Louis Holtzman, S.H.S. ’78, remembers learning how to read the sidelong glance, the shift in body position, the hesitation that indicated a patient had more to tell him.

It was the 1970s. The physician assistant (PA) was enrolled in an exciting two-year baccalaureate degree program at the recently opened Johns Hopkins University School of Health Services. He was among 30 students determined to earn the title of “health associate,” a new kind of health professional who could work as part of a primary care team to expand and improve health care delivery. 

Over the next 40 years, Holtzman often imagined his Johns Hopkins instructor whispering “Think about what else is going on here. What are they trying to tell you?” as he and his wife, classmate Kathy Kline, S.H.S. ’78, built diverse, community-oriented careers as PAs in California and the Pacific Northwest.

Many students followed similarly novel paths. Jeanne Most, S.H.S. ’75, took a job in the women’s detention center at Rikers Island. Other health associates went to rural practices in Alaska and North Carolina or to clinics in disadvantaged urban communities. One early graduate delivered health care at a United Farm Workers clinic in Calexico, California. Some eventually decided to become physicians.

“Although we all went to the same program, it enabled us to do so many different things and succeed in them,” Kline says. “Nobody ever said, ‘You’re going to be put into one slot forever.’ We were always encouraged to push against that.”

Zeitgeist of the Times

You might say that the School of Health Services captured the zeitgeist of the late 1960s and early 1970s.

In 1970, when public health physician Dennis G. Carlson was named director of the new Johns Hopkins Center for Allied Health Careers, he had just completed a master’s degree in the history of medicine at Johns Hopkins after serving as dean of a new public health college in Ethiopia. The then 40-year-old physician was tasked with planning and developing a school for a new type of health care practitioner.

“It was a time when health care was expanding beyond the hospital into health centers and community life to meet the needs of neighboring populations,” he writes in his autobiography, Scalpel, Spirit and Seeds: My Life Promoting Health in Ethiopia and Around the World (Gatekeeper Press, 2024). “Emerging systems required health care teams with physicians and other specialized providers who could apply a broad-based education to the delivery of personal, family and community care.”

After intensive research and planning, the School for Health Services launched its first training program in fall 1973. The late pediatrician Archie Golden, then an associate professor in the school of medicine, was named as its founding director. The two-year baccalaureate program for health associates was located across from the hospital in Hampton House. Admission required a minimum of 60 semester hours of college work; many students already had undergraduate degrees, and some had master’s degrees.

Created to stand apart from programs then available for PAs, it aimed to produce “radically different” primary care practitioners to deal with common medical ailments; provide regular, accessible assistance to underserved populations; and increase health care services across the board.

“The thesis of the Hopkins program is that illnesses cannot be detached from people,” Debra Shore wrote in a 1975 article in Johns Hopkins Magazine. Being a competent care provider meant becoming a bit of a social worker, counselor, health educator and manager.

Organized around the human life cycle, the teaching modules focused on illnesses related to each stage of development. As students learned about problems such as diabetes, depression, hypertension and upper respiratory infections, they also did an increasing amount of clinical work in hospitals and health centers in the Baltimore metropolitan area.

“Today we talk about social determinants of health, but that was baked into the curriculum. Personal and social factors in patients’ lives were up front in terms of the training offered,” says Ed Schor, who joined the Health Services faculty as a 29-year-old after completing his residency in pediatrics at The Johns Hopkins Hospital.

A colleague had suggested he cross the street to Hampton House and talk to Golden and Carlson about their new academic venture. They not only hired him but made him one of two faculty managers.

“They took a big chance on me,” the retired pediatrician recalls. “And they wound up recruiting a faculty of generally like-minded people who were quite progressive. The notion of doing team-based teaching and problem-based teaching, of putting together a faculty that was at least half non-health professionals, was way ahead of its time.

“Not only was the faculty an exciting group, but the students were even more so. The admissions criteria included demonstrating a commitment to serving people.”

Promoting Health Through the Arts

The health associates program was the first at Johns Hopkins to use simulated patients, to help build the students’ skills in interpersonal communication. That method is now widely used in medical schools.

Carlson says another groundbreaking part of the program was requiring courses in the arts to encourage students to use affective dimensions in primary care and improve their capacities for cross-cultural effectiveness. Study areas included music, visual arts, drama, dance, literature, the history of science and medicine, and philosophy.

“Very few people in the Hopkins community know that we pioneered the utilization of the arts in promoting health more than 50 years ago,” he says.

In Carlson’s course, Modern American Drama: Psychodrama and Family Health, for instance, students read works by such playwrights as Eugene O’Neill, Arthur Miller and Tennessee Williams, then analyzed and integrated them with the basic theory of family therapy and psychodrama therapy. Next, they either created and acted out a short drama based on one of the plays they had read, a drama in the life of one of their patients, or some situation in their own families.

Details of the program’s education methods are included in the 1982 book The Art of Teaching Primary Care, edited by Golden, Carlson and Jan Hagen, assistant professor and senior year manager of the health associates program.

A Camelot Experience

The health associates program initially received $3 million from the Robert Wood Johnson Foundation; this grant was renewed for another three years. It also received funding from the U.S. Health Resources and Services Administration and the National Endowment for the Humanities. When that funding ran out, Johns Hopkins leaders ultimately decided the institution could not maintain financial support for the program. The School of Health Services was closed in 1979.

In its six-year existence, the school prepared 150 broadly skilled graduates to contribute to primary health care programs and assist underserved populations. Some 85% of all graduates went on to practice primary care; 40% worked in rural areas, according to Carlson.

When Dan Jerrems, S.H.S. ’79, a graduate of the Great Books program at St. John’s College, was accepted, he had already worked for four years as an orderly in the emergency department at what was then Anne Arundel General Hospital.

In his career as a PA, he went on to work in pediatrics, general surgery, internal medicine, environmental medicine, neurosurgery, and ob-gyn practices and hospitals in the Baltimore area. Along the way, he also served as the statewide coordinator of the Nuclear Freeze campaign and directed the Baltimore Recycling Coalition.

Jerrems says the health associates program emphasized socioeconomic causes of health problems, such as environmental exposures and industrial pollution. “A number of the faculty and students were critical of the medical industrial complex: big pharma, big supply companies and equipment companies that were all profit driven. Being more radical, I suppose, we felt that health care is a right and not a privilege.”

School of Health Services graduate Freddi Segal-Gidan, S.H.S. ’78 became the nation’s first PA to complete a fellowship in geriatric medicine. Then, since getting her Ph.D. in gerontology, she has been teaching at USC’s Keck School of Medicine and serving as the director of the USC/Rancho California Alzheimer’s Disease Center. Her current research focuses on improving the geriatric workforce through the interdisciplinary training of health professionals.

Like many of her classmates, Segal-Gidan considers the School of Health Services as a brief and shining moment. She recalls the heady, inspiring climate created by a brand-new school, a problem-based and team-taught curriculum, and risk-taking faculty and students.

“People talked about the Kennedy era as a ‘Camelot era,’” she says. “I think it was the same way at the school.”