Family Medicine Comes to Massachusetts (cont'd.)
Dennis Dimitri described his Balint group this way:
One of the things that really engendered a lot of closeness among the residents was the Balint groups. And that was something that was a new concept to me—I had never participated in anything like that before. The Balint groups really were sometimes like mini-psychotherapy sessions, and so people were very open, very honest, usually very supportive. But it created a sort of closeness and intimacy with people that you don't typically get in most other work relationship environments because this was really an opportunity to kind of go above and beyond the usual kind of sharing you would do about your work.(59)
By 1980, the program had graduated 38 residents and by 1981 would reach its full strength of 12 residency graduates per year. Nevertheless, neither the mere existence of the residency nor its institutional basis at the medical school, nor even the strong support it seemed to draw from Massachusetts legislators were sufficient insulation against the effects of the state's economic ups and downs during those early years. Thus, only a year after the program was launched with Dick Walton having promised medical school money for the educational contributions of the three program sites, in Dan Lasser's words,
…the medical school turned around and said, what money? We never told you [that] you had any money to give to these health centers. So all of a sudden, these health centers have made commitments, and the health centers were independently owned and operated.(60)
As a result, this became a major crisis for Family Medicine in Massachusetts. In the end, with lobbying behind the scenes as well as more overt campaigning by the Massachusetts Academy for Family Physicians, a $750,000 appropriation was made specifically to fund family medicine, while the faculty and administration of the school made explicit their support for family medicine and primary care as a core goal of the institution.
Again, despite the Legislature's fiscal support for the residency in that instance, by 1980-1981, the medical school was forced to hold the program hostage to threatened legislative cuts that were targeted at the medical school as a whole. Only after the threat of cutting the program in Family Medicine, did the Legislature reinstate most of the school's appropriation in a supplementary allocation. Still, that the medical school's Chancellor, Dr. Robert Tranquada, could feel reasonably confident that his tactic would succeed eloquently attests to the esteem in which Family Medicine was held in Massachusetts after less than a decade of operation.(61) Of course, the residents did not know that at the time.
Here is how Dennis Dimitri remembers this incident, from his perspective as a one of the co-chief residents in Family Medicine, or, as he felt then, like a "little pipsqueak":
When I was a third year resident, I was one of two residents, Tom Hines was the other one, who was elected by our fellow residents to be chief residents for the whole program … there were two co-chief residents for the entire program … So there had traditionally always been, and I think somewhere buried in the Commonwealth's budget there may still be, a line item for the family medicine residency at the [UMMS], and it was like a million dollar line item in the budget. And the Legislature … there was a typical legislative battle going on about budgetary constraints, and I guess the legislators were making some noise about what they were going to do with whatever portion of the medical school budget they used to contribute in those days, and the chancellor at the time, our impression was that he was using us, [i.e.] the Family Medicine residents, as a pawn in his financial battle, because he said [to the Legislature], "Well, if you do that, the first thing I'm going to do is I'm going to have to eliminate the family practice residency."
So as you might imagine, we were all pretty distraught and upset about that, so in my role as the chief resident I was charged by my fellow residents, and for some reason Tom wasn't available, so I had to go do this by myself, I was charged to go meet with Dr. Tranquada, and present to him the manifesto from the Family Medicine residents, displaying our displeasure with being used and tossed around in this battle, and I just remember making an appointment, having to go there, and sitting in this big office, and I felt like some little pipsqueak going there, and in the end actually having a very pleasant talk with Dr. Tranquada, being reassured that everything would be OK and that the Family Practice residency was really important to the medical school and they would never really want to do anything to jeopardize it … I can't remember all the details of how that finally transpired. Obviously the residency didn't get closed down, but that was probably my first experience with being asked to be a leader for my fellow residents and take an issue of importance to them to a very high level person who, frankly, I was a little bit trembling about because he was the chancellor of the medical school and I was a mere family practice resident at the time.(62)
Indeed, the Family Medicine "line item" crisis of 1980-1981 was the last occasion when the school's support for the program has seemed in doubt.