The Rockefeller Connection in the Medical Center’s Beginnings


Henry Weil’86 and Rachel MacLean’20

In 1928, P&S and Presbyterian Hospital opened the Columbia-Presbyterian Medical Center at 168th Street, catalyzing the academic medical center movement, which revolutionized medical education and patient care across the United States.

However, in 1917, the proposed alliance between P&S and Presbyterian Hospital was on the brink of dissolution. The original agreement to unify the two institutions, brokered in 1911 by Edward Harkness (Presbyterian Hospital trustee) and Samuel Lambert (P&S dean), was in pieces. Columbia had been unable to uphold its end of a financial agreement, and tension brewing between the two institutions had spilled into the New York newspapers. Quick action was needed to save the partnership.

An unpublished letter, shown above, tells of a meeting between Edward Harkness and John D. Rockefeller Jr. in the midst of these troubled 1917 P&S-Presbyterian Hospital negotiations. Rockefeller, a prominent philanthropist with a strong public health focus, was aggressively working to modernize medical education across the United States. So, too, was the recipient of the letter, Abraham Flexner, who authored the famous 1910 report that evaluated North American medical schools; Flexner worked for Rockefeller in supporting medical education reform. Their vision, which Flexner had studied in Europe, was to promote medical schools with full-time faculty who would advance health care by doing research and training clinicians. 

Harkness, too, was dedicated to advancing medical education, particularly at P&S. Around 1910, he began seeking a permanent hospital partner for P&S. He first courted Roosevelt Hospital, offering a new surgical pavilion in exchange for P&S student education. When that proposal failed, he became a supporter of the P&S-Presbyterian union. However, this letter captures a moment in which he felt he was “groping in the dark,” perhaps puzzling over how to rescue the ailing alliance between hospital and medical school. He had bought the 168th Street property in secret, in hopes of donating it to the medical center, but progress had stalled. Accepting help from Rockefeller and Flexner—both seasoned and highly active medical education reformists—was logical, and Harkness shared their vision of revolutionizing health care delivery by co-locating education, research, and patient care. 

In this letter, Rockefeller recounts his offer to support Harkness in his vision for restructuring medical education in New York. Eventually, this pledge would provide the financial underpinning of the 168th Street medical center, alongside Harkness’ own contribution. The negotiations that followed were not simple, however; as is detailed in that letter, Rockefeller stipulated that Harkness had his support, but only so long as the plan for P&S had “full-time features.” This was typical of the quid pro quo approach taken by Rockefeller and Flexner: They would donate buildings (co-locating medical schools and hospitals) and in return, medical schools would hire full-time, salaried physician faculties. Rockefeller and Flexner already had succeeded in implementing full-time plans at such schools as Johns Hopkins, Washington University, and the University of Chicago. Nonetheless, the Rockefeller/Flexner approach had been slow to recruit additional medical schools, and they saw P&S as an important opportunity.

By building a state-of-the-art academic medical center in a major American city for the first time, Columbia played an important role in the continued spread of the academic medical center movement, which facilitated progress in American health care throughout the 20th century. The P&S-Presbyterian Hospital alliance ultimately proceeded without the full-time plan through a compromise that ushered in the concept of “geographic” full time, under which faculty physicians were permitted to have part-time private practices but not when teaching at an academic medical center. In the face of Columbia physicians’ opposition to the full-time requirement, Rockefeller had decided to cut his losses; improving medical education in New York City was too important to delay. In 1921, Rockefeller gave $1 million to fund the new 168th Street medical center. Though a sizable sum, Rockefeller’s contribution was surpassed by Harkness, who donated $1.3 million and the Washington Heights property to the medical center.

These efforts by some of the most prominent figures in medical education history brought P&S and Presbyterian together at last. In the process, it created the widely adopted template for academic medical centers in the United States. Two P&S deans, Samuel Lambert and William Darrach, presided over the negotiations. Countless hospital and university board members weighed in. And Rockefeller made the crucial choice to defer to P&S physicians on amending the full-time model when progress seemed hopeless. 

Through it all, Harkness was the common denominator. His steadfast support for the cause highlighted his quiet dedication to improving the future of medical education in New York City. Though his father Stephen’s name is on the Harkness Pavilion at what is now the Columbia University Medical Center, P&S—and U.S. health care—might not be what it is today without Edward Harkness.

The idea for this piece arose when the authors found the letter at the Rockefeller Archive Center in Sleepy Hollow, N.Y. Intrigued by the letter’s relevance to the history of P&S and the medical center, they reviewed other records, including those in the Health Sciences Archives, that revealed the dedication of Harkness, Rockefeller, Flexner, and many others to advancing medical education. Henry Weil, MD, is director of the Columbia-Bassett medical program. Rachel MacLean is a Columbia-Bassett medical student. The authors gratefully acknowledge Tom Rosenbaum for his knowledge, patience, and assistance in researching this piece.