The Boston University School of Medicine (BUSM) was established in 1873 when the University assumed responsibility for the New England Female Medical College. Among its historic distinctions are its commitment to equal education for women and men and the development of the nation’s first academically affiliated Home Medical Service. In more recent decades, the School developed an extensive program of biomedical research based in several major research facilities. Department of Medicine faculty are important contributors to the research programs of the School and are able to take full advantage of the research facilities and core research support centers of the School.
Boston University Medical Center Hospital (BUMCH) was founded in 1855 as the Massachusetts Homeopathic Hospital. In 1910 the Evans Memorial Department of Clinical Research was established by a series of gifts by Mrs. Maria Antoinette Evans to endow a research department of medicine at the Hospital. The Evans Department was one of the few research institutions of its kind when its activities began in 1912. Although technically a separate research institute, the Evans Department has always functioned as an integral part of the clinical care and training programs of Boston Medical Center and of the Department of Medicine at BUSM. This is in accordance with Mrs. Evans’ stipulation that research, clinical care, and teaching should be intimately interrelated in the Department that she endowed.
Boston City Hospital (BCH) opened in 1864 and was the first municipal hospital established in the United States. In 1923 the Thorndike Memorial Laboratory was established with support provided by Dr. George L. Thorndike in memory of his brother, William, a long-time BCH staff member. The Thorndike became one of the nation’s most distinguished research facilities under the aegis of the BCH Harvard Medical Services. In 1968, the Finland Laboratory for Infectious Diseases was established at BCH in honor of Dr. Maxwell Finland, a leading clinical investigator in infectious diseases. When academic and clinical responsibility for BCH passed to Boston University in 1973, these laboratories were incorporated into the research programs of the Department of Medicine faculty.
In July, 1996, BUMCH and BCH were merged into the Boston Medical Center, a not-for-profit institution that fully retains the missions and commitments of its predecessor institutions.
The Boston Veterans Administration Medical Center was the first Dean’s Committee VA hospital, i.e., the first specifically designated as a teaching hospital. It is a major training site for students and residents. In addition, its faculty conduct a varied research program, including active, basic, clinical, and health services research efforts.
Evans Memorial Department of Clinical Research
The Evans Memorial Department of Clinical Research was established on June 19, 1910, when Mrs. Maria Antoinette Evans made the first in a series of gifts to University Hospital (then Massachusetts Homeopathic Hospital) to endow a research department of medicine. Her purpose was to create a memorial to her husband, Robert Dawson Evans, a very successful businessman, whose estate also provided a wing for Boston’s Museum of Fine Arts. The current Evans Building, which is the third structure to house the ever-growing Department, was dedicated in 1971. It contains more than 100,000 square feet of research laboratories and offices for the staff of the Department of Medicine. This building was purchased by Boston University in fiscal year 2000. Many Evans Department of Medicine researchers were relocated to the new Evans Biomedical Research Center located at 650 Albany Street.
Directors of the Evans Memorial Department of Clinical Research
|Dr. David L. Coleman||2006 – present|
|Dr. Thomas Moore, ad interim||2005– 2006|
|Dr. Joseph Loscalzo||1997 – 2005|
|Dr. Norman Levinsky||1972 – 1997|
|Dr. Robert Wilkins||1960 – 1972|
|Dr. Chester S. Keefer||1939 – 1960|
|Dr. Reginald H. Fitz||1935 – 1939|
|Dr. Allen W. Rowe||1930 – 1935|
|Dr. Henry M. Pollock||1918 – 1930|
|Dr. Frank C. Richardson||1912 – 1918|
Evans Medical Foundation
The Evans Medical Foundation was founded in 1975. The faculty of the Department of Medicine voted to reorganize themselves as a non-profit corporation, the Evans Medical Foundation, to improve medical care for all patients and to provide first-class care for all. In addition, the reorganization facilitated the use of income from clinical activities of the departmental faculty to enhance patient care and to support teaching and clinical research at Boston University Medical Campus. The title, Evans Medical Foundation, was chosen to indicate the close relation of the Foundation to the Evans Department of Medicine, the formal name for the research activities of the Department of Medicine at the Boston Medical Center. By supporting research, education, and clinical care, the Foundation has developed a new approach to fulfilling the mandate of Maria Antoinette Evans.
Boston University Medical Group
In 1977, the Foundation contracted with the former University Hospital to provide ambulatory services for the Hospital, both in general medicine and in all the subspecialties of internal medicine. The Foundation represented the legal mechanism for reorganizing the clinical practice of the Department of Medicine at the University Hospital. Before that time, the full-time faculty of the Department had maintained separate office practices. The offices were scattered around the Hospital, typically in association with the laboratory facilities of each faculty member. The patients were “private” patients of the faculty. At the same time, there were general medical and subspecialty clinics of the Hospital in which “public” patients were seen. These clinics were staffed by residents and fellows, usually with limited faculty supervision. They were old-fashioned, “hard-bench” clinics with few amenities.
At the same time a new Section of the Department of Medicine, General Internal Medicine, was organized to develop academic and clinical programs in that area. The Hospital outfitted a floor of the Doctor’s Office Building to house the Evans Medical Group, that is, the ambulatory activities of the Department of Medicine. The Evans Medical Group undertook to provide clinical care in a uniform manner for all patients, ending the traditional separation of private and public patients. At the same time, the new facility and a new support staff enhanced the style and amenities of the practice for all patients receiving ambulatory medical care at University Hospital.
Recent History of the Department of Medicine
During the first decade of activity, the number of patient visits to the Evans Medical Group more than doubled, from approximately 21,000 visits in 1977-78 to more than 45,000 visits by 1986-87. By 1995, it had reached approximately 55,000. In accordance with its charter as a non-profit academic corporation, the Foundation used clinical income to recruit and support faculty, to help pay research costs, and to enhance educational programs within the Department of Medicine. The Foundation also assumed full financial responsibility for the practice expenses of the Evans Medical Group. By virtue of its steady growth, indicating patient satisfaction, and the substantial improvements inpatient care amenities, the Foundation fulfilled its original mission.
Following the creation of the Boston Medical Center on July 1, 1996, the Evans Medical Group changed its name to the Boston University Medical Group to reflect its expanding, integrated clinical practice. The Boston University Medical Group represented the clinical arm of the Department of Medicine and all of its ambulatory practices. In the sixteen years since the formation of Boston Medical Center, the Department of Medicine’s clinical practice has increased dramatically. As an example, the number of patient visits in the integrated ambulatory practices in the 2011-12 academic year was 268,000 –a nearly five fold increase over the volume at the time of the creation of Boston Medical Center.
In addition to the increase in outpatient visits since the merger, the Department of Medicine’s inpatient discharges increased recently to over 8000. The department’s clinical faculty have nearly doubled their clinical work over the past six years to over 725,000 work Relative Value Units. Although the majority of the department’s patients come from Boston and surrounding communities, several tertiary care programs attract patients from throughout the country. These programs include patients referred for: addiction medicine, pulmonary hypertension, sarcoidosis, cardiomyopathy, vasculitis, scleroderma, HIV care, women’s health, reproductive medicine, thyroid disease, diabetes, obesity, asthma, inflammatory bowel disease, chronic renal disease, geriatrics, and sickle cell disease. The department’s programs in clinical quality have received particular emphasis over the past five years. Important improvements have been made in each of the domains of quality, particularly in clinic access, inpatient unexpected mortality, resident supervision, patient satisfaction, and efficiency of care.
Evolution to a Leading Research Intensive Department of Medicine
The department’s research programs have become nationally prominent among research-intensive departments of medicine. The income from the Evans Endowment has been used over the course of the department’s history to invest in research faculty, infrastructure, and program development. The department currently includes over 250 funded investigators among the 435 faculty with a total research budget of approximately $120 million, excluding funding to the National Emerging Infectious Disease Laboratory, VA, and Roger Williams Medical Center.
The faculty are organized in a number of Sections, which include not only the usual medical subspecialties but also a number of special research sections such as Computational Biomedicine, Vascular Biology, Preventive Medicine, Genetic Biomedicine, and Clinical Epidemiology. Many of the research programs of the Department involve extensive collaboration between Sections and with other departments of the BU Medical and Charles River Campuses.
Each of the sections of the department has substantial research programs that are supported by extramural peer-reviewed grant support from federal and private sources. Examples of particularly strong research program include those in tuberculosis, HIV, sexually-transmitted disease, pulmonary inflammation, lung development, stem cell biology, metabolic disease and obesity, myocardial dysfunction, endothelial function in disease states, asthma, androgens, thyroid disease, diabetes, glomerular disease, genetics of neurodegenerative disorders, vascular biology, pulmonary hypertension, renal ischemic injury, mitochondrial function, treatment of substance abuse, geriatrics, disparities in health outcomes, sickle cell disease, amyloid, vasculitis, scleroderma, and epidemiology of cardiovascular disease, particularly through the Framingham Heart Study.
The department established the Evans Center for Interdisciplinary Biomedical Research in 2009. The Evans Center was designed to catalyze interdisciplinary research initiatives identified by faculty. Resources provided by the Evans Center have resulted in 50 funded research proposals and participation by 150 faculty and nearly 100 graduate students and post-doctoral fellows since inception of the center. The department also established the first section of Computational Biomedicine among departments of medicine in 2009. The section of Computational Biomedicine has grown to include 9 faculty, 21 trainees and has secured 11 new extramural grants over its initial three years. Substantial investments in research core infrastructure have been made to more fully leverage state of the art instrumentation and expertise in research. In 2011-12, approximately 100 different faculty used one or more of the department’s research cores and users of the cores have generated $36 m in extramural research funding from 2009-12. Among the department’s innovative cores, a state of the art digital tiered storage system was established in 2011. This storage system is unique among academic medical centers and provides for secure storage of patient information compliant with all federal and university regulations.
Just preceding the formation of BMC, the respective residency programs of Boston City Hospital and Boston University Hospital merged to form a single residency program. The residency currently includes 151 residents and has a Primary Care track available. The residents rotate through the VA and Boston Medical Center, and at a number of federally-qualified neighborhood health centers affiliated with Boston Medical Center. The department also provides additional training to over clinical 115 fellows in the specialties of internal medicine and approximately 100 post-doctoral fellows. In addition to clinical training, the Department established a Ph.D. Graduate Training Program in Molecular Medicine in 1999 that has awarded 55 Ph.D.’s. The GPMM currently has 60 graduate students enrolled in the program. In 2009, the department designed a Ph.D. graduate training program in Nutrition and Metabolism. The program has 20 graduate students enrolled in the program.