Editor's Note: This is the fifth in a seven-part series about the history of family medicine at Duke University Medical Center.
Read Part 1 | Read Part 2 | Read Part 3 | Read Part 4 | Read Part 6 | Read Part 7
Media coverage and criticism of Duke University Medical Center’s decision in 1985 to phase out the family medicine training program and clinical operations of the Department of Community and Family Medicine came at a fast and furious pace.
Kathryn M. Andolsek, M.D., MPH, professor of community and family medicine and assistant dean of premedical education in the Duke University School of Medicine, recalled the story being in the news every day and today is amazed how the story continued to grow in a time before social media.
“Without Twitter, Facebook, or 24/7 news programming,” she said, “it was a pretty big thing and really never went away.”
April 9, 1985
The Duke student newspaper, The Chronicle, ran a front-page story on April 9, 1985, about E. Harvey Estes, Jr., M.D.’s resignation as chair of the department. In the article, Estes called the rejection of the family medicine program “intellectual snobbery” on the part of the other clinical departments.
April 10, 1985
The Durham Morning Herald also ran a front-page story about Estes’ resignation on April 10, 1985. The article stated that the family medicine program cared for about 23,000 people a year, and that about 8,000 of those people would not be eligible for care under Duke’s new primary care initiative.
April 11, 1985
An article in the Durham Sun on April 11, 1985, featured comments from Ralph Jennings, president of Durham County General Hospital Corporation. Jennings said Duke’s decision came as a surprise to him and that he hoped to keep the family medicine program alive at Durham County General Hospital with academic sponsorship from another university.
April 12, 1985
In an April 12, 1985, Duke University Medical Center Intercom article, William Anlyan, M.D., then-chancellor of health affairs for Duke University, said that family practice played a needed role in the delivery of health care, but that it could function more effectively in a community hospital setting, rather than being a component of the Duke structure directly.
Also on April 12, 1985, the Durham Morning Herald published an editorial criticizing Duke’s decision to phase out its family medicine program.
“When [Duke’s] medical center opts to phase out the family practice program serving thousands in the Triangle area, it can scarcely avoid the perception of an institution that cares more about dollar signs than about ministering to the needs of the people,” the editorial stated.
The editorial was accompanied by a cartoon, drawn by V.C. Rogers, featuring a man with a pitchfork in his back, reading a manual for “First Aid for the Back.”
The N.C. Academy of Family Physicians (NCAFP) released a statement on April 12, 1985, expressing shock and dismay over Duke’s decision.
“Family physicians in North Carolina and the entire nation are shocked and dismayed by the announcement of Duke University to terminate its program to train family physicians,” said W. Donald Moore, president of the NCAFP.
April 13, 1985
NCAFP executive director Sue Makey, told the Durham Morning Herald in an April 13, 1985, article, that the NCAFP would fight to save the training program at Duke. She said that it was imperative that they keep those training slots for family physicians in North Carolina.
“Duke is the largest, single training center for residents in family practice in the state,” she was quoted as saying. She said keeping such a program was essential because there were not enough family doctors to meet the needs of the state’s citizens, particularly those living in rural areas.
April 14, 1985
Anlyan said in an April 14, 1985, Durham Sun article that Duke’s decision to end the family practice program had been misconstrued by many as an attack on family medicine. He went on to explain that the reason behind the move was that family medicine could not be taught properly in a hospital devoted to highly specialized care, such as Duke.
April 17, 1985
The Durham Sun published an editorial April 17, 1985, criticizing the decision. “Durham promotes itself as the City of Medicine. The inference is that medical care is readily available, not just for rare diseases but for the common, everyday variety as well. If Durham is to be worthy of its name, the medical community must ensure that the City of Medicine designation is more than an empty promise.”
May 9, 1985
Durham’s bi-weekly newspaper, The Independent, also published an article on May 9, 1985, summarizing the events that had taken place. And news of Estes’ resignation was picked up by The Associated Press and ran in any number of newspapers across the country, including in a June issue of Carolina Business & Finance journal.
Estes fires back
April 29, 1985
After resigning as chair of the Department of Community and Family Medicine, Estes wrote a nine-page report to “Academic Family Medicine Departments and Family Practice Residency Programs Regarding Recent Actions at Duke University Medicine Center.”
“So every department in the country was notified,” said Estes, distinguished service professor emeritus, in a recent interview. “Every university that had a department of family medicine was warned about this.”
His April 29, 1985, report summarized the actions taken by Anlyan to phase out family medicine, and the events that led to the decision. The report offered background on the creation of the family medicine program at Watts Hospital, ongoing struggles over patient referrals to the community hospital instead of to Duke University Hospital, and the results of the Llewin and Associates, Inc. report. Estes also analyzed the philosophical issues between family medicine and the other departments, and expressed economic concerns.
May 3, 1985
A document obtained from Duke University Medical Center Archives titled “Duke’s Continuing Commitment to Primary Medical Care,’ dated May 3, 1985, stated that Duke and the Durham County Hospital Corporation had held several meetings regarding the Duke-Watts Family Medicine Residency Program that were supportive and positive. “Duke remains willing to provide faculty support to this joint program. Our decision does not represent a termination of this residency, only its relocation.”
This statement backed up a previous statement by Anlyan in an April 14, 1985, Durham Sun article that Duke planned to maintain the medical center’s ties with the Duke-Watts Family Medicine Residency Program, with a reversal of roles — Durham County General Hospital would be responsible for the recruitment of residents and medical staff, and specialty training for doctors at the center would be provided by Duke.
But following the distribution of Estes' April 29, 1985, report, letters from family physicians across the country were sent to Anlyan supporting family medicine and criticizing his decision and Duke, just as Robert G. Winfree, then-associate vice chancellor for health affairs, had predicted in his March 29, 1985, memo to Anlyan.
“Everybody was writing Bill Anlyan,” Estes said. “He had about three letters in favor of what he did, and he had about three or four hundred from the other side.”
The overall message of the letters was a threat from family physicians across the state that they would no longer refer patients to Duke for specialty care if the family medicine program was eliminated.
May 8, 1985
“Dear Dr. Anlyan: Enclosed please find your Physician Referral Manual, that you sent me last year, as I will no longer be needing it,” wrote a Duke medical school alum and family physician from Robbinsville, N.C. “I should tell you also that I am returning my request from the Duke Annual Fund without a contribution this year, nor do I plan on donating any other funds as long as this current attitude prevails at Duke.”
May 15, 1985
A family physician from Garner, N.C., wrote: “Because you can no longer support family practice in North Carolina, I will no longer be able to support Duke University Medical Center and will be using other institutions for referral of problem patients.”
Approximately 220 Duke University medical students also signed a petition, available at Duke University Medical Center Archives, which stated, “We, Duke medical students, petition Duke University regarding the decision to phase out the Department of Community and Family Medicine. We feel the decision was made hastily, apparently against the recommendations of the external review firm, Llewin and Associates Inc., and without student or faculty input. We are concerned about the effect this will have on our own medical education and health care in Durham and North Carolina. We urge you to reconsider plans to phase out family medicine at Duke.”
Andolsek, then-director of the Duke-Watts Family Medicine Residency Program, said the Duke-Watts Family Medicine Center also received a lot of support from its patients.
“You just had patients writing letters to the editor, making phone calls, coming in and offering their support, saying ‘Just go ahead and set up your own practice, we’ll come see you,’” Andolsek recalled. “You really got this sense that the patients really valued what we had done, and cared about us as people. Then clearly we were sort of a rallying cry for people around the state, people around the country in family medicine.”
The tide turns
By June 1985, the message from Duke University Medical Center had shifted and small steps were being made to repair the damage that had been done with the April announcement of the phase out of family medicine and other clinical operations of the Department of Community and Family Medicine.
June 7, 1985
An editorial in the Durham Morning Herald on June 7, 1985, cites NCAFP president Moore as saying Anlyan had proposed a rearrangement of the family medicine program and that the changes “look very promising.”
The editorial was accompanied by a cartoon by Rogers showing a family medicine physician that had been run over by a Duke ambulance, but another physician with a first aid kit on the way to help.
July 5, 1985
A joint statement by Anlyan and George R. Parkerson, Jr., M.D., then-chair of the Department of Community and Family Medicine, dated July 5, 1985, “Status Report on Family Medicine at Duke,” said “The present status can be summarized by the statement that Duke University Medical Center supports family medicine and plans to continue this support in the manner most appropriate for this medical center.”
July 11, 1985
A joint statement of Duke University Medical Center and Durham County Hospital Corporation was released on July 11, 1985.
“Duke University Medical Center and Durham County Hospital Corporation will continue to sponsor the Family Medicine Center as a joint venture, and have initiated efforts to recruit the next residency class for the three-year program, located at the Family Medicine Center on the Durham County Hospital Corporation campus.
Want to read more about the department?
Visit the History page to read stories about the origins of the Department of Community Health Sciences, the beginnings of the Duke Physician Assistant Program, the history of Occupational and Environmental Medicine at Duke, Community Health's origins, and Family Medicine' complicated history.
Also read a two-part series examining the department's role in helping the university, the state, and the nation adapt to the changing face of health care.