|Today, Primary Care Progress is nationwide and has established more than 50 chapters at health professions training schools around the country. But the organization grew from a local crisis at just one medical school. In 2009, the administration of Harvard Medical School announced that the division of primary care would soon be defunded. Below, President Andrew Morris-Singer shares the story of the origin and evolution of PCP:
Our response to being defunded
To those of us on the primary care track at Harvard Medical School at that time, the decision to defund the division of primary care felt like an assault on all of our worth. It hurt, deeply. The response of the primary care community was swift and intentionally visible. It mobilized the outrage, first through a petition and then through a large community town hall that drew hundreds. From the start we knew our strategy would have to diverge from the typical approach to creating change in health care – one that normally relies exclusively on data, expert-driven recommendations and individual action. Not because we lacked the data or a compelling case for why the division mattered, but rather because the defunding decision had more to do with institutional politics, budgets and other issues that had nothing to do with the value of primary care. The truth about primary care mattered less. What mattered more was that a surprisingly large swath of the primary care academic community was upset – and upset enough to take time out of their practice and studies to show up to a town hall to vocalize that frustration. And that act of coming together helped all of us experience something we hadn’t felt before: our power.
A therapeutic impact on our own academic community
In retrospect, we were running an experiment. We were engaging in an activity that felt quite new to most of us: harnessing our collective power to bring about significant change at an academic institution. In the process we discovered something amazing. Our activities weren’t just impacting the administration. They were also having a significant impact on our own academic community – a therapeutic impact. There was something about our town halls and activities that was having a revitalizing effect on all of us at an individual and collective level. Our primary care despondency syndrome was being replaced by a sense of possibility. Disengaged parties were re-engaging. Students and trainees were stepping up and taking on leadership in a manner previously not seen – voicing a perception that they could be a part of “the change.”
Realizing our power to effect change in communities across the nation
It became increasingly apparent to us that the primary care community shared a number of characteristics with other marginalized communities – a sense of devaluation, isolation and disempowerment. We recognized that if we organized our activities in particular ways, we would not only mobilize the power we had to effect change at Harvard, but would also revitalize our entire community nationwide in the process – furthering our long-term capacity to effect change. This strategy had been brilliantly executed by other marginalized communities, like the LGBT rights movement. But doing so would require our primary care community to collectively develop a set of relational leadership practices with a much more sophisticated approach to people and change.
The experiment gave us the confidence to go national. We formed Primary Care Progress, a national nonprofit, and started reaching out to primary care students and trainees across the country. We were teaching and coaching students, residents and faculty in the same advocacy skills we used at Harvard. Before we knew it, PCP chapters began popping up all over the country as more and more people began adopting the same social strategy. These chapters became the space where passionate primary care trainees and students could use their new leadership skills to engage a diverse group from the different professions of primary care, and advance new powerful efforts to improve both how primary care was being delivered and how the next generation was being trained. As each new PCP chapter joined the community, working on their own unique local campaigns to advance primary care, our collective network not only gained a new cadre of like-minded colleagues, but also an additional set of insights and strategies for creating change.
Devloping a connected community of interprofessional change makers
And that’s when we realized the relevance and timeliness of what we were doing: developing an interprofessional cadre of change makers who not only possessed a powerful, new set of leadership practices to effect change in the full spectrum of our professional endeavors (clinical, innovation, teaming, advocacy), but who also felt connected to one another and increasingly saw the local actions they were taking as part of a growing, primary care revitalization movement.
Our community is well on our way toward a primary care future that is more valued, more effective, patient-centered and sustainable. We hope you will join us.