FIG1 A postresidency fellowship
program at Harvard University is preparing physicians and other health care
professionals to lead efforts to reduce disparities in health care for ethnic
minorities and underserved populations.
The Harvard fellowships offer real-world experience. For example,
Octavio Martinez Jr., M.D., M.B.A., M.P.H., shadowed Bernard Arons, M.D., when
he was director of the federal Center for Mental Health Services.
Courtesy of Octavio Martinez
Psychiatrists can apply for one of two fellowships under the Harvard
University Fellowship Program in Minority Health Policy, both of which lead to
a master's degree in public health at the university's School of Public Health
or a master's degree in public administration at the university's John F.
Kennedy School of Government.
The fellowship pays for tuition and fees, and fellows receive a $50,000
stipend for the year.
In addition to taking courses at Harvard's schools of medicine, government,
and public health, fellows take specialized courses in minority health
The program began in 1995 with the Commonwealth Fund/Harvard University
Fellowship in Minority Health Policy, which selects five fellows a year and
seeks to prepare physicians for leadership roles in health policy, public
health, and academia.
According to a program brochure, courses offered through the fellowship
seek to help physicians "improve the effectiveness of the health care
system to address the health needs of minority and disadvantaged
In 2001 Harvard added the California Endowment Scholars in Health Policy
Fellowship, open to physicians, doctoral-level psychologists, and dentists
interested in reducing disparities in the health status and access to care of
underserved populations in California.
According to Joan Reede, M.D., M.P.H., M.S., director of both fellowships,
it is the "hands-on" aspect of the fellowships that makes much of
the learning possible.
For instance, each of the fellows makes site visits to federal, state, and
local health agencies to understand how those agencies work and make
connections with agency leaders. This way, Reede noted, the fellows can better
understand the agencies' missions "in regard to health disparities,
minority health, and the health of poor populations."
In addition, fellows spend three to four days shadowing nationally
recognized leaders in their area of expertise. Fellows can thus attend senior
staff meetings and participate in policymaking, said Reede, who is also dean
for diversity and community partnership at Harvard.
As a pediatrician with training in child psychiatry, Reed encouraged
psychiatrists' participation in the fellowships.
"We need to have psychiatrists at the table when we are figuring out
how best to allocate resources" to address the mental health needs of
minority and poor populations, she remarked.
Francis Lu, M.D., is chair of APA's Council on Minority Mental Health and
Health Disparities and sits on the advisory committee for the California
Endowment Scholars in Health Policy. He also recommended the fellowship.
"I see this fellowship program as a way people can learn essential
leadership and management skills that will affect mental health policy,"
Lu told Psychiatric News.
Richard Nunes, M.D., M.P.H., who completed the California Endowment
Scholars fellowship in June, views the fellowship as a vehicle to improve the
delivery of services to minority patients with mental illness. "I've
seen a lot of inefficiency in terms of how services are delivered," he
Nunes is now chief of child psychiatry for Santa Clara County, Calif.
"As psychiatrists, many of the patients we treat are underserved..
.not just [because of] race and ethnicity, but the fact that due to mental
illness, they are stigmatized" by the health care system, he noted.
During the fellowship, Nunes shadowed Stephen Mayberg, Ph.D., director of
the California Department of Mental Health, and participated in a conference
about Proposition 63, also known as the Mental Health Services Act.
Californians passed Proposition 63 in November 2004. It authorizes a 1
percent tax on annual adjusted gross incomes over $1 million to support
county-operated mental health systems.
In his current role, Nunes is helping to decide how money generated by
Proposition 63 is allocated within Santa Clara County.
He said that the fellowship gave him insight into "the challenges
facing health care delivery" to marginalized populations and noted that
the "opportunities, education, and exposure offered by the fellowship
are probably unmatched anywhere else."
Octavio Martinez Jr., M.D., M.B.A., M.P.H., the first psychiatrist to
complete the Commonwealth Fund fellowship program, agreed. "This
fellowship was the only one I found that put it all together" by
combining education on policymaking and management with education about
disparities in health care among racial and ethnic minorities.
Martinez completed the fellowship in 2002. He is an assistant professor of
psychiatry, faculty associate in the Center for Medical Humanities and Ethics,
and director of the consultation-liaison service in the Department of
Psychiatry at the University of Texas Health Science Center at San
Martinez helps devise the curriculum for medical students at the university
and has relied on his fellowship experiences to introduce information about
health disparities in underserved populations to the medical students, he
In addition, he has forged a relationship between the university's
psychiatry department and Barrio Comprehensive Family Health Care in San
Antonio, which serves the medical needs of many Latino patients. Martinez
provides mental health services there and has developed a mental health clinic
at the center.
In addition, he has applied for a grant that will enable psychiatry
residents and medical students to rotate through Barrio Comprehensive as part
of their training.
He cites the fellowship's networking opportunities as chief among its
benefits—he has maintained contact with many of the people he met during
his shadowing experience with Bernard Arons, M.D., who was then director of
the Center for Mental Health Services of the federal Substance Abuse and
Mental Health Services Administration.
He also pointed out that networking continues long past the year spent at
Harvard. Each year there are annual meetings held in Boston for members and
alumni of both fellowships.
"The fellowship has built a cadre of people who are committed to
making a difference in health care for the underserved," he said.
The deadline for application to both fellowships is January 3, 2006.
More information about the California Endowment Scholars in Health
Policy at Harvard University is posted at<www.mfdp.med.harvard.edu/fellows_faculty/California_endowment/program/details.htm>.
Information about the Commonwealth Fund/Harvard University Fellowship in
Minority Health Policy is posted at<www.mfdp.med.harvard.edu/fellows_faculty/cfhuf>.▪