The Impact of New Community Health Programs on One Medical Teaching Institution

THE IMPACT OF NEW COMMUNITY HEALTH PROGRAMS ON ONE MEDICAL TEACHING INSTITUTION* DAVID E. ROGERS, AfJJ.t In recent years, many medical schools have become involved in new outreach programs designed to deliver more efficient, comprehensive care to defined population groups. This has led to a significant body of literature on how to organize for such ventures, how to pay for them, market them, and evaluate them. The changes in the way care is dispensed and the effects on those who receive such care, have also been reported. There has, however, been a notable lack of literature on another vitally important factor in this equation—namely, what are the effects on the institution which elects to enter this arena? Over three years ago, The Johns Hopkins medical institutions decided to take on new responsibilities for designing and operating prepaid comprehensive health programs—one for the newly emerging city of Columbia, Maryland, the other for certain residents of the East Baltimore community close to the medical center. The present article presents one individual's view of the changes in one medical teaching center which have resulted from this commitment. As one might anticipate at the outset, the impact on a medical school and its teaching hospital is variable. Such programs touch some parts of the institution quite profoundly, other parts not at all. Some of the effects are good—some of the effects are troublesome. Before describing what has happened at Hopkins, I might first point out a self-evident fact: The modern medical teaching center is a ponderous and diverse institution with many differing constitu- * Based on remarks made at a Conference on Community Centered Health Plans, September 1971, Columbia, Maryland. + Formerly dean of the medical faculty, The Johns Hopkins University School of Medicine . President, Robert Wood Johnson Foundation, 142 Livingston Avenue, New Brunswick , New Jersey 08902. 326 I David E. Rogers · Community Health Programs encies. The different component parts have differing objectives, needs, and views of the world. Consequently, it is not surprising that entry into these new and untried fields for universities is viewed with differing opinions—often strong ones—by different groups. The constituencies include the following: 1.First, those who administrate, who are at the moment exquisitely sensitive to problems of money, space, and institutional relationships with government, community, and the outside world. 2.Second, the faculty who in the final analysis determine the caliber of the institution and its programs. Acceptance and support of new ventures by a significant segment of this group is critical to their success. 3.Third, large numbers of young men and women who have completed their M.D. training who are receiving highly concentrated and quite specialized residency or fellowship training or graduate training in basic science areas leading to the Ph.D. degree. 4.Fourth, the consumers, the population which receives its medical care from the medical center and which must participate in the design of such programs. 5.Last, a crop of idealistic young men and women called medical students, for whom the whole structure was actually created. Despite the relatively small size of this latter group (at Hopkins they number only 400 of the 3,000 Hopkins family), they are the cement which holds the whole enterprise together, and their educational needs constitute a major focal point for all segments of the institution. Considering this diverse group, it should come as no surprise to know that at this time of national unrest—dissatisfaction with the health-care system, rapidly changing views on medical school curriculum , profound anxieties about the dwindling support of biomedical research, and rapidly expanding responsibilities for medical institutions —that establishment of new community-oriented programs is not a simple task for a universityl The Initial Commitment Merely making the commitment to get immersed in these new areas was, of itself, a learning experience with profound impact on Hopkins . Almost six years ago Hopkins was approached by those planning Columbia, a planned community about midway between Washington and Baltimore, with the suggestion that Hopkins design and staff a total health-care system for this new and interesting city. A long Perspectives in Biology and Medicine · Spring 1972 | 327 series of high-level discussions involving the...