50 Years of Excellence

As Caroline Richardson, MD, chair of family medicine, looks at the past, present, and future of her department, she has one word for the impact of the program on a national scale: ”astonishing.”

More than 620 residency graduates have passed through the program since its inception in 1975. Over 50 years of research and teaching have produced thousands of published academic papers, prepared thousands of students to provide essential patient-centered care, and trained half of the family medicine physicians in the state.

“Here in Rhode Island, a significant portion of primary care doctors were trained in our programs,” Richardson says. “Brown has always had a strong focus on teaching excellence and that includes how we teach our physicians.”

Richardson will join alumni and faculty to mark its 50th anniversary with a gala and a residency reunion breakfast on March 7 and 8. The department celebrates its continued success not only as part of the Care New England Health System, but for its indelible place in Rhode Island’s health care.

“As a general rule, family medicine has a strong interest in serving patients that have been traditionally underserved,” she says. “We’re not going to lose our focus on care for people who have been marginalized. That is one of our central missions.”

Professor of Family Medicine Jeffrey Borkan, MD, PhD, who served as chair of the department for 21 years until 2022, compiled an extensive history of family medicine at Brown. Borkan oversaw significant expansion of the department during his tenure, including adding a second residency training site, four new fellowship programs, a large increase in faculty, and new partnerships with The Miriam, Kent, and Women & Infants hospitals.

“There was a need for more advanced primary care,” Borkan says about the state of physicians in Rhode Island in the ’70s. “We were the first Ivy League medical school to put its toe in the water by establishing this department.”

Brown launched the family medicine residency in 1975, and established the department in 1978. For its first 40 years, the program focused primarily on Pawtucket and Central Falls, and most clinical services resided at the Memorial Hospital of Rhode Island. However, following the closure of Memorial in 2018, adult inpatient services and training shifted to The Miriam and Kent hospitals, with maternal and child health care at Women & Infants and Kent. 

“We went from being this locally known entity to providing most of the family medicine care throughout the state,” Borkan says of the department’s evolution. “Nearly half of the family doctors in the state were trained in Brown’s residency program.”

Those who attended Brown near the establishment of the department have fond memories of their time there. Clinical Professor Emerita of Family Medicine Julianne Y. Ip '75 MD'78 RES'81, P'18, says when she first arrived at Brown, the Medical Education Program had just launched and she quickly grew close with her classmates and faculty members. 

“The faculty were devoted to us. I can’t think of a better word to describe them,” she says. “Even now, when I speak with cohorts and others abroad, they talk about how the faculty is engaged and excited to teach you, and I could feel that back eons ago.”

Ip says that even as medical students, she and her peers were teaching each other, and they were encouraged to mentor up-and-coming physicians behind them as well. That approach, she says, of taking the time to care for students and residents, their futures, and the well-being of patients, motivated her to eventually join Brown’s faculty—and then become the first associate dean of the Program in Liberal Medical Education, a position she held until her retirement in 2021.

“The underlying philosophy of family medicine hasn’t changed,” Ip says. “Taking a holistic view of patients and meeting them as a person and understanding their lived experiences is still at the core.”

As the department looks ahead, the world of family medicine is not without its challenges. Integrating technological advances and addressing the shortage of primary care physicians will remain major focuses of the department in the coming years, but Richardson says there needs to be a balance between patient relationships and modernized approaches to health care and record keeping.

“One of the overarching issues that’s making it difficult to work in primary care is the complexity and information overload we’ve been experiencing,” Richardson says. “Physicians have to quickly get up to speed with whatever they need to be an expert in with diverse patients and conditions, and to address that, whether from learning from scientific literature or medical records, is a big challenge.”

Borkan adds that remaining agile is paramount to the department as it moves forward, and growing the number of primary care physicians will be essential not only to Rhode Island, but for the nation. Out of roughly 750 graduate medical education slots at Brown-affiliated hospitals, Borkan says fewer than 100 are within primary care—and that number will need to be doubled or even tripled to meet the demands of the health care system.

“It’s fair to say that people have become more and more subspecialized within medicine,” he says. “We need our colleagues across different specialities, but I think it's important that we continue to have champions for primary care, like the leadership of Care New England and the dean of the medical school.”