mat-\nchased at the expense of life-long re-\nter, the former accusing his colleague of\nmorse. The principals in a duel are blame-\nmalpractice in the conduct of an opera-\nworthy, but for them there are excuses,\ntion, and as apparently there was no older\nseeing that most human beings are more\nand wiser person at hand to pour oil on\nor less passionate by nature. For the sec-\nthe troubled waters a hostile meeting en-\nonds, generally speaking, there is abso-\nsued, with the above mentioned deplor-\nlutely nothing to be said. They are sim-\nwww.ama-assi http://www.ama-asst\nYour access to the world of medicine.\nable result. That duels should still sur-\nply the abettors of a crime in which they\nvive on the Continent, especially in\nrun no bodily risk, and it is against them\nmilitary circles is perhaps not to be won-\nthat retributive justice should be mainly\ndered at under the existing regime, but\ndirected. If seconds would only consider\nhappily the vast majority of medical men\nthe heinousness of their position, there\nof all nationalities are the possessors of\nwould soon be an end of dueling.\nwell balanced minds, and recourse among\nJAMA. 1898;30:690\nEdited by Brian P. Pace, MA, Assistant Editor.\nAmerican Medical Association\nPhysicians dedicated to the health of America\nJAMA, March 18, 1998-Vol 279, No. 11\nJAMA 100 Years Ago 832 e\n05/21/98\n13:04\n301 402 0338\n004/016\nBecoming\nA Physician\nDevelopment of Values and\nAttitudes in Medicine\nEdited by:\nEileen C. Shapiro\nLeah M. Lowenstein, M.D., D.Phil,\nBallinger Publishing Company Cambridge, Massachusetts\nA Subsidiary of Harper & Row, Publishers, Inc.\n05/21/98\n13:04\n301 402 0338\n005/016\nChapter 13\nThe Federal Government's\nPhysician Manpower Policies\nEli Ginzberg, Ph.\nProfessional socialization of physicians today occurs in an\nenvironment of increasing federal involvement in and regu-\nlation of the selection, training, and practice options of\nphysicians. The background of this federal involvement is explored\nin this chapter.\nTHE HISTORICAL CONTEXT\nAs the United States approaches the end of the twentieth century,\nit is important to remember the long-term relations between Ameri-\ncan medicine and the federal government that existed from World\nWar I until after World War II. The 1920s were the heyday of con-\nservatism, the era of Harding, Coolidge, and Hoover. Governmental\nofficials in Washington were deeply committed to the belief: \"the\nless government, the better.\" The American Medical Association\n(AMA) was able to operate with little or no challenge from gov-\nemment, consumer, or pressure groups; regulation or legislation\nintended to affect directly the numbers, training, or allocation of\nphysician manpower was no part of the federal agenda. Even in the\nmore radical days of Franklin D. Roosevelt, the President was suf-\nficiently respectful of the power and prestige of the AMA to exclude\nhealth from his Social Security bill, During the New Deal, the AMA\nwas allowed, even encouraged, to play the dominant role in deter-\nmining public policy issues related to physicians. The purpose of the\npresent chapter is to explain those post-World War II events that have\nworked to alter the government's posture toward physician man-\n261\n05/21/98\n13:04\n301 402 0338\n006/016\n262 Public Policy\nThe Federal Govel\npower issues which, in turn, provides the societal context for the pro-\nThe National Institute of M\nfessional socialization of physicians.\nthority to train personnel, bec\nThe relationship between the government and medicine was first\nexpansion of the nation's poc\nchallenged shortly before the outbreak of World War II when Demo-\ncongressional concern with \"II\ncrats in Congress unsuccessfully sought the passage of a national\ncialty and geographic location,\nhealth insurance bill. In the late 1940s President Truman supported\n1950s through the 1960s the N\na second attempt, which also failed. Determined to find some way to\neral practitioners, pediatricians\nimprove the health care received by the American people, Mr. Tru-\nspecialists qualify as psychiatri\nman then appointed what came to be known as the Magnuson\nsupport was the continuing ac\nCommission, named after its chairman, which issued its report\nmental hospitals. However, the\nshortly before Truman left office. The commission recommended a\nnewly minted psychiatrists esta\nlarger role for the government in increasing the supply of health re-\naffluent with psychoanalytic te\nsources, sponsoring research, and financing selected aspects of health\nable to provide basic care for pa\nservices. Further, the commission advocated that Congress act with\nDuring the 1950s, initiatives\nnew and sustained vigor to bring the potentialities of modern medi-\nily limited to increasingly liber\ncine to all Americans. A specific recommendation to a sympathetic\nof research, and this increased\nCongress was that federal funding be provided to assist medical\nthe infusion of new resources i:\nschools, many of which were hard pressed financially. The reasoning\nhowever, took a more active IC\nunderlying the recommendations of the Magnuson Commission can\nconsiderably more income to S]\nbe briefly summarized: American medicine had achieved many out-\nand with a rapid rise in the bir\nstanding results in the treatment of battle casualties in World War II.\nmand for obstetrical and pedia\nThese achievements, along with important advances in chemother-\nsicians became a matter of C\napy, convinced commission members that with these additional re-\ncommunities. Moreover, larger\nsources at its command, an expanded and improved health care\nuates sought entrance to medica\nsystem would yield major additional benefits to the American peo-\nto build new medical schools, a\nple. The commissioners also recognized that the nation's medical\nened nor encouraged by the AM\nschools faced a difficult financial future, that research would require\nmedicine continued to control\nlarge additional funding, and that many poor and near poor needed\nundergraduate medical educatio\nhelp in gaining access to the health services system.\ntrol but a modest rate of expans\nThe commission had sought a middle ground between the conser-\nAs described in the previous\nvatism of the AMA, which preferred a \"hands-off\" governmental\ngrowing number of communitie\npolicy concerning medicine, and the growing belief in Washington\nin attracting and retaining phy\nthat Americans were being deprived of important health services be-\ngrowing areas could not find a\ncause of the attitudes and power of organized medicine. Nonetheless,\nappointment without a long W\nthe AMA successfully opposed the commission's recommendation of\npressure on Congress to interve\nfinancial aid to medical schools, although the AMA did refrain from\ncians. The AMA was accused of\nlobbying against congressional efforts to make such funds available\nsupply and thus maintain high\nthrough expanded support for biomedical research. Thus, through\nwas finally willing to act.\nthis indirect approach, the federal government paid for the advanced\nIn 1963, federal funds becan\ntraining of numerous researchers and, by paying indirect costs on\ntion of new medical schools. Se\nresearch contracts, Congress made substantial funds available to the\npansion of existing schools foll\nhealth science centers of those universities that competed success-\npurposes to schools in financial\nfully for research grants and contracts.\n05/21/98\n13:05\n301 402 0338\n007/016\nThe Federal Government's Physician Manpower Policies 263\nthe societal context for the pro-\nThe National Institute of Mental Health (NIMH), which had au-\nthority to train personnel, became a major force in the substantial\nimment and medicine was first\nexpansion of the nation's pool of psychiatrists. In light of recent\nk of World War II when Demo-\ncongressional concern with \"maldistribution of physicians\" by spe-\nght the passage of a national\ncialty and geographic location, it is interesting to note that from the\nOs President Truman supported\n1950s through the 1960s the NIMH made liberal grants to help gen-\netermined to find some way to\neral practitioners, pediatricians, internists, and even some surgical\nthe American people, Mr. Tru-\nspecialists qualify as psychiatrists. The ostensible rationale for such\nbe known as the Magnuson\nsupport was the continuing acute shortage of psychiatrists in state\nman, which issued its report\nmental hospitals. However, their training completed, most of these\ne commission recommended a\nnewly minted psychiatrists established private practices to treat the\neasing the supply of health re-\naffluent with psychoanalytic techniques, and in fact were not avail-\nncing selected aspects of health\nable to provide basic care for patients in state mental institutions.\nlocated that Congress act with\nDuring the 1950s, initiatives in federal health policy were primar-\npotentialities of modern medi-\nily limited to increasingly liberal support for a broadened spectrum\nmmendation to a sympathetic\nof research, and this increased support contributed substantially to\nbe provided to assist medical\nthe infusion of new resources into U.S. medical schools. The states,\nssed financially. The reasoning\nhowever, took a more active role. With the American public having\nhe Magnuson Commission can\nconsiderably more income to spend, with medicine able to do more,\nlicine had achieved many out-\nand with a rapid rise in the birth rate (reflected in an increased de-\nittle casualties in World War II.\nmand for obstetrical and pediatric services), the \"shortage\" of phy-\nrtant advances in chemother-\nsicians became a matter of concern to an increasing number of\nthat with these additional re-\ncommunities. Moreover, larger numbers of young male college grad-\ned and improved health care\nuates sought entrance to medical schools. Hence several states moved\nbenefits to the American peo-\nto build new medical schools, a development that was neither threat-\n:ed that the nation's medical\nened nor encouraged by the AMA. However, as in the past, organized\nre, that research would require\nmedicine continued to control accreditation of institutions providing\ny poor and near poor needed\nundergraduate medical education, thus assuring not only quality con-\nices system.\ntrol but a modest rate of expansion.\nle ground between the conser-\nAs described in the previous chapter, as the decade progressed a\na \"hands-off\" governmental\ngrowing number of communities and groups experienced difficulties\ngrowing belief in Washington\nin attracting and retaining physicians. Many individuals in rapidly\nimportant health services be-\ngrowing areas could not find a physician who would give them an\nanized medicine. Nonetheless,\nappointment without a long waiting time. The result was increased\nmission's recommendation of\npressure on Congress to intervene and enlarge the supply of physi-\nigh the AMA did refrain from\ncians. The AMA was accused of practices that worked to contain the\nto make such funds available\nsupply and thus maintain high incomes for its members. Congress\ndical research. Thus, through\nwas finally willing to act.\nrnment paid for the advanced\nIn 1963, federal funds became available to assist in the construc-\nby paying indirect costs on\ntion of new medical schools. Seriatim, funds were voted for the ex-\nstantial funds available to the\npansion of existing schools followed by special grants for operating\nsities that competed success-\npurposes to schools in financial distress. And by the late 1960s, gov-\n05/21/98\n13:06\n301 402 0338\n008/016\n264 Public Policy\nThe Federal Gover\nemmental involvement took the next crucial step of making funds\ncialists and subspecialists and t\navailable to medical schools willing to expand their enrollments.\nphysicians to attend to the gel\nTo place these acts in perspective, it is important to remember\nexperience of the United King\nthat several commissions and taskforces had studied the adequacy of\nguideline entered the debate; pl\nthe nation's supply of physicians and without exception had argued\nless than 50 percent of all physic\nin favor of an expanded role by the federal government to increase\nThe new actions of 1971 we)\nthe rate at which the supply was being enlarged. Nonetheless, until\nthe Nixon Administration deci\nthe early 1960s, the AMA saw no reason for such an enlargement of\nshortage of 50,000 physicians h\nthe role of the federal government, which had not previously played\nwhy the federal government shc\na direct role in financing the production of physician manpower.\ncation. Why not encourage the\nAccording to the AMA, there was no compelling reason for the ini-\ncover full costs; why not simp.\ntiation of such policies. But by the mid-1960s the AMA, faced with\ncessful applicants from low-inc\nthe threat of Medicare and other, in their view, undesirable innova-\nquestions for a conservative ad\ntions, decided to contest no longer the argument that the community\nreceived a proper hearing either\nneeded more doctors. After this concession, the AMA ceased its tena-\nof the Democrat-controlled Co\ncious fight against federal funding for medical education.\nCongress were not convinced t)\nIn the early 1950s, the failure of national health insurance legisla-\ncould be resolved satisfactorily\ntion to be enacted had led the Magnuson Commission to recommend\nvention. After much wranglin\nthe alternative strategy of expanding resources as the second best\nHealth Professions Education A\napproach to strengthening the health care system. By the mid-1960s,\nwas passed. This legislation It\nin the face of growing concern that the promises of biomedical re-\nfederal interest in physician dis\nsearch were not being fulfilled, federal funds had begun to be shifted\ntrol over inflow of foreign med\nfrom research to services. This shift became more rapid after the en-\nernmental support to the med\nactment of Medicare and Medicaid. Moreover, the passage of the\navailable to U.S. citizens pursu\nMedicare and Medicaid legislation gave encouragement to advocates\nFurther, this legislation effectiv\nof supply expansion. How could the health services that Congress\nnotice that if they did not colle\nhad just promised the American people be delivered in the face of a\ntribution of residencies in prin\nshortage of 50,000 physicians, a figure reported with authority by\n1980, they would face specific a\nthe nation's senior health officials? Congress crossed the skirmish\nThis last stipulation was not a\nline and opened the federal treasury for the direct training of physi-\nalready had been met by the tir\ncian manpower, convinced that the promised services could be pro-\never, the congressional directive 1\nvided only by adding to the pool of physician manpower.\nfor U.S. citizens studying abroa\nIn 1971, Congress increased its involvement in the production of\nsettled the following year by a :\nphysician manpower by regularizing its contributions through capi-\nfering\" with the admission proce\ntation (grants to medical schools based on the number of medical\nThe new controls of the inflo\nstudents enrolled) and at the same time making funds available for\npact. Since the days of Hitler, wh\nthe residency training of family care physicians. By these two ac-\nand Austrian physicians came to\ntions, Congress affirmed the national interest in health manpower\nthere had been a continuing but\nand carved an additional role for itself in the financing of residency\nsurmounted sizable hurdles in F\ntraining.\nobtain a license. These refugee I\nThe background for the latter action stemmed from a growing be-\nEuropean medical schools wher\nlief by many observers in and out of government and the profession\nwas not greatly different from\nthat U.S. medicine was weighted too heavily in the direction of spe-\nchanges in U.S. immigration sta\n05/21/98\n13:07\n301 402 0338\n009/016\nThe Federal Government's Physician Manpower Policies 265\nt crucial step of making funds\ncialists and subspecialists and that there were too few primary care\nexpand their enrollments.\nphysicians to attend to the general ills of patients. Drawing on the\n; it is important to remember\nexperience of the United Kingdom and Canada, a new statistical\nces had studied the adequacy of\nguideline entered the debate; primary care physicians should not be\nI without exception had argued\nless than 50 percent of all physicians.\nfederal government to increase\nThe new actions of 1971 were hardly on the statute books before\nng enlarged. Nonetheless, until\nthe Nixon Administration decided that since the long-proclaimed\nason for such an enlargement of\nshortage of 50,000 physicians had disappeared, there was no reason\nwhich had not previously played\nwhy the federal government should continue to finance medical edu-\niction of physician manpower.\ncation. Why not encourage the medical schools to raise tuition to\n) compelling reason for the ini-\ncover full costs; why not simply offer adequate loan funds to suc-\nnid-1960s the AMA, faced with\ncessful applicants from low-income homes? These were reasonable\ntheir view, undesirable innova-\nquestions for a conservative administration to raise but they never\ne argument that the community\nreceived a proper hearing either in the public domain or in the halls\nession, the AMA ceased its tena-\nof the Democrat-controlled Congress. Moreover, the public and the\nmedical education.\nCongress were not convinced that national health manpower issues\nnational health insurance legisla-\ncould be resolved satisfactorily without further governmental inter-\nson Commission to recommend\nvention. After much wrangling between Senate and House, the\ng resources as the second best\nHealth Professions Education Assistance Act of 1976 (PL 94-484)\ncare system. By the mid-1960s,\nwas passed. This legislation reconfirmed capitation, strengthened\nthe promises of biomedical re-\nfederal interest in physician distribution, provided for tighter con-\nal funds had begun to be shifted\ntrol over inflow of foreign medical graduates (FMGs), and tied gov-\nbecame more rapid after the en-\nemmental support to the medical schools' making limited spaces\nMoreover, the passage of the\navailable to U.S. citizens pursuing their medical education abroad.\nve encouragement to advocates\nFurther, this legislation effectively placed health science centers on\ne health services that Congress\nnotice that if they did not collectively meet the required 50:50 dis-\nple be delivered in the face of a\ntribution of residencies in primary care to those in specialties by\nure reported with authority by\n1980, they would face specific quotas, institution by institution.\nCongress crossed the skirmish\nThis last stipulation was not a real threat since the quota for 1980\nfor the direct training of physi-\nalready had been met by the time the legislation became law. How-\npromised services could be pro-\never, the congressional directive to the medical schools to make room\nhysician manpower.\nfor U.S. citizens studying abroad set off a major altercation that was\nvolvement in the production of\nsettled the following year by a semiretreat by Congress from \"inter-\nits contributions through capi-\nfering\" with the admission process of medical schools.\nised on the number of medical\nThe new controls of the inflow of FMGs, however, had major im-\ntime making funds available for\npact. Since the days of Hitler, when considerable numbers of German\ne physicians. By these two ac-\nand Austrian physicians came to the United States, and up to 1965,\nal interest in health manpower\nthere had been a continuing but not large inflow of FMGs who had\nelf in the financing of residency\nsurmounted sizable hurdles in passing the examinations required to\nobtain a license. These refugee physicians were usually graduates of\nion stemmed from a growing be-\nEuropean medical schools where the substance of instruction often\nE government and the profession\nwas not greatly different from that of the United States. In 1965,\n) heavily in the direction of spe-\nchanges in U.S. immigration statutes prompted a sizable inflow of\n05/21/98\n13:07\n301 402 0338\n010/016\n266 Public Policy\nThe Federal GOVE\nphysicians from Asia and other parts of the world where medical edu-\n(HEW) policy papers dealing\ncation was considerably different from that in the United States. Be-\npoints of this review are summa\ncause of the uncontrolled expansion of residencies that could not be\nBetween 1978 and 1990, th\nfilled by graduates from U.S. medical schools alone, these FMGs\nthe United States will increas\nwere welcomed by many hospitals that otherwise would have been\nwhich is likely to prove the hi,\nsignificantly understaffed. In fact, some hospitals on the East Coast\nderal laws and regulations are\nundertook annual recruiting missions abroad. By the early 1970s, the\nmedical graduates is not effect\nnumber of foreign medical students who entered the country-most\nwill be even higher.\nof whom remained in the United States to practice-equaled in num-\nber the output of U.S. medical schools. Widespread complaints by\nApparently, the federal go\nthis trend. Evidence indicates\nAmerican physicians and patients occurred about the professional in-\ntions still face difficulties in ga\nadequacy of many foreign medical graduates. The situation clearly\nlarly private care. It is difficult\nwarranted attention.\nably on an administration's S\nTo summarize, in the fourteen-year period from 1963 to 1977\ngovernment restrict the numbe\nCongress used federal money and other means to make an impact on\nprobably will not be politicall:\nthe medical educational establishment in the following ways, to:\nto reduce the size of new class\nprove feasible is governmental\nRecognize a national interest in medical education\nprograms to assure that accele\nExpand enrollments and facilities\nphysicians is not encouraged.\nHelp schools in financial distress with operating support\nReduced earnings and less fr\npursue a specialty are possible\nTie federal assistance to specific increases in enrollments\nThis could make medicine a I\nSubsidize residency training in fields determined to be in short\nand thereby result in a decrea\nsupply\nHowever, at present there are\nInterdict the continued inflow of large numbers of FMGs\nseeking admission to medical\nrollments probably will not dro\nEstablish individual and collective goals on admissions to medical\n6,000 U.S. citizens currently st\nschool and/or residency training as a condition for financial sup-\nsorbed, along with later expatr\nport\ntem, thus further swelling the st\nImprove geographic distribution by providing for loan forgiveness\nOne must also attend to the\nwhich are also in a position to i\nIn addition, Congress supported the training of physician extend-\nAdded pressures on state legis]\ners, encouraged the enrollment of minorities, made available special\nplaces for their children, citizer\nloan funds, established the National Health Service Corps, and devel-\nmunities anticipating the econ\noped other initiatives. This abbreviated history points up a decade of\npanded medical school would bi\nfrenetic activity in which the federal government felt called upon to\nSeveral forces operate to con\nintervene increasingly to shape and reshape the supply and distribu-\nlikely to be effective is the cha\ntion of physician manpower.\nand the length of commitmen\npractice of medicine. An averag\nCURRENT TRENDS, 1978\nin the annual hours of work t\nrealm of possibility. If that OCC\nIn June 1978 a special ad hoc panel of the Institute of Medicine met\nwill be considerably improved.\nto review a series of Department of Health, Education, and Welfare\ncentage of the profession and\n05/21/98\n13:08\n301 402 0338\n011/016\nThe Federal Government's Physician Manpower Policies 267\nof the world where medical edu-\n(HEW) policy papers dealing with physician manpower. The major\nn that in the United States. Be-\npoints of this review are summarized below.\nof residencies that could not be\nBetween 1978 and 1990, the ratio of physicians to population in\n:al schools alone, these FMGs\nthe United States will increase by one-third to 235 per 100,000,\nat otherwise would have been\nwhich is likely to prove the highest in the world. If the present fed-\nne hospitals on the East Coast\nderal laws and regulations are modified so that the inflow of foreign\nabroad. By the early 1970s, the\nmedical graduates is not effectively slowed, in twelve years this ratio\nwho entered the country-most\nwill be even higher.\nes to practice-equaled in num-\nApparently, the federal government cannot do much to deflect\nols. Widespread complaints by\nthis trend. Evidence indicates that sizable rural and urban popula-\nurred about the professional in-\ntions still face difficulties in gaining access to medical care, particu-\nraduates. The situation clearly\nlarly private care. It is difficult to see how Congress would act favor-\nably on an administration's suggestion, if it were made, that the\nar period from 1963 to 1977\ngovernment restrict the numbers of physicians in medical school. It\ner means to make an impact on\nprobably will not be politically feasible to use capitation payments\nin the following ways, to:\nto reduce the size of new classes entering medical school. What may\nprove feasible is governmental review of its incentive and support\ndical education\nprograms to assure that accelerated growth of the supply of future\nphysicians is not encouraged.\nith operating support\nReduced earnings and less freedom of choice for the individual to\npursue a specialty are possible outcomes of future federal policies.\ncreases in enrollments\nThis could make medicine a less attractive field in the near future\nilds determined to be in short\nand thereby result in a decrease in the numbers seeking to enter.\nHowever, at present there are so many more qualified candidates\narge numbers of FMGs\nseeking admission to medical school than places available that en-\nrollments probably will not drop. Moreover, it is expected that some\ngoals on admissions to medical\n6,000 U.S. citizens currently studying abroad will eventually be ab-\n$ a condition for financial sup-\nsorbed, along with later expatriates, into the American medical sys-\ntern, thus further swelling the supply.\nproviding for loan forgiveness\nOne must also attend to the continuing role of state governments,\nwhich are also in a position to affect the future supply of physicians.\ne training of physician extend-\nAdded pressures on state legislators continue from parents seeking\nnorities, made available special\nplaces for their children, citizens seeking improved access, and com-\nHealth Service Corps, and devel-\nmunities anticipating the economic stimulation that a new or ex-\nd history points up a decade of\npanded medical school would bring.\ngovernment felt called upon to\nSeveral forces operate to contain the rate of growth. The one most\nshape the supply and distribu-\nlikely to be effective is the change that will come in the work year\nand the length of commitment of the individual physician to the\npractice of medicine. An average decline of 15 percent to 20 percent\nin the annual hours of work by physicians by 1990 is within the\nrealm of possibility. If that occurs, the demand-supply relationship\nof the Institute of Medicine met\nwill be considerably improved. With women comprising a larger per-\nHealth, Education, and Welfare\ncentage of the profession and with more physicians practicing in\n05/21/98\n13:08\n7301 402 0338\n012/016\n268 Public Policy\nThe Federal Gover\ngroups or in salaried positions, a coming reduction in work hours\nuent bodies that established the\nseems likely.\nit would be an error, in my vie\nHowever, if physicians are able to control their earnings and there-\nempt the CCME from playing\nby earn the same income for less time, the manpower position may\njudgment of the recent General\nlook more advantageous than it really is. A rapid increase in the ratio\nThe government has a legitin\nof physicians to population may well lead to acceleration in the total\ncies and has some leverage at\ncosts of operating the health care system. The federal government\nbursement for the care of hospit\nwill then regret its involvement in expanding the supply of physi-\ndifficulty in determining what\ncians, and may be forced to supplement ever larger portions of the\nand the adequacy of reimburser\nannual health bill.\nmay be seen in the following\nIn the second arena in which the federal government is increas-\nencourage the training of an ac\ningly involved-that of \"maldistribution\" by specialty-there is an\nsicians, the complex issue of re\nabsence of any agreement among \"experts\" in the assessment both\nvices (to open more training sl.\nof the existent situation and the optimal one. Enthusiasts for more\nthe same time, the question o\n\"primary care physicians\" believe that most of the malfunctioning\nschedules could in fact be tran\nof the present system could be alleviated by the training of more pri-\nspecialty and subspecialty res:\nmary care physicians. They believe that primary care physicians\nBoth undertakings are fraught\ncould treat most patients (70 to 80 percent), control referrals, inter-\nated with the issue of whether\ndict the unnecessary use of hospitalization and high technology,\nence the geographic distributio\nmove health care in the direction of preventive services, and under-\nwhether the government shoul\ngird still other positive developments.\ntice of physicians in underserve\nHowever, it must be noted that there is no agreement on the defi-\nphysicians away from surplus a)\nnition of a primary care physician, no clarity as to how current\nAn effective policy must be\nmodes of practice can be modified to give primary care physicians\ndata it is impossible for the fe\nlarger roles, and most importantly, little sensitivity to the fact that\ncriteria for areas assumed to I\nmany consumers may not agree that it is preferable for them to be\nbase does not currently exist a\ntreated in the first instance by a primary care physician. Moreover,\nits establishment. For example\nthere is no reliable data about how active physicians now divide their\nYork City has one of the high\ntime among patients requiring primary care, specialty care, and sub-\nworld. But the New York Cit\nspecialty care. In the absence of such data the protagonists are deal-\nported a considerable number\ning with ideology, not reality. While it may be possible to support\nwhich there is no physician in F\nthe contention that there is a surplus of surgeons or neurosurgeons,\nIt is possible that the fede\nit surely does not follow that such a generalization could be substan-\nurban areas by facilitating the I\ntiated for all specialties or for the maldistribution of specialists. Thus\nthe use of reimbursement poli\nthe subject remains so elusive that sensible social intervention is hard\nzation of facilities, and other\nto design, and even harder to implement.\nwilling to practice in or close\nNevertheless, there is some basis for believing that the approach\nreasonable.\nwhereby specialty boards approve residency programs solely by ref-\nProblems concerning the da\nerence to standards of quality is in need of modification. The govern-\nhold true for governmental ir\nment, particularly in the embodiment of HEW, has been trying to\nareas of surplus. \"Surplus\" ar\ninvolve the Coordinating Council for Medical Education (CCME) in\nphysicians, and it may strain 1\nsuch modification of procedures, in concert with representatives of\nif established members of the\nthe public and with the freedom to act independently of the constit-\nto relocate. Perhaps the best II\n05/21/98\n13:09\n301 402 0338\n013/016\nThe Federal Government's Physician Manpower Policies 269\ning reduction in work hours\nuent bodies that established the CCME. The outcome is unclear, but\nit would be an error, in my view, for the federal government to pre-\nntrol their earnings and there-\nempt the CCME from playing a more active role. This is also the\nthe manpower position may\njudgment of the recent General Accounting Office (GAO) report.\n5. A rapid increase in the ratio\nThe government has a legitimate interest in the matter of residen-\nad to acceleration in the total\ncies and has some leverage at its disposal via the methods of reim-\ntem. The federal government\nbursement for the care of hospitalized Medicaid patients. One critical\npanding the supply of physi-\ndifficulty in determining what goals the government should pursue,\nnt ever larger portions of the\nand the adequacy of reimbursement levers to accomplish those goals,\nmay be seen in the following example. If the government were to\nederal government is increas-\nencourage the training of an additional number of primary care phy-\non\" by specialty-there is an\nsicians, the complex issue of reimbursement for ambulatory care ser-\nperts\" in the assessment both\nvices (to open more training slots) would need to be confronted. At\nnal one, Enthusiasts for more\nthe same time, the question of whether changes in reimbursement\nt most of the malfunctioning\nschedules could in fact be translated into cutbacks in the number of\ned by the training of more pri-\nspecialty and subspecialty residencies would need to be explored.\nthat primary care physicians\nBoth undertakings are fraught with difficulty and are closely associ-\nreent), control referrals, inter-\nated with the issue of whether the federal government should influ-\nzation and high technology,\nence the geographic distribution of physicians and, more specifically,\nreventive services, and under-\nwhether the government should encourage the settlement and prac-\ntice of physicians in underserved areas and exercise pressures to draw\ne is no agreement on the defi-\nphysicians away from surplus areas.\n10 clarity as to how current\nAn effective policy must be based on reliable data. Without such\ngive primary care physicians\ndata it is impossible for the federal authorities to establish objective\ntle sensitivity to the fact that\ncriteria for areas assumed to be in shortage or surplus. Such a data\nt is preferable for them to be\nbase does not currently exist and there are significant difficulties to\nary care physician. Moreover,\nits establishment. For example, the borough of Manhattan in New\nve physicians now divide their\nYork City has one of the highest physician to resident ratios in the\ncare, specialty care, and sub-\nworld. But the New York City Department of Health recently re-\ndata the protagonists are deal-\nported a considerable number of census tracts within the borough in\nit may be possible to support\nwhich there is no physician in private practice.\nof surgeons or neurosurgeons,\nIt is possible that the federal government can assist underserved\nneralization could be substan-\nurban areas by facilitating the growth of new practice modes through\nistribution of specialists. Thus\nthe use of reimbursement policies for ambulatory care, the moderni-\nible social intervention is hard\nzation of facilities, and other forms of assistance. Physicians may be\nt.\nwilling to practice in or close to ghetto areas if the conditions are\nr believing that the approach\nreasonable.\nlency programs solely by ref-\nProblems concerning the data base and criteria for assessment also\n1 of modification. The govern-\nhold true for governmental interdiction of physicians practicing in\nof HEW, has been trying to\nareas of surplus. \"Surplus\" areas might be short of certain types of\nMedical Education (CCME) in\nphysicians, and it may strain the limits of governmental intervention\noncert with representatives of\nif established members of the profession were uprooted and forced\nindependently of the constit-\nto relocate. Perhaps the best method would be the offer of monetary\n05/21/98\n13:10\n301 402 0338\n014/016\n270 Public Policy\nThe Federal Gove\nand other inducements to new physicians to establish practices else-\ntion, usually without repaying\nwhere. Another possible method would be simply to place certain\nbe that the government can no\nlocations \"off limits\" to new entrants. However, this would solidify\nneed to examine how well t\nthe advantages of the established group and run against federal ef-\nwhether they accept or balk\nforts, like those of the Federal Trade Commission, to reduce the\nmore complain to Congress tha\nmonopoly power now available for physicians.\nas well be performed by paran\nAs is true of many new ideas in health manpower policy, it is hard\nducing or eliminating their oblig\nto design a federal effort that could contribute to the redistribution\nDifficulty also arises from th\nof physicians at a bearable cost. Once one recognizes that all such\nernment to control the assignr\nefforts are likely to be confronted by unanticipated (and negative)\nprogram will succeed will be er\nconsequences, the ground for action becomes more tenuous.\neral agencies are able to elicit t\nDuring most of the past decade, the government has been engaged\nhealth departments, Health S\nin supporting the training of physician extenders. Evidence of large-\nschools that are likely to be t\nscale increases in the supply of physicians questions the necessity of\nhow they could be better ser\ncontinued government support of these extender programs, and the\ntralized procedure is the possi\nanswer hinges on issues of scale and utility. The scale of federal con-\nThe onus would fall on feder:\ntributions is relatively small; most extenders are trained without\nmight be jeopardized.\nfederal assistance. Evidence indicates that many extenders serve\nAnother major concern is th\npopulation groups that have difficulty in attracting and retaining\ncine. Even before the Bakke d\nphysicians. Because it is expected that such difficulties for certain\nagainst such recruitment. Altl\nurban and rural groups will continue, it would be a mistake to elim-\nexceed those of pre-affirmative\ninate federal support now. More experimentation is needed to deter-\nclining rapidly. There is little\nmine the optimal use of extenders. However, the coming \"surplus\"\nmajor federal intervention.\nof physicians argues against any expansion of federal support while\nOne possible federal effort W\ncontinuing experimentation argues for maintenance of present effort.\nminority enrollments to increa\nExperimentation requires the production of new supplies and some\nnorities by a threat of loss of\nmodification of reimbursement mechanisms. At present it appears\nmake more funds available to\nfinancially unwise to set extenders free to be reimbursed for their\nand improved outreach progran\nservices on a fee-for-service basis. On the other hand, more flexibility\nadmission years. A third effor\ncould be achieved in their utilization if urban, like rural, clinics were\navailable to help selected min<\nreimbursed for services rendered by extenders. Another suggestion is\nfully as professional researcher\nthat the government monitor continued increases in the supply of\nschool faculty largely are develo\nextenders as compared to increases in the output of physicians. If\nThe continuing financial dif\nthe comparison indicates a weakening demand for extenders, federal\nSchool of Medicine (largely a ft\nsupport could be reduced or eliminated.\ning hospital) raise the issue of\nThe presumption that within the next five years the federal gov-\nport not only for Meharry but\nernment will have a substantial pool of new graduates entering the\nfor other minority groups such\nNational Health Service Corps-that is, graduates forced to accept\nThe federal government is hard\nassignments in underserved areas as a way of working off their in-\nfrom a major source of supply\ndebtedness to the nation-may be incorrect. Thus far, states and\nwant to review the basis for its\nphilanthropic foundations have had little success in extracting service\nfrom being asked to finance n\nfrom those whose education they financed. Somehow the potentially\nthe United States sees gains fro\nindentured have managed to extricate themselves from their obliga-\nabove the present 5 to 6 perc\n05/21/98\n13:10\n301 402 0338\n015/016\nThe Federal Government's Physician Manpower Policies 271\nins to establish practices else-\ntion, usually without repaying the money advanced to them. It may\nd be simply to place certain\nbe that the government can now enforce the obligation. But we will\nHowever, this would solidify\nneed to examine how well the early graduates are assigned and\nup and run against federal ef-\nwhether they accept or balk at their posts. If several hundred or\n: Commission, to reduce the\nmore complain to Congress that they are doing work that could just\nsicians.\nas well be performed by paramedics, they may again succeed in re-\nth manpower policy, it is hard\nducing or eliminating their obligation.\nintribute to the redistribution\nDifficulty also arises from the dubious capacity of the federal gov-\n: one recognizes that all such\nernment to control the assignment process. The likelihood that the\nunanticipated (and negative)\nprogram will succeed will be enhanced if those in the pertinent fed-\ncomes more tenuous.\neral agencies are able to elicit the active cooperation of state or local\ngovernment has been engaged\nhealth departments, Health Service Agencies, or selected medical\nextenders. Evidence of large-\nschools that are likely to be best informed about local needs and\nans questions the necessity of\nhow they could be better served. The clear risk to such a decen-\ne extender programs, and the\ntralized procedure is the possibility of error by the intermediaries.\nility. The scale of federal con-\nThe onus would fall on federal shoulders, and the entire program\nktenders are trained without\nmight be jeopardized.\nthat many extenders serve\nAnother major concern is the recruitment of minorities into medi-\ny in attracting and retaining\ncine, Even before the Bakke decision, signs were indicating a trend\nt such difficulties for certain\nagainst such recruitment. Although present minority enrollments\nit would be a mistake to elim-\nexceed those of pre-affirmative action years, such enrollments are de-\nimentation is needed to deter-\nclining rapidly. There is little likelihood of reversal unless there is\nowever, the coming \"surplus\"\nmajor federal intervention.\nision of federal support while\nOne possible federal effort would be to pressure schools with low\nmaintenance of present effort.\nminority enrollments to increase their efforts at recruitment of mi-\nion of new supplies and some\nnorities by a threat of loss of federal monies. Another would be to\nanisms. At present it appears\nmake more funds available to assist schools to undertake expanded\nee to be reimbursed for their\nand improved outreach programs and remedial education in the pre-\nhe other hand, more flexibility\nadmission years. A third effort would be to make special funding\nf urban, like rural, clinics were\navailable to help selected minority students compete more success-\ntenders. Another suggestion is\nfully as professional researchers, a pool from which future medical\ned increases in the supply of\nschool faculty largely are developed.\n1 the output of physicians. If\nThe continuing financial difficulties of Meharry Medical College\ndemand for extenders, federal\nSchool of Medicine (largely a function of the difficulties of its teach-\n1.\ning hospital) raise the issue of federal policy toward continuing sup-\next five years the federal gov-\nport not only for Meharry but also for financing medical education\nof new graduates entering the\nfor other minority groups such as Chicanos and Native Americans.\nS, graduates forced to accept\nThe federal government is hardly in a position to withdraw support\nway of working off their in-\nfrom a major source of supply of black physicians, although it may\nncorrect. Thus far, states and\nwant to review the basis for its support of Meharry to protect itself\ntle success in extracting service\nfrom being asked to finance new medical schools for minorities. If\niced. Somehow the potentially\nthe United States sees gains from increasing the proportion of blacks\nthemselves from their obliga-\nabove the present 5 to 6 percent of enrollees in medical school, it\n05/21/98\n13:11\n301 402 0338\n016/016\n272 Public Policy\nwill have to take action along multiple fronts since the medical estab-\nlishment, left to its own devices, seems to be in partial retreat.\nPlacing this forecast alongside our recapitulation of the recent\npast leads to the conclusion that the federal government can more\nreadily intervene than it can accomplish the goals at which its inter-\nvention is aimed. Accordingly, in my view, a cautionary stance to-\nIndex\nward future interventions in physician manpower may be the better\npart of wisdom.\nREFERENCES\nDepartment of Health, Education, and Welfare. August 1978. A Report to\nthe President and Congress on the Status of Health Professions Personnel in the\nUnited States, Publication No. 78-93 (HRA).\nGinzberg, E. 1978. \"How Much Will U.S. Medicine Change in the Decade\nAhead?\" Annals of Internal Medicine 89, 4 (October).\n- 1978. Health Manpower and Health Policy. Montclair, N.J.: Allan-\nheld, Osmun and Co.\nGraduate Medical Education National Advisory Committee Staff Papers,\nAcademic culture, 24, 42, 45\nDHEW, HRA 78-10. \"Physician Manpower Requirements.\"\nAcademic medicine, 6, 63-64, 98,\nHRD-77-92. May 16, 1978. \"Are Enough Physicians of the Right Types\n140, 151, 250. See also Research,\nTrained in the U.S.?\"\nas career choice\nRogers, D.E. 1978. American Medicine: Challenge for the 1980s. Cambridge,\nAdaptation. See also Coping mecha-\nnisms\nMass.: Ballinger Publishing Co.\neffect of pediatric internship on,\nWaitzkin, H. 1978. \"A Marxist View of Medical Care.\" Annals of Internal\n113-14, 119, 121, 128-31, 136\nMedicine 89: 264-278. (Bibliography of 260 items.)\nfor stress, x, 88-91, 201-12\nAdmission. See also Selection\ncriteria for, 82, 84-85\nand data collection for career\nchoice, 56-57, 62-68, 76-78\nand federal government, 265-67\nand stress in medical school, XX,\n83-88\nAdorno, T.W., 28\nAdsett, C., 204-205\nAdult socialization, 10, 37-46\nAdvisors, 129, 142-43, 145, 147-50,\n156-58\nAllport, Gordon, 27\nAloia, J.F., and Jonas, E., 116, 132\nAlpert, J.J., 115\nand Charney, E., 169\nAmbulatory care, 38, 117, 164-69,\n254-55, 258, 269\nAmerican Academy of Family\nPractice, 56\nAmerican Academy of Pediatrics,\n100\nAmerican Board of Family Practice,\n56\nAmerican Board of Internal Medi-\ncine, 97, 101\n05/21/98\n13:03\n301 402 0338\n002/016\nJAMA 100 Years Ago\nApril 2, 1898\nNEW SECRET ORDER FOR PHYSICIANS.\nThe Mystic Order of Disciples of Asculapius, is being organized by Frank C. Hoyt,\nM.D., superintendent of the Iowa Hospital for the Insane, Clarinda, Iowa. It is\ndesigned to work in conjunction with medical societies, and in no way supplant them,\nand the enterprise is fraternal, not commercial in character. Full information can be\nobtained by addressing Dr. Hoyt.\nJAMA. 1898;30:808\nApril 9, 1898\nTREATMENT OF IMPETIGO WITH FRANKLINIZATION.\nFourteen cases rapidly cured with \"electric effluvation\" are reported by Doumer\nSome things\nand Levezier of Lille, all children from six months to 12 years of age, accompanied by\nmarked improvement in the appetite and health. The seances were repeated three\nimprove with age.\ntimes a week, lasting ten minutes each time, two to eight being generally required,\nand a machine powerful enough to emit sparks eight centimeters in length-Sem.\nMéd., February 9.\nJAMA. 1898:30:866\nBut you need a new\nApril 16, 1898\nPDR Generics\nIRREGULAR HOURS AND SMALL PAY.\nevery year.\nThe stranger remarked: \"I think I can tell what your business is.\" \"What?\" \"Night\nwatch.\" \"No, friend, you are mistaken; they can go to sleep on their beat and they\nDon't let the word \"generics\" in the\ndraw their wages regularly.\" \"Well, then you're a fireman, ain't you?\" \"Worse than\ntitle fool you. This highly specialized\nthat; no such regular pay or sleep for me.\" \"Well, what are you then?\" \"Why, I'm a\ndoctor; one of those unfortunate fellows who are called up so often that they don't\nreference provides complete prescrib-\nknow night from day, excepting when they get out of town, and never draw their pay\ning and pricing information on virtually\nwhile they are away, either.\"\nevery brand and generic prescription\nJAMA. 1898;30:933\nmedication on the market today.\nApril 23, 1898\nWith more than 24,000 listings -\nBOARD OF HEALTH CAN NOT RESTRICT MODE OF LAYING FLOOR.\nmany new this year - it's the most\ncomprehensive reference of its kind\nNew Jersey gives boards of health power to adopt ordinances; to regulate plumb-\navailable from any source.\ning and ventilation and secure the sanitary condition of all buildings; to regulate the\nkeeping of all kinds of animals and the accumulation of offal; and to abate any nuisance\nin any place. But notwithstanding this the supreme court of that State holds, Feb. 21,\nPrescribe with confidence. Order today!\n1898, in State VS. Board of Health, that the board of health of Asbury Park had no\npower to restrict the owners of a stable to the mode of laying a stable floor prescribed\n1998 POR' Generics\nby an ordinance of the board. The owners had the alternative, says the court, of re-\nOrder #: OP923198AGD\nsorting to any other method which would secure the sanitary condition of the stable,\nAMA member price: $67.95\nNonmember price: $79.95\nthough by departing from the prescribed method they took the risk of creating a nui-\nsance. If the stable was a nuisance, the owners must be prosecuted for maintaining\nAvailable February 1998\na nuisance and not for failing to comply with the plans specified in the ordinance.\nSatisfaction guaranteed\nJAMA. 1898;30:998\nor return within 30 days\nfor full refund.\nApril 30, 1898\nNew!\nCONNECTION BETWEEN NASAL AFFECTIONS AND PSYCHIATRY.\nC. Ziem urges a more active treatment for certain mental disturbances, and traces\nCall 800 621-8335.\nthe connection between them and nasal troubles, especially affections of the acces-\nPriority Code AGP. Visa, MasterCard,\nsory cavities, determining disturbances in the circulation of the frontal region of the\nAmerican Express, Optima accepted. Applicable\nbrain. His communication in the Monats. f. Ohr. k., 1897, 11 and 12, describes his own\nstate sales tax and shipping and handling added.\npersonal experience with scientific candor and accuracy, and is a convincing plea in\nfavor of the alleged connection.-Cbl. f. Chir., March 12.\nAmerican Medical Association\nJAMA. 1898;30:1050\nPhysicians dedicated to the health of America\nSTATE\nEdited by Brian P. Pace, MA, Assistant Editor.\n978 JAMA, April 1, 1998-Vol 279, No. 13\nJAMA 100 Years Ago\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/facts.html#buildings.\n145\nNumber of Students Enrolled for the PhD in the Division of Medical Sciences, Fall 1997\n500\nContinuing Education\nCourses offered: 206\nNew courses: 38\nAttendees: 38,426\nStates represented: 50\nCountries represented: 63\nCountway Library\nLibrary\nThe Countway Library [http://www.med.harvard.edu/countway/] comprises the Harvard Medical School\nand Boston Medical Libraries\nHoused in the Countway Library Building\nVolumes: 608,900\nMonographs: 203,000\nSerials: 3,971\nRare books: More than 25,000\nSpecial Collections\nHistory of medicine (810 incunabula)\nEuropean books printed 16th-19th centuries\nEnglish books published 1475-1800\nAmerican books 1668-1870, especially New England imprints and Bostoniana\n14th century medical Hebraica and Judaica\nManuscripts and archives, especially of New England origin\nNational archive of medical illustration\nWarren Collection of early books in the history of medicine\nWorld famous collection of medical medals and portraits\nUsers per day\n1,000\nJournal pages copied per year\n5 million\nMultiple databases for on-line services\nMore than 2 million files downloaded from Countway Library site monthly\nNobel Laureates\nNobel Laureates\nGeorge Minot, 1934, Medicine and Physiology\nResearch on liver treatment of the anemias (with Murphy)\nWilliam P. Murphy, 1934, Medicine and Physiology\nDiabetes and diseases of the blood (with Minot)\nFritz A. Lipmann, 1953, Medicine and Physiology\nIdentified coenzyme A and discovered basic principles in understanding of proteins\nJohn F. Enders, 1954, Medicine and Physiology\nApplication of tissue-culture methods in developing a polio virus, the ingredient of the polio vaccine\n(with Robbins and Weller)\n3 of 4\n05/19/98 13:01:25\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/tfacts.html#buildings.\nFrederick C. Robbins,* 1954, Medicine and Physiology\nApplication of tissue-culture methods to the study of viral diseases (with Enders and Weller)\nThomas H. Weller, 1954, Medicine and Physiology\nApplication of tissue-culture methods to the study of viral diseases (with Enders and Robbins)\nGeorg von Bekesy, 1961, Medicine and Physiology\nDiscovered the traveling wave while researching how the ear responds to sound waves\nJames D. Watson, 1962, Medicine and Physiology\nDescribed the structure of DNA\nKonrad E. Bloch, 1964, Medicine and Physiology\nStudied the pattern of reactions involved in the biosynthesis of cholesterol and fatty acids\nGeorge Wald, 1967, Medicine and Physiology\nResearch on the biochemistry of vision\nBaruj Benacerraf, 1980, Medicine and Physiology\nDiscovered that disease-fighting ability is passed on genetically, although the immune-response gene\nvaries from person to person\nDavid Hubel, 1981, Medicine\nResearch on information-processing in the visual system (with Wiesel)\nTorsten Wiesel, 1981, Medicine\nResearch on information-processing in the visual system (with Hubel)\nBernard Lown, Herbert Abrams, Eric Chivian, and James Muller, 1985, Peace\nCofounders, with Evgueni Chazov, Leonid Ilyin, and Mikhail Kuzin from the Soviet Union, of the\nInternational Physicians for the Prevention of Nuclear War\nJoseph E. Murray, 1990, Medicine\nDeveloped new procedures for organ transplant (with E. Donnall Thomas, formerly of the University of\nWashington)\n'Robbins was awarded the Nobel Prize for work done while a member of the Harvard Faculty. When the\naward was made, he was a member of the faculty of Western Reserve University.\nAbout HMS I Education & Admissions I Research I Administration & Faculty\nHarvard Medical Web\nLast Updated: October 16, 1997\n4 of 4\n05/19/98 13:01:26\nHarvard Medical School: A History and Background\nhttp://www.hms.harvard.edu/about/intro.html\nIntroduction to Harvard Medical School\nHarvard Medical School is one of the world's preeminent institutions in medical education and research.\nThe breadth and depth of its scientific and clinical disciplines are unsurpassed. The School has more\nthan 8,000 faculty and 17 affiliated facilities.\nAt the core of the Medical School are its educational and research programs. The student body is\ncomposed of 650 men and women in the MD program; 440 students in the PhD program; and 145 in the\njoint MD-PhD programs, part of which is sponsored in collaboration with MIT. For its medical students,\nHarvard has inaugurated the/New Pathway curriculum, a problem-solving, case-method approach to\nNEW\nlearning, offering the opportunity to come in contact with patient cases early in their studies.\nPATHWAY\nThe Medical School has nine departments in basic- and social-science disciplines: Cell Biology,\nBiological Chemistry and Molecular Pharmacology, Genetics, Microbiology and Molecular Genetics,\nNeurobiology, and Pathology, and the Departments of Ambulatory Care and Prevention, Health Care\nPolicy, and Social Medicine. In 1992, a new state-of-the-art research building was dedicated to house\nNeurobiology, Genetics, and Pathology. With this new building, virtually all of the Medical School's\nresearch and educational facilities have been renovated or newly constructed in the last eight years.\nMost of the heads of the above departments have been appointed within the past five years. In turn, they\nare in the process of recruiting exceptionally strong, world-class faculty members to enhance and expand\nthe current complement of faculty. The Medical School is the largest of Harvard's graduate faculties and\nhas traditionally been a trend-setter for many University-wide initiatives.\nlast updated on September 19, 1997\nAbout HMS Education & Admissions I Research| Faculty & Administration\nHarvard Medical Web\n1 of 1\n05/19/98 13:00:47\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/facts.html#buildings\nLeadership, Buildings, & Departments\nDean, Harvard Medical School\nJoseph B. Martin, MD, PhD\nDean, Harvard School of Dental Medicine\nR. Bruce Donoff, DMD, MD\nMedical School Established\n1782\nBuildings on Campus\nMain quadrangle, opened 1906\nHarvard School of Dental Medicine, 1867\nVanderbilt Hall (Student Residence), 1927\nFrancis A. Countway Library, 1965\nLaboratory for Human Reproduction and Reproductive Biology, 1972\nSeeley G. Mudd Building, 1977\nMedical Education Center, 1987, Named for Daniel C. Tosteson, 1997\nWarren Alpert Building, 1992\nGoldenson Building Renovations, 1994\nHarvard Institutes of Medicine, 1996\nDepartments\nAmbulatory Care and Prevention\nBiological Chemistry and Molecular Pharmacology\nCell Biology\nGenetics\nHealth Care Policy\nMicrobiology and Molecular Genetics\nNeurobiology\nPathology\nSocial Medicine\n44 hospital-based clinical departments\nNew England Regional Primate Research Center\nAffiliated Hospitals & Research Institutions\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nCambridge Hospital\nCenter for Blood Research\nChildren's Hospital\nDana-Farber Cancer Institute\nHarvard Pilgrim Health Care\nJoslin Diabetes Center\nJudge Baker Children's Center\nMcLean Hospital\nMassachusetts Eye and Ear Infirmary\nMassachusetts General Hospital\nMassachusetts Mental Health Center\nMount Auburn Hospital\nSchepens Eye Research Institute\nSpaulding Rehabilitation Hospital\nVeterans Administration Medical Center (Brockton/West Roxbury)\nFinancial Figures\nFinancial Summary\nBudget Fiscal Year 1997)\n1 of 4\n05/19/98 13:01:25\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/facts.html/buildings\n$241,000,000\nEndowments\nJune 1997: $1,235,000,000\nProfessorships: 193\nFirst Gift\nIn 1772, Ezekiel Hersey established two professorships in Anatomy and Physic (Medicine) at the\nyet-to-be established Medical School\nGifts Fiscal Year 1997\nFor current use: $19,223,000\nFor capital:\nEndowment: $16,087,000\nLoan funds: $338,000\nTotal gifts: $35,648,000\nResearch and Training Dollars 1997\nU.S. government direct and indirect: $92,463,000\nPrivate funding direct and indirect: $62,782,000\nTotal: $155,245,000\nFinancial Aid Fiscal Year 1996-1997\nAverage scholarship: $12,908\nUnit loan: $20,000\nPercentage of students receiving financial aid: 71.4\nNumber of students graduating with loans: 126\nAverage loan debt on graduation: $73,339\nRange of debt (Class of 1996): $5,700-$162,000\nAverage Cost 1996-1997\n$40,900, including tuition of $25,200\nPeople in Education\nFaculty\nOver 2,800 senior faculty (assistant, associate, and full professors) -- over 80% have full-time\nappointments\nFaculty Instructors\nOver 4,600 full-time and part-time\nTrainees\nOver 5,000 residents, interns and postdoctoral fellows\nLiving Alumni\n8,600 from classes 1917-1997\nStudents\n165 entering freshman annually\nFirst-Year Class Entered in 1996\nApplicants: 3,956\nMatriculants: 76 men, 88 Women\nUnder-represented minorities: 30\nFirst-year students from 27 states and 7 countries\nNumber of Students Enrolled in MD-PhD Program, Fall 1997\n2 of 4\n05/19/98 13:01:25\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/facts.html#financial\nLeadership, Buildings, & Departments\nDean, Harvard Medical School\nJoseph B. Martin, MD, PhD\nDean, Harvard School of Dental Medicine\nR. Bruce Donoff, DMD, MD\nMedical School Established\n1782\nBuildings on Campus\nMain quadrangle, opened 1906\nHarvard School of Dental Medicine, 1867\nVanderbilt Hall (Student Residence), 1927\nFrancis A. Countway Library, 1965\nLaboratory for Human Reproduction and Reproductive Biology, 1972\nSeeley G. Mudd Building, 1977\nMedical Education Center, 1987, Named for Daniel C. Tosteson, 1997\nWarren Alpert Building, 1992\nGoldenson Building Renovations, 1994\nHarvard Institutes of Medicine, 1996\nDepartments\nAmbulatory Care and Prevention\nBiological Chemistry and Molecular Pharmacology\nCell Biology\nGenetics\nHealth Care Policy\nMicrobiology and Molecular Genetics\nNeurobiology\nPathology\nSocial Medicine\n44 hospital-based clinical departments\nNew England Regional Primate Research Center\nAffiliated Hospitals & Research Institutions\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nCambridge Hospital\nCenter for Blood Research\nChildren's Hospital\nDana-Farber Cancer Institute\nHarvard Pilgrim Health Care\nJoslin Diabetes Center\nJudge Baker Children's Center\nMcLean Hospital\nMassachusetts Eye and Ear Infirmary\nMassachusetts General Hospital\nMassachusetts Mental Health Center\nMount Auburn Hospital\nSchepens Eye Research Institute\nSpaulding Rehabilitation Hospital\nVeterans Administration Medical Center (Brockton/West Roxbury)\nFinancial Figures\nFinancial Summary\nBudget Fiscal Year 1997)\n1 of 4\n05/19/98 13:01:37\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/facts.html#financia\n$241,000,000\nEndowments\nJune 1997: $1,235,000,000\nProfessorships: 193\nFirst Gift\nIn 1772, Ezekiel Hersey established two professorships in Anatomy and Physic (Medicine) at the\nyet-to-be established Medical School\nGifts Fiscal Year 1997\nFor current use: $19,223,000\nFor capital:\nEndowment: $16,087,000\nLoan funds: $338,000\nTotal gifts: $35,648,000\nResearch and Training Dollars 1997\nU.S. government direct and indirect: $92,463,000\nPrivate funding direct and indirect: $62,782,000\nTotal: $155,245,000\nFinancial Aid Fiscal Year 1996-1997\nAverage scholarship: $12,908\nUnit loan: $20,000\nPercentage of students receiving financial aid: 71.4\nNumber of students graduating with loans: 126\nAverage loan debt on graduation: $73,339\nRange of debt (Class of 1996): $5,700-$162,000\nAverage Cost 1996-1997\n$40,900, including tuition of $25,200\nPeople in Education\nFaculty\nOver 2,800 senior faculty (assistant, associate, and full professors) -- over 80% have full-time\nappointments\nFaculty Instructors\nOver 4,600 full-time and part-time\nTrainees\nOver 5,000 residents, interns and postdoctoral fellows\nLiving Alumni\n8,600 from classes 1917-1997\nStudents\n165 entering freshman annually\nFirst-Year Class Entered in 1996\nApplicants: 3,956\nMatriculants: 76 men, 88 Women\nUnder-represented minorities: 30\nFirst-year students from 27 states and 7 countries\nNumber of Students Enrolled in MD-PhD Program, Fall 1997\n2 of 4\n05/19/98 13:01:37\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/facts.html#financial\n145\nNumber of Students Enrolled for the PhD in the Division of Medical Sciences, Fall 1997\n500\nContinuing Education\nCourses offered: 206\nNew courses: 38\nAttendees: 38,426\nStates represented: 50\nCountries represented: 63\nCountway Library\nLibrary\nThe Countway Library [http://www.med.harvard.edu/countway/] comprises the Harvard Medical School\nand Boston Medical Libraries\nHoused in the Countway Library Building\nVolumes: 608,900\nMonographs: 203,000\nSerials: 3,971\nRare books: More than 25,000\nSpecial Collections\nHistory of medicine (810 incunabula)\nEuropean books printed 16th-19th centuries\nEnglish books published 1475-1800\nAmerican books 1668-1870, especially New England imprints and Bostoniana\n14th century medical Hebraica and Judaica\nManuscripts and archives, especially of New England origin\nNational archive of medical illustration\nWarren Collection of early books in the history of medicine\nWorld famous collection of medical medals and portraits\nUsers per day\n1,000\nJournal pages copied per year\n5 million\nMultiple databases for on-line services\nMore than 2 million files downloaded from Countway Library site monthly\nNobel Laureates\nNobel Laureates\nGeorge Minot, 1934, Medicine and Physiology\nResearch on liver treatment of the anemias (with Murphy)\nWilliam P. Murphy, 1934, Medicine and Physiology\nDiabetes and diseases of the blood (with Minot)\nFritz A. Lipmann, 1953, Medicine and Physiology\nIdentified coenzyme A and discovered basic principles in understanding of proteins\nJohn F. Enders, 1954, Medicine and Physiology\nApplication of tissue-culture methods in developing a polio virus, the ingredient of the polio vaccine\n(with Robbins and Weller)\n3 of 4\n05/19/98 13:01:37\nHarvard Medical School Facts and Figures\nhttp://www.hms.harvard.edu/about/facts.html#financial\nFrederick C. Robbins,* 1954, Medicine and Physiology\nApplication of tissue-culture methods to the study of viral diseases (with Enders and Weller)\nThomas H. Weller, 1954, Medicine and Physiology\nApplication of tissue-culture methods to the study of viral diseases (with Enders and Robbins)\nGeorg von Bekesy, 1961, Medicine and Physiology\nDiscovered the traveling wave while researching how the ear responds to sound waves\nJames D. Watson, 1962, Medicine and Physiology\nDescribed the structure of DNA\nKonrad E. Bloch, 1964, Medicine and Physiology\nStudied the pattern of reactions involved in the biosynthesis of cholesterol and fatty acids\nGeorge Wald, 1967, Medicine and Physiology\nResearch on the biochemistry of vision\nBaruj Benacerraf, 1980, Medicine and Physiology\nDiscovered that disease-fighting ability is passed on genetically, although the immune-response gene\nvaries from person to person\nDavid Hubel, 1981, Medicine\nResearch on information-processing in the visual system (with Wiesel)\nTorsten Wiesel, 1981, Medicine\nResearch on information-processing in the visual system (with Hubel)\nBernard Lown, Herbert Abrams, Eric Chivian, and James Muller, 1985, Peace\nCofounders, with Evgueni Chazov, Leonid Ilyin, and Mikhail Kuzin from the Soviet Union, of the\nInternational Physicians for the Prevention of Nuclear War\nJoseph E. Murray, 1990, Medicine\nDeveloped new procedures for organ transplant (with E. Donnall Thomas, formerly of the University of\nWashington)\nRobbins was awarded the Nobel Prize for work done while a member of the Harvard Faculty. When the\naward was made, he was a member of the faculty of Western Reserve University.\nAbout HMS I Education & Admissions I Research I Administration & Faculty\nHarvard Medical Web\nLast Updated: October 16, 1997\n4 of 4\n05/19/98 13:01:38\nNews, Facts & Access\nhttp://www.med.harvard.edu/news.html\nHarvard Medical Web\nNEWS, FACTS & MAPS\nNEWS\nPress Releases\nHarvard Medical School and Harvard School of Dental Medicine\nMedia Relations\nHarvard Medical School and Harvard School of Dental Medicine\nHarvard Medical School Affiliated Teaching Hospitals and Research\nInstitutes\nFACTS\nThe Harvard Medical Community\nThe Harvard medical community is a complex group of schools, hospitals and\nresearch institutions in which the Harvard University Faculty of Medicine\nconduct research, educate future physicians and scientists, and provide\nstate-of-the-art patient care.\nThe Harvard Faculty of Medicine work at the 1906 marble quadrangle that\nhouses the administration of Harvard Medical School and six basic science\ndepartments and two social science and policy departments. The faculty also\nwork in an additional 42 clinical departments based at the 17 affiliated\nhospitals and research institutions that are connected through the charter of\nthe Harvard Medical Center. The faculty also work at the Harvard School of\nDental Medicine in a building adjoining the quadrangle.\nEach of the institutions maintains various degrees of autonomy, though a\nnumber are now linked through two large health care systems Partners and\nCareGroup, and all come together for the academic missions of teaching and\nresearch. This far-flung faculty produces an incredible depth and breadth in\nits ability to conduct cutting-edge research and to create innovations in\nmedical education, with basic and clinical research and education occurring at\nmost sites.\nMAPS & DIRECTIONS\nDirections to Harvard Medical School\nHarvard Medical School Quadrangle\nLongwood Medical Area\nPublic Transit\nBack to Harvard Medical Web\nlast updated on February 23, 1998\n1 of 1\n05/19/98 11:53:20\nHarvard Medical Center Network Maps\nhttp://www.hmcnet.harvard.edu/txtmap.html\nHarvard Medical Center\nNetwork\nHMC index About the HMC Network I Residency/Fellowship Search\nClinical Departments I Preclinical Departments Affiliate sites Affiliate sites by\ndiscipline\nHarvard Medical School Clinical Departments [top]\nAmbulatory Care\nAnaesthesia\nDermatology\nMedicine\nNeurology\nOB/GYN\nOpthamology\nOrthopedics\nOtolaryngology\nPathology\nPediatrics\nPhysical Medicine and Rehabilitation\nPsychiatry\nRadiology\nRadiation Oncology\nSurgery\nHarvard Medical School Preclinical Departments [top]\nBiological Chemistry & Molecular Pharmacolgy\nCell Biology\nGenetics\nHealth Care Policy\nMicrobiology and Molecular Genetics\nPathology\nSocial Medicine\nAffiliate Homepages [top]\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nBrockton/West Roxbury Veterans Administration Medical Center\nCambridge Hospital\nCenter for Blood Research\nChildren's Hospital\nDana Farber Cancer Institute\nHarvard Medical School\nHarvard Pilgrim Health Care\nHarvard University\nJoslin Diabetes Center\nJudge Baker Center\nMassachusetts Eye and Ear Institute\nMassachusetts General Hospital\n1 of 4\n05/19/98 11:55:56\nHarvard Medical Center Network Maps\nhttp://www.hmcnet.harvard.edu/txtmap.html\nMcLean Hospital\nMount Auburn Hospital\nSchepens Eye Institute\nSpaulding Rehabilitation Hospital\nAffiliate Sites (by clinical discipline) [top]\nAmbulatory Care\nBeth Israel Deaconess Medical Center\nHarvard Community Health Care\nJoslin Diabetes Center\nAnesthesia\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nChildren's Hospital\nMassachusetts Eye and Ear Institute\nMassachusetts General Hospital\nDermatology\nBeth Israel Medical Center\nBrigham and Women's Hospital\nMedicine\nBrigham and Women's Hospital\nCambridge Hospital\nChildren's Hospital\nMassachusetts General Hospital\nNeurology\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hosptial\nChildren's Hospital\nHarvard Medical School\nMassachusetts General Hospital\nSchepens Eye Research Institute\nOB/GYN\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nChildren's Hospital\nJoslin Diabetes Center Gynecology services\nJoslin Diabetes Center Pregnancy services\nMassachusetts General Hospital\nOpthamology\nChildren's Hospital\nJoslin Diabetes Center\nMassachusetts Eye and Ear Institute\n2 of 4\n05/19/98 11:55:56\nHarvard Medical Center Network Maps\nhttp://www.hmcnet.harvard.edu/txtmap.htm.\nOrthopedic Surgery\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nChildren's Hospital\nMassachusetts General Hospital\nOtolaryngology\nBeth Israel Deaconess Medical Center\nChildren's Hosptial\nMassachusetts Eye and Ear Institute\nPathology\nCenter for Blood Research\nHarvard Medical School\nBeth Israel Deaconess Medical School\nBrigham and Women's Hospital\nChildren's Hospital\nMassachusetts General Hospital\nPediatrics\nChildren's Hospital\nJoslin Diabetes Center\nMassachusetts General Hospital\nPhysical Medicine and Rehabilitation\nBeth Israel Deaconess Medical Center\nSpaulding Rehabilitation Hospital\nPsychiatry\nBeth Israel Deaconess Medical Center\nCambridge Hospital\nChildren's Hospital\nJoslin Diabetes Center\nMcLean Hospital\nMassachusetts General Hospital\nRadiology\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nChildren's Hospital\nMassachusetts Eye and Ear Institute\nMassachusetts General Hospital\nRadiation Oncology\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nChildren's Hospital\nMassachusetts General Hospital\nSurgery\n3 of 4\n05/19/98 11:55:57\nHarvard Medical Center Network Maps\nhttp://www.hmcnet.harvard.edu/txtmap.html\nBeth Israel Deaconess Medical Center\nBrigham and Women's Hospital\nChildren's Hospital\nSearch for a Residency or Fellowship [top]\nIf you have additions or corrections to these maps, please contact\[email protected]\nLast modified: 3/3/98\ntop I Harvard Medical Center Network index\n4 of 4\n05/19/98 11:55:57\nHarvard Medical School: Important Dates\nhttp://www.harvard.edu/academics/catalogs/medical/calendars.htm.\nHarvard Medical School Course Catalog\nGENERAL\nHarvard Medical School\nINFORMATION\nCalendars for Academic Year 1997-98\nAbout HMS\nPrograms of study\nGeneral\nAcademic policies\nYear I, Cannon, Castle, Holmes, & Peabody Societies\nYear II, Cannon, Castle, Holmes, & Peabody Societies\nClinical Rotations July 1997 - June 1998\nCOURSE LISTINGS\nIndex\nPreclinical - Year I\nPreclinical - Year II\nGeneral Calendar\nHST Courses\nClinical\nAUGUST 1997\nEpidemiology\nSocial Medicine\n25\nMon\nCCHP* Year II classes begin\n26/27\nWed/Thur\nCore Clerkships\nUSMLE** Step II Examination\nAdvanced\nBiomedical\nSEPTEMBER\nElectives\n1\nMon\nHMS-Division of\nLabor Day - no classes\nMedical Sciences\n2/3\nTue/Wed\nHMS (all societies) Year I Registration & Orientation\nCourses\n2\nTue\nHST Year II classes begin\n3\nWed\nHST Year I Orientation Luncheon\n3\nWed\nMIT classes begin\nOTHER WEB SITES\n4\nThur\nYear I classes begin\nHarvard Medical\nOCTOBER\nWeb\nHarvard University\n13\nMon\nColumbus Day - no classes\n14/15\nTues/Wed\nUSMLE Step I Examination\nNOVEMBER\n11\nTue\nVeterans Day - no classes\n27-29 Thur-Sun\nThanksgiving recess\nDECEMBER\n12\nFri\nHST classes end\n15-19\nMon-Thur\nMIT final exam period\n15-19\nMon-Thur\nHST final exam period\n19\nFri\nHST winter recess begins\n22\nMon\nCCHP Winter recess begins\nJANUARY 1998\n3\nThurs\nCCHP Classes resume\n5\nMon\nMIT independent activities begin\n5\nMon\nHST January classes begin\n12\nMon\nM.L. King Day - no classes\n30\nFri\nHST January classes end\nFEBRUARY\n1 of 5\n05/19/98 12:06:02\nHarvard Medical School: Important Dates\nhttp://www.harvard.edu/academics/catalogs/medical/calendars.hml\n2\nMon\nMIT Registration Day\n2\nMon\nHST spring classes begin\n16\nMon\nPresidents Day - no classes\nMARCH\n3/4\nTue/Wed\nUSMLE Step II Examination\n12\nThur\nPM HST Forum (Test)\n23-27\nMon-Sun\nCCHP and HST Spring recess\nAPRIL\n20\nMon\nHoliday at MIT only (Patriot's Day)\n21\nThur\nPM Soma Weiss Assembly\nMAY\n15\nFri\nHST classes end\n18-22\nMon-Fri\nMIT final exam period\n18-22\nMon-Fri\nHST final exam period\n22\nFri\nCCHP Year II classes end\n25\nMon\nMemorial Day - no classes\nJUNE\n3\nWed\nHST Commencement\n4\nThur\nHarvard Commencement\n5\nFri\nMIT Commencement\n9/10\nTue/Wed\nUSMLE Step I Examination\n19\nFri\nCCHP Year I classes end\n* Cannon/Castle/Holmes/Peabody Societies (New Pathway program)\n** United States Medical Licensing Examination\n*** Harvard - MIT Health Sciences and Technology Program\nYear I: Cannon, Castle, Holmes, & Peabody Societies\nOrientation:\nTue - Wed, Sept 2-3\nHuman Body: IN 701.0\nAll mornings: Thu, Sept 4 - Tue, Oct 28\nHB Final Exam: Tue, Oct 28\nHoliday: Mon, Oct 13\nChem Biol Cell: IN 711.0\nAll mornings: Wed, Oct 29 - Fri, Dec 12\nCBC Final Exam: Fri, Dec 12\nHolidays: Tue, Nov 11 & Nov 27 - 28\nIntegrated Human Physiology: IN 712.0\nAll mornings: Mon, Dec 15 - Wed, Feb 11\nHP Final Exam: Wed, Feb 11\nWinter Recess: Mon, Dec 22 - Fri, Jan 2\nHoliday: Mon, Jan 19\n2 of 5\n05/19/98 12:06:03\nHarvard Medical School: Important Dates\nhttp://www.harvard.edu/academics/catalogs/medical/calendars.hml\nPharmacology: IN 705.0\nAll mornings: Thu, Feb 12 - Thu, Mar 12\nPharm Final Exam: Thu, Mar 12\nHoliday: Mon, Feb 16\nGenetics, Embryology, Reproduction: IN 703.0\nAll mornings: Fri, Mar 13 - Tue, April 28\nGER Final Exam: Tue, April 28\nImmunology, Microbiology & Infectious Disease: IN 704.0\nAll mornings: Wed, Apr 29 - Fri, June 19*\nOne Afternoon Session: TBA\nIMD Final Exam: Tue, June 23\nHoliday: Mon, May 25\n*HMS Commencement: Thu, June 4\nClinical Epidemiology & Social Medicine\nFall Semester:\nTue afternoons: Sept 9 - Dec 16\nThu afternoons: Sept 11 - Dec 18\nSpring Semester:\nTue afternoons: Feb 3 - Mar 17 & Mar 31 - May 12\nThu afternoons: Feb 5 - Mar 19 & Apr 2 - May 21*\nHoliday: Thu: Nov 27\n*Soma Weiss Research Day: Thu, PM - No Classes\nPatient/Doctor I: IN 709.JA\nFall Semester:\nMon afternoons: Sept 8 - Dec 15\nWed afternoons: Sept 10 - Dec 17 (Wed, Nov 26-No Class)\nSpring Semester:\nMon afternoons: Jan 5 - Mar 16 & Mar 30 - June 8\nWed afternoons: Jan 7 - Mar 18 & Apr 1 - June 10\nHolidays:\nMon: Oct 13, Jan 19, Feb 16, May 25\nWed: Nov 26-No Class\nAssessment: Spring dates TBA\nRecess:\nWinter: Dec 22, 1997 - Jan 2, 1998\nSpring: Mar 23, 1998 - Mar 27, 1998\nAcademic Year I ends Tuesday, June 23, 1998\nYear II (1997 - 1998) Cannon, Castle, Holmes, & Peabody\nSocieties\nHuman Nervous System & Behavior: IN 707.0\nAll mornings: Mon, Aug 25 - Tue, Oct 21\nHNSB Mid-Block Exam: TBA\nHNSB Final Exam: Mon & Tue, Oct 20 & 21\nHolidays: Mon, Sept 1 & Mon, Oct 13\nPathology: IN 714.0\nAll mornings: Wed, Oct 22 - Fri, Nov 14\nPathology Final Exam: Fri, Nov 14\n3 of 5\n05/19/98 12:06:03\nHarvard Medical School: Important Dates\nhttp://www.harvard.edu/academics/catalogs/medical/calendars.html\nHoliday: Tue, Nov 11\nHuman Systems: IN 708.0\nMon - Fri mornings: Mon, Nov 17 - Fri, Jan 30\nMon/Tue/Thu/Fri mornings: Mon, Feb 2 - Fri, Apr 3\nTue/Thu/Fri mornings: Tue, Apr 7 - Fri, May 22\nHolidays:\nNov 27&28\nJan 19\nFeb 16\nWinter Recess\nDec 22 - Jan 2\nSpring Recess\nMarch 23 - March 27\nHuman Systems Sections:\nModule I (Dermatology/Respiratory/Cardiovascular/Hematology)\nMon, Nov 17, 1997 - Mon, Feb 9, 1998\nModule II\n(Gastroenterology/Musculoskeletal/Renal/Endocrine/Reproductive)\nTues, Feb 10, 1998 - Fri, May 22, 1998\nBehavioral Science (Psychopathology): PS 700M.J\nFall Semester (Cannon, Castle, Holmes & Peabody Students):\nTue afternoons: Sept 2 - Dec 9\nThu afternoons: Sept 4 - Dec 11\nSpring Semester (HST Students):\nTuesday Afternoons: Feb 3 - Mar 17 & Apr 7 - May 12\nPreventive Medicine/Nutrition: PM 711.0\nSpring Semester:\nTue afternoons: Jan 13 - Mar 17 & Apr 7 - Apr 28\nPatient/Doctor II\nWednesday Afternoons: Sept 3 - Dec 17 & Jan 7 - Jan 28\nAll day Wednesday: Feb 4 - Apr 1\nAll day Monday & Wednesday: Apr 6 - May 20\nNo Classes: Wed, Nov 26\nOSCE April 6, 8, & 10\nRecess:\nWinter: Dec 22, 1997 - Jan 2, 1998\nSpring: Mar 23, 1998 - Mar 27, 1998\nAcademic Year II ends Friday, May 22, 1998\nClinical Rotation Dates\nJuly 1997 - June 1998\n4 of 5\n05/19/98 12:06:03\nHarvard Medical School: Important Dates\nhttp://www.harvard.edu/academics/catalogs/medical/calendars.htm\nLast day\nRotation\nRotation Dates\nto drop\nJuly\nJuly 7 - Aug 3\nMay 1\nAugust\nAug 4 - Aug 31\nJune 1\nUSMLE Step II Exam:\nAug 26-27, 1997\nRegistration deadline for this exam\nis May 28, 1997\nSeptember\nSept 1 - Sept 28\nJuly 1\nOctober\nSept 29 - Oct 26\nAugust 1\nUSMLE Step I Exam:\nOct 14-15, 1997\nRegistration deadline for this exam\nis July 17, 1997\nNovember\nOct 27 - Nov 23\nSept 1\nDecember\nNov 24 - Dec 21\nOct 1\nRecess\nDec 22 - Jan 4\nJanuary\nJan 5 - Feb 1\nNov 1\nFebruary\nFeb 2 - - Mar 1\nDec 1\nMarch\nMar 2 - Mar 29\nJan 1\nUSMLE Step I Exam:\nMar 3-4, 1998\nRegistration deadline for this exam\nis Dec 5, 1997\nRecess\nMar 30 - Apr 5\nApril\nApr 6 - May 3\nFeb 1\nMay\nMay 4 - May 31\nMar 1\nJune\nJune 1 - June 28\nApr 1\nCommencement\nJune 4, 1998\nUSMLE Step I Exam:\nJune 9-10, 1998\nRegistration deadline for this exam is\n(Tentative)\nMar 13, 1998 (Tentative)\nRecess\nJune 29 - July 5\nStudents doing clinical rotations should check with the course director\nregarding holiday time off.\n*Last Day to Drop:This is the last day to drop one month clerkships only;\nThree month clerkships are set and cannot be changed.\nBack to Academic Policies\n5 of 5\n05/19/98 12:06:03\nMAY-12-1998 11:31\nHMS-DEAN'S OFFICE\n617 432 3907 P.02\n1\nJoseph B. Martin\nOpen Doors Address\nHARVARD MEDICAL SCHOOL\nDean's\n11.\nOn Sept. 2, the first day of Orientation Week, Dean Joseph Martin\nwelcomed first-year students at a reception outside the\nall\nadministration building. The ceremony marked the opening of the\nbuilding's traditionally locked doors onio the Quad, a gesture the\nSpeech-\nLetter to the Commissions\ndean explained in his remarks, which are excerpted below.\nMain\nA warm welcome to each and every one of you. I welcome you as\nCommunity\nnew members to the Harvard Medical community, 168 medical\nstudents and 32 dental medicine students.\nSeruice\nIn saying \"community,\" I mean something much broader than that\nbounded by this marble quadrangle.\nI want to take just a few minutes this afternoon to discuss the\nmany layers of community that have, as of today, become integral to\nyour life. And I want to caution that you may occasionally lose sight\nof these over the next four years as you immerse yourselves in the\nstudy of medicine and dentistry.\nI want to describe the community of medicine at Harvard in the\ncontext of the broader Harvard Medical community, the alumni who\nhave come before you, and the faculty, residents, and postdocs at our\n17 affiliated teaching hospitals and research institutions.\nYou are here bccause among medical and dental schools, Harvard\nis unsurpassed. You came here because you expect the best\neducation possible in a community of distinguished scholars,\nteachers, scientists, and clinicians.\nI also want to spend a few moments thinking about another\ncommunity that will bc important to you over the years, one that you\nmay have trouble keeping sight of while you're here. This\ncommunity is our neighbors-the community on nearby Mission Hill,\nthe community of greater Boston, the U.S., and, indeed, the whole\nworld. These communities are the raison d'être of your new\nprofession.\nThrough your experiences here, you will have the opportunity to\nbecome leaders in your profession-physicians and scientists who\nmake sure the profession stays true to its commitment to improve the\nwell-being of all our communities.\nAlthough I officially started my tenure as dean of the Harvard\nFaculty of Medicine on July 1, I join with you today in fully entering\nthis community. I have heard stories about your superlative\nachievements before arriving here, and it is a privilege to be\nrejoining the Harvard Medical community with you today.\nAs a symbol of my commitment to go with you through your\ntransition into the medical profession, I want to announce today that\nthese front doors of HMS-doors that, for decades, have been locked\nto you until your graduation day-will be open to you now every day.\nWell. at least every Monday through Friday from 9 to 5.\nThe opening of these doors is symbolic: it represents my priorities\nfor Harvard Medical School. We in this building will be open and\naccessible to all our communities; at the same time, we will be\nlooking for ways we can be of assistance-to our students seeking\nknowledge, our affiliates seeking collaboration, or a neighborhood\nhealth clinic seeking another pair of hands\n1 of 2\n5/12/98 12:19 PM\nMAY-12-1998 11:32\nHMS-DEAN'S OFFICE\n617 432 3907 P.03\nPrior to my leaving San Francisco for Boston, I was invited to\ncomment on the future of medical education. At that time I said:\n\"Our most important task right now is to make the communities\naround us aware of what we do in the academic centers. The public\nis very interested in biomedical research; health and science still get\non the evening news regularly. But I don't think the public\nunderstands how science leads to the advances that people are\ninterested in, and how science is threatened right now.\"\nThen I closed, saying, \"We need to open our doors and\ncommunicate that the work we are doing is for everybody.\"\nNow, with these doors open, during my tenure here, community\noutreach and service will remain an individual choice but will be a\nmandate for HMS as an institution.\nThere is one last aspect of responsibility to community that I\nwould like to address. It is something that underlies everything that\nyou have heard today, and that is ethics, the foundation of our\nmedical profession.\nSo to conclude: as you become immersed in your first year of\nmedical or dental school, periodically take time to think about how\nyou interact with all your communities, the Harvard Medical\ncommunity, the community of doctors and dentists, and our\nneighboring communities-in Boston, across the U.S., and around the\nglobe.\nCarefully consider ways that you can take your membership in the\nHarvard Medical community as an opportunity to become leaders in\nusing the science and the art of medicine to make all our\ncommunities better.\nAs a result, you will become better members of the medical and\ndental profession.\n-Joseph B. Martin\nlast updated on October 9, 1997\nAbout HMSI Education & Admissions I Researchi Administration & Faculty\nHarvard Medical Web\n2 of 2\n5/12/98 12:19 PM\nMAY-29-1998 11:31\nHMS-DEAN'S OFFICE\n617 432 3907\nP.01\nHarvard Medical School\nOFFICE OF THE DEAN OF THE FACULTY OF MEDICINE\n25 SHATTUCK STREET\nBOSTON, MASSACHUSETTS 02115\nTELEPHONE: (617) 432-1501\nFACSIMILE: (617) 432-3907\nVIA FACSIMILE\nTo:\nMichael\nFacsimile:\n202-456-6244\nFrom:\nGloria M. Lacap\nOffice of the Dean of the Faculty of Medicine\nTelephone:\n617-432-3792\nFacsimile:\n617-432-3665\nRe:\nStudent Speakers at Graduation on June 4, 1998\nDate:\n29 May 1998\n# Pages (incl. cover sheet):\n2\nMAY-12-1998 11:32\nHMS-DEAN'S OFFICE\n617 432 3907\nP.04\nOSEPH B. MAR' 'IN\nDean's priorites Spach\nSEVEN PRIORITIES FOR HARVARD MEDICAL SCHOOL\nI will now list-and briefly discuss with you-the seven priorities\nthat shape my vision for Harvard Medical School in the coming\nyears.\nMy first priority is to maintain and strengthen the basic science\ndepartments. My passion for science, and the great importance I\nplace on the quality of scientific work, led me to spend a full day in\neach of the basic science departments this past summer. I was\nthoroughly impressed with the intellectual ability and enthusiasm of\nthe faculty, the ample laboratory facilities, and the groundbreaking\nresearch being done in each department.\nTo ensure that the pursuit of fundamental truth continues to\nflourish here at the Medical School, I am committed to preserving\nwhat is best about our basic science departments-the unsurpassed\nintellectual capital of the faculty; the freedom, and the means, to\nfollow wherever the quest of pure knowledge leads-while at the\nMAY-12-1998 11:32\nHMS-DEAN'S OFFICE\n617 432 3907 P.05\nS me time introducing changes that I believe wi I make our\ndepartments even better.\nOne way I hope to strengthen the basic science enterprise here is by\nfostering closer collaboration between departments, including,\nwhere appropriate, joint recruitment and shared resources. Science\nthat is increasingly interdisciplinary calls for new thinking in terms\nof recruitment, and I believe that cross-departmental appointments\nmay lead to increased scientific collaboration and to a shared vision\namong leaders in research.\nMy second priority is to improve the sometimes fractured\ninstitutional relationships between Harvard Medical School\nand its affiliated institutions.\nMA-12-1998 11:33\n0 e of the first steps I have taken to ccompl sh this is to\nestablish a physical presence at each of the major affiliates.\nThis presence will take the form of satellite offices-or\nembassies, as I like to think of them-that will serve as a direct\nresource for faculty and students, and where I will hold office\nhours each month.\nThe first of these satellite offices opened at MGH in October,\nthe office at Brigham & Women's this month. The Beth Israel\nDeaconess Institute office will open in December, and the office\nat Children's Hospital in January.\nAs I mentioned a moment ago with regard to basic science\ndepartments, I plan to encourage and facilitate joint recruitment\nand dual appointments between the Quad and the affiliates. I\nbelieve this cross-cutting approach will help to draw the entire\nHarvard medical community closer together in the crucial effort to\nbuild bridges between basic science and clinical practice.\nMAY-12-1998 11.33\nMy third priority is to cultiv te d versity in all its forms. Let me\nmake it clear that diversity here at Harvard Medical School is not\nan issue of fairness, but of quality-the quality of our educational\nprograms and the quality of care in our medical community. The\nethnic and cultural diversity of our medical students, faculty, and\nstaff-or the lack thereof-contributes directly to the quality and\nscope of research, education, and patient care that is practiced here.\nA more diverse and culturally representative medical community\npractices higher quality medicine, the better to serve the larger\ncommunity.\nI am proud of the minority representation we have currently\nachieved in the student body. We need to continue our efforts to\nattract and encourage the best minority students, particularly in\nlight of the Supreme Court's ruling this week upholding\nCalifornia's proposition 209, and the distressing news from the\nAssociation of American Medical Colleges that minority\napplications to medical schools nationwide decreased 8.4 percent\nlast year.\nMAY-12-1998 11:33\nHMS-DEAN'S OFFICE\n617 432 3907 P.08\nIn addition, we need to see a corresponding increase in the number\nof underrepresented minority students in our residency programs\nand on our faculty.\nAnother concern is the advancement of women. Although progress\nhas been made-as shown by a new student population of 50%\nwomen-that there are still areas, such as the promotion of women\nfaculty members and staff, where more work needs to be done.\nWith these challenges in mind, I have charged William Silen, the\nDean for Faculty Development and Diversity, with the task of\ncoordinating all diversity programs throughout the Harvard\nmedical community.\nMedical education is my fourth priority. I am impressed with the\nresults of the New Pathway-the innovative approach to medical\neducation introduced by my distinguished predecessor, Dan\nTosteson. But even the New Pathway will run the risk of premature\naging if it fails to keep pace with the rapid changes in today's health\ncare environment.\nMAY-12-1998 11:33\nHMS-DEAN'S OFFICE\n617 432 3907\nP.09\nOur Ph.D. and M.D./Ph.D. programs represent another traditional\nstrength that we must carefully nurture. In recent years, the Ph.D.\nprogram in the Division of Medical Sciences has been expanded and\nreorganized to great effect. But severe cuts in Federal aid threaten\nthe program. And even more serious financial problems plague the\ncombined M.D./Ph.D. program, which trains scientists to bridge the\ngap between basic and clinical research. Now, more than ever, we\ncannot afford to watch our support erode in these areas.\nMy fifth priority is to enhance and optimize the use of information\ntechnology here at Harvard Medical School, particularly in the\nareas of educational, research, and administrative computing\nThe sixth priority is community and public service, which is an\nintegral part of a complete medical education and an activity of\nincalculable value within the Harvard medical community, the city,\nthe nation, and the world at large. I applaud the efforts of our\nstudents who undertake public service projects, and encourage all of\nour students to serve the larger community in some way.\nMAY-12-1998 11:34\nHMS-DEAN'S OFFICE\n617 432 3907 P.10\nOn a wider scale, Harvard Medical International marshals the\nresources of the Faculty of Medicine, the affiliates, and selected\nexternal partners in an effort to promote quality healthcare\nworldwide.\nFinally, number seven among my priorities must be resource\ndevelopment. For all of our efforts to succeed, resources are\nessential.\nAlthough I have given you only a broad outline, I hope it has left\nyou with a sense of the direction, or rather directions, in which I\nplan to take Harvard Medical School during my tenure as Dean.\nFor me, these seven points will serve as reminders of the core values\nwe strive to sustain, and as guideposts to assess our progress in the\ncoming years towards the important goals they represent.\nThank you very much. I will now take any questions you may have.\nTOTAL P.10\nMAY.20.1998\n3:03PM\nHMS PUBLIC AFFAIRS (617)432-0446\nNO.730\nP.2\nPROGRAM\nINTRODUCTION AND WELCOME\nAllison Sarah Bryant and\nSamuel Clayton Somers\nCo-Moderators\nSTUDENT ADDRESSES\nKelly A. Cook\n\"The Fabric of Life\"\nTokunbo Kemi Babagberni\n\"On Call\"\nRev. Anthony Lamar Mitchell\n\"What I. Really Learned in Medical School\"\nADDRESS\nFirst Lady Hillary Rodham Clinton,\nCommencement Address\nCLASS PRESENTATIONS AND CONFERRAL OF DEGREES\nHarvard School of Dental Medicine\nR Bruce Donoff, DMD, MD.\nDean, Harvard School of Dental Medicine\nHarvard Medical School\nJoseph B. Martin, MD, PhD\nDean of the Faculty of Medicine, Harvard Medical School\nADMINISTRATION OF THE OATH OF THE CLASS OF 1998\nSo that everyone may see, please remain seated during the entire program.\nPhotographs are to be taken from your seat. Thank you.\n4th, inleresting student\nwincen. veryacture- -\nhad baby durny 4th\nyear- worked with\nme on Family Jan ^\n(information a Hached)\nHarvard Medical School\nES\nOliver Wendell Holmes Society\nDaniel A. Goodenough, Ph.D., Master\n(617) 432-2156\nFax: (617) 432-2500\nMedical Education Center\n260 Longwood Avenue\nBoston, Massachusetts 02115\nDEAN'S LETTER FOR VICTORIA ANGELA MCGHEE SMITH\nNOVEMBER 1, 1997\nDear Colleague:\nIt is our pleasure to write this Dean's Letter for Victoria McGhee Smith, who is applying for residency training\nin Family Medicine. Vicki received her B.A. from Yale University summa cum laude in Near Eastern Languages and\nCivilization in 1990. At Yale, Vicki was elected ФВК and received Distinction in Near East Languages. In addition to\nher academic work, she worked as a Healthworker in the Women's Health Services and was a volunteer at Yale-New\nHaven Hospital. She originally planned to develop a career as a diplomat, but after spending some time observing life at\nthe American embassy in Cairo decided to pursue other interests. After graduation from Yale, Vicki worked as a teacher\nin California as part of the Teach for America Program, teaching 4th and 5th grade in Ingelwood, CA. In 1992, Vicki\nenrolled at El Camino College to complete her pre-medical courses, earning the General Chemistry McQuerry Award for\nDistinction in Chemistry. While at El Camino, she also worked half time, coordinating a computer lab for vocational and\ntechnical students, acting as tutor in both computing and math skills and serving as an Independent Study Coordinator for\na basic skills program. She managed also to find time to volunteer as a Medical Assistant at Clinica Para Las Americas,\nand keep herself fluent in Spanish.\nSince matriculating at the Harvard Medical School, Vicki has been an energetic and engaged student. She has\nbeen a Member of the Multicultural Fellows Committee and co-chair of the Third World Caucus (TWC). With her\ncolleagues, she engineered the TWC weekend a program at HMS for accepted underrepresented minority students which\nwas a terrific success. In the summer of 1995, Vicki joined the Urban Health Project, working for the Family Van\ndeveloping activities for Mattapan youth with funds she was awarded for a grant she had written. She also counseled\nadolescent mothers about contraception and STDs at the Brookside Community Health Center. During the past year, she\nhas been the Chair of the Family Practice Interest Group. During her first year, Vicki also worked as a Research\nAssistant in the Department of Adolescent Medicine at Children's Hospital, Boston. In addition to performing literature\nsearches, she wrote a chapter on adolescent pregnancy and childbearing for a textbook on adolescent gynecology edited\nby Dr. Jean Emans. In her second year, Vicki worked as a research assistant for the Beth Israel WELL Program (Women\nEnjoying Longer Lives), an outreach educational program to minority women of middle age. As a member of the\nMassachusetts Academy of Family Physicians' Medical School Cooperative Committee, Vicki worked on a project to\neducate medical students about the field of Family Practice, and helped develop a conference about Family Practice for\nmedical students held at Tufts Medical School. In recognition of her outstanding achievements in community work,\nVicki was selected by the W.K. Kellogg Foundation to receive their Community Based Training Fellowship for 1997.\nAdditional honors include election to the Aesculapian Club, the Linnane Scholarship and the AAUW Selected\nProfessions Fellowship.\nDuring her basic science studies of the first two years, Vicki's tutors praised her keen intellect, superb\ninterpersonal skills, and good understanding of the course material. \"Vicki excelled in her ability to relate the clinical\nperspectives to the cases. She consistently was able to focus on the relevant issued and successfully help the group reach\nan understanding of the practical aspects of medical problems which arose in the body.\" \"Vicki was clearly the leader of\nthe tutorial, both with her good will and her interest in pursuing the case to its depths. She was not dominating, but\nencouraged everyone to participate. In the best group of tutorial students in my eight years of teaching, she was only a\nslight first among equals, but with no inclination to be more, and was invaluable in helping the shy members. Her study\nhabits are good and her knowledge increased during the course substantially.\"\n0150560434:Smith, Victoria Angela; Personal Statement Page I\nVictoria Angela McGhee Smith\nI entered Harvard Medical School in the fall of 1994 wanting to become a Family Practice\nphysician. Experiences as a teacher and as a medical assistant in low-cost health clinics shaped this\ndecision.\nVignette #1:\n\"Good afternoon, Mrs. Gaston. This is Ms. McGhee (my maiden name), Dasmont's teacher I'd\nlike to know if I could stop by and speak with you and your husband this week.\"\nA sharp intake of breath crosses the phone lines.\n\"What did Dasmont do wrong? Is he going to be suspended?\"\n\"Dasmont hasn't done anything wrong. I just want to discuss his progress with you and hear your\nconcerns about his education.\"\nLike Mrs Gaston, most of the parents that I called responded with alarm to my suggestion of a\nhome visit. I decided to embark upon a home visitation campaign as I recognized that to successfully\nteach each of my students I could not view my classroom as existing in a vacuum. My home visits\nhelped me to better understand the myriad of forces at work in my students' lives which encouraged or\ndiscouraged them from learning. Just as important was the creation of a team spirit with myself, the\nparents or guardians, and the student working together for a common goal.\nVignette #2:\n\"The first thing on today's agenda is a discussion of the following problem. Many of our patients\nare\nreturning to us reinfected with a sexually transmitted disease that we have successfully treated Does\nanyone have any suggestions as to how to deal with this issue?\" queried the medical director of\nWomen's Health Services (WHS), a low-cost health center for women in which I worked as a\nhealthworker during my sophomore and senior years of college.\nAfter a long discussion, it was decided that WHS would treat the male partners of their patients.\nThe rationale behind that decision was that there were few to no low-cost health care options for men in\nthe New Haven area to have their sexually transmitted diseases treated and if WHS truly cared\nabout its female patients it had to care for their male partners.\nMy teaching experience and experiences in community health centers like WHS demonstrated to\nme the interdependence of individuals and the families and communities. I also realized that I tend to\nthink of problems in a holistic fashion. Even before entering medical school, Family Practice seemed to\nme to be the medical specialty that thought about a patient's health in a way that expands beyond the\nindividual to his/her family and environment\nMy clinical rotations in medical school as well as my extracurricular activities have merely served\nto\nconfirm the fit of Family Practice for me. One particular patient encounter during my pediatrics rotation\nexemplifies my interest in Family Practice. One night in the pediatric emergency room I was asked to\nevaluate an intoxicated 15 year old Latina female brought in by her mother and maternal grandmother\nJasmine's mother did not know that her daughter drank. Upon discovering Jasmine drunk, she rushed\nher to the hospital to have her stomach pumped. After interviewing Mrs. Cortes and Jasmine\nseparately, it became clear that Jasmine's drinking was in response to the breakup of her parents'\nmarriage as well as conflicts with her mother concerning her need for independence. Meanwhile, her\nmother was struggling with the fact that her \"little girl\" had become an adolescent and was scared that\nJasmine was associating with teens who would lead her to substance abuse and sexual exploration.\nFortunately, my intern gave me the opportunity to spend one hour with Jasmine and her mother trying to\nbegin the process of resolving some of the many conflicts between this mother and daughter That night\nI experienced the joys and frustrations of working with a family and became further convinced that my\nfuture lies in a career in Family Practice.\nMy career goals after residency are to obtain more training in Preventive Medicine and Public\n0150560434 Smith, Victoria Angela; Personal Statement - Page 2\nHealth and work as a family physician in a medically underserved area. I hope to work in or create a\ncomprehensive community health center that attends to the multiplicity of needs of the community it\nserves. A truly comprehensive health center addresses not only the physical and medical needs of its\npatients but also seeks to work on emotional, educational, financial, and spiritual concerns of a\ncommunity. As a Family Practice physician, I look forward to the challenge of practicing medicine\namong the medically underserved in the United States and abroad.\nThe Family Van\nMission Statement:\nIn 1988 the death rate for infants in the United States was 10 per 1,000 births;\nin Boston, infants died at more than twice that rate. A case-by-case study examined the\nfactors that led to 144 of the infant deaths in Boston in 1990 and 1991 Researchers\nfound three major themes running through the stories that the mothers of these infants\ntold Over 70 percent of these cases were plagued by insufficient tracking and linkages\nwithin the health care system. Sixty percent of the women had unplanned pregnancies.\nOver 30 percent reported that negative interactions with providers led to negative\nfeelings about health care. And, more than 16 percent of the women were homeless\nsome time during their pregnancy.\nIn 1992, The Family Van, a collaboration among six neighborhood health\ncenters, state and local agencies, and the Beth Israel Hospital, began to bring its unique\ncombination of community expertise and health care resources into the neighborhoods\nthat experienced the highest rates of infant mortality Each day, The Family Van parks\nat a predetermined corner in one of six Boston neighborhoods. The program offers\npregnancy testing, reproductive health counseling, nutrition counseling, and personalized\nreferrals to over 100 local programs dealing with such issues as HIV/AIDS, free\nmedical care, homelessness, violence prevention, and drug rehabilitation.\nThe Family Van seeks to be part of the communities it serves. We do this by\ndesign, ideology, and atmosphere. Each collaborator provides staff for the Van who are\nselected to meet the needs of the particular communities served. Community roots and\nlanguage skills are all considered essential to the success of the program.\nThe issue for most of our clients is not simply insurance or transportation,\nit is, broadly speaking, a sense that institutions designed to serve them are\nunwelcoming or even hostile. It is the unease of the outsider looking into a fast-\npaced world that cannot hear their whole story or begin to address the holes that\na lifetime of deprivation has created in the ability to manage the business of life.\nIdeologically, we believe that better health outcomes are more readily achieved\nthrough sharing information and resources than by access to medical intervention. A\nstudy of over 9,000 women nationwide found that better birth outcomes were linked\nmore tightly to positive informational exchanges between women and health care\nproviders than they were to the use of extensive diagnostic procedures. The Family\nVan provides an atmosphere where women, men and teens can exchange information\nand learn about the city resources that are dedicated to address their needs.\n-\nmore\ninformation\non one of\nthe students\nWithdrawal/Redaction Marker\nClinton Library\nDOCUMENT NO.\nSUBJECT/TITLE\nDATE\nRESTRICTION\nAND TYPE\n001. resume\nAddress (Partial) Phone No. (Partial) (1 page)\nn.d.\nP6/b(6)\nCOLLECTION:\nClinton Presidential Records\nFirst Lady's Office\nSpeechwriting (Laura Schiller: Events, Meetings 5/98-7/98)\nOA/Box Number: 24611\nFOLDER TITLE:\n[Harvard Medical School - 6/4/98][Folder 1][2]\n2006-1733-F\nbm701\nRESTRICTION CODES\nPresidential Records Act - [44 U.S.C. 2204(a)]\nFreedom of Information Act - [5 U.S.C. 552(b)]\nP1 National Security Classified Information |(a)(1) of the PRA|\nb(1) National security classified information [(b)(1) of the FOIA]\nP2 Relating to the appointment to Federal office [(a)(2) of the PRAJ\nb(2) Release would disclose internal personnel rules and practices of\nP3 Release would violate a Federal statute [(a)(3) of the PRA\nan agency |(b)(2) of the FOIA]\nP4 Release would disclose trade secrets or confidential commercial or\nb(3) Release would violate a Federal statute [(b)(3) of the FOIA]\nfinancial information [(a)(4) of the PRA]\nb(4) Release would disclose trade secrets or confidential or financial\nP5 Release would disclose confidential advice between the President\ninformation [(b)(4) of the FOIA]\nand his advisors, or between such advisors |a)(5) of the PRA]\nb(6) Release would constitute a clearly unwarranted invasion of\nP6 Release would constitute a clearly unwarranted invasion of\npersonal privacy [(b)(6) of the FOIA]\npersonal privacy |(a)(6) of the PRA]\nb(7) Release would disclose information compiled for law enforcement\npurposes [(b)(7) of the FOIA]\nC. Closed in accordance with restrictions contained in donor's deed\nb(8) Release would disclose information concerning the regulation of\nof gift.\nfinancial institutions [(b)(8) of the FOIA)\nPRM. Personal record misfile defined in accordance with 44 U.S.C.\nb(9) Release would disclose geological or geophysical information\n2201(3).\nconcerning wells |(b)(9) of the FOIA]\nRR. Document will be reviewed upon request.\nChi-Cheng Huang\n[001]\nPermanent Address\nCurrent Address\nP6/(b)(6)\nP6/(b)(6)\nEducation\nHarvard Medical School, Boston, Massachusetts\nM.D. Candidate\n1993-98\nTexas A&M University, College Station, Texas\nB.A. Cell and Molecular Biology, Magna Cum Laude\n1989-93\nHonors\nMedical School\nCiba-Geigy Outstanding Community Service Award\n1995\nAlbert Schweitzer Urban Health Fellowship\n1995\nCollege\nBarry M. Goldwater Science Scholarship\n1990-93\nTexas A&M University Scholar\n1990-93\nTexas A&M President's Endowed Scholar\n1989-93\nTexas A&M Brown-Rudder Outstanding Senior Student Award\n1993\nPhi Kappa Phi Outstanding Junior Award\n1992\nTexas A&M Thomas S. Gathright Scholar Award\n1991\nTexas A&M Buck Weirus Spirit Award\n1991\nCommunity\nCo-Director of Resources International\n1996-1997\nService\na non-profit organization that sends medical equipment\nto clinics and hospitals in the United States and abroad.\nM.D. Anderson Cancer Hospital-Camp Star Trials Counselor\n1990,91,93,95\nMentorship Program - Place of Promise, Dorchester, MA\n1994-97\nVolunteer at Brookside Community Health Clinic\n1994-96\nCreated Spanish/English Well Child Program\nOakwood Middle School Tutorial Program\n1989-91\nBig Brother/Big Sister Program\n1989-90\nInternational\nMedical Experience in Viacha, Bolivia\nFall 1997\nExperience\nWorked at Alalay Orphanage with Street Children\nin El Alto,Bolivia\nSummer 1997\nStudent at Institute of Bilingual and Multicultural Studies,\nCuernavaca, Mexico\nAugust 1995\nMedical Experience at Hospital Vozandes in Shell, Ecuador\nSummer 1994\nWestern Amazon Jungle\nStudent at Universidad de las Americas, Puebla, México\nSummer 1993\nL.T. Jordan Institute for International Awareness\n1992-93\nDirector of Living Abroad in England Program at Texas A&M\nInternational Peace Camp in the Republic of Serbia\nAugust 1992\nQuaker United Nation Summer School, Geneva, Switzerland\nJuly 1992\nKings College London - Reciprocal Exchange Program\n1991-92\nActivities\nPark Street Church Sunday Night Leadership Team\n1996-97\nPark Street Church Choir\n1993\nUniversity of London Chorus\n1991-92\nThe Octaves - Men's Singing Octet\n1989-90\nLanguages\nEnglish, Taiwanese, Spanish\nInterests\nTennis, Running, Singing, Traveling, Cooking, Hermeneutics, Social Justice\nPAGE\n2\n5TH STORY of Level 1 printed in FULL format.\nCopyright 1998 The New York Times Company\nThe New York Times\nMay 18, 1998, Monday, Late Edition - Final\nSECTION: Section A; Page 10; Column 6; National Desk\nLENGTH: 747 words\nHEADLINE: More Children Go Uninsured Despite Status For Medicaid\nBYLINE: By ROBERT PEAR\nDATELINE: WASHINGTON, May 17\nBODY:\nA new Federal study finds that 4.7 million children far more than previously\nestimated are eligible for Medicaid but are not enrolled in the program and\nhave no health insurance benefits.\nThe finding means that two of every five uninsured children in the United\nStates could have coverage through Medicaid, which provides comprehensive health\nbenefits, if they or their parents would just apply for it.\nThe study, published today in the journal Health Affairs, said 21.2 million\nchildren ages 18 or younger were eligible for Medicaid, the Federal-state\nprogram for low-income people. But, it said, 22 percent of them were not in\nMedicaid or any other public or private health insurance program.\nThe White House had estimated that three million children were eligible for\nMedicaid but not enrolled. And in January, President Clinton ordered the\nDepartment of Health and Human Services to locate such children and sign them\nup.\nMr. Clinton has repeatedly proposed new health programs for children and has\noften complained that the number of uninsured Americans is increasing because of\nCongress's failure to enact his proposals for universal coverage in 1994. But\nthe study suggests that the Government and low-income families have not made\nfull use of the existing Medicaid program, which has been revised by Congress\nover the last decade to expand eligibility.\nThe main author of the new report, Thomas M. Selden, who is an economist at\nthe Federal Agency for Health Care Policy and Research, a unit of the Public\nHealth Service, said, \"Over all, we estimate that 4.7 million children age 18\nand under were uninsured despite being eligible for Medicaid.\" They represent 39\npercent of uninsured children, a group that numbers 12 million.\nMr. Selden said he and his colleagues at the Public Health Service had\nidentified \"a much larger group of Medicaid-eligible but uninsured children than\nhas previously been known to exist.' Earlier studies focused on children ages 10\nand younger and did not consider all the children who might benefit from recent\nstate expansions of the Medicaid program, Mr. Selden said.\nChanges in Medicaid since the late 1980's have nearly doubled the number of\neligible children, the study found. The changes were pushed through Congress\nPAGE\n3\nThe New York Times, May 18, 1998\nby Senator John H. Chafee, Republican of Rhode Island, and Representative Henry\nA. Waxman, Democrat of California.\nChildren who received cash assistance through the old welfare program, Aid to\nFamilies With Dependent Children, were automatically enrolled in Medicaid. But\nthe new study found that teen-agers and children who became eligible for\nMedicaid because of recent program expansions were less likely to be enrolled.\nThese families \"may have been less aware of their Medicaid eligibility, given\nthat they were ineligible for cash assistance,\" the study said. In addition, it\nsuggested, \"such families may have resided in neighborhoods with lower\nMedicaid prevalence, which might have reduced their awareness of the program and\nperhaps increased their sense of stigma\" associated with Medicaid. The study\nalso makes these points:\n*Of the 4.7 million children who are eligible for Medicaid but not enrolled\nin the program, 3.3 million are younger than age 13, and 1.4 million are between\nages 13 and 18.\n*Young children eligible for Medicaid are more likely than older children to\nbe enrolled in the program.\n*Sweeping changes in welfare policy made by the Federal Government and the\nstates in the last few years could inadvertently increase the number of\nuninsured children. The new laws impose time limits and other restrictions on\nwelfare benefits. Many children may still be eligible for Medicaid after they\nlose cash assistance, but they and their parents may have to make special\nefforts to get such health benefits.\nAnother study in the same issue of Health Affairs documents changes in\ninsurance coverage of mental health care. The proportion of insured workers with\nmental health benefits has increased in recent years, the study says, but the\nbenefits have become less generous as insurers impose stricter limits on the use\nof mental health services and charge higher co-payments.\nHealth maintenance organizations and other managed-care plans generally\nimpose such limits, and the number of Americans in such health plans has soared\nin the last decade, said one of the authors, Gail A. Jensen, an expert on\nemployee benefits at Wayne State University, in Detroit.\nLANGUAGE: ENGLISH\nLOAD-DATE: May 18, 1998\nAbout the Harvard Medical Area\nhttp://www.hsdm.med.harvard.edu/pages/history.htm\n\" an 10ST\nAbout Harvard School of Dental Medicine\nHarvard College opened in Cambridge, Massachusetts, in 1636 with an enrollment of 12 students\nand one Master to teach all subjects. Its mission was to educate the religious and intellectual leaders\nof the newly settled New England colonies. Expanding its size and extending its geographical\nboundaries during the 19th century, the College added graduate and professional schools which now\nnumber ten. Three of these are located in the Harvard Medical Area: the School of Dental Medicine,\nthe Medical School, and the School of Public Health. The Medical Area also includes some of the\nworlds Finest affliated teaching and research hospitals. Today Harvard is one of the worlds\noutstanding universities with a total graduate and undergraduate enrollment of approximately 18,000\ndegree candidates. Its mission, however, has remained essentially the same though considerably\nbroadened in scope: to educate the leaders of our complex international society.\nHarvard University, with its beautiful Georgian architecture and deeply rooted academic\ntraditions, has maintained a strong link with its New England past. But the makeup of its student\npopulation has broadened from one dominated by students from the Northeastern United States to one\nattracting a wide representation from throughout the United States and from over 100 countries.\nWithin its ranks can be found some of the worlds most gifted students and productive scholars.\nHARVARD SCHOOL OF DENTAL MEDICINE\nThe Frst university-based dental school in the country, Harvard Dental School was founded in\n1867. It was also the Frst to be established in close affliation with a medical school (Harvard Medical\nSchool) and to make the full scholarly and scientiFc resources of a university available to dental\neducation.\nIn 1940, under President James B. Conant, the School was reorganized as Harvard School of\nDental Medicine to place stronger emphasis on the biological basis of oral medicine and to institute\nmultidisciplinary programs of dental research. A unique feature of the curriculum placed dental\nstudents in joint classes with medical students for two years of basic science and pathophysiology and\nfor an introduction to clinical medicine on the wards of Harvard teaching hospitals and in community\nhealth centers.\nIn 1957, the School of Dental Medicine was awarded National Institute of Dental Research\ntraining grant funding and began to expand and enhance its postdoctoral educational programs,\ncombining advanced clinical and biomedical research training for dentists planning careers in\nacademic dentistry. Several postdoctoral programs were developed under the leadership of former\ndean, Dr. Paul Goldhaber. These include a four-year Doctor of Medical Sciences in Oral Biology\nprogram; a Fve- and six-year Oral and Maxillofacial Surgery/MD/General Surgery program; and a\ngroup of three- and four-year, joint-degree programs combining advanced clinical training and\nresearch in health-care systems, health policy or biomedical sciences.\nHARVARD MEDICAL SCHOOL\nHarvard Medical School, the third to be established in the United States, opened in 1782. From its\nbeginnings in a basement with a faculty of three, to its present status as the worlds pre-eminent\ninstitution in medical education and research, it has grown to a complex network of clinical and\npreclinical departments, laboratories and afFliated hospitals, a full- and part-time faculty of almost\n3,000 and a student body of over 800 men and women. At the core of Harvard Medical School is its\neffort to combine growth with excellence in medical education, patient care, and scientiFc\ninvestigation.\nHARVARD SCHOOL OF PUBLIC HEALTH\nHarvard School of Public Health is the youngest of the three professional schools in the Harvard\n1 of 2\n05/20/98 14:49:48\nAbout the Harvard Medical Area\nhttp://www.hsdm.med.harvard.edu/pages/history.htm\nMedical Area. The primary mission of the School of Public Health is to carry out teaching and\nresearch aimed at improving the health of population groups throughout the world. The School\nemphasizes not only the development and implementation of disease prevention and treatment\nprograms, but also the planning and management of the systems that are involved in the delivery of\nhealth services in this country and abroad.\n2 of 2\n05/20/98 14:49:48\nTHE\nTHE WHITE HOUSE\nDomestic Policy Council\nDATE: 5-19\nFACSIMILE FOR: Laura Schiller\nPHONE: ( ) -\nFAX: :()6-5709\nFACSIMILE FROM: Sarah Bianchi\nPHONE: ( ) - -\nFAX: ( ) -\nNUMBER OF PAGES (INCLUDING COVER): 3\n[\n]\nFOR YOUR REVIEW\n[ ]\nPER MY E-MAIL OR VOICE-MAIL MESSAGE TO YOU\n[ ]\nPER YOUR REQUEST\nCOMMENTS:\nPAGE\n55\n6TH STORY of Level 1 printed in FULL format.\nCopyright 1995 Information Access Company,\na Thomson Corporation Company\nIAC (SM) Newsletter Database (TM)\nHarvard Medical School Health Publications Group\nHarvard Health Letter\nNovember 1, 1995\nSECTION: No. 1, Vol. 21; ISSN: 1052-1577\nLENGTH: 943 words\nHEADLINE: MILESTONES: Health Letter Celebrates 20 Years\nBODY:\nYears ago people didn't think twice about bending over for a shot, even if\nthey hadn't been told what was in the syringe or how it might help. Today, no\nself-respecting doctor or patient would be satisfied with such an encounter.\nIn 1975, when the first issue of the Harvard Health Letter was published,\npeople were just beginning to question the absolute authority of doctors and to\ndemand a more active role in their own care. The new publication was the\nbrainchild of Timothy Johnson, a Harvard physician who went on to become medical\neditor for ABC News, and Stephen E. Goldfinger, faculty dean for continuing\neducation at Harvard Medical School and now editor in chief of the Health\nLetter.\nDr. Johnson envisioned a newsletter that would use Harvard's tremendous\nresources to bring state-of-the-art medical information to the general public,\nmuch as continuing education courses do for physicians. This proposal struck a\nchord with Dr. Goldfinger, who already felt that old-fashioned paternalistic\nmedicine, in which the doctor's word was law, was not the best approach for\npatients.\nA skeptical era\nThe consumer activism that took hold in the 1960s set the stage for the\nHealth Letter. Just as Ralph Nader's shocking revelations about automobile\nsafety made people more demanding of car makers, scandalous news had undermined\npublic trust in the medical establishment. In 1973, for example, people read\nabout government doctors who had left African-American participants in a\nsyphilis experiment untreated for years and about physicians who sterilized\nmentally retarded girls against their will.\nIt was a tumultuous time. New diagnostic tools and treatments were\nproliferating, hospitals were getting larger and more intimidating, and doctors\nhad been taught that educating patients was less important than ordering the\nright test and deciding which drug to use. On television people saw doctors and\npatients disagreeing about which operation for breast cancer was best, but had\nno way of evaluating what they heard.\nAnd who could they trust? In 1973 the American Hospital Association (AHA)\nreleased a document called a Patient's Bill of Rights which appeared to promise\nthe kind of humanistic care people really wanted. Then the AHA disappointed many\npeople when it told hospitals that implementing the edict was voluntary.\nPAGE\n56\nHarvard Health Letter November 1, 1995\nNo wonder consumers were beginning to feel that hospitals and clinics, like\ncar dealerships, were places where they were truly on their own. The founders of\nthe Health Letter felt that they could address these concerns, at least in some\nmodest way. \"We wanted to empower people to make better lifestyle and preventive\nmedicine choices, Dr. Johnson recalled, \"and we wanted them to understand\nbetter what was happening to them when they entered the health care system. \"\nA growth process\nDr. Johnson expected that large corporations would purchase multiple copies\nof this new publication, then distribute it as part of a corporate health and\nfitness program. For the first couple of years, this marketing approach reached\nabout 20,000 readers. Once magazines and newspapers began writing about the\nnewsletter, originally a four-page monthly called the Harvard Medical School\nHealth Letter, individual subscriptions caught on. By the time the Health Letter\ncelebrated its eighth birthday, it was reaching about 300,000 people.\nWilliam Ira Bennett, another Harvard physician who now divides his time\nbetween magazine editing and the practice of psychiatry, steered the newsletter\nthrough most of the 1980s. An unprecedented explosion in biomedical knowledge\nmade it harder than ever for doctors and patients to stay current, and the\nHealth Letter used its insider's view to stay ahead of the curve. It grew from\nsix to eight pages, added staff to meet the demands of an increasingly\nsophisticated readership, changed its appearance, and shortened its name. It was\nalso during this era that dozens of similar publications, started by medical\nschools and universities across the nation, began following in its footsteps.\nA closer look\nIn recent years, the Health Letter has added quarterly special supplements\nthat tackle major medical topics or take an in-depth look at the quality, cost,\nor availability of health care. For each of the past four years, the Harvard\nMedical School faculty members who serve on the advisory board have worked with\nus to rank the 10 most important advances in medical research reported during\nthe previous 12 months. This exercise helps readers (and editors, too) step back\nand take the long view.\nThe Health Letter continues to evolve in both form and content, and future\nsubscribers may have the option of reading it on their computer screens. Still,\nDr. Bennett is struck by how true the Health Letter has remained to its original\nmission. Every month it brings timely and accurate information to readers in an\nunderstandable and useful form, and it still relies on the resources of Harvard\nMedical School to do this.\nArticles reflect the contributions of writers, Health Letter editors, and\nHarvard faculty. They are reviewed before publication by the advisory board and\nother expert consultants who generously donate their time and knowledge.\nThis issue marks the beginning of the Health Letter's third decade of\npublication--a milestone that its founders never expected to celebrate when they\npasted up those early issues in a tiny office at the medical school. What has\ngiven this publication such longevity, of course, is the loyalty of our\nsubscribers. Thank you for being our life force.\nPAGE 57\nHarvard Health Letter November 1, 1995\n--PATRICIA THOMAS\nCOPYRIGHT 1995 President and Fellows of Harvard College\nLANGUAGE: ENGLISH\nIAC-ACC-NO: 3018013 ND\nLOAD-DATE: January 06, 1996\nPAGE\n48\n3RD STORY of Level 1 printed in FULL format.\nCopyright 1997 Information Access Company,\na Thomson Corporation Company\nIAC (SM) Newsletter Database (TM)\nFaulkner & Gray, Inc.\nMedicine & Health\ninteresting\nMay 5, 1997\nSECTION: No. 18, Vol. 51; ISSN: 1047-8892\narticle\nLENGTH: 2597 words\nHEADLINE: Managed Care Brings Danger and Opportunity for Research\nBODY:\nThe transformation of the health care marketplace by managed care presents\nboth challenges and opportunities for clinical research. As academic medical\ncenters (AMCs) restructure themselves to compete more effectively in an\naggressively bottom-line-oriented environment, it remains unclear how research\nactivities will be sustained in the future that historically have been supported\nby clinical revenues to a degree that remains the subject of debate.\nIn a paper published in Health Affairs in Fall 1996, Robert E. Mechanic and\nAllen Dobson of The Lewin Group concluded \"that managed care has had a limited\nimpact on clinical research so far, but that economic forces affecting AMCs may\ndramatically alter the future research environment.\" An informal survey by the\nNational Institute of Allergy and Infectious Diseases (NIAID) of the impact of\nmanaged care on its research grantees found that most of them could be described\nas \"the worried well\"--not yet feeling any negative effects but concerned about\nwhat the future may hold.\nAt the same time, a consensus is developing that the growing influence of\nmanaged care over the clinical research agenda could be a boon for\npopulationbased research and research that focuses on disease prevention,\nclinical effectiveness, and outcomes.\n\"It will be increasingly possible to tap populations for clinical research\nthat you couldn't tap before,\" \" said Merwyn R. Greenlick, former director of\nKaiser Permanente's Center for Health Research in Portland, Oregon, and chair of\nthe department of public health and preventive medicine at Oregon Health\nSciences University. \"The potential is quite enormous.\"\nThe emergence of a strong managed care sector \"constitutes some special\nopportunities for clinical research that really haven't been there before,' said\nTom Inui, MD, chair of the department of ambulatory care and prevention at\nHarvard Medical School and national director of Health of the Public, which\npromotes population-oriented research at AMCs. \"While there's a lot of pain\ninvolved in the restructuring, there are important scientific reasons why we\nneed to move in this direction if we want to maximize the value of the research\nproduct for the public,\" Inui says Central to the debate about the impact of\nmanaged care on clinical research is what David A. Burnett of the Illinois-based\nUniversity HealthSystem Consortium (UHC) has described as \"the intricate web of\nrelationships that exists across and within the clinical and research components\nof AMCs.\" Persistent skepticism by some outside observers about the extent to\nwhich AMCs' clinical revenues are being squeezed by managed care as well as\nPAGE\n49\nMedicine & Health May 5, 1997\nthe extent to which those revenues have been used to support clinical research\nhas pressured AMCs to document these effects more precisely.\nBy the Numbers\nBoth UHC and the Association of American Medical Colleges (AAMC) have made\nefforts to supply the objective data that is needed. Burnett reported in the\nFall 1996 issue of Health Affairs that a UHC analysis of financial data for its\n70 AMC members, found effects that vary with market maturity; and \"that when\nhealth care markets move from Stage 3 (provider consolidation) to Stage 4\n(managed competition), managed care has a dramatic impact on AMC hospitals.\"\nBetween 1991 and 1994, \"hospitals in Stage 2 (loose framework) and Stage 3\nmarkets experienced increases of 10.8 percent and 9.4 percent in net hospital\nrevenue per discharge, respectively. During the same time, hospitals in markets\nthat had moved into Stage 4 experienced a 7.2 percent decrease in net hospital\nrevenue per discharge.' In 1995 UHC tentatively identified 13 member markets at\nStage 4 compared with only one (Minneapolis) in 1993-94.\nIn a study published in Academic Medicine in March 1996, Robert F. Jones and\nSusan C. Sanderson of AAMC estimated that 28 cents of every dollar of revenue\ngenerated by medical schools' faculty practice plans (FPPs) supported academic\nprograms. Generalizing to all medical schools on the basis of data from 60\ninstitutions, they estimated that FPPs provided $ 2.4 billion in support for\nteaching and research activities in fiscal year 1993 arid that $ 816 million of\nthis amount supported faculty research while the balance supported education and\nother academic programs.\nA November 1996 report by a AAMC task force on medical school financing found\nthat aggregate medical school revenues, including revenues from FPPs, continued\nto increase through 1994-95, although the rate of increase has slowed. The task\nforce attributed the increase to several factors, including more complete\nreporting of FPP revenues and an increase in clinical effort by faculty members.\nAverage FPP revenues per clinical faculty member have remained flat in\nconstant dollar terms since 1992, the task force concluded. Moreover, medical\nschools in areas of high HMO penetration saw their FPP margins decline from 20\npercent in 1991 to 9 percent in 1995. Over the same period, FPP margins at\nmedical schools in areas of low HMO penetration remained relatively constant at\nbetween 10 and 14 percent.\nCritics note that because no two medical schools do their financial\naccounting in the same way, uniform data on which to base these analyses are\nsparse. The AAMC task force acknowledges that the financial data schools are\nrequired to report provides limited information about changes in discretionary\nrevenues over time. \"The lack of these data or of other measures of financial\nhealth commonly used in industry, such as marginal cash flow, liquidity, and\naccess to capital, presents a major obstacle to responsive policy formulation.\"\nAmong public medical schools, reliance on clinical cross-subsidies may depend\non the level of state support received. A financial analysis conducted by Penn\nState College of Medicine found that 60 percent of the college's budget comes\nfrom clinical income. In 1994-95, the college received $ 4.5 million in state\nsupport--less than any of the nation's 75 public medical schools. The median\nlevel of state support was $ 36.7 million.\nPAGE\n50\nMedicine & Health May 5, 1997\nAnother 21 percent of the Penn State medical college's budget came from\nexternal research grants. However, C. McCollister Evarts, dean of the medical\ncollege, reckons that grants cover at most 90 percent of the cost of sustaining\nthe college's research programs.\nThere are many reasons why external grants do not cover the entire cost of an\ninstitution's research enterprise, according to Samuel Silverstein, chair of the\nphysiology department at Columbia University School of Medicine. Laboratory\nequipment and staff must be maintained continually, whereas grants provide\nfunding for fixed periods of time.\nBecause of the high level of competition for research grants (roughly one in\nfive National Institutes of Health grant applications receives funding), even\nthe most distinguished investigators can find themselves temporarily without\nexternal funding, said Silverstein. \"Even Nobel laureates have grant problems at\ntimes. In addition, external funders usually will not pay for the collection of\npreliminary data, even though investigators need such data to support a research\ngrant application.\n\"AMCs feel that they are victims of unfair competition,\" said David\nBlumenthal, MD, head of the health policy unit at Massachusetts General Hospital\nand a professor at Harvard Medical School, at a recent National Institutes of\nHealth-sponsored conference on managed care and clinical research. Blumenthal\nexpressed what many associated with AMCs probably feel: When forced to compete\nsolely on the basis of price with institutions that do not bear the\nresponsibility (and costs) of research, education as well as patient care, they\nare at a disadvantage.\nIn addition, AMCs provide about half of all indigent medical care in the\nUnited States--a responsibility that often represents a heavy financial burden.\nSurvival Strategies\nA February 1997 article in the Journal of the American Medical Association by\nJohn I. Gallin, MD, director of the NIH Clinical Center, and Helen L. Smits, MD,\nformerly with the Health Care Financing Administration, describes a variety of\nmanagement strategies common to AMCs that are successfully coping with the\nchanged health care delivery environment.\nProminent among these strategies are replacing traditional academic,\nconsensus-based management structures with streamlined corporate-style\nleadership models that permit quick, decisive action; aggressively pursuing more\nefficient purchasing and contracting arrangements; investing heavily in\ninformation systems that enable precise tracking of costs and revenues for\nclinical services, research, and education; affiliating with managed care plans\nor setting up their own; and setting up clinical research institutes intended to\ngenerate revenue by conducting clinical trials for the pharmaceutical and\nbiotechnology industries.\nAmong other advantages, alliances with managed care organizations offer AMCs\naccess to patients in remote, outpatient, and ambulatory care settings where\nmany health care services that used to require hospital admission are now being\nprovided.\nPAGE\n51\nMedicine & Health May 5, 1997\nA subset of managed care plans, predominantly not-for-profit groupand staff\nmodel health maintenance organizations, have a history of involvement in\nclinical research that stretches back to the 1950s. Some of the earliest\nrandomized controlled trials of routine mammography to detect breast cancer were\nconducted by the Health Insurance Plan of Greater New York in the 1960s and\n1970s.\nEdward H. Wagner, MD, is director of the Center for Health Studies and the\nMacCell Institute for Healthcare Innovation at Group Health Cooperative (GHC) of\nPuget Sound and chair of the HMO Research Network, a group of HMO-based research\ncenters formed in 1996. In addition to GHC, network members include Harvard\nPilgrim Health Care, Henry Ford Health System, and several Kaiser Permanente\nregional divisions. HMO Research Network members currently hold NIH research\ngrants and contracts worth an estimated $ 25 million a year.\nThe HMO research setting \"is characterized by a large defined population,\ngood computerized health data on every member of that population, and a high\ninterest in prevention and primary care, said Wagner. Because of those\ncharacteristics, HMO-based research centers tend to do population-based\nepidemiologic and health services research that focuses on disease prevention\nand on common health problems encountered in primary care practice.\nWagner is currently spending about half of his time on a fellowship jointly\nsponsored by the National Institutes of Health and the American Association of\nHealth Plans, working on how to increase managed care organizations'\nparticipation in NIH clinical studies.\nLarge defined populations and good computerized health data are precisely the\ncharacteristics of managed care organizations that make them attractive to\npeople like Lawrence Deyton, MD, acting director of extramural research at\nNIAID.\nFor example, Deyton said, to learn how effective a new vaccine is or how to\nmake the best clinical use of a new medication (such as the new protease\ninhibitors in AIDS treatment) \"requires a study that would need tens of\nthousands of patients and cost NIH millions of dollars.\" For NIH to collaborate\non such a study with a large managed care organization that had a unified\npatient database could be mutually beneficial, said Deyton.\n\"Managed care organizations want to know how to deliver the best quality care\nmost efficiently. That's of interest to NIH, too. You can also learn a lot about\nmechanisms of action and disease processes from those kinds of trials, so you\nget two bangs for the buck.\"\nLost In Translation?\nWhile many in clinical research agree that a greater emphasis on clinical\neffectiveness research is overdue, they worry that the shift will come at the\nexpense of research that endeavors to translate advances in basic science into\nimprovements in patient care. \"Translational\" research is essential to moving\nclinical innovations into practice, said Blumenthal, but this type of\nresearch--by definition somewhat speculative--has relied the most on\ncross-subsidies for support.\nPAGE\n52\nMedicine & Health May 5, 1997\nRoger Meyer, MD, senior consultant on clinical research for AAMC, draws an\nanalogy with the practice of \"carving out\" coverage of mental health and other\nspecialty services. \"To the degree that you carve out clinical trials and\noutcomes research, you are disconnecting what has been an iterative process of\nscientific advancement. II\nMeyer also notes that clinical trials and outcomes research are more likely\nthan translational research to ultimately be profitable. \"If you carve out\nwhatever profitability there is, AMCs will be left to bear \"the costs\nassociate. d with knowledge development.\"\nAnother fear is that, as faculty members spend more time on clinical work to\ngenerate income, they will not have the time to devote to research--or they may\nbe discouraged from devoting time to research because it reduces their clinical\nproductivity.\nFrom managed care's perspective, these concerns may or may not be valid, but\nthey don't alter the fact that health care payers are no longer willing to pay\nthe premium that AMCs have traditionally charged for their clinical services. A\nrecent study commissioned by the American Association of Health Plans, for\nexample, found that while capitated health plans pay major teaching hospitals\nabout $ 1,000 per discharge more than they pay non-teaching hospitals, capitated\nplans pay such hospitals $ 2,200 less per case than private fee-for-service\ninsurance does. \"AMCs don't seem to understand the pressure we are under from\nthe people who buy Our Services,' said Wagner. \"Raising premiums is just not an\noption in many marketplaces.\"\nGreenlick, who has lived on both sides of the divide between managed care and\nacademic medicine for 30 years, said that AMCs are now paying the price for\ntheir failure to explicitly account for the costs of research in the past. \"I\ndon't think it's appropriate to finance clinical research out of patient care\ndollars,' he said. \"That's not the same as running an efficient practice, making\na profit, and using that profit explicitly to support research and education.\nThat's the direction AMCs are trying to take now, and that should have come 25\nyears ago.\"\nThe next two to three years represent an important transition period for AMCs\nthat may set the course for the future of clinical research in the United\nStates. Two prospective studies supported by the Commonwealth Fund may provide\nsignificant insights into how both AMCs and their individual faculty members\nadapt to a radically different environment.\nBlumenthal is leading a study that focuses on how AMC faculty members are\naffected by the swirl of change occurring around them. Through surveys to be\nconducted three years apart, he is endeavoring to quantify changes in how\nfaculty members allocate their time among research, teaching, and clinical work\nand the extent to which their research budgets are funded by internal rather\nthan external sources.\nInstitutional change is the focus of an AAMC study that is using data\ncollected from a \"sentinel\" network of 14 AMCs around the country. Paul Griner,\nMD, who heads the AAMC's Center for the Assessment and Management of Change in\nAcademic Medicine, said: \"We hope to identify creative approaches that AMCs are\ntaking to respond to the challenges they face. Eleanor Mayfield, Silver\nSpring MD\nPAGE 53\nMedicine & Health May 5, 1997\nCOPYRIGHT 1997 Faulkner & Gray\nLANGUAGE: ENGLISH\nIAC-ACC-NO: 03657754 ND\nLOAD-DATE: May 19, 1997\n38TH STORY of Level 1 printed in FULL format.\nCopyright 1998 Globe Newspaper Company\nThe Boston Globe\nArticleabant\nJanuary 18, 1998, Sunday, City Edition\nSECTION: ECONOMY; Pg. C1\nLENGTH: 2397 words\nIt\nis\nHEADLINE: A doctor's heart, CEO's skill;\nPartners Healthcare chief's passion is driving force behind firm's success;\nfirst\n2 pages\nEXECUTIVE FOCUS / SAMUEL O. THIER\nBYLINE: By Kimberly Blanton, Globe Staff\nBODY:\nSamuel O. Thier has transformed even the Sunday crossword puzzle into a\ncompetitive sport - racing with his sister to finish first. And he revels in a\ngood controversy: From the helm of the Institute of Medicine in Washington a\ndecade ago, he lobbed politically explosive reports on AIDS and breast cancer at\nCapitol Hill.\nBut if the chief executive of Partners Healthcare System Inc. has a singular\npassion, it is neither competition nor politics. It is medicine.\nThat passion, sparked as a boy while accompanying his physician father on\nhouse calls in his Brooklyn neighborhood, is still stoked, once a month, when\nDr. Thier makes rounds at Massachusetts General Hospital, where he once served\nas chief resident.\nPartners Healthcare - operator of Massachusetts General and Brigham and\nWomen's Hospital - is thriving under the doctor's care.\nThier, whose career as an executive is guided by his experience as a\nphysician, has successfully engineered the unwieldy 1994 merger of two of the\nnation's most prestigious academic teaching institutions, Mass. General and the\nBrigham. He has done SO using a combination of supreme self-confidence - some\nsay intimidation - a wicked sense of humor from which few are spared, and a\nclear vision of what he wants to achieve.\nIn the four years since he joined Partners, its fund-raising. hospital\nadmissions, and spending on treatment of the uninsured have all risen, Mass.\nGeneral and the Brigham consistently have pulled in more National Institutes of\nHealth grants for medical research than any other US hospital, as they have for\nmore than a decade.\n\"He is a doctor and he has an interest in medicine - much more SO than any\nother hospital administrators,\" said philanthropist Melvin Nessel, who gave $ 10\nmillion last year to Mass. General for a cancer center after his wife received\ntreatment there. \"If it hadn't been for Dr. Thier, I would not have made this\ngift.\"\nBut Thier, who reluctantly left his perch as president of Brandeis University\nto commandeer the hospital merger, has also used Partners as a platform from\nwhich to promote a much bigger agenda: protecting medical research and\nPAGE\n42\nThe Boston Globe, January 18, 1998\nteaching, the soul of the US health care system, from the menacing financial\npressures of managed care and federal budget cuts.\n\"I didn't need any more chevrons, Thier said in a recent interview as he\nexplained why he left Brandeis to join Partners. \"The reason I'm back in this is\nI don't like what's happening in medicine.\"\nThier, 60, is much sought after as a super-administrator - in recent years he\nreceived overtures from at least three prestigious universities. That was hardly\ntrue when he finished medical school at a university with a modest reputation,\nState University of New York in Syracuse.\nA stellar student, Thier was 16 when he finished high school at James Madison\nHigh in Brooklyn, launching pad for luminaries such as US Supreme Court Justice\nRuth Bader Ginsburg, Nobel laureate in economics Robert Solow, and actor Martin\nLandau. He went on to Cornell University and graduated first in his 1960 class\nat medical school by age 21.\nDespite these distinctions, he was an underdog in competing for a residency\nat Mass. General against graduates of Harvard University and other top-drawer\nmedical schools. But the marginal candidate impressed skeptical committee\nmembers during his interview, launching into a cocky monologue on hemophilia -\nhe had happened to read about the blood disorder the day before in the library\nof another hospital while waiting for an interview.\nThier's acceptance was no fluke: He was selected to the prestigious post of\nchief resident in his final year of training and scored highest on the national\nboards for internal medicine.\nWorking with Mass. General's best and brightest in the 1960s provided an\nintellectual challenge unlike any Thier had experienced since his late-night\ndebates as a child with his father. And it opened doors for Thier - he was\nrecruited for academic postings at the University of Pennsylvania's medical\nschool and then Yale and the National Academy of Sciences in Washington - and\ncreated a debt he said he is now repaying. When Mass. General called, Thier\nsaid, \"it was like having your family say you've got to come home and help. What\nare you going to say? 'No'?\"\nCommitment to free care\nWhat becomes obvious to anyone who spends time with Thier is that he really\ndoes give a damn about the quality of care given to the more than 1 million\npatients treated at Partners' hospitals every year. Thier has boosted the budget\nfor community health programs. He is \"committed with every fiber of his being\"\nto free care for those unable to pay, said Matt Fishman, community health\ndirector at Partners.\nAnd he is fascinated by complex medical cases, which present the type of\ndiagnostic mystery Thier loves to solve. On a recent December morning, Thier,\ncrowded into a small office at Mass. General with residents and students, delved\ninto details of a case of an elderly man with a liver abscess. (It was later\nfound to be caused by a leaky intestine.)\nThier clearly enjoyed the role of teaching, punctuating the discussion with\nmedical jokes. When told the patient had diagnosed himself as having\nPAGE\n43\nThe Boston Globe, January 18, 1998\n\"molecular ice\" caused by living on the bitter cold North Shore, Thier shot\nback, \"Sounds like Kurt Vonnegut.\" His sharp wit is just as often aimed at\nhimself. Squinting at an X-ray of a man's bowel, Thier laughed, \"Once you get to\ntrifocals there is no proper distance.\"\nIn the patient's room, Thier's edge softens as he leans over the bed, asking\nquestions about his drinking habits, his bowel movements, his golf game. The\npatient plays golf with a group of men - all over age 80. \"Someone has to\nremember where the ball went,\" Thier quips. Before leaving the patient's room,\nThier offers some comforting words and encouragement.\nIt is classic Dr. Thier.\nDefies stereotypes\nPartners' physicians and executives have found their boss cannot be\npigeon-holded. He can be intimidating, colleagues and underlings say, and then\nturn on the charm.\nEllen Zane, who came to Partners from Quincy Hospital to take on the\nformidable job of building, from the ground up, a network of 1,000 physicians\nlinked to Partners and its hospitals, said Thier never wavered in his support.\nThe job \"would've been impossible without his incredibly deep, sincere,\nforthright support,\" said Zane.\nHe can be a withering intellectual opponent.\nUnder the pressures of Partners, his biggest career challenge yet, Thier's\nimpatience flares with those who don't keep pace with his racing thoughts or\nmeet his perfectionist demands. \"Every time I leave a meeting with him, I feel\ntalked down to. It's not something that's a secret in this industry,\" said one\nhealth care executive. Yet Thier once surprised a Partners executive by calling\nto thank him for challenging him in a meeting. The executive had lost the\nargument.\nAs chairman of the department of internal medicine at Yale from 1975 to 1985,\nhe was called \"Fear Thier\" and \"Syncope Sam\" - syncope is a medical term for\nfainting, which is what one Yale medical student did under questioning by Thier\nabout a patient.\n\"He's very aggressive and very charismatic,\" said Dr. Norman Marieb, a\nprofessor at the Yale New Haven Hospital. \"When he wants something he goes after\nit and doesn't pull any punches. He's honest. He's fair. But he's very direct.\nThere are some people who shake a little bit at that.\"\nThier's loyalty and high expectations, said another colleague, means \"You\ndon't want to let Sam down. He has a unique ability to instill that.\"\nUnderneath Thier's sturdy intellect and a driving ambition is a man as\ndevoted to the women in his life as he was to the Brooklyn Dodgers baseball team\nas a boy until they broke his heart by losing to the New York Giants in the 1951\npennant race. His daughters - one an environmentalist, one an intellectual\nproperty attorney, and one a medical journal editor - call him often for career\nadvice. He is proud of his wife's own professional accomplishments. Paula Thier\nwas membership coordinator for the National Trust for Historic Preservation\nPAGE\n44\nThe Boston Globe, January 18, 1998\nduring their years in Washington, before moving to the Chestnut Hill section of\nNewton. \"People would look at me and say, 'Are you Paula Thier's husband?' \"\nThier says, grinning.\nThier and a friend once acted as yentas, matching up his colleague at Yale\nwith her recently divorced girlfriend. Thier enthusiastically agreed to fly to\nSan Francisco to dine with the couple and \"encourage them and make sure he took\nher to a fancy place, recalled Thier's friend and co-conspirator, Barbara J.\nCulliton. The matchmaking scheme worked: The couple married.\nThe Washington years\nAt Partners, Thier is using political skills honed during years in\nWashington. The registered Independent arrived in Washington and allied himself\nwith Senator Ted Kennedy, the senior Democratic senator from Massachusetts, C.\nEverett Koop, the former US surgeon general, and others. He put the obscure\nInstitute of Medicine, the medical research arm of the National Academy of\nSciences, on the political map. According to a 1987 article in The Wall Street\nJournal, \"When Institute of Medicine Speaks, People Listen.\"\nHis agency's reports became known in Congress as the gold standard of precise\nand unbiased analysis. A seminal 1986 report on AIDS riveted lawmakers'\nattention to the dimensions of the public health issue for the first time.\nAnother report spotlighted the absence of breast cancer research by the National\nInstitutes of Health. \"Sam Thier put his finger on it,\" said Nick Littlefield,\nKennedy's former chief counsel. \"It was like a bomb went off in Washington.\nIn any job, Thier has an unerring sense of how to fix a problem. When asked\nto join Brandeis in 1992, a secular, Jewish-sponsored university, to\nreinvigorate its flagging finances and burnish its reputation, Thier, who is\nJewish, thought, simply, \"I can fix this.\" Quoting playwright Goethe during his\ninauguration speech at Brandeis, Thier said, \"You must labor to possess that\nwhich you have inherited.\"\nFix it he did. During a brief tenure at Brandeis, he repaired what one\nprofessor called its \"inferiority complex\" by lifting faculty morale and putting\nthe university on sounder financial footing. \"Sam is clearly a leader,' said\nJehuda Reinharz, Brandeis's current president.\nPartners has given Thier a new platform from which to again influence\nnational health care policy.\nWhen Congress, debating the budget last year, eyed federal funds used by\nhospitals to subsidize faculty and research, Thier mobilized his cohorts at\nteaching hospitals around the country and successfully blocked the cuts, arguing\nreductions would devastate important medical research.\nThier has been just as good at negotiating office politics and merging Mass.\nGeneral and the Brigham, with their star-studded rosters of physicians. He has\nbeen fearless about making unpopular decisions, such as reducing the numbers in\nthe hospitals' joint residency program; the cuts meant longer hours and bigger\npatient loads for staff physicians. Thier \"stepped into a snakepit,\" said Dr.\nMartin Solomon, a prominent physician at Beth Israel Deaconess who knows him. He\n\"prevented them from cutting each other's throats.\"\nPAGE\n45\nThe Boston Globe, January 18, 1998\nThe decision to merge Mass. General and Brigham and Women's, made before\nThier joined the system, rocked the health care world. But Thier was left to\nfield criticism inside Boston's medical community thats has shrunk, according to\nthe consulting firm Coopers & Lybrand.\nThier has another view: Partners's business strategy is key to protecting the\nhospitals' tradition of pioneering surgery and medical research, which includes\nthe first use of ether as an anesthetic during surgery in the United States and\nthe world's first organ transplant.\nBecause of the high costs and the relatively small revenue generated by\nteaching and research, academic medical systems are costly to operate. Financial\npressures on teaching hospitals have increased in recent years amid cost-cutting\nby insurers and reductions in federal reimbursements for Medicare and Medicaid\npatients by Congress.\nTo husband cash for teaching and research, Thier has slashed $ 180 million\nfrom Partners' budget, which was $ 2.1 billion last year. Thier was ruthless in\nmerging administrative staffs of both hospitals, though he has coddled medical\nstaff and barely merged clinical operations.\nThe Mass. General-Brigham merger was an experiment that put Partners in the\nvanguard of academic medical centers in a battle against insurance companies\nsqueezing them to provide health care services at lower and lower cost. Thier\nhas further bolstered Partners's clout with insurers by building, to date, an\n844-physician network that can refer patients to its hospitals.\n\"The point I want to make is there isn't anything remotely close to\" the\nstature of the two academic medical centers in New England, Thier said. \"And we\nhave to maintain that.\n1:\nOccupation: Chief executive, Partners Healthcare System Inc., operator of\nMassachusetts General, Brigham and Women's, and McLean hospitals; North Shore\nHealth System; and Spaulding Rehabilitation Hospital.\nBorn: June 23, 1937, Brooklyn, N.Y.\nFamily: Wife, Paula Thier, and daughters, Audrey, Stephanie, and Sara.\nMedical school: State University of N.Y., Syracuse, 1960.\nBiggest accomplishment: Chief resident at Mass. General.\nChildhood memory: The Brooklyn Dodgers loss to the New York Giants in 1951\npennant.\nWeekend activities: Tennis with anyone and Boston Celtics games with\ngrandchildren.\nLiterary leanings: British playwright Richard Brinsley Sheridan.\n2: Partners Healthcare System under Thier\nPAGE\n46\nThe Boston Globe, January 18, 1998\n1995 1996 1997 Fund-raising $ 37.9m $ 51.1m $ 59.0m Market share1 NA 14.97%\n15.28%2 Spending on uninsured patients $ 93.1m $ 104.2m $ 107.0m2 Research\nfunding3 $ 326.1m $ 339.1m $ 354.4m\n1 Mass. General/Brigham share of acute-care hospital admissions in Eastern\nMassachusetts\n2 Estimate\n3 Research funding from National Institutes of Health and other sources. NA\nnot available SOURCE: Partners Healthcare System Inc. and Coopers & Lybrand\nGLOBE STAFF CHART\nGRAPHIC: CHART PHOTO, 1. Partners CEO Samuel O. Thier visits with patient Donald\nMonell, 80, of Gloucester. Thier still makes rounds once a month at Mass.\nGeneral Hospital, where he once served as chief resident. / GLOBE STAFF\nPHOTO/PAM BERRY 2. Dr. Thier: \"The reason I'm back in this is I don't like\nwhat's happening in medicine.\" GLOBE STAFF PHOTO/PAM BERRY\nLANGUAGE: ENGLISH\nLOAD-DATE: January 22, 1998"
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