Conclusion

Ironically, the closing of City Hospital was beneficial to the Family Health and Social Service Center in providing the opportunity to acquire increased and renovated space as well as recognition of its crucial role in the Main South neighborhood. But, what were the long term effects on the residency program? It can be argued that although the residents lost a battle, Family Medicine in Massachusetts finally began to win the war. For one, by 1978 the residency program "home" was no longer at City Hospital, but had been integrated into the medical center itself, a prerequisite to a fuller integration of the specialty into the medical school's clinical, educational, research, and administrative structures. As a sign of the program's coming-of-age, in 1979 a residency program director with responsibility for all program sites was hired. Dr. Dan Lasser (who became chair of the department in 1998) vividly recalled the spirit of participatory democracy, social activism, shared responsibility, and just plain self-assertiveness that characterized the residents he encountered at his first interview:

[In 1979] I put together a little talk on quality assurance - I figured these kids don't know anything about quality assurance. I'm only two years older than them. They told the residents, this guy is coming, and he's going to be the residency director, and you get a chance to interview him. And their point of view was, we just came off a strike. We don't want anybody from the medical school telling us what to do. The medical school is an evil empire that doesn't want to put any money into this program. We were just based at City Hospital, they made us move to UMass Medical School, although the rotations moved to Hahnemann Hospital and to Memorial and to Holden Hospital, so we don't want any top down administration for this thing.

It was a very collaborative environment. One of the prime contacts I had then was a fellow named Jeff Modest, who had just organized a thing that he was calling a residency executive committee, which was like a management board, which was going to be 50% faculty and 50% residents, 25% central administration and 25% each of the health centers. It was democratic to the nth degree, no matter how you sliced it and diced it, it was representative. And one of the questions was will the new residency director come in and endorse the notion of having an executive committee? And I didn't meet many of the other faculty. The few faculty I met were basically saying to me, "Would you please come and take this job? Please?"

So I went to this residents' meeting and I brought my overheads and I was prepared to talk to them about quality assurance and they said, you're not here to give a talk, you're here for us to interview you, and they grilled me, they absolutely grilled me—will you do this, will you listen to us, and will you endorse this new executive committee. And I remember walking out of that meeting and Jan Albrecht, who was the administrative director of the program said to me, "I'm so sorry - you're probably going to walk out of here and never talk to us again." And I said, "No, this is really a fun group of people, this is great! Yeah, I'll take the job."(109)

When the medical school in 1981 tried to use the residency as a pawn in its budget battles with the Massachusetts legislature, residents like Dennis Dimitri, as we have seen in Section II, were empowered by their shared experience and culture to go directly to the Chancellor and ask: "Why?"

By 1984, ten years after the start of the program with the original four residents, 86 family physicians had graduated from the three Worcester program sites and the Fitchburg site. From 1976 until 2005, according to a recent study by Ferguson et al, 454 residents have graduated from the Worcester program, of whom 47.6% are women, 52.4% men. Ethnically, the program is representative of Massachusetts's largely white population: 87% of graduates are white, 5% Asian, 3.8% Hispanic, and 3.2% African American. Two-thirds of all residency graduates still practice in New England, with half of all graduates remaining in Massachusetts in particular. Strikingly, the study indicates that the patient characteristics of residency graduates today vary minimally from the characteristics of their original residency training site.(110)

The words of some of those graduates might best sum up the powerful role the program has played in the formation of these physicians and why Family Medicine residents stood at the forefront of community activism in Worcester to defend locally accessible, community-engaged health care for all citizens, even the newest and poorest of the city. Today, when primary health care is under renewed pressure to see more patients with a shrinking pool of family physicians, these core values remain vital to the task of encouraging more young physicians to pursue this medical pathway.(111)

I think this has been a very rewarding professional life. There's always little things that we'd all do differently, but big picture-wise, I can go to sleep at night feeling totally comfortable about the fact that I did the right things in terms of my career choices, both for me personally as well as being able to say that I think I did the right thing in terms of whatever socially-motivated reasons one would have behind some of the choices you make. That's a nice feeling to be able to have. You know, the trite way it's often put is to be able to "do well by doing good," but I think there's a lot of truth to that. You can do a lot of good as a family physician and generally speaking you'll still do well by yourself too. So as a career I would certainly continue to encourage it. - Dennis Dimitri

[The residency] did set the groundwork for a lot of the work I did later on, which included many home visits, active participation in end of life issues, and helping people transition in a non-medical way. Generally being more engaged I think with people's social settings and personal lives than the conventional model would have us believe is proper and appropriate. In fact that's always been one of my fondest memories of medicine, the home visits at 3 a.m. for the dying patient, or attending the funeral for the patient down south that went on for three hours, and on and on. That makes it a broader social context and it really kind of keeps it real. De-industrializes the process which everyone else—all the MBAs—seem hell-bent on carrying out now. So, it's still, first and foremost, an art form and that will never change. - Ken Fabert(112)