{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/5m6251hd7g/manifest","type":"Manifest","label":{"en":["Dr. Marian Bishop (Part 2)"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1992-06-01 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Interview","Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. William Ventres (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family medicine","family physician","Society of Teachers of Family Medicine","Marian Bishop"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Marian Bishop (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eA continuation of the oral history captured by Dr. Ventres on May 5, 1991. \u003c/p\u003e (general)"]}},{"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"]}}],"summary":{"en":["\u003cp\u003eA continuation of the oral history captured by Dr. Ventres on May 5, 1991.\u0026nbsp;\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: \u0026nbsp;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/3629/collection_resources/150959/file/278376","type":"Canvas","label":{"en":["Media File 1 of 3 - Bishop_Marian_Pt2_92_a.wav"]},"duration":1857.10249,"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/3629/collection_resources/150959/file/278376/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150959/file/278376/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/376/original/Bishop_Marian_Pt2_92_a.wav?1750872512","type":"Audio","format":"audio/wav","duration":1857.10249,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150959/file/278376","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150959/file/278376/transcript/81409","type":"AnnotationPage","label":{"en":["Dr. Marian Bishop interview transcript 2 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150959/file/278376/transcript/81409/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Telephone Interview by William Ventres of Marion Bishop\n\nJune 1, 1992\n\nQ. - William Ventres, MD\n\nA. – F. Marian Bishop, PhD, MSPH\n\n_______________________________\n\nQ.  This is a second interview with F. Marian Bishop, the date is June 1, 1992. Dr. Bishop is in Salt Lake City, Utah, I'm here in Tucson, this is a phone interview.\n\n***\n\nQ.  All set?\n\nA.  Uh-huh.\n\nQ.  Okay, is this an okay time, or do you need a little bit more time...\n\nA.  No.\n\nQ.  ...before we begin?\n\nA.  Oh, no, let's get going.\n\nQ.  Okay. I wanted to start by asking if you, if in thinking about this interview, if you had any, and perhaps looking through what you had said before, if you had any comments or issues that you wanted to bring up.\n\nA.  Well, I reread what we said in '91. I wouldn't change anything except I certainly didn't realize I spoke that way.\n\nQ.  Really? How so?\n\nA.  Oh, so circuitous and – I’m going to change my habits, instead of saying 'yeah,' saying 'yes.'\n\nQ.  Uh-huh.\n\nA.  And instead of starting someplace and then sort of stopping and starting over again, which I seem to have done all through the interview, I'm going to see if I can't get my act together. Terrible interview.\n\nQ.  Well, I'd have to – actually I'd have to tell you this, and this is a secret between you and me. You should listen to [    ]. Your interview was actually, in reading through it, was one of the most concise of them all. You may not think so when you look at it, but it's pretty odd how people talk. It's a lot different than the way they think and they write, and especially when they're kind of reflecting on things, so don't think that it's all that bad.\n\nA. Well, look here – how many times in one lifetime do you have the opportunity to get in on the ground floor of something? Now that's a perfectly straightforward sentence. And then the next thing is, 'You know, it's sort of a, again is a, serendipitous event.' What in the world is all that stuff?\n\nQ.  Well, that's just the way people talk.\n\nA.  'So I actually, my own growth and development and even my own chronological age,' well the thought's there, but why do I have all of that business in there?\n\nQ.  Well, again that's just the way – if you've read, I've read several of these, and yours is the least problematic of them. Actually, [    ]'s and  [    ]'s were horrid. But I think they ended up reasonably well, and I took all that out.\n\nA.  Okay, so what do you need?\n\nQ.  Well, what I – if you don't have anything, areas, I had some areas that I wanted to fill in from what we talked about, and some areas that I wanted to expand upon.\n\nA.  All right.\n\nQ.  And I'll just kind of touch on these, and what I need to let you know is that oftentimes I pick and choose, so I piece things together, and it may not be one thing leading to the next as you have already talked about it. One of the things was, in the articles that you sent me, you had worked initially a lot on kind of the day-to-day practice management and the day-to-day activities of family physicians, or actually of general practitioners in the 1960s.\n\nA.  I did.\n\nQ.  And I wanted to know, I mean you did a good deal of work on that. I wanted to know what you thought – what the role, what role GPs were filling in the 1960s, and kind of compare that with what role they're filling now.\n\nA.  I don't know that I've thought about that.\n\nQ.  You know, that's a little bit of a different twist, but I kind of...\n\nA.  You see, I haven't repeated that research. If I ever had time to go back into research, I think one of the things I would like to do is repeat that study. That's, you know, virtually a 30-year hiatus now. And if I'm looking, if I just look at what happens in our clinic, which – where I do have a lot of knowledge because I track very carefully the funding base through our clinics that we administer here in the department – the practice of medicine is much more complicated administratively than it was in the '60s. That study is one year, two years predating Medicare. So the insurance, the payment mech-anism, certainly any of the – why am I blocking the name – you know, the review process, the quality review process was missing in '63. So I can't help but believe when I look at what we have to do in our own clinic to get paid and to fall into the quality assurance requirements that it, the administra-tion, the administrative headaches are much bigger than they were in the '60s. Then in terms of the role of the physician, there still – we divided, as I remember, and I haven't looked at that in ages, I just pulled them out and sent them to you, but we divided after looking at a pilot study of what the physician, the general practitioner was doing, into diagnosis, treatment, patient education, prevention, administration, and just sort of personal, establishing rapport. I don't know that we've changed all that much in terms of those activities.\n\nQ.  Okay.\n\nA.  But it would be a fascinating study to repeat, wouldn't it?\n\nQ.  It would be. You know, I'm interested in what motivated you to do that kind of study back 30 years ago.\n\nA.  We had, Mack Parrish and Sherwood Baker, who's still living, and Mack, by the way, who just died in February, and I, we were all on the faculty, we had our students out even in those days at the University of Missouri in a required preceptorship.\n\nQ.  Even before there was really a Family Practice Department?\n\nA.  Right, Missouri did. And so as a way to sort of find out what the students were learning, and also to sort of get a handle on the health care delivery, we did that. I had a tie with the Sociology Department at the University of Missouri, and it – in those days the University of Missouri Sociology Department was very heavily vested into rural sociology. So that sort of in a way tied with I think some of the other materials I sent you, where Sherwood and I teamed with the Sociology Department to look at numbers of practitioners in the State of Missouri and what was happening to them. You know, it sort off predated the concerns of diminishing family practitioners, or general practitioners in the rural areas. So it's just sort of a package. If I went back into research I'd be very interested in going back into that area again.\n\nQ.  Were you from a rural area yourself?\n\nA.  No, well, I was from Springfield, Missouri. It was about, it is at present the third largest city in the state and I think it was about the fourth largest at that time.\n\nQ.  And they just started a family practice program there a few years back, I think, in Springfield.\n\nA.  Yeah, well, the local hospitals. In fact the residency director's a medical student of mine.\n\nQ.  Oh, no kidding. That's great. You know, in one of the articles you described some very interesting things about referral patterns and what not, and how the system needs some restructuring to almost look at family physi-cians as physicians of – well, primary care. And to have an integrated program of referral systems. You think that's come to be?\n\nA.  No, but I think we're talking about it (laughs).\n\nQ.  In what ways?\n\nA.  Well, certainly I hear more – even I think from when we did this interview in '91, the knowledge level about primary care and the referral, you know, through the primary care physician, has gotten stronger. Don't you think, nationally?\n\nQ.  Mm-hm.\n\nA.  So I think we're – we, the nation, is talking about it and in terms of health care reform it's probably going to be. How, I don't know, you know, the specifics, but I think we'll get there. It's amazing that it's taken 20 years for the nation to get that concerned about it.\n\nQ.  You mean you talked about this in 1969?\n\nA.  Yeah.\n\nQ.  Why do you think it's taken 20 years, and what's motivating it?\n\nA.  I don't know, Bill. It's beyond my scope to think about it. I feel like I can barely cope with what I have to do to get our training programs and keep our clinics going. I'm going to let somebody else like Bush, Clinton and Perot solve the health care problems.\n\nQ.  Okay, well, I'm – that’s very hopeful that you think that they can solve it, that they can sort of entertain it.\n\nA.  I don't know that anybody can solve it. I think it's, sometimes I think it's beyond salvaging. The mess and paperwork of insurance companies, if I were going to put my own system in, I would go to at least a single form. Maybe not a single insurance carrier, but I'm not sure but what we don't have to go that direction, too, but at least a single form, and a single set of ground rules for what we are and we're not going to cover. This is ridiculous that every carrier, and there are hundreds of them, have different forms and different ground rules. But that's a personal opinion. I feel like I'm much more able to comment definitively on family medicine than I am on the national health care system.\n\nQ.  Well, I'd be interested in what you think of the role for family medicine is in that...\n\nA.  I think it's going to be key. I think the – we’ve got to get back to a generalist – in fact, this weekend I was reading the AMA News, and there was a quote I wish I'd pulled out, in fact maybe I did. Hold on just a...\n\nQ.  Sure.\n\nA.  I just had it here 'cause there was an article by Marvin Dunn that I wanted to send to him. [to someone in room] Did I put – let me have that little AMA sheet right there back again. Let's see if that quote's there. I thought it was really a good quote. No, wait a minute, no, it was – but  essentially somebody said we have set up a Cadillac system of medicine to run Cadillac automobiles without worrying about the roads they need to run on or knowing where they're going to go. And I don't know who did that, but it was in the June 1 AMA News. And I thought it was a very good statement about sort of where we are. You know, we set up a Cadillac – oh, here it is. Yeah. It is, it's on page 40. It's somebody by the name of Steve McDermott, president of a 700-physician independent practice association in the San Francisco Bay area, discussing how medical schools are producing too many specialists. And here's the quote: \"Here's an analogy for physicians. We built all these Cadillacs and Mercedes and someone forgot to build the roads. We have highly skilled physicians practicing with no direction.\" I thought that was a pretty good statement.\n\nQ.  Yeah. You know, you've been in medical schools for your professional care, in family medicine departments or in community medicine departments in the past, and what's it going to take, where's the movement going to be in family and community medicine to make the changes that you're alluding to?\n\nA.  I think the outside pressures are going to finally have to come to bear to make it happen. Some changes in reimbursement, pressures by state legislatures who say we are supporting only what we need in our, you know, in our state or in our catchment area. And there certainly are some examples of that. I just got a copy of State of Virginia's proposal that for their funding for their medical school there's going to get sort of restructured according to the number of primary care physicians that are turned out. You know, there have been several state proposals to that effect. So my – I don't know pre-cisely, but my answer is that I think it's going to have to come from not just medical schools doing it on their own, but from some interest in medical schools and some external pressures be brought to bear.\n\nQ.  Okay. I'm going to switch back a little bit to some points I wanted to kind of tie together from what we previously talked about. First of all, just some of dates, kind of real bureaucratic things. You started at the University of Missouri in 1961, was it? It was a little confusing to me.\n\nA.  Actually I started there I think in '63 full-time, yeah.\n\nQ.  And that meeting in Kansas City that you talked about? Do you remember what year that was?\n\nA.  Yeah, that was somewhere around '69 or '68. It was just, maybe it was around '67, '68, it was when the Academy was still talking about changing from general practice to family practice and getting the residencies established.  \n\nQ.  And in that three- or four- or maybe five-year interim, you were mainly working on this course that you talked about...\n\nA.  For medical students.\n\nQ.  For medical students?\n\nA.  Yeah, did some of that research.\n\nQ.  Okay. And what – you know, you talked a couple of times about being a non-physician. As a non-physician not yet in family medicine and in STFM, I like how you feel that STFM has been an inclusive organization, you felt part of it. But before that time, did you have – did you feel part of medicine, did you, were there aspects – I guess a couple of things, did you feel part of it, did you feel that that gave you special ways of looking at medicine because you weren't a physician, and did you get new or interesting ideas from that perspective that perhaps physicians didn't get? And this is before...\n\nA.  [    ] that's so far back I can't remember all that. You know, it's hard to know where you were then and where you are now. The – I think the point I was trying to make is that if you look at medical schools in the '60s, the other home for non-physicians was in psychiatry. You know there were psychologists, social workers. There were some non-physicians in community health, but they were more targeted to be a PhD epidemiologist, PhD biostat-istician, those kind of people. I kind of came in as neither fish nor fowl in that respect. My dean, Vernon Wilson, wanted a behavioral scientist, was on the Willard Report, thought it up to be in family medicine and the department I was in was to be, and turned out to be, the predecessor of family medicine. It was, started out a year after I, two years or a year after I came on faculty, the first GP Sherwood Baker, came on faculty at the University of Missouri. So it was inclined, it was always intended to be, move into a department of family practice. So – it would have been kind of boring, though, to forever and ever teach medical students in the first or second year, I've forgotten now what course, year that course was, for 30 years. And although I would give Missouri a lot of credit because they were very early in trying to get the behavioral sciences in their medical student curriculum, even though it was kind of a weird title, \"Human Ecology,\" but that was the intent.\n\nQ.  Well, it did sound like you started some kind of creative things, the role-playing you talked about for example.\n\nA.  We did, yeah. We were very early with that at the University of Missouri, and Gayle Stephens in his Intellectual Basis [of Family Practice] talks about how Bob and I came over to his residency, and that was the first time he'd ever seen role-playing. This is old hat now, but in those days it was a very exciting and different way of teaching.\n\nQ.  And in your article you talk about it in a little bit different way than we think of it today. We think of it in terms of clinical practice, but it was more in terms of management styles in the article that you sent me, and referral patterns. You know, how physicians manage patients that go somewhere else and what not.\n\nA.  Oh, we taught it in the, used it also in the doctor-patient interviewing and relationship.\n\nQ.  You did, okay. You talk about, or you talked about how your career paralleled the establishment of family medicine and how exciting that was for you. And again especially this parallel development. I'm wondering if there were parallel struggles that you can also think of, in your own career or in family medicine or the issues that were difficult that you and family medicine had had to face.\n\nA.  Well, even though we've been committed, the discipline of family medicine has been committed to the behavioral orientation of the practice of medicine, I'm not sure there's been a clear concept of what that means. So it's always been sort of vague, and I think that came out with Don Ransom. So being a behavioral scientist, you had sort of a vague job description of what that really meant or entailed. That was a part of, even though there was a commitment to it in family medicine, a vagueness of what they actually wanted to have happen with that. I also have always had an interest in administra-tion. You know, I intended to be an administrator. So in the years when I was not considered an administrator, I had a certain sense of frustration because I knew I could have done as good a job as some of the other people I was watching doing. But my being in an environment where it – the MDs were the administrators and the non-MDs were sort of the, you know, the sort of teach-ing support system, that didn't happen for a number of years. You had to – I had to put in my, I guess my time in grade. And a lot of sort of behind-the-scenes administrative activities for the person who was in, some of the people who were in the forefront.\n\nQ.  When did the transition for you occur in terms of administration? When did you move primarily into administration?\n\nA.  Well, it's a moot line, because if you, if you're administering a course where you've got a team effort, and you know, you're not the only one teaching it, you're in administration. And certainly when I went to the University of Oklahoma, I was responsible for probably as much teaching time as any one single faculty member at the whole University of Oklahoma Medical School. Had 108 hours in Year 1, and I think 86 or 87 or something like that in Year 2. Now that's a lot of teaching time to be responsible for. And yet that was a team, that was a team effort, and I was responsible for that, not to any single department chairman, almost to the dean's office because it was an interdisciplinary, multi-departmental teaching focus. So that was admini-stration in that sense. But it wasn't the kind of administration I'm doing now. In terms of budget, recruiting faculty, that kind of thing, I didn't really move into that until I went to Alabama with Gayle Stephens, but I've always had an administrative role after about the first two years, or since 1967 I guess, when I had responsibility for teaching time, some of it more time and some of it less time.\n\nQ.  You know, it strikes me that, maybe that is another parallel thing, that now we're seeing more family medicine people in administration. I don't know.\n\nA.  Well, we certainly haven't made much inroads in terms of seeing family medicine people in dean’s or vice president’s positions, in medical education.\n\nQ.  You think they're still primarily just within departments.\n\nA.  Yeah. In fact there's – I just read again in something I was reading on my new stuff over the weekend that some family physician who I don't really know well has been named Dean at the medical school in West Virginia. But we've had only about what, one family physician who was a dean of a full-fledged four-year medical school in recent, ten years?\n\nQ.  Ted Phillips?\n\nA.  Well, Ted was always Acting, see, or Interim. He never was named Dean. But the one I'm thinking of was in Texas. And he was down in Texas, and then he went to Tennessee for Dean there. But he's no longer Dean. So to my knowledge I don't think we've got, outside of this one guy that's going into West Virginia, a single family physician, board-certified family physician who's Dean of a medical school. Do you know any?\n\nQ.  I don't know. Is that going to be an important transition?\n\nA.  Yes, I think we need deans in medical schools and we need vice presidents for health sciences to be family physicians or family medicine educators.\n\nQ.  How does that happen? Or how is that going to happen?\n\nA.  Well, I don't know. Right now we're so short – we’re short enough to keep our departments going. So I don't know. I think we've got a couple of people who are looking at those kinds of jobs. So I don't know how it happens. But I think when we've got about equal numbers with the other disciplines, then we will have arrived in medical education.\n\nQ.  But I'm sensing that you consider that a big need in family medicine.\n\nA.  Yes, I do. I've always felt we needed them. But when you see the amount of power that the Council of Deans has and the information flow through there through the AAMC to not have any family physicians in that Council is a detriment.\n\nQ.  You know, I'm wondering if there are many even general pediatricians or general internists that are deans either. I don't know.\n\nA.  I think you're correct. They're nearly all super-specialists. I would think that that is an accurate observation, Bill.\n\nQ.  Is that your next move?\n\nA.  No. I have missed the time for that.\n\nQ.  Okay. Any other struggles that parallel struggles with family medicine in your own professional development that you can think of?\n\nA.  Well, I can't come up with any. I think you probably got enough information to fill an article without my struggling to think of something.\n\nQ.  Okay. Can I ask a few other things?\n\nA.  Sure.\n\nQ.  You had mentioned that you have a real interest in health promotion and community prevention.\n\nA.  Disease prevention?\n\nQ.  Disease prevention, right. Where did that interest come from? Do you recall, or do you recall some significant events or times or...\n\nA.  No, I don't specifically, except many, you know, many people in family medicine have also of course kept a parallel interest in membership in the Association of Teachers of Preventive Medicine. And it just seems to me to be a given that we're better off to prevent something rather than to cure it after it happens.\n\n[tape side ends]\n\nA.  ...I think we can work better on it, but again it's the funding base and, you know, what drives the practice of medicine is the reimbursement. And if we talk about shortage of primary care physicians, the shortage of trained people in preventive medicine is even more acute.\n\nQ.  Are there some ways that you know, that you'd like to see more ties? I mean that's something else you talked about in your STFM history, you know, the development of the ties between ATPM and...\n\nA.  Well, I was the one who put together that joint STFM/ATPM report. There's a lot of overlapping membership. I think it's been unfortunate that we haven't been able to do more things together. And I don't know the reason why. You know, it's just everybody's busy, every organization's sort of busy doing their own thing and it's just hard for it to happen.\n\nQ.  You know, somehow I remember something about Lynn Carmichael saying that ATPM initially was thinking about you know, STFM, or that family medicine would be a branch of ATPM. Do you recall that?\n\nA.  No, I don't. I remember Lynn saying that in terms of the name and the organization he had looked at ATPM as a prototype organization because, see, ATPM is 50 years old. \n\nQ.  A lot longer than...\n\nA.  Oh, yeah. It's twice, we're 25 and it's 50, it celebrated its 50th year this year. But I don't remember, I never was in on any discussions where ATPM thought STFM would be a branch.\n\nQ.  Okay. I've got another switch, and this is something I brought up the other day, is that obviously STFM and the organization has been an important organization for you. You were there very early on, and you've continued through your presidency and beyond in many active ways. I wonder if you can just comment on some of the personal reflections on why, what sustenance you got out of the organization, why was it important and exciting for you to be a part of?\n\nA.  I think we covered that, just in kind of rereading that interview from '91. Why was it exciting? Well, how many times – I made the point, how many times in your lifetime do you get in on the ground floor of something? And I was in on the ground floor, and made to feel very welcome and a part of it. So that was exciting. The other thing is that there's a difference in coming in with a small group of people that you know intimately and watching it expand in size, as opposed to coming in when it's 3,000 people. It's just a different ambience. So getting in on the ground floor, knowing everybody who belonged to STFM either by sight or by name, which would be impossible today, is quite a different feeling. And then I was in a somewhat unique position that probably won't happen again, of being on the Board of Directors from the time it started in '69 until 1982. So I followed every change that we made and every expansion and bylaws difference and so, you know, it was a unique opportunity that probably won't happen again. Well, certainly won't happen again for me but I don't think even in STFM it would be possible for anybody to put that much time in to the Board.\n\nQ.  Those were elected positions?\n\nA.  Yes. Every one was an elected position.\n\nQ.  Why was that important to you to be so integral a member during those early years?\n\nA.  Oh, I don't know, it just happens. Maybe it's because of my administrative interest it happened, but each, there was nothing planned. Each thing just sort of happened.\n\nQ.  You know, you were one of the few women on that initial list of people of that meeting, 1969. What was that like?\n\nA.  I don't remember. I went back and looked at that list, I think, I went back and looked at the charter list, and I think there were four or five women on the charter list.\n\nQ.  None of the others I know – Carolyn Aradine, several others – Beatrice Berle? You may remember these.\n\nA.  Yeah, I don't. I don't remember.\n\nQ.  You think...\n\nA.  I don't remember being the only woman in the room at those early meetings, but I might well have been, I just don't recall.\n\nQ.  Was that at all an important thing that we need to touch on, about being a woman in what, a founding woman in a field that has been – I mean all the other people, early on, were men. Or not all, perhaps, but most of them. Is that something important to touch upon?\n\nA.  I don't remember any special significance to it. I've always felt very comfortable with these colleagues. I don't think they, that I ever sort of differentiated gender.\n\nQ.  Do you think that's something particular to family medicine?\n\nA.  I don't know, I just don't know, Bill.\n\nQ.  You know, your comment on the videotape about having entered [    ], and how one of the family – was it Lee Blanchard? – kind of said, 'Well, I'm going to go around the side entrance with you?'\n\nA.  Yeah. When we went to the Cosmos Club.\n\nQ.  Right. But that was not a family medicine organization.\n\nA.  No, no, that was the Association of American Medical Colleges where we had to appear, and they apparently had their administrative meeting at the Cosmos Club. But you know, that was kind of before the days of sensitivity to those things. It was just beginning to come along.\n\nQ.  Well, Lee Blanchard was obviously sensitive to it.\n\nA.  Well, he wasn't going to leave me to go around to the side door by myself, you know. He was just – I don't know that he was sensitive to the door, to the women and the men's, as sensitive to leaving me to go fend for myself. He was just a real gentleman. But it was the signs of the times, you know, we still, we'd just what, come through the civil rights, hadn't we?\n\nQ.  Very soon before that, yeah.\n\nA.  Yeah, you know, I don't think we realized the civil rights movement and the bill was just signed in about two years ahead of that. Lyndon Johnson, didn't he sign the Civil Rights Act?\n\nQ.  Right.\n\nA.  So I think people were just beginning to be sensitive to those things.\n\nQ.  Has that changed over the years? I mean is that something that you're more sensitive now that women in family medicine or another, in other medical areas, have needs that are different or have...\n\nA.  I don't know, Bill. Certainly in that sense I would not belong to a – I think there are many men now who would not and do not – and it's illegal anyway – belong to clubs that exclude women. I believe STFM has always been open to women, and by sheer numbers there have not been as many involved, but look at the change in numbers of women coming into family medicine now, and I would expect in your lifetime you will see change. Just because the number, the pool from which we could draw leadership is so much expanded.\n\nQ.  You know, you talked about how close it was a group of folks back in the early days. What do you do when you're like me, when I'm coming into STFM and there are 3,000 members, and the meetings do have 800 members. I mean where do you find – I mean what would your advice be to me, where do I find that excitement or that – or do I look elsewhere?\n\nA.  Well, I wondered if maybe the special interest groups don't serve in some respects that purpose. If you find, if new members find a special interest group or two special interest groups or something that really interests them, and there's a group of people who share a like interest, if that maybe won't solve some of the problem, but it's just going to be different. Life is going to be different. Did you hear – well, I was just reviewing the Johnny Carson's tape, I didn't get to see it so I taped his last, you know, his last show and I just looked at it over the weekend. I was astounded when he said that when he went on the show there were, what, 30 [sic] billion people, and today what the exponential number of that is going to be? You know, from the growth in 30 years. Life is just different. Travel is different. The crowds are different. And it's not going to ever I think go back to the way we were in the '60s. But if you've never experienced that, you may not miss it. You know, for me, I remember those days when we walked into a room and there were 50 or 100 people and you knew every one of them. Well, the only way you can do that if, to recreate a little of that, is where you walk into a small group and those people see each other regularly and you know most of those people. But life is just different, as we have more and more people on this planet, it's not going to ever be the same.\n\nQ.  Was it a visionary time back then?\n\nA.  I don't think we knew where we were going. I think there was an excitement that we were going to go someplace. I wouldn't say that there was anybody in '69 that would have forecast the way we are now. Somebody said we were going to be larger than we are now.\n\nQ.  Really?\n\nA.  And more influential. But there was certainly a sense of excitement that something new was going to happen. But remember the Academy was never that small. 'Cause the Academy, even when they took the leadership, for family medicine was what, about 40,000 people. So they've never been that small like STFM. And yet there are members that go into the Academy that have some of that same, you know, sense. I think you just have to find your own small network. And where mine was the whole membership at that time, which it no longer is, because it's coalesced down to a smaller group, the same thing is true for the newer members.\n\nQ.  Is there going to be a ground floor entrance in something else, do you think, coming up?\n\nA.  I don't know. I don't know. There certainly has been – you mean in medicine – there certainly has been an attempt to keep any \"new discipline\" like geriatrics or sports medicine or adolescent medicine from going off and separating out.\n\nQ.  So these attempts were then to be more within disciplines already established.\n\nA.  Yeah, you know, to make them a special [    ]. But you know there are always, we're always in new formations of groups. Look, you can take, what's the reason to split the program directors off? What's the reason to split the chairmen off? There's always kind of a formation of people with special interests, and sometimes those go into separate organizations and become their own bureaucratic thing, and other times they orbit around another organization. So potentially the program director's group would be going through, although it's not a new discipline in the sense of education, but it's sort of going through that formation too of a group of new people who are trying to determine what their destiny is as directors of residencies.\n\nQ.  You know, with any new group and STFM might have had that, I don't know, were there fears that you think people in STFM had or that you had when things got started? As well as the excitement?\n\nA.  I don't think so. In your 20s, nothing much is, you don't think about those things, you just keep going. Life stretches on forever.\n\nQ.  That may be.\n\nA.  Any fears as things developed as you moved beyond your 20s? Any fears now, maybe? About where medicine is going, the future of family medicine?\n\nA.  Oh, I think family medicine's got a good future. I feel very optimistic about it. I believe primary care or the need for something like that is going to put it in a very good position. I hope we've seen the lull in terms of student interest, and that will peak back. I feel very optimistic.\n\nQ.  I guess I wonder, because you talked about the things that are going to reform medicine are going to come from the outside. And I almost feel as though family medicine doesn't, when you say that, and that you're optimistic, I almost feel as though family medicine doesn't have much control over its future.\n\nA.  Oh, I think we do, I think we do. But listen, if I could tell you how to reform medical education, I wouldn't be sitting here talking to you, I'd be in Washington, DC, head of the AAMC or heaven knows where. I don't have all the answers. And I'm not saying that there's not some interest in reform internal to medical schools. I think there is. You can see quite a few changes. You can witness a number of medical schools that are changing their curriculum to put in more ambulatory care and less inpatient care. You know, those are all contributory factors.\n\nQ.  Problem-based education, you see that.\n\nA.  Mm-hm. But medical education is big business, and big business responds to external pressures as well as internal. And that's why I said I think that the external pressures are going to be the thing that's going to finally push it over and above what individual medical schools are doing on their own. So don't read too much into what I'm saying. I'm no oracle and not very wise in those things.\n\nQ.  None of us are. If I can just switch again to a little bit more personal area, I'm wondering what your major emphases are right now? What activities or administrative activities really give you the most interest, are most important to you right now? We've talked about historically, but I'm just wondering where you're thinking now.\n\nA.  Well, we're doing some local, you know, I'm still involved on the national scene, but locally there are several things I want to get in place here at my institution, and several of those have been accomplished, some of them are not. I came here to bring this Department of Family Medicine more into the orbit of the medical school in the university, you know, a hospital. That's not to diminish our community base, but to make us more visible and to integrate us more into the university hospital scene. We've made good strides in that. We needed a new clinic. We have a new clinic, and now we need another one, and I want to get the plans in place for the other one. We did not have a required medical student clerkship. That comes online this year. We now have a required third-year medical student clerkship. We are involved in expanding our residency network so that we've got, we will have a rural residency site in Provo.\n\nQ.  Really?\n\nA.  And I hope to get that online and work with the hospital there so that we are ready to take residence, I say '93, everybody blanches, so let's say '94. So all of those are sort of administrative things that are going on here. I think this school does have an interest in primary care, and – I mean in looking at what we need to do for primary care. There's no game plan in place as yet. And there probably won't be because we've got an interim dean and an interim vice president, so until we get those in place we're probably not going to do very much. On the national scene, I had been very much involved in the last several years with the National Board of Medical Examiners. I like that organization, I think it's doing a very credible job, takes a lot of slings and arrows for some things that it doesn't do that people perceive that it does, but I've been very much involved in that, and I'm in my second term on the Executive Committee of the National Board. And one of the things that interests me is, as I've been able to be in on the ground floor of the change to the single pathway to licensure, which will start being implemented I guess this year. And that's been a coalition between the National Board of Medical Examiners and the State Federated Boards of Licensure. So I've been involved in that on the national scene. I've served on two very interesting and I think quite important national advisory councils for the federal government. I've been on the Health Professions Education Advisory Council and served as the chairman of that for two years. And then I just completed a year ago a term on the National Advisory Council for the National Health Service Corps. When I went on that council, the thought was that we were going to go into, preside over the demise of the Corps. It has been revitalized and is flourishing and I think is going to contribute a great deal to solving our, you know, health care maldistribution in our primary care. So that was very exciting.\n\nQ.  If you might give me the freedom to interpret a little bit, I'm hearing that you are very active in organizations, and that those are important to you and how you perceive your role in medicine.\n\nA.  I've belonged to some organizations where I don't do anything. There are others...\n\nQ.  . . .Establishing, I mean even in the department, you know, being an administrative person in the department. Really establishing and developing these – this is your route for change. I don't know.\n\nA.  Well, yes if you – I’ve never just stood still. I learned from my former mentor that no decision is actually a decision. And he always said, 'I'd rather have to live with a wrong decision than live with a nondecision.' And I sort of think I agree with that. I think I've made some wrong decisions, but I don't usually just sit and have things happen because no decisions are made. You should try to get in there and assess the options and let's make a decision.\n\nQ.  Who is that mentor, if I might ask?\n\nA.  Vernon Wilson.\n\nQ.  Vernon Wilson.\n\nA.  Yeah.\n\nQ.  And do you try and pass that advice on? I mean is that important advice to...\n\nA.  I – when it comes up I usually refer to it. He had a little motto that he took with him when he went to federal government, and it's a picture of a – in fact, I'm sitting here looking at it, I've got one on my bookcase. It's a picture of the Wright’s airplane, and it says 'It won't fly, Orville.' And every time somebody said to him, 'It won't work,' he'd always say, 'Well, look at that, it won't fly, Orville.'\n\nQ.  As a last question, were there any special moments at this 25th anniversary meeting of STFM that really were engaging for you?\n\nA.  I loved the videotape. I thought that was very well-done and a very good sort of historical record to have. I had not seen it before and had had no part in making it. I thought the videotape was very good. I enjoyed seeing some of the early founders and people that were there in getting the discip-line going. I personally, just because it meant something to me, enjoyed starting the dance with the Founders Dance. There were not as many of us there as I would have liked, but I thought that was nice. I guess I thought it was a neat mixture of sort of looking at our past but at the same time looking at where we're going, and then I thought the Memorabilia Room was really very well-done. Cynda Johnson did that. And I thought that was nice, and I spent a fair amount of time in there and it always interested me how many newer mem-bers were sort of in wandering around and seemed to enjoy looking at it.\n\nQ.  Ted (Dan?) Quill(?) told me that much of the pictures, or many of the pictures and things in that room came from your library. Most of them, the vast majority she said.\n\nA.  Oh, some of them did, but well, actually the pictures that were up on the board came out of the STFM files. I had those Venezuelan rugs with our STFM logo on them. The orange one was given to me when I was president of STFM by the Venezuelan family practice organization, and I had the molas(?) from the Panama meeting. I brought my gavel, although I think everybody else has a gavel, I shipped that in. I had absconded when I was president of STFM with the original STFM cup design. I was in the office and made the decision that we were going to sell STFM cups, and the prototype was in there, along with an ashtray. And Bill, Bob Martin who was then editor, you know, wanted the cup and the ashtray, and I said, 'No, I'm going to take 'em.' \n\nQ.  So you did.\n\nA.  I did. So I still have that here at the house. And then of course we all had our, sort of our President's books, everybody brought those in or sent them in. So they were all there, and those all belonged to people. So I wouldn't say that the vast majority of it was mine. Maybe half of the stuff that was just sort of different I had still here at home. And actually what I wanted to send in, and we decided we couldn't ship it, I've got framed posters of our STFM foreign meetings in Panama, in Puerto Rico, and in Venezuela. But they're in glass, and Bob decided, he said we just couldn't ship them in.\n\nQ.  I'm cognizant of our time now and I want to kind of bring things to a close. I guess what I'd like to do is to see if we can have maybe another 15-minute...\n\n[tape ends]\n\nA.  ...he was ADFM, with the program chairmen, how's that all going to mesh and how we all going to work together. And you're right, I didn't – this was to try to chronicle things that happened so that we didn't lose them. And who was where, when. And even then it's not complete. I had proposed to Bob that he ask the secretary-treasurer to put together a, at the end of each year, a history, sort of here's the events so that if somebody needs to go back and do that 50 years from now it will be there. 'Cause I had to go back and find that, and it's hard to put your hands on it, especially when things are archived and we didn't have the same kind of records then that we have now. But I think that our real challenge administratively and organizationally is how we're going to fit in with the primary care organizations and with our own family and family medicine.\n\nQ.  All the different associations and whatnot.\n\nA.  The academic family medicine steering committee, you know, is probably the next big challenge. And if that works, that will be a very strong [    ] for the discipline.\n\nQ.  You know, I guess I just don't know enough about the different organizations to know why they don't work together as well.\n\nA.  Well, we do now. I don't think it's that we don't work well, but I think, how can we minimize redundancy, maximize our resources. And that takes work. That doesn't happen. You know, we're still a volunteer organization, and people do for STFM essentially as much as they're willing to volunteer for. Now the Academy is more of a, is a volunteer organization, but it's also more staff-driven. If you're working with staff that can put your policies together and your research, what's going to happen that's going to positively and negatively impact the discipline, you've got a little different level of expertise than you have with us, where if I have the time to do it, I do it, if I want to do it I do it, if I don't, it doesn't get done. So I think we've got a real opportunity to look at, as a discipline of family medicine, as a family of family medicine, how can we maximize our strengths and utilize our resources to better advantage?\n\nQ.  You know, the Academy's kind of a political organization. Are there any kind of – I don't even know if there are really think tanks in, that are not just voluntary organizations, that don't have a power base, that are think tanks in primary care, family medicine, whatever. Even looking for ties between, I can't remember the name of it, it's in your book, but the ambula-tory pediatrics group and SGIM. Are there any think tanks like that? I don't even know.\n\nA.  I don't know. I think almost everybody that's effective has got money. You know, look at the Institute of Medicine, the federal government, the Hoover Institute is heavily funded by endowment. The Hasting Institute is heavily endowed. We still are a fairly low dues organization, if you look at the AMA or other kinds of...\n\nQ.  Even the AAFP.\n\nA.  Yeah. So anyway, I think that's the challenge for STFM. Now I don't know that that's a challenge for family medicine, but I think it will affect how family medicine goes, how effective we are.\n\nQ.  Why was it – two things come to mind. Why was it important for you to write the history? Why is history important, from your perspective? I have my own perspective, but I'd be interested in hearing yours. And why do you think younger people came into that room to look at what was going on?\n\nA.  Why was it important for me to write it? I probably had more information available than any other one person. That's not more information collectively, but in terms of any one individual I probably had more of it available. And if I'm not able to write it, a lot of it's going to be lost unless we can get some pieces of it here and there. And the fact that it was a labor of love for STFM. You know, I felt it was a contribution and I was willing to do it. Why are you willing to do these interviews?\n\nQ.  Why? Well, actually that is something pretty – it’s a personal thing in that I have gotten a tremendous amount out of this, seeing or hearing – I look at history as a way of making choices and changes and actually becoming a change agent in the future. You know, I can't – I wasn't around 25 years ago, but I sense that excitement, and that's really exciting for me to sense that, almost vicariously but then I look at ways that I take that little bit of excitement that I gain from folks like yourself and Gene Farley and Don Ransom and all the people I've interviewed, and I take that into my own practice and into my own work.\n\nA.  Well, see, and I got a lot out of going back. It sort of brought back good memories to me and I think, I didn't make up this theme, but cele-brating our past, creating our future, is where it is. You know, we kind of look at where we've been and for some reason in our culture, 5, 10, 15, 25 and 50 years have special significance, I don't know why, but it does. So I thought it was fun to do, it was important to do, and it was timely, and if I didn't get it done now it was never going to get done. So why did people come into the room? Well, I think for one thing, the pictures were a big draw. You look at Joe Scherger as he looked as a resident, like a hippie...\n\nQ.  Little bit longer hair.\n\nA.  Yeah, and Gene Farley and then some of the newer pictures of the younger people that were in there in the '80s and the '90s, yeah, I think the pictures were a big draw. And I think it was sort of fun for people to look through some of the books and see some of the things that had happened. And the pictures of the Presidents have never been on public display. You know, I started that picture gallery when I was President. We didn't have them. And so I started that, and I think that's – we don't have as many people getting to our headquarters as maybe the Academy does, and I think those were interesting to people. I don't know, I think generally people like to go back and sort of look at their roots at special times.\n\nQ.  And is that what you hope that they take from your book as well?\n\nA.  Well, I would hope that they would sense even if they weren't there some of the excitement, some of the steps that were taken that seem common-place now. You know, the idea of a separate meeting was a really risky event. Would you believe that now? You know, it would never fly, no one would come, we'd be financially destitute, there wouldn't be a good program. Ralph Berggren was the chairman of that meeting and you know, if he'd listened to everything everybody said, we would never have gone to New Orleans. It just took off and we've never looked back. The idea of, would you believe that the multiplicity of special interest groups was kind of a wild idea the year I was President. Yet [    ]. So to kind of look, some of the things that just seem so commonplace to us now were really kind of harebrained and far out. So some of the things that we think are kind of harebrained and far out now may be very commonplace 15 years from now.\n\nQ.  And by looking at the past you get a sense for that.\n\nA.  Yes. You just kind of take it a step at a time.  \n\nQ.  That's right, that's right. Yeah. I'm sorry, I have gotten a lot of information and you know, I have always – in these articles I want to do the best job that I can and that takes going over things and over things.\n\nA.  But just take out all my oohs and ahs and yeahs and bad language.  \n\nQ.  But again, I have to tell you that it's nothing like [    ]. With all due respect to [    ], it was amazing how – and when he saw his trans-cript, I think everyone comments on that, and maybe it's just because I have a transcriptionist who does a very good job of trying to get every little thing. \n\nA.  Well, I realize that when I get a word processor or typewriter I type in good English, usually, but I do not apparently speak in good English.  Q.  Well, you're speaking better English than many folks, so I wouldn't worry about that.\n\nA.  Okay.\n\nQ.  Well, I'll look forward to talking with you at 9:00 next Monday, the 8th, that's 10 o'clock your time, and it should be shorter and we'll see what happens then. If you think of anything in the meantime, just jot it down and make a mental note and I'll let you bring that out.\n\nA.  Okay.\n\nQ.  Great. 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