{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/0c4sj1cg89/manifest","type":"Manifest","label":{"en":["Dr. Thomas Campbell"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer: The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eDr. Campbell gives a description of his time at Harvard for undergraduate as well as his training and education at Harvard Medical School. After he left Medical School he earned awards for outstanding practice and education in his time at Harvard. He became a part of the AAFP and participated in many of the accompanying affiliations of the AAFP and even became President of the ADFM in 2011. He talks extensively about his time with the FMAH and all that it does for the health of America. As well as the initiatives that he is proud of that he has had a hand in running and legislating. As a scholar of a prestigious school like Harvard, Dr. Campbell is a distinctively exemplary physician and educator.\u003c/p\u003e (summary)"]}},{"label":{"en":["Date"]},"value":{"en":["2017-07-19 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Herbert Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians","Family Medicine for America's Health"]}},{"label":{"en":["Subject"]},"value":{"en":["Thomas Campbell, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eDr. Campbell gives a description of his time at Harvard for undergraduate as well as his training and education at Harvard Medical School. After he left Medical School he earned awards for outstanding practice and education in his time at Harvard. He became a part of the AAFP and participated in many of the accompanying affiliations of the AAFP and even became President of the ADFM in 2011. He talks extensively about his time with the FMAH and all that it does for the health of America. As well as the initiatives that he is proud of that he has had a hand in running and legislating. As a scholar of a prestigious school like Harvard, Dr. Campbell is a distinctively exemplary physician and educator.\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879","type":"Canvas","label":{"en":["Media File 1 of 1 - CampbellThomas_01_Access.mp3"]},"duration":3508.8579,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/879/original/CampbellThomas_01_Access.mp3?1761147456","type":"Audio","format":"audio/mpeg","duration":3508.8579,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879/transcript/85512","type":"AnnotationPage","label":{"en":["Dr. Thomas Campbell interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879/transcript/85512/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1 \n\nDr. Young: This is side 1 of tape 1 of the oral history of Dr. Tom Campbell recorded on July 19, 2017. I’m Dr. Herbert Young, a volunteer for the Center for the History of Family Medicine. The topic for this recording is Family Medicine for America’s Health.\n\nDr. Campbell, first can I ask, do we have your permission to record this interview?\n\nDr. Campbell: Yes, you do.\n\nDr. Young. Wonderful. And can we start with getting your full name?\n\nDr. Campbell? Thomas L. Campbell, MD. I’m Chair of the Department of Family Medicine at the University of Rochester School of Medicine and Dentistry.\n\nAnd how long have you been doing that position?\n\nDr. Campbell:  About fifteen years.\n\nDr. Young: Tell us a little more, if you would, about your professional background.\n\nDr. Campbell: Well, I came to the University of Rochester almost forty years ago as a resident. Went to Harvard Medical School, was in a class that actually had eight people going into family medicine, which was pretty remarkable in those days. Three of them came to the University of Rochester. And I got interested right from the beginning with the work that George Engel did here with the -- and got interested in the psycho-socialized practice of medicine. Went on to do a fellowship with George Engel along with doing family therapy training. And most of my career has been focused on the impact of family on health and how to take the family systems approach to family medicine as well as overall mental health issues in primary care in other psycho-social issues. For about fifteen to twenty years I taught very closely with Susan McDaniels (?) who was a close colleague. She came as a family physician in psycho-social medicine and then became chair fifteen years ago. And, still, Susan McDaniels is a Vice Chair for the department. I did, in my previous life, a lot of publishing about the role of family in health care and edited a journal called Family Systems In Health, with Susan McDaniels, for a number of years. But now I’ve been just mostly just focused on the administrative tasks of being a chair of the department.\n\nDr. Young: Being a chair definitely changes one’s trajectory a bit.\n\nDr. Campbell: Absolutely. I’ve enjoyed it but it definitely – I’m impressed with people who are able to continue to keep their scholarship and academic careers going. I have really had to quit those and put most of my energy into just supporting the department.\n\nDr. Young: How large a faculty and how many residents?\n\nDr. Campbell: We have about twenty-five. Between twenty-five and thirty faculty. And we have a twelve, twelve, twelve residency program. And we just started actually a nurse practitioner residency program that is integrated into our family medicine residency program. \n\nDr. Young: Do you draw your residents primarily from New York State?\n\nDr. Campbell: No, we draw them nationally. I would say probably a third come from New York state and two-thirds from outside. And we try to keep a half of them to remain in the region and the other half after graduation go out across the country. \n\nDr. Young: How did you get involved in Family Medicine for America’s Health?\n\nDr. Campbell: Well, it came out of my relationship with the Association of Departments of Family Medicine. I was president, then past president of ADFM just at the time that FMA Health was beginning to take off. And each of the eight family medicine organizations have a representative to the board. And I was on the executive committee of ADFM and coming off as past president had an interest in this, and ADFM nominated me to be their organizational representative to FMA Health.\n\nDr. Young: And how did the various organizations decide to undertake FMA Health?\n\nDr. Campbell: This came out of Working Party. So there had been discussion at previous\n\nWorking Party about do we need to do Future of Family Medicine 2 (?)? Do we need to reassess where they are and have a strategic plan going forward? It took several Working Parties. So obviously being on the ADFM executive committee, I was going to Working Parties over those years. And as it evolved, the decision to move ahead with doing both a strategic plan and a communication plan, it came out of Working Party. Then Working Party set up the initial proposal both for the communication (?) and strategic plan and out of that developed Family Medicine for America’s Health.\n\nDr. Young: As long as you brought it up, let’s turn to that a bit. How does FMA Health differ from the Future of Family Medicine project?\n\nDr. Campbell: So I was not intimately involved. I certainly know some of the products that came out of the Future of Family Medicine. I think that a lot was learned in that process. There were a lot of valuable things that came out of it. And that was sort of used as a template to decided, okay, what should we do differently, what should we do the same. And I think there were a couple of things, the process things and there are some actual outcome things. In the process it was felt that one of the drawbacks was there was no centralizing organization of the Future of Family Medicine. That once the different, I don’t know if they were called tasks (I don’t know what they were called), were identified, that essentially each organization took responsibility for it. And there was no oversight, no tracking how it was going to say, okay, this is NAPCRG’s job to advance research in family medicine. So there was a feeling that there needed to be more structure in that and that that structure then needed to be accountable to others. And the other part of it, there needed to be a central funding mechanism. That they shouldn’t rely simply upon the funds of each organization for the project but rather there should be funding for the overall organization. And there were two areas that developed where the Future of Family Medicine fell short. And the first was that it didn’t address payment reform adequately. So as a result, it was felt it was very important to put a lot of, probably the most important part of Family Medicine for America’s Health is the payment reform because from that flows almost everything else. And the second was that we do not do a good job of communicating with the public about what is a family physician, what is primary care and why is it important not only to the public but to key stakeholders like   \n\ngovernment officials, foundations, insurance companies and the like. So out of that grew the communication plan that paralleled to integrate with the strategic plan. And then under the strategic plan -- focused on payment reform and practice reform.\n\nDr. Young: So Future of Family Medicine I know came out with, I think it was ten objectives. And at least my experience with the Academy, we initially worked on a lot of research before NAPCRG then stepped forward a little bit later to take that on. And as you’re pointing out, there wasn’t sort of an ongoing coordination in terms of the work of organizations and the funding was up to the organizations themselves, so those were significant changes in approach in terms of FMA Health.     \n\nCan you talk a little bit about how FMA Health is organized in terms of the board and sub-units and so forth?\n\nDr. Campbell: Sure. So there has been sort of an evolution. It was initially formed as representatives from the eight organizations, although I don’t believe the ACOSP (?), the osteopathic organization was initially included. There were a lot of questions about what is the role of osteopathy in all of this. It may not have been initially, but shortly after we realized we  needed to include them and have an ACOSP representative. But the initial was that eight members on the board, represented from each group, and each group’s organization chose their representative. And from that we chose Glen -- to be our board chair and then decided what else do we need to add to it. What do we need? What skills, what representation do we need? And that’s when we came up with a number of different additions to the board that included young professionals, somebody representing people recently out of residency. So the next step was a chapter representative. We thought it was important to have a chapter exec on our board. And a public member - and I think there is one other than I’m blocking out right but I will probably come back to. So that formed the initial board. And the only minor change was we decided it was important that the chair of the board and subsequently the CEO of FMA Health not be an actual representative from one of the organizations but would be independent from that. So as a result, Glen no longer represented AAFP and then we put -- on as the rep from AAFP. The group then decided, based upon the strategic plan, what were the tactic teams and who would be liaisons to each of the tactic teams and then each of the compositions of the tactic teams, who would chair each tactic team, -- a report. And all of this has been and continues to be supported in a major way by --. I don’t know actually know what -- stands for. It stands for something. And they’re instrumental in keeping us on track and doing the kind of due diligence between board meetings and board calls.\n\nDr. Young: How long did it take to develop the strategic plan?\n\nDr. Campbell: I honestly don’t remember. I would guess that it took probably six months or so. There were several iterations. And we eventually took that back to … It’s been so long ago. There was a future plan that included the strategies. And I think the initial strategic plan included the tactics and then what were the tactics, the tactic teams, and how they kind of interwove with the strategies. And at that point we initially had just six tactic teams. Then we expanded that to seven by adding a health equity tactic team. \n\nDr. Young: So there was an evolution in terms of the process including the adding of that additional tactic team. Was that from learning’s that were occurring or changes in the environment, some combination?\n\nDr. Campbell: It was partially kind of an introspection by the board and partially feedback that we, and we still, one of our major problems is that we have no racial diversity, ethnic and racial diversity on our board. And that’s a big problem and we’ve struggled with that over time. But in addition, though one of the strategies was about reducing disparities, we did not have it prominent in our strategic plan. So out of that came the decision that the best way to address that was to actually have a separate health equity team and that that tactic team would also help inform the other tactic teams to be sure they were addressing health equity and diversity across all of the tactics.\n\nDr. Young: And why do you feel that there is a continuing problem of a lack of diversity in the leadership? \n\nDr. Campbell: Well, the problem has been identifying the, sort of like it is in every organization, finding the right people who also represent a racial, ethnic minority to be on the board. And I think some of it was blinders. When we initially did this, we weren’t thinking enough about diversity after the eight initials chosen by the organizations. And they obviously didn’t choose to nominate anybody from a racial, ethnic minority. And then when we went to add people on it, there was some discussion. But I think in retrospect the group would agree and I would agree that we should have paid more attention to the diversity. Now, we did replace two people on the board, the public member and the chapter exec, because the public member really could not spend the time. She had a baby and was not able to come to meetings. And the chapter exec decided that he really didn’t think he was adding what he needed to and felt he had other commitments he had to deal with and that he should step down. And then as we replaced both of them we looked very hard at trying to find people of racial and ethnic minorities and we could not find a single chapter exec  that was a minority. I know there might be somebody, but nobody has ever -- who was even acceptable. And similarly we could not find anybody that we thought would be a good public member.\n\nDr. Young: Is this reflective at all of who the current residents, faculty – you know, the specialty as a whole?\n\nDr. Campbell:  Oh, yes, as a specialty. But medicine and society - this is a problem across all of society. And certainly what the health equity team has addressed and is trying to educate not only the board but the discipline as a whole about some of our blind spots and our need to pay more attention to diversity. But being in a position of chair, trying to recruit under-represented minorities for faculty is extremely difficult. It’s a difficult task we have to keep working on. A lot of it has to do with developing the pipeline. We need more particularly more -- and Hispanics in medical schools, their residencies and then in faculties.\n\nDr. Young: So this is sort of an underlying factor in addition to things like payment and technology and so forth that you all are struggling with?\n\nDr. Campbell? Yes, definitely it’s a big issue. And I think that’s why it’s been very helpful to have the health equity team because it is a very talented group and they have really … There’s the Starfield Summit, I guess a Starfield 2 Summit which was on health equity, was a great success. And I think that the products (?) of that will be very helpful for the field as a whole and also to FMA Health project. And they have been the people who kind of remind us of what are the key issues we need to be addressing that affect health equity and diversity.\n\nDr. Young: So again, returning to sort of the differences with FMA Health from the Future of Family Medicine, any other comments say the project teams or the core teams, I should say, and what they’re doing?\n\nDr. Campbell: I would say first, because it was centralized in … I don’t know if we’ve ever calculated how much money was spent on the Future of Family Medicine because each organization did it. I think it’s a dramatically more amount of money. Almost half of that is the communication plan. And then the tactic teams have been independent of organizations. And that has been both good and then at times a challenge. But mostly been good in that you get a broad representation across the organizations. I think the other thing that this has done that I think has been one of the legacies that I think will be very helpful is it’s really pushed the eight … The Working Parties include osteopathy. So the osteopaths were never invited to Working Party until somebody else started saying why don’t we use them as part of the FMA Health. And then of course CAFM coming to the Working Parties. But the other is just that in order for them to sort of be the overseers of the board, because they are funders, they have to work more closely together. And I really saw in the – I was on Working Party for about four or five years because I was the -- chair after -- ADFM past presidents I think for two years. So I think I was on it for five years. And I saw a dramatic change in how a Working Party functions during that time from the kind of a gathering together and sharing what people are doing to really beginning to work more closely together and try to speak with a more unified voice. That still has a ways to go and I think that’s one of the challenges that FMA Health feels, particularly as we have another I think it’s two or two and a half years to go in that we want to be sure that there is a strong organization that can take this on to continue to push it and keep people accountable and that the Working Party needs to handle the structure. My personal feeling is I think the Working Party ought to function more \n\nlike CAFM does. It works quite well as the council of the four academic organizations where they have phone calls once a month and meet twice a year at the Working Parties, how they chair, actually make decisions. And it really allows the academic organizations to speak with one voice. We don’t have that now in family medicine. We have Working Parties, it’s just a loose, it’s just the organizations getting together. \n\nDr. Young: And for our transcriptionist, if you could spell out what CAFM stands for?\n\nDr.  Campbell: Council of Academic Family Medicine. And it’s composed of? It consists of the four academic organizations. So that’s STFM, ADFM, NAPCRG, and AFMRD. Do you need those spelled out, what they are? That would be helpful to the transcriptionist, yes. So the Associations of  Departments of Family Medicine, ADFM; Society of Teachers of Family Medicine, STFM; The Association of Family Residency Programs, AFMRD; and NAPCRG, so North American Primary Care Research Group. And I think that has worked quite well, certainly in the time that I was involved with it.\n\nDr. Young: In terms of the division of resources, you mentioned, I think, that one of the differences with Family Medicine for America’s Health was that there was a communication strategy and resources devoted to that. Can you talk a little bit about that? \n\nDr. Campbell: Sure. And I think there’s a little bit of a name challenge here. So technically, as I understand it, Family Medicine for America’s Health is just the strategic plan part and then Health Is Primary is the communication. But we still, the FMA Health board officially we do oversee. So I get that --. We oversee the communication plan and get reports on them regularly and make recommendations that they follow through on. So the decision was that … And I think AAFP sold this mostly and they have been the major funder of it, that there needed to be a much stronger campaign to address the importance of primary care. Now, there’s a lot of debates, many debates about what we include and we don’t include, whether it should be about family medicine or whether it should be about primary care, the value of primary care. And there were several reasons for the decision to stick with primary care, purpose foremost that we sort of developed a strategic plan and the mission for FMA Health and we felt it was really important that it be about advancing the health of the country through advancing family medicine and primary care. That it not be primarily about advancing the discipline. That we wanted to step outside that and say our goal is to improve the health of the nation and that we can do that by strengthening family medicine and primary care. There were lots of debates early on about should we be more inclusive and include the other primary care organizations. And there were both practical and theoretical reasons that that was decided not to. That we would start with just family medicine and we would then engage the other primary care specialties as the project went on. And there’s still ongoing debate about that. I think there’s strengths and weaknesses to this approach. I think mostly it was the right decision to do and has allowed us to move forward quite effectively.\n\nDr. Young: And when you say the other primary care specialties, meaning broadly like the American Academy of Pediatrics or more specialized primary care organizations within other specialties?\n\nDr. Campbell: Well, that is part of the challenge and part of the reason the decision was not to – because it’s not so clear. So even if you pick internal medicine – so the biggest obviously is primary care and internal medicine. But even then there is no clear organization for the FPIM (?) citing (?) general, internal medicine. General internal medicine includes both hospitalists and primary care. And it’s an academic organization, so it doesn’t focus just on primary care physicians out in practice in. And ACP, the American College of Physicians, is a huge organization that represents across all of the specialties. So it wasn’t a clear organization to partner with.\n\nDr. Young: I can see where this can get very complex very quickly. So if you are a rural family physician and you see patients in the hospital you are doing a type of hospital practice. If you are in a more urban setting and you’re the hospitalist for a group, are you still doing primary care?\n\nDr. Campbell: So not all family physicians do primary care. So if you are a pure hospitalist or you are a sports medicine doctor or a palliative care physician but you are trained as a family physician, you’re not doing primary care. However in our discipline 90% (I -- the number), 90% of people in family medicine are actually doing primary care. The scope of practice is quite variable and changing and that’s a whole other issue, but it’s focused on that. \n\nDr. Young: And then just to complicate things … We’re talking about physicians; I’m sure you             \n\nall discussed about other health care clinicians who are not physicians but are involved in primary care?\n\nDr. Campbell: Right. So the other key two areas are – and we are talking about clinicians, not       \n\nstaff. But the other two areas obviously are nurse practitioners and PA’s. And that also opens a whole bag of worms and lots of controversies about that in terms of what is the role of nurse practitioners in primary care; can they work independently - and all these different things? And there is a lot of differences of opinion within the eight organizations about that. So I think that was one other reason why we decided that we’re not going to try to reach out for the whole project. That we have reached out to them in a number of tactics. Probably the biggest one has now been the Shared Principles of Primary Care in which that effort done by the engagement team to essentially update and revise the original PCMH principles is intended to be as inclusive as possible and recognize all of the people that are involved with primary care, particularly including nurse practitioners and PA’s. We also had a lot of attention around the notion of do primary care teams need to be led by physicians. And I can’t remember the exact language that we used. It was kind of compromised language that recognized that, no, you do not (?) have to say all the teams could be led by other members of the team, but we did feel strongly that they did have to be finished (?) and informed.\n\nDr. Young: You mentioned the Principles of Primary Care and this is something that is now a defined document and you’re seeking sign onto?\n\nDr. Campbell: Correct. So I don’t know this for sure, but I think all the organizations that now preside within the PCPCP – so that’s the Primary Care Patient-Centered Collaborative. And they are seeking not really ownership but they are seeking coordination of that and they are seeking endorsements by organizations similar to what they’ve done with their other efforts. PCPCP is a very eclectic group that involves businesses, insurance companies, healthcare providers, even hospitals. So they’re trying to get as many organizations to sign onto this agreement. And I can’t remember the number – I think they’re up to about seventy. They’re also turning to individual departments of family medicine and hopefully medical schools, medical centers to sign on as a piece of the shared principles of what primary care is about.\n\nDr. Young: And then what will be done once the sign-on’s are complete? Is there a strategy to influence healthcare development in the United States with that or …\n\nDr. Campbell: Yes. I think the goal is and probably will go primarily through PCPCP in their efforts to promote primary care. But this will be the documents that will go to stakeholders to say this is what primary care is about, this is what we’re promoting. This is what is going to essentially transform the healthcare system. That we can achieve the triple A, improve primary care. What is primary care here -- in the scope of what primary care is about.\n\nDr. Young: And then how does that relate to some of the work of the other core teams that are looking at the technology or research or engagement?\n\nDr. Campbell: So they’re informed by all these different efforts. So there are – each tactic team has probably anywhere from two to five tactics that they’re currently working on and that is information is shared so that where there’s health equity and what health equity has done, informs the workforce issues. So they’re all intertwined and they meet … Up through this year they meet twice a year, I believe it is, in what is called … I’m blocking the name of it – where all the tactic teams come together and they meet some separately and some together and they present what they’re doing to each other so they’ve got a synergistic effect in moving things forward.\n\nDr. Young: So there’s an ability to amplify the principles, it sounds like, through the work of the core teams. And it sounds like the principles could have been influenced also by the thinking of the various core teams?\n\nDr. Campbell: I don’t know how much they input … I mean certainly they’re shared widely, the Shared Principles, with both the board and the core tactic teams. I don’t know how much input they gave. But quite frankly, from my standpoint, the Shared Principles are pretty mom and apple pie – this is what we all agree primary care is about. The only difference is that it is more inclusive of all the members of the primary care team and it emphasizes engagement of patients. I think those are the two things that were a refinement (?) over the initial PCMH principles. \n\nDr. Young: One of the things that in the oral histories we’ve been wanting to do is to is to get the perspective of board members and core team leaders over time with what’s going on in terms of the specialty and health care in the United States. Could you talk a little bit about what you see is happening? And since we started these interviews we’ve had a election and all. But where do you see family medicine going? Where do you see health care in the United States going?\n\nDr. Campbell: Oh, man, you’ve got to have a crystal ball to see where health care is going. If we had talked two days ago it would have been different. We were just talking to the CEO of our system and were saying they just don’t know what’s going to happen in terms of – despite the failure of the Republican’s plan, what’s going to happen to …\n\nDr. Young: And let me say, you can speak to what that means for the work of Family Medicine for America’s Health given the fact that we have a changing environment and so forth. Because obviously if the project is headed one direction but the decision-makers in Washington and industry and so forth are headed other directions, that’s a dilemma. But this project is much more fluid, it seems to me, in one sense than the prior project of Future of Family Medicine. This is very alive.\n\nDr. Campbell: Yes. And I think what we do know is that health care costs not going down and that’s a major crises and everybody agrees on that and that something’s got to be done about it. There might not be agreement about much else in the country, but that is true, and that there is going to be continued push to value-based reimbursement models as a way to pay for outcomes rather than for what we do to people. And I think that is the opportunity that family medicine and primary care in general has to really demonstrate that it can help solve the particular problem because we know that primary care reduces health care costs and improves health care quality. So I think in that sense we’re very much aligned to the notion … I think that’s the thing in some ways drive this whole project, for the ability to say, okay, particularly if we can get the comprehensive primary care payment as a way to save costs to the system and improve quality and convince the key stakeholders - insurance companies, politicians, hospitals that this is the way that they are going to be successful in the new health care world which will be increasingly capitated and population-based, then all the things that we’re doing will be lined up. And take advantage of that and really help push family medicine forward. \n\nDr. Young: To put you on the spot again – we’re in a position at the moment where Congress hasn’t figured out how it’s going to or what it’s going to do. States are struggling with budgets and decisions. Would you care to predict at all what we’ll see in a year or two  or is that just an impossible task?\n\nDr. Campbell: I think everybody agrees we’re moving more and more to the value-based, to population-based. And I think that’s what we have to keep pushing because it’s a shared concern about cost of health care. So I think that’s going to continue to happen. We’re going to see more and more focus on getting paid for quality, getting paid for managing costs. And that’s happening in the private sector as well as with Medicare. So with MITS (?) and with the MACRA (?), we’re always going to be doing this. And so being prepared to manage populations in a successful way is going to be absolutely critical. And I think we’re just moving down that line. The other question will be how much money will be in the system. So in New York state we’re going through a huge -- project which ends in two years that’s not all clear. (Inaudible) is a Medicaid reform, it’s a federal project done through states which basically the version that we have is designed to reform Medicaid so it’s prepared for value-based reimbursement and moving to population health. But what we don’t know is at the end of that time if the amount of money that’s going to be available is comparable to what we have now or with inflationary growth, with some control in growth, or will it actually be cut. If the changes that Republicans put into place actually happen then we’d be looking at dramatic cuts in Medicaid and very difficult to do the population health. But if that doesn’t happen, I think there are really opportunities to get better care at lower cost through primary care-based population health. \n\nDr. Young: How is the specialty preparing for this? And I’m thinking of training, for example.\n\nDr. Campbell: Well, I think that that’s more and more a major component of residency programs. And AFMRD certainly has that high on their radar list to make sure that residencies are teaching about population health, quality improvement, how to manage their panels, information technology. Kind of the tools for the new health care system. So I think that the residencies – certainly our residencies put a huge emphasis on that. And our graduates have gone out, employed by our university, and we get feedback saying they are so much better prepared for this than their internal medicine, primary care colleagues. \n\nDr. Young: And how about the practicing physicians who aren’t just graduating from residencies?\n\nDr. Campbell: That is so tough. I mean just seeing what’s happening with MACRA, it’s so hard for practicing docs who are already feeling under pressure on multiple levels of implementing EMR’s and having to deal with meaningful use and then add onto all of that, okay, you need to not only understand MACRA but you need to start reporting these measures; otherwise you’ll be at risk. I think it’s still a very tough situation for the average practicing physicians at a fee-for-service model. It’s a little easier for employed. And obviously one of the reasons why more and more family physicians are being employed is because then the employer sets up systems by which the reporting takes place and the like. So for us, we need to be aware of it, but the actual reporting of the data and the deal with the finances is done by our medical center, not by our department.      \n\nDr. Young: Can you talk a bit about what Family Medicine for America’s Health has been doing to help with the change in practice? It seems to me one of the things that I’ve read is the core teams have reached out beyond their own membership in a variety of ways identifying individuals who want to provide input or doing focus groups, things like that.\n\nDr. Campbell: Yes. So practice and payment are sort of coming together to form one team because it really makes sense because they’re so intertwined. And I think the most important thing coming out of the entire project is the development of a primary care payment model and how to actually implement that. And once you understand how to do that, how do you help practices transition from traditional fee-for-service to a comprehensive primary care payment model. And they have two teams that are doing multiple different projects to address that. So they are doing what they call Bright Lights, basically looking at best practices and seeing where are the places where family docs have done that, they’ve made the transition. And for the most part, where they see that, they see dramatic changes in the satisfaction of those family physicians. I’ve not heard of anybody who works in a system with comprehensive primary care payment where they’re not just incredibly delighted about it. It changes the way that they work. So there are a number of projects. They’ve got the Primary Care Payment Calculator project to actually figure out how we should cost this out – so how do you make sure you take care of, you address all the different variables that should go into a per member (?), per month primary care payment. They are planning a major summit a year from now for both the payments and population health. So they’re doing the summit. They are interviewing groups to try to figure out … This is an interesting project – they’re doing focus groups of physicians who describe themselves from different cities as well as the practice information, those that are using the motivation model: --, preparation, action and maintenance. So they did it by groups, interviewed them to see what are you doing as your next step, how did you get to where you are – so if we can see, we can develop a pathway to comprehensive primary care payment. I think that’s probably the most overall defining thing. And also it starts with Summit 3, which is going to be about primary care metrics.\n\nDr. Young: Does it amaze you that across the variety of types of practice arrangements and locations, geography and so forth, that there are principles that are being recognized work across these various locations and that they’re being embraced by practices which have physicians from all different stages of development and training? Is that a positive thing about the specialty, about the people and the practice?\n\nDr. Campbell: Oh yes, absolutely. The fact that we can find some common strategies or common best practices and of course try to spread them across. Now, the problem is that everybody in different environments have very different situations. For instance, I’m in a university setting and there’s no way we could ever develop a comprehensive primary care payment model. They’re not going to allow us to break off from the overall contracts that they have. But in many places it does work and it’s a matter of figuring out how do you get there and what’s the next steps for different practices depending on what stage they are towards moving to this model.\n\nDr. Young: Have you discovered any things that surprised you in your work with Family Medicine for America’s Health, whether it’s perspectives from other organizations with which you all have dealt or the response of the various organizations, all family physician-oriented; but obviously STFM is different than AAFP is different than the board, et cetera?\n\nDr. Campbell: Honestly, the biggest thing is I was surprised and a little disappointed at how much politics there is between the organizations which makes it so difficult to speak with a common voice. That there are fundamental differences between some of the organizations and it’s difficult , to get them to all agree. I mean just on the faces - when I tell people in other disciplines that we have eight family medicine organizations, they look at me like I’m crazy. Eight different organizations? When I was the ADFM president, I tried to propose a model similar to what internal medicine has done, called the Alliance of Internal Medicine which is an umbrella organization that oversees at least all the academic organizations. So there’s the Alliance for Internal Medicine and then there’s ACP. And from what I hear, it works quite well. So they can use the infrastructure to support all the academic organizations but there’s still a chairs (?) group and there’s still a residency group and the like. But that got nowhere. Unfortunately each organization is invested in their current model and there is a resistance to joining together. So as a result we have eight organizations all trying to agree on things and speak of one voice but often having difficulty in doing that. \n\nDr. Young: Is that reflective of the realities of having to deal with the problems that each of those organizations address – or something else?\n\nDr. Campbell:  I think some of it. I think a lot of it is historical. I don’t know how much, for instance, the ACP and ABIM, how much they … They probably have similar conflicts because a board has different responsibilities than a membership organization. And so it may be just that this has been an opportunity to look under the hood and see the challenges of a discipline which has so many different stakeholders. But I would certainly like to see if we could reduce it from eight to maybe half that number. We have four family medicine organizations; one representing academics, one representing the board. We probably have to have, we’ll call it PNACOFP (?) since they’re not going to come together in any foreseeable future.  \n\nDr. Young: As you look ahead, any predictions as the project comes to an end in several years, as to what will happen moving forward? For example, will the core teams find a life somehow still as inner-organizational or are we going to go back some issues being sort of seated firmly within one organization? \n\nDr. Campbell: For the most part, the latter. That is the --, and that’s really the task that’s going on now and we will be doing a lot of work with Working Party this next month to address that, which is how do we make sure there’s a successful handoff because three or four of the teams are ending at the end of this year. That was a revision that was made part way through. That was actually a major change that happened that was quite, kind of came as a surprise. The Working Party requested that some of the teams … Originally they wanted all of the teams to wrap up sooner so that more dollars could be put toward the communication plans and less towards strategic plans. And after a series of negotiations, the decision that the majority of the tactic teams would sunset as of the end of this year but that several … The practice team is together and the health equities needs to continue for the full period of time of the project. So those other groups – we’re in the stage of trying to clearly identify and keep people accountable about what aspects of the projects that are going on will be taken on by what groups. For some of this, it’s been quite easy. For the research team, essentially NAPCRG said we will take over the research tactic team and we will be responsible for the tactics that they’ve been working on. And that’s been pretty easy and straight-forward. When you get to workforce, that’s much more complicated because there are at least three organizations that are very engaged in education – AAFP, SPFM and ADFM and AFMRD. So that’s where we have to figure out and make sure that there’s a whole process by which people identify whether or they’re willing to take responsibility, a big R (?) for a project, versus consulting or wanting to be informed. Then what does that exactly mean? Clarifying that and actually having an agreement with each organization, as they pick something up, to say this is what we agree to do and will be held accountable for. Because the more we continue to oversee everything for the length of the project, even the projects that have been taken over by individual family medicine organizations, so that we can make sure that things get done. What will happen after the entire project is done, how do we make sure that they go forward, that’s the bigger challenge the Working Party needs to address – and we’ll be talking about which Working Party over the next couple of meetings.\n\nDr. Young: So if I’m hearing, on the positive side there will be one organization or perhaps several that take the lead in carrying forward the work of the core team and they can involve other organizations. I think on research, for example, the head of the National Research Network for the Academy is a member, so there is a connection. At the worst end, it could go back to what some felt some of the objectives ended up in the Future of Family Medicine and not having as much inter-organizational cooperation. And of course that comes back to budgets and time available within organizations that may have competing priorities as well. Exactly. It sounds like an adventure.\n\nDr. Campbell: Definitely it’s going to be a challenge both in terms of negotiating what responsibilities people will have and getting it very clear so that it doesn’t slip. And then keeping people accountable. I’m fairly confident that it will go well through the links of the history of FMA Health board. But when we sunset, which I think is in another two years, then the Working Party has got to figure out for them how are they going to make sure that these projects continue and the strategic plan goes on. And they don’t currently have a structure since they don’t have any structure. They just get together. They don’t have an executive group. They have the execs that communicate regularly, but they don’t have a structure for overseeing the projects. And I believe that will actually lead to more collaboration between the eight organizations as they take responsibility for it. They have definitely begun working more together to set this project up and to kind of oversee the project but they’re going to have to manage the project at the end of two more years. \n\nDr. Young: What other issues do you think should be part of this oral history? Or any things we’ve discussed that you want to revisit?\n\nDr. Campbell: Sort of the highlights that I think are very good are that the engagement team – Ben Eckerly (?) has been a very passionate advocate for getting patients not only on all boards of the eight organizations – that’s a goal that we have that we’ll be pushing quite hard. I think we’re halfway there now. But also that as many practices possible have patient advisory committees that inform their practice so we really engage patients more than we have. And they have developed models looking at best practices. Kevin Koback is taking a big lead in that with the UCSF (?). They have a whole program on this. So I think that is very exciting to change the nature of patient engagement in our practices. The workforce has a big challenge with the workforce needs. I’m hopeful that they will be able to come up with … There will be a consensus of (and I want to make sure I get this right) … The hope is to establish a goal called 25 By 30 which is that 25% of the graduates of medical schools will go into family medicine by the year 2030. So depending upon your view, that may be viewed as a stretch goal or may be viewed as a doable goal. But we’re hoping that the organizations will at least establish that as a goal to reach for - and then they have a bunch of projects to help address that.   \n\nDr. Young: We’re going to stop the tape.\n\nI want to thank you very much for spending this time doing this oral history. And we want to come back in about five to seven years post-project. Hope you will be available.\n\nDr. Campbell: I certainly hope so too. If I’m around, literally, I would be delighted to talk again. And I appreciate the opportunity of sharing by thoughts and being part of this history.\n\nDr. Young: Thank you so much.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879#t=0.0,3508.8579"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879/transcript/85513","type":"AnnotationPage","label":{"en":["Dr. Thomas Campbell information sheet [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879/transcript/85513/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Campbell, Thomas (19\n\nInterviewer: Dr. Herbert Young\n\nInterview Date: July 19th, 2017\n\nBiography\n\nThomas L. Campbell studied at Harvard University for his undergraduate and got his degree in Environmental Health Science in 1974. He then went to Harvard Medical School and graduated in 1979, Summa Cum Laude. Upon graduation, Dr. Campbell did his Fellowship in the Division of Behavioral and Psychosocial Medicine from 1982-1983 at the University of Rochester in New York. He then moved to study in the Family Therapy Training Program from 1985-1987. By the late 80’s he was a part of the AAFP and won the Society of Teachers of Family Medicine Patient Care Awards for Innovation in Family Medicine Education in 1988. In 2011 he became the President of the Association of Departments of Family Medicine (ADFM). He recently stepped down as chair of the University of Rochester Medical Center Department of Family Medicine in July 2019, having served as the department’s leader for 15 years.\n\nOral History Summary\n\nDr. Campbell gives a description of his time at Harvard for undergraduate as well as his training and education at Harvard Medical School. After he left Medical School he earned awards for outstanding practice and education in his time at Harvard. He became a part of the AAFP and participated in many of the accompanying affiliations of the AAFP and even became President of the ADFM in 2011. He talks extensively about his time with the FMAH and all that it does for the health of America. As well as the initiatives that he is proud of that he has had a hand in running and legislating. As a scholar of a prestigious school like Harvard, Dr. Campbell is a distinctively exemplary physician and educator.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162450/file/295879#t=0.0,3508.8579"}]}]}]}