Just as a PCP’s Columbia chapter met to discuss re-energizing their efforts they were faced with the ultimate crisis: the planned closure of their family medicine program. Today on the blog, chapter members provide their perspective on the situation that propelled them back into action.
By the Students of PCP Columbia
“I’m sorry, but I can’t believe this!” exclaimed a third-year medical student, who sat across the table appearing uncharacteristically distraught, staring slack-jawed at her phone. A group of Columbia Primary Care Progress
chapter members - representing nursing, occupational therapy and medicine - were gathered in the windowless basement of the health sciences building on a Monday evening. We had met to discuss our listserv (listless), our campus presence (absent) and our new members (none). PCP Columbia was a student group stalled, and this was our effort to regroup and ask ourselves: “What next?”
As if in response, troubling news now stared back at us from our inboxes: New York-Presbyterian
(NYP) - which is affiliated with Columbia’s medical center
- had decided to defund its Center for Family and Community Medicine
and fire the family medicine residents and faculty
. We’re not sure that any two people felt the same upon hearing this news, but our team’s response mirrored the collective reaction: disbelief, confusion, varying shades of outrage. Perhaps most salient, however, was a desire to act.
This much was evident when, that same night, we found ourselves in another windowless room with even more students - this one brimming with the frantic energy of a campaign headquarters. Actionable goals were scrawled on the board with names assigned to each: letter-writing, media contacts, coordinating with residents, scheduling our next meeting and more.
We saw in that room a hive of individuals - energized and motivated - moved to act as a whole against something they held to be unacceptable. Even after the decision was quickly - and fortunately - reversed the next day, our community came together at a town hall that afternoon to say: We do not accept that this is in the best interest of all those who are treated, work and learn at NYP. We do not accept that decisions are made without the input of all parties affected. We do not accept that our institution chooses to divest itself from primary care rather than be a champion of constructive change in our health care system.
NYP’s decision had the fortunate side effect of invigorating the Columbia primary care community. Prior to Monday, those here who supported family medicine were motivated but not well-organized, passively trusting that family medicine faculty would continue to serve Washington Heights and the student body at NYP. That assumption was shattered the moment the decision came down, with subtext that was plain to see: NYP and Columbia need to be reminded of the fundamental value of family medicine and primary care.
Whereas the events that unfurled unified and empowered us, this subtext is what directs us going forward. We’ve decided our goal is not only to save, but also to grow family medicine, and we must leverage our power to sit down and work with decision makers. As stated in Family Medicine for America’s Health
’s “Health is Primary
“Even as family medicine makes its case, presenting evidence and pointing to improved outcomes, it also must look for ways to help the rest of American health care to see a path forward for themselves. Subspecialists and hospitals will need help understanding why they must transition to being cost centers and support systems for primary care and population health rather than being revenue centers at the top of the financial food chain." 
Outrage will diminish with time, and that is for the best as long as it gives way to reason and action. An adversarial approach consisting of our demanding and their refusing will only serve to alienate decision makers, and widen the chasm that separates where we are and where we want to be. To traverse that gap, we must work with decision makers to translate what we know to be true into a language that resonates with all parties - that family medicine at Columbia is a worthy and vital investment.
PCP Columbia is currently working to increase support for family medicine at Columbia. Follow their efforts, and those of the program, on Twitter at @PCP_Columbia
 Phillips, R. L., Pugno, P. A., Saultz, J. W., Tuggy, M. L., Borkan, J. M., Hoekzema, G. S., ... & Puffer, J. C. (2014). “Health is Primary: Family Medicine for America’s Health.” The Annals of Family Medicine, 12(Suppl 1), S1-S12.