Tags: community , redesigning care

Audrey Provenzano with patient

The Kraft Fellowship in Community Health Leadership is a competitive two-year post-residency program dedicated to preparing a new generation of physician-leaders to foster new models of collaboration between academic medicine and community health centers.

Kraft Fellows are selected on the basis of academic achievement, leadership ability, and demonstrated commitment to caring for underserved patients. Each one of them brings a unique set of experiences and perspectives to the program - and so we thought you might enjoy getting to know each Kraft Fellow a little bit better.

The latest fellow in our series is Dr. Audrey Provenzano, an alumna of Wellesley College and Yale University School of Medicine who completed her residency at Brigham and Women’s Hospital. Read about her fellowship at The Dimock Center below, in her own words.

Why community health?

My mother shaped much of how I see the world, and one of her greatest lessons to me was one of social justice. So, I approached a career in medicine through that lens, with the desire to work for vulnerable and underserved patients. When I was in medical school, I fell in love with community health through HAVEN, the student-run free clinic at Yale, which was run out of Fair Haven Community Health Center. I loved that the clinic approached health with a broad point of view, and attempted to address the social determinants of health that so deeply impact health outcomes for their patient population. I knew that was the environment in which I wanted to practice in the future.

Why the Kraft Fellowship?

The Kraft offers a mixture of clinical experience, skill building through work at the Harvard School of Public Health, and leadership training that is truly unique.  The fellowship has definitely helped me grow as a leader and better understand the world of community health.

What have you learned from the Kraft Fellowship's clinical practice component?

I've become acquainted with how challenging primary care really is. It's a great honor and privilege to be part of this profession, to be sure, but the day-to-day work in a system that is truly broken is very challenging. It has helped me understand that while exciting programs like HAVEN at Yale and the Kraft Fellowship here in Boston are essential for getting more talent into primary care and community health, emerging leaders like myself also need to work to change the day-to-day realities of practicing in primary care, because the current system can make it an unsustainable career choice for many clinicians.

Audrey Provenzano with colleague

What surprised you about your work at The Dimock Center?

How fully and readily the Dimock community embraced me. All of the patients and staff have been incredibly loving and warm and welcoming. Dimock truly is a community health center in every sense of the word.

Tell us about a patient who has stayed with you.

I saw a young healthy woman for a school physical. As she was healthy, she rarely came to the clinic and her insurance had lapsed. To get it restored, she had to call a few phone numbers and fill out some documents. She sighed and rolled her eyes and said to me, "Every time I go to the doctor, the paperwork is so painful." I'll never forget it. Here is a totally healthy person, who interacts very rarely with the health care system -- and yet every time she does, it is a huge ordeal. It encapsulated for me how far we are from a patient-centered system. Right now our system is centered on payers and caregivers rather than being centered on patients.

What happens next?

I am very excited to be joining the Adult Medicine Department at The Dimock Center full-time, and taking on the role of Director of Quality. I am looking forward to continuing to care for the patients I have had the privilege to get to know over the last two years and working more closely with my inspiring Dimock colleagues.

What happens later?

I envision myself in the clinic, caring for patients. This is where our health care system must become more centered, and where I think that the solutions for our most pressing problems will be found. I also see myself at the table with policy-makers, payers and researchers, looking for strategies to improve health outcomes among underserved patients and developing innovative programs to address the social determinants of health.

Audrey Provenzano

What would you like to accomplish over the course of your career?

I would like to become a consummate primary care doctor, which takes many years of practice to achieve the depth and breadth of knowledge required.

I would like to become an effective advocate for underserved patients.

I would like to continue to work clinically with medical students and residents and promote primary care and community health as exciting and challenging career choices.

I would like to become a leader in community health and primary care and work closely with policymakers and payers to think about alternative payment structures and delivery models to promote more patient-centered care and address social determinants of health.

How have your experiences during the Kraft Fellowship made you a better, more insightful clinician and leader?

I remain idealistic and optimistic about changing our health care system -- but my ideas and plans are now grounded in meaningful experience with patients and with the broken health care system.

What's your favorite Kraft Center memory?

One of my favorite parts of the Kraft Fellowship has been the opportunity to get to know my co-fellows and the practitioners in my class. They are all incredible community clinicians in a wide range of primary care disciplines who are dedicated to caring for the underserved. It's very rare that we as caregivers have the opportunity to gather and reflect together and also to learn from one another. My hope is to stay connected with them in the coming years and continue to call on their wisdom and experience as I navigate the challenges ahead. And I hope they will call upon me as well.

Read about Kraft Fellow Dr. Ian Huntington.