{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/7659c6ts3m/manifest","type":"Manifest","label":{"en":["John Swanson, MPH"]},"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":["Date"]},"value":{"en":["2012-12-12 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Sandy Panther (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians","Future of Family Medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["John Swanson, MPH (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"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/2195/collection_resources/154851/file/284001","type":"Canvas","label":{"en":["Media File 1 of 2 - Swanson_John_12_a.wav"]},"duration":3391.00099,"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/2195/collection_resources/154851/file/284001/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284001/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/001/original/Swanson_John_12_a.wav?1754487642","type":"Audio","format":"audio/wav","duration":3391.00099,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284001","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284001/transcript/82277","type":"AnnotationPage","label":{"en":["John Swanson interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284001/transcript/82277/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"John, I would like you to start with when you were born, where you were born and then give me some historical perspective of who your parents were, what they did for a living, siblings, and then your early and middle and graduate education. \n\nAt the time I was born which was August 27, 1945, my parents lived in a small town in southeast Nebraska by the name of Tecumseh. The did their doctoring in a little town twenty miles away called Auburn, Nebraska, and I was born in a small hospital in Auburn, Nebraska. Interestingly, at that time mothers tended to spend perhaps as much as a week or ten days in the hospital recuperating from giving birth. So my mother was in for about that length of time. And I remember having [seeing?] the hospital bill for the doctor, the hospital, and everything related to the delivery and it was a little over $200 total, which I thought was very curious and a sign of the times. My mother’s name was Mary Lee Rice Swanson. And she had grown up in Columbus, Ohio. So she was a big city girl. And my father’s name was Vincent Lander Swanson and he grew up on a farm in Nebraska, actually not too awfully far from where I was born. The name of the burg nearby where he grew up on his farm is Svedberg. And needless to say, his parents were Swedish immigrants that farmed in that area. Going forward, I grew up in Tecumseh through my entire childhood and through college. During that time, my father was a small businessman and his first kind of profession, if you will, he was an airplane pilot. It was a dream he had growing up on the farm to fly and he realized that dream. And in 1944, right after he and my mom were married, they moved to King City, California where my dad was almost thirty at that time and he really didn’t qualify for World War II as an active duty person. But he joined the Army Civilian Air Corps and was stationed in King City, California where he was a flight instructor teaching people basic flight instruction who were to go on for their training and become World War II pilots. After that operation closed down with the war ending, he moved to this town of Tecumseh that we grew up in and managed a small airport with a grass strip in that community. He taught people to fly. There was a part of the GI benefit after World War II, one of the – could be spent learning to fly and bring down the airline industry to civilian standards. And he also was a crop duster which was a fairly challenging and dangerous profession. But he did this from 1945 until 1960 at which point I guess he decided he had had it with flying and he became the owner/operator of a monument business (kind of a switching of gears) in Tecumseh and did that until 1966 at which time he bought a larger business in another town and my family moved to Fremont, Nebraska. My two brothers and they moved and live, and my mom is still living. My father died in 2003 at the age of ninety. And my mother is now eighty-seven and still living in the same home in Fremont, Nebraska. \n\nI believe the thing you mentioned was talking about my early education. I went to grade school, junior high and high school essentially in the same two buildings that were connected by an annex. And my mother could see me walking to the front door of the school out her back kitchen window, across several backyards. So that is kind of a wonderful way to grow up in a small town with people that you knew your entire life. I graduated from high school with thirty-five other people, most of whom I had gone to kindergarten with, and many of whom I still know today – which is one of the blessings in my life. It is also this coming year the fiftieth class reunion. And just to give you a little idea of what kind of student I was, I was looking through my yearbooks and I looked at my freshman yearbook. You know how you have people find them. Well, I was looking at two of my teachers and I thought I could read you the comments because this says a lot: my English teacher said “In spite of how ornery you have been, you will always be remembered as a good friend and student. Wish you all the luck in the world.”  In a small school we had about six or eight teachers total. And my math teacher was clearly always the most outstanding teacher in our school and I had math with her all four years. She said “John, let’s become a good team next year and really get you to have some good study habits. I feel you really need them.”  So that’s kind of how I left junior high and it kind of describes my grade school, junior high and high school approach to education. Like I said, I graduated in 1963 with thirty-six people in my graduating class. I was the senior class president. I don’t know what they were thinking, but I was. And I had a very high achieving class. I graduated barely in the upper one-third of this class. And I will not go on with all of the accomplishments of the people from this class because it’s not about them. But I went on to college at the University of Nebraska. Started in 1963, graduated in 1968. And something happened while I was in college, which probably I don’t need to go into. But I began to take my education much more seriously. I went to college to become a pharmacist and I did accomplish that. And along the way I began accumulating academic awards. And by the time I graduated in 1968, I graduated with what they called at the University of Nebraska, my alma mater, high distinction, which I think I more sophisticated, fancy schools would be called magna cum laude. So I did good in college and it was a far stretch from where I started when I got out of high school. As I approached graduation, I was however a little perplexed. Because by that time it was clear to me that I wasn’t sure I wanted to be a pharmacist, which was a bit of a problem.  Another one of these nice stories is I was the first person on either side of my family to graduate from college. So it was quite an accomplishment in my family as well, to have a profession. But I didn’t want to be a retail pharmacist. I was not interested in the five, ten, fifteen, twenty and wasn’t really interested in being a small businessman. And, in fact, that’s all the University of Nebraska really trains you to be.  I’d never been in a hospital. But this was also the time of the Vietnam War. And I don’t know quite what word to use, but I was scared. I was not prepared to carry a gun. I was very emotionally distraught over the possibility of being drafted. And there was this thing that nobody at Nebraska had ever heard of, called the Public Health Service. And the Public Health Service is one of the seven uniformed services along with the Coastal and Geodetic Survey and all the other military ones that you know and it actually counted as military service. So I applied for it and lo and behold, through a series of steps in the process I kind of made the final cut. And it’s what I think of, I wouldn’t say the happiest moment in my life but one of the more emotionally charged moments of my life. I was sitting in my apartment my fifth year of pharmacy school getting ready to graduate and I got a phone call in the middle of the afternoon. This man said “Hello, my name is Edward P. Dodds (?) and I’m the Chief of the United States Public Health Service Pharmacy Program and I wondered if you would like to accept the hospital pharmacy position in the Public Health Service hospital in New Orleans.” And it’s hard to say how positively, how emotionally I reacted to that because it answered all the problems, all of my concerns about being drafted. And it offered an opportunity to do something in pharmacy that made much more sense to me, which was to apply my knowledge and skills in a hospital setting. So I had little difficulty and immediately on the spot accepting this position which in reality was one of those forks in one’s life where you don’t know what would have happened to you had you take the other fork. You can only speculate. But it would have meant taking a management training program at Osco Drug in Rockville, Illinois, still being partnered with my high school sweetheart. And instead I went in this completely opposite direction. And as you hear the rest of my story, you will see how it all fed into it.\n\nAnd a life lesson happened on that phone call too which was that he said what had happened is that “We accepted twenty-four residents this year in the Public Health Service program and you were number 25.  But a fellow who had accepted a commission was in a very serious car accident and will not be able to accept the position.” And I realized that fate does have a major role to play in all of our lives. But it’s not necessarily a blind fate because I was number 25. So it was just one of those really critically emotional points in my life and one that led me down a path that I never look back on.  So that is how I ended up in the Public Health Service in New Orleans from Tecumseh, Nebraska which was, needless to say, in 1968 a very different environment than I had ever experienced in my life. It was still highly segregated and things that I had never imagined or seen, I became confronted with. But on the other hand, living in New Orleans in 1968, first year out of college, was something that was an experience one can never underestimate how wonderful it was.\n\n            \n\nSo I was there for a year, in New Orleans, and did a residency in hospital pharmacy of which a couple of experiences are worthy of mention.  One, the state of Louisiana had set up one of the early poison control centers for the entire state. And the hospital pharmacy residents had the responsibility and distinction and honor and challenge of sleeping in the hospital once a week. There were six or seven of us, so once a week sleeping at the hospital in the poison control center with a phone that could ring anytime during the night that you would pick up. And it may be a hotline to Charity Hospital where somebody had come in that had ingested some awful substance that they were calling to ask you what they should do about. Or individual mothers calling up about things that the children had swallowed or gotten in their eye or on their skin. It was another one of those experiences in life that I learned a lot from and that had quite an emotional impact on me. And the other thing was, as a resident in the Public Health Service in the hospital pharmacy resident program, we got to go and spend two weeks at the National Institutes Clinic Center. This is where the National Institutes of Health Clinical Center is where they’re treating patients but experimenting with the newest and most highly experimental drugs and procedures imaginable. I remember one of the things I got to do … under a laminar flow hood, which at that point in 1968 was state of the art for working in a sterilized environment to mix drugs that were going to be given to the boy in the bubble, which was a program that was in active development at that time. So among the many wonderful experiences with the Public Health Service, those were a couple of them.\n\nAfter the first year, we were all transferred to some other United States Public Health Service facility. And I got transferred to the Public Health Service hospital in New York City. So this small town boy was having quite an experience from New Orleans now to New York City. There was a Public Health Service hospital on Staten Island at the time, so I became a staff pharmacist there. And in the Public Health Service, the two main sets of clients were anybody who was part of the U.S. Merchant Marine which was why the Public Health Service was originally established back in the 1700s, to provide a benefit and to draw people into the U.S. Merchant Marine. And then secondly, the Coast Guard. The Coast Guard does not have a medical corps of its own, so this was the medical corps and hospital and clinical facilities for those two groups of individuals and their families. But in addition, any active or retired military person can also seek care at these facilities. So I went along and after about a year working in the hospital facility I thought that a lot of what I did could be done by a far less well-trained and educated person than I was. So I got this idea about training hospital pharmacy technicians, which in the day there wasn’t any such thing. So I got my boss there at the hospital, the head pharmacist, to kind of support me. And I began talking to the local hospital pharmacy society in New York City and community college on Staten Island and a local hospital on Staten Island with the idea of trying to organize something to train hospital pharmacy technicians. And about this time, my boss was invited to go to Manhattan to meet with the New York City Health and Hospital Corporation which runs all the city hospitals in all of New York City. He couldn’t or didn’t want to go and asked me if I wanted to go and present my proposal to this group of the head pharmacists of hospitals in the New York City Health and Hospital Corporation. So I thought, what the heck, I thought it was a great opportunity. So I trudge over to Manhattan and climb my way to this twenty-, thirty-story tall city building and find my way up to the floor where the meeting is and walk into this room which was like something I’d never seen before. In a sense, like the AAFP Board Room. But I went in and sat down and it filled up with all these distinguished men who were the head pharmacists in all these hospitals. And they proceeded to conduct their regular meeting. And at the end, the Chair looked over at me and said we haven’t heard anything from this young man yet. Do you have anything you would like to share? So I had the opportunity to present my ideas to this group and it was as if I had just discovered sliced bread or something. They were all fired up, all over me. It was just an incredible experience on many levels. But I kind of all of a sudden got a lot of momentum behind this idea and it was very exciting to me. Much more exciting than working in the hospital pharmacy. And at the same time, I had never been out of the country and I was sort of interested in that idea as well. And I saw this job, this thing posted in the office in the hospital that was from the Project Hope, which I’d never heard of before. And they were going to be in New York City recruiting for pharmacists for the Hope ship for a voyage to Jamaica. And one of the things they were looking for was somebody who could work with the Jamaican government to create a new program to train hospital pharmacy technicians. And I thought, oh my god, and went over to Manhattan again, interviewed with this lady from the Hope ship. And when I told her what I was thinking and what I was doing, it was probably like the only person that she had ever talked to that ever thought about this. And lo and behold, I got offered a position on the Hope ship to be one of the three pharmacists and also to be the person to work with the Jamaican government to develop this program. So after a year and a half in New York, I end up getting on a ship in Baltimore, a World War II vintage hospital ship that President Kennedy had outfitted and leased to the Project Hope for $1 a year. And Dr. William Walsh, the founder of Project Hope, was a great fundraiser and got enough money to support these voyages, these trips. And host countries would apply and say what type of things that they need. So it just so happened they were in Jamaica and the government wanted to create this program. So I think of that year and developing from scratch, working with the couple of people in the Jamaican Health Service, to develop the program, develop the curriculum, select the students, teach the first class of students, place the first class of students and to find out many years later that the program is still operating and producing hospital pharmacy technicians for the Jamaican Health Service is probably if not the most satisfying, it’s one of the most satisfying professional accomplishments in my life. So that was a year in Kingston, Jamaica on the Hope ship. And during that time I applied to and was accepted for a master’s program in Public Health at the University of California-Berkeley. We got back from Jamaica on the Hope ship on Thanksgiving of 1971. And I think I already knew at that time that I was going to go to Berkeley in September of 1972.  So in my kind of naiveté, I decided I needed to kind of take that year off and do all the things I’ve never done and always wanted to do. Of course, I was probably only twenty-four or twenty-five at this point. So between Thanksgiving and the next September, I did a number of things that I had never done and always wanted to do, including being a ski bum at Squaw Valley Ski Resort for that winter with another guy in a house that was on the mountain. And I worked various jobs around the ski resort and lived the life. I was a ski bum for a winter, among a lot of other traveling around the country that I don’t need to go into. Then in September 1972, I moved to Berkeley and over the next two years had a wonderful time in a learning environment that was very unlike anything I had ever experienced before. There were no right or wrong answers. It was just all about learning how to think and write, two things that in pharmacy I had not particularly done a lot of. I had mostly memorized things and regurgitated back. It was a science curriculum and this was anything but a science curriculum. But I felt like I did, for the first time, learn how to think a little more critically and certainly began to learn how to express myself in writing. \n\nAfter completing my program at Berkeley, I went back to the international field, becoming a Peace Corps volunteer at the age of, I think, twenty-eight. This was during the Nixon years and he was trying to turn the Peace Corps into a cadre of highly trained technical assistants to various countries which was a far cry from the original mission of the Peace Corps which would be community developers. And I believe the community developer approach made far more sense than the technical assistance role. But nevertheless, that was the role I was cast into as one of four people in a program to provide health planning technical assistance to the folks in Colombia, South America. So the three colleagues and I met in Washington, DC to be oriented. And it turned out that two of the people were married and the third person had just graduated from North Carolina School of Public Health. And a long story short is within a year or so after we met in Washington, DC at the Peace Corps orientation, we were married. Her name was Elizabeth Ebbs and she became the mother of my son Matthew who was born in December of 1974 while we were still Peace Corps volunteers in Colombia. Which wasn’t met with great support by the Peace Corps hierarchy, but there was little they could do about it. So we continued on the two years in Colombia. The first year we were cali, (?) Colombia and I worked on a multidisciplinary complete rural health development project for a community in Colombia. And the second year we were located in a rural city called Pasto, Colombia in Nariño state which was just north of the Ecuadorian border. And in that position we both worked with the state government to develop and implement a community health plan for the state of Nariño. So that was two years in the Peace Corps in Colombia which involved both getting married and having a baby in addition to the wonderful opportunity to live in that culture, learn to look at my country through the eyes of another country and another culture which is one of those things that changed my life, changed my world, changed my perspective and shaped how I pursued the rest of my life, to a high degree.\n\n                \n\nSo that takes us up to 1975. So as not to have to take life seriously or engage it full on, I applied to and got accepted to a doctoral program in international public health at Johns Hopkins University at the School of Public Health and Hygiene in Baltimore. So we all moved to Baltimore and my wife got a part-time job working for an HMO and I go to graduate school. At the end of that year, which was a great, great experience, I came to the realization that another three years of graduate school and research and struggling was just about more than I could envision. So we decided that it was time to have a house, two cars and a garage and a couple of real jobs. So I applied for and got a job working for the Commonwealth of Pennsylvania in Harrisburg, Pennsylvania in the Commonwealth Department of Health working within the context of what was then a national federally organized processes system for comprehensive health planning. And in each state there was a health planning and development agency and that is the agency I went to work for in July 1976 in specifically, what was called at that time, manpower development which later came to be called workforce development. But it was a two-person operation and we were supposed to design a health manpower workforce plan for the state of Pennsylvania. And Sandy, I think I’m getting tired. I’ve been talking too long.\n\nI have two questions that I’d like to go back to and then either take a break fully or we can continue on. You mentioned very briefly, early on, either two brothers or…\n\nYes, my family.\n\nHow many brothers and sisters did you have and their names? \n\nIn my childhood, five years after I was born, that would be 1950, I had a brother born whose name was Christopher. And another three years after that I had another brother born and his name is Mark. So that would have been 1955 [actually 1953]. And much later, that would be after my family had moved from Tecumseh to Fremont and when I was in New York City in the Public Health Service my mother, at the age of forty-five, gave birth to another boy whose name is James. And at that time I was twenty-four years old. So I have three brothers, one of whom, just because of the age differential, I feel more like an uncle than his brother. But by now he is in his forties. So we have much more in common now as fully grown adults than we did when he was much younger and living at home while I was out gallivanting about the world. So that is my family.\n\nWhat determined your desire to go into pharmacy? Was there someone who influenced you or was it just something that came naturally? \n\nI think when I was a young child and perhaps even into high school I had a romantic notion about going into something like forestry. And as I got older, every year my family went from Tecumseh to this other town of Auburn where there was a family who had kind of adopted my mother and father when they were brand new back from World War II. And we went and had Thanksgiving with that family every year. And there was another family not related to either our family or the other that also participated in this Thanksgiving dinner. And they had a son who I suspect was five to ten years older than me. His name was Kenny Huff. And Kenny, by that time, had graduated from pharmacy school and he was in the United States Navy. And he sent me postcards from all over the world, from all these different posts. And he had gone through maybe ROTC when he was in college. And the whole package began to kind of sink in with me, going to pharmacy school, doing Navy ROTC and graduating and joining the Navy and sailing the seven seas. So I did, even up to and including joining Navy ROTC, Reserve Officer Training Corps, when I went to the University of Nebraska, so for the first year I wore my uniform and marched and learned all kinds of interesting things. But between my freshman and sophomore years, I got the viral disease that makes you so tired. What do you call that?\n\nMononucleosis. \n\nMononucleosis – I got a very bad case of mononucleosis. I was the sickest I’d ever been and was even hospitalized. So when it came time to go back to school, I was not able to meet my ROTC obligations. And then the reality of the Vietnam War began to set in. So that ended my ROTC career and my joining the Navy and sailing the seven seas. But I stuck with my pharmacy and got my degree in pharmacy. That’s that story.\n\nNow we have two options: we can take a break or we can go back to the Pennsylvania Department of Health. You started out in 1979? \n\n1976, the Pennsylvania Department of Health. That’s all pretty well-detailed in the resume that I provided you. But I can certainly go back and share some of the highlights from those years, if you would like.\n\nWhy don’t you share the highlights? \n\nAs I was saying, in 1976 I went to the Pennsylvania Department of Health. And we talked about it being in the Division of Health Manpower Development. A couple of the highlights from that is we worked with a consultant and it turned out to be somebody who became quite well-known in circles of health economics and who I had the opportunity to touch base with over the rest of my career. His name is Uwe Reinhardt. He was a PhD health economist at Princeton. And we actually engaged him back before he was as well-known as he became to be our consultant in helping us develop this manpower plan for the state of Pennsylvania. We worked with medical school deans, state legislators, with the Pennsylvania Department of Education. We worked with a broad coalition of people to develop this plan. What I remember was we wrote all of the plan, testimony for the Secretary of Health, all kinds of stuff and we were pretty much stopped dead in our tracks because we were proposing that medical schools and residencies should be training like this – many, many, many more primary care physicians than they were. The state of Pennsylvania medical schools were heavily dominated by NIH research agendas with some exceptions. The many medical schools in Pennsylvania produced far two few primary care doctors to meet the needs of the state presently and into the future. So my crusade for primary care began, I would say, in 1976. But the medical schools had all the power and the money in the state and I think it’s perhaps, to shorten the story, why we were not nearly as successful as we hoped to be and as the Secretary of Health and the Governor and everybody hoped to be in putting together a blueprint that the medical schools in the state and health care industry in the state would accept and implement as designed. So it was a great opportunity for me to get into this arena, to work with the kinds of people that I would be working with throughout the rest of my career, to go through the politics of developing and advocating for major change in the health care education industry and running into the same roadblocks then that I ran into and continued to run into up until the time I retired in 2010.\n\nFollowing my two years in the Division of Health Manpower, I became the Director of the Division of Alternative Health Delivery Systems which, of course, is a euphemism for a lot of things that we don’t often like to talk about. We’ve been using alternative health delivery systems to describe managed care, HMOs, etc. for a long time. Anyway, I became the Director of Alternative Health Delivery Systems. And in that role I worked largely with federal health delivery resources. That would include funds as well as organizations established by the federal government at state and regional levels and federal programs such as the National Health Service Corps. Actually, this is the time during which I met Bob Graham who became the EVP of the AAFP a couple of years before I came to work for the AAFP. But we placed National Health Service Corps primary care physicians in shortage areas throughout the state. We had a cooperative agreement with the federal government to do that in Pennsylvania. We would decide where they were most badly needed and worked with the federal government to place them. We provided CME programs for primary care providers throughout that time. We worked with the Medicaid program and helped to introduce Medicaid capitation into four community health centers. A number of programs like that. Developed the Pennsylvania Clearinghouse for Primary Care Providers to help match people looking for primary care positions with opportunities that existed in the state at that time. I think I skipped over something. I went from 1976 to ’78 and I skipped over perhaps my most satisfying experience while I was at the Pennsylvania Department of Health and perhaps the most unusual. This was still during the Nixon years. And he and the federal government decided they wanted to promote HMOs in the United States and there was a law passed to do so. And it created a framework for HMO development and money to support HMO development. And one of the ideas the federal government had was to choose a couple of states and run a project to promote the development of HMOs at the state level of Pennsylvania. So they created these model state HMO offices and the state of Pennsylvania and the state of Massachusetts were the two that were chosen to do this. So it sounds kind of odd that the federal government at that time was promoting HMOs, but they were. And I left the manpower develop-ment program to become this HMO project director and we did some very unusual things. We chose four – not Pittsburgh or Philadelphia, but the next largest cities like Wilkes-Barre, Scranton, Erie, cities like that in Pennsylvania. And I personally would go out and try and orga-nize coalitions. The federal model was the coalitions should include the labor groups, business groups, large employers and the local health care establishments – in other words, hospitals and doctors. So I would go to these communities and try to organize coalitions. For example, I went to Erie, Pennsylvania and I met with the human resources director for Hammermill Paper Cor-poration to try to sell this idea of forming this coalition on the local level. And if they were suc-cessful in treating a non-profit organization, there was federal money available to help them plan, develop and implement an HMO in the community. So after meeting with the Hammermill HR director, I met with the International Paper Workers Union. I’d never met with any corporate people. I’d never met with any union people. And then after meeting with the two of them, the most exciting of all was meeting in the backroom of some doctor’s office with the immediate past president, president and president-elect of the local medical societies and tell them what a good idea it was to form this non-profit corporation to establish and HMO in this community. It was like playing with fire. It was pretty exciting. It was pretty challenging and never dull. So little by little over a period of a couple of years I worked with these four communities and was able to get them to come together and form these non-profit corporations at the local level and apply for federal money. And not all of them ended up in successful HMOs but a couple of them did.\n\nAnother interesting thing we did was planned and implemented two governors’ conferences on HMOs in 1979 and 1981 which included Dick Thornburgh, who eventually became Attorney General and was the Governor at that time and was really supportive of what we were doing, and hosted two conferences which attracted over 500 people. And again, having key labor, business and provider interests in Pennsylvania. And probably the weirdest thing of all we did, we devel-oped a multimedia HMO public awareness campaign where we worked with the Pennsylvania State University, their public radio station staff, and developed television and radio public serv-ice announcements on HMOs. And our two highest profile celebrities who we recruited to do this were the basketball player Julius Irving, from the Philadelphia 76ers and Willie Stargell for the Pittsburgh Pirates both of whom became Hall of Fame members at their respective sports. But how bizarre to think of Willie Stargell doing an HMO public service announcement. And we even made one animated public service announcement for HMOs. So that was a quite crazy ex-perience. I’ve already talked about what I did next at the Pennsylvania Department of Health, ’81 to ’87, Director of Division of Alternative Health Delivery Systems. And as a part of that process was the Director of Primary Care for the state of Pennsylvania working with a lot of rural health primary care centers using mostly federal money and asked for [National] Health Service Corps providers to do that.\n\nSo that takes us up until the time that I came to the AAFP in January of 1987.\n\n(Break)\n\nJohn, now if you could take us into the AAFP. Give us the positions that you’ve held and the departments over which you supervised. \n\nWe had left off with me leaving the Pennsylvania Department of Health at the end of 1986. I had been looking for a new job at that time and actually had interviewed for a number of things. I had a colleague who had been reading a periodical and also was looking for a job and brought me a job opportunity for the American Academy of Family Physicians. And at that time one of my kind of ideas about finding a new job was to move back to the Midwest. I had grown up in the Midwest, I had been gone for twenty years from the Midwest. Matthew, my son . . . I guess I failed to mention previously his mother and I had gotten divorced after three years of marriage, so in 1977 and I raised my son as a single father. So by this time he was twelve years old and we had never lived close to any of my family who were all in the Midwest. So moving to the Mid-west had some appeal to me. And this job happened to be in Kansas City and was one of the three cities that I had actually thought that I would enjoy moving to and living in – Chicago, Kansas City or Denver. And when I read the notice for this job, it was like reading my own resume. They wanted somebody who had expertise in rural health, health maintenance organi-zations and primary care development, and you may have noticed from my previous discussion of my time in the Pennsylvania Department of Health that all three of those had been part of my responsibilities while there. So I applied and was asked to come to Kansas City for an interview. And the people I interviewed with at the Academy were Charlotte Krebs who at the time was Director of the Socioeconomics Division and Mike Miller who was her boss, Vice President for I think our Washington, DC office in Socioeconomics. So I came and interviewed and shortly thereafter was offered the position of the Director of Health Care Services. So it had “Director” in the title even though it wasn’t a division director. And I believe what was going on at this time at the Academy was they were beginning to try to hire people who were more specialized in their area of knowledge and expertise and trying to make the jobs more appealing and at a higher level. I wasn’t the first person who had been hired with the title of director. I think Dr. Herb Young had also been hired with that title a year or so before I was and was also another division director. So very happily accepted the job offer and in January of 1987 Matthew and I moved to Kansas City. We took up residence in Overland Park, Kansas. As I grew up, I’d always heard about the excellence of the Shawnee Mission School District. So it was certainly a no-brainer for us to move there. We moved into a house about a half black from the grade school, a block from the junior high and a mile from Shawnee Mission South and settled into a nice community with lots of kids and got on our way.\n\nSo I came in as the Director of Health Care Services. I believe it was two years later, I was, I guess you could say, promoted (that’s what the letter said) to become the Assistant Division Director for Socioeconomics. I’m not sure there had ever been an assistant division director in Socioeconomics. The assistant director position in the Academy was just beginning to kind of come into its own. And I stayed in the position of assistant director to Charlotte Krebs until she left in 1999 at which time I applied for the Director of the Socioeconomics Division and was successful in getting that position. And I stayed as the Director of the Socioeconomics Division which became the Practice Enhancement Division until I retired in 2010. And so in reality while the titles changed and the range of responsibility and accountability and supervisory responsi-bility increased over those twenty-four years I was there, I was in the same division and being responsible for many of the same things during that entire period. As I think back on the time, the twenty-four years I worked for the Academy, I realize that the opportunities that I had to have leadership roles in various member commissions, committees, work groups, task forces are too enumerable to even try to share all of them. And the family physician volunteer members that I had the privilege and honor to work with and work for, it all really came home to me when I was preparing to retire. At the last Scientific Assembly meeting that I attended, it was one of the more emotional times of my life. Because I didn’t realize, with all the people who came up to me and thanked me and wished me well and said goodbye, I realized how many, probably hun-dreds of people, family physicians, members that I had the opportunity to know and to work with and to have a relationship with. It was truly one of the blessings of my life. Those twenty-four years, and all the people that I had the opportunity to meet, to know, to work with. And that’s just the member side, then there’s the staff side on top of that. And I had the opportunity to work on many staff level groups within the division that I was responsible for as well as the senior management team that became known as the Compass group that met every Tuesday morning at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284001#t=0.0,600.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284001/transcript/82277/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And all kinds of staff, committees and task forces over the years. I wish I had them all in my head – names, dates, the people. Unfortunately I don’t – but that’s beside the point.\n\nA few of the things that stick in my mind the most and that I would not want this interview to leave without mentioning at least – I’ll go ahead and list a dozen or so things that I particularly remember and why they may be important to me. When I first came to the Academy, Dr. Graham who was the Executive Vice President at the time, and Mike Miller and Charlotte, they were the three people that I related to most directly and most frequently in terms of taking direc-tion and helping set direction. As I mentioned earlier, had to do with HMOs, explicitly I remem-ber Dr. Graham saying we need to get our members’ heads out of the sand as it relates to HMOs. There was this movement kind of sweeping the country that portended to have great benefits to family medicine, shining the light on family medicine, family physicians as the care coordinators known in those days, unfortunately, as gatekeepers. And so one of the very first things that I had the privilege of doing was organizing an activity called the Administrative Interchange which was a euphemism for family physicians involved in the management or leadership of HMOs around the country. And there were quite a few of them that were not kindly thought of by the general membership of AAFP. They were kind of pariahs. They had gone over to the dark side. But we felt that as an organization that we needed to one, include these people so they would not feel excluded from the Academy, lose their family medicine home. And also we needed to hear from them and learn from them and take what we could from them to guide the Academy’s activities and also to inform and educate the general membership about what was going on. And so for a number of years beginning in 1988 we organized these events where we would invite folks who were involved in managed care and invite speakers and create forums for these folks to get to know each other, not to feel so isolated as they did in their home communities. And very interestingly, as it turns out, many of these people who met in those early years went on to become not only leaders in the managed care industry, the insurance industry, but also become presidents of the AAFP, members of the Board of Directors of the AAFP, chairs of  key com-missions at the AAFP. It was sort of a real cutting edge thing to do, that Dr. Graham would be known for and associated with forward thinking. That was one of my earliest opportunities to contribute to the Academy. Another program that I, along with Jan Carter and Norm Kahn, created a program called the Fundamentals of Management. It was 1995 that we began working with a number of family physicians who were in various management positions around the country to create this course for family physicians who …it was actually to develop family physicians for entry level management positions in health care organizations around the country. Now this again was something that had never been done. The AAFP had always been much more of a clinically-oriented organization. And with the rise of managed care and physician sponsored networks around the country, we felt that there was a strong need for more manage-ment training of family physicians who are the natural specialty of physicians to become mana-gers because they are people-people. They relate to people on a personal level and they’re gene-ralists and very well-suited for management positions. So we created this course and it was a rather unique and forward-thinking model for adult education at that time. It consisted of select-ing a class of thirty-six students at a time. Having them do pre-course work before they came to a week-long onsite training program. The onsite program was case study-based and a group of thirty-six working in six small groups of six each. Following the week-long onsite training, each of them went back to their respective communities, developed a management project working with a mentor from the Fundamentals of Management program, one of the faculty people, and conducted a management program in their health care organization and developed a written re-port of that presentation. Ultimately all thirty-six came back together at the Scientific Assembly that fall. Got together with the same group of thirty-six. Each of them in turn presented their management program as a result of their management project to their group. We also arranged special classwork for the group as a whole, classes designed just for them at Assembly. And then there would be formal graduation and dinner for the graduates of the course at Assembly. We successfully obtained industry funding for this program to reduce the financial impact on the thirty-six people that participated. They had to take time away from their practice to come to the week-long course. And, of course, all the rest of the time spent meeting other requirements of the course. But for ten years we ran this program with grant support. And it turned out, we had two sets of thirty-six students going through a few years. So if it lasted ten years, it probably trained more than 500 family physicians in basic tenets of business management.  \n\nOne of the things I am really very proud of having been involved with – a related activity to the first two was that when I first came to the Academy there was almost no non-clinical CME at the Annual Scientific Assembly at all. And beginning in the early nineties and building year over year, working with the Commission on Health Care Services which I staffed, we built up to as many as twenty-eight courses by the mid-2000s of courses related to non-clinical, some business, some topical managed care. But leadership, management training, a whole new track for the Scientific Assembly that the Scientific Assembly programming committee turned over to the Health Care Services Commission and me to organize. And I think that also is something that I consider a legacy that I’m proud of. I also had a role in probably one of the most significant developments in the history of the AAFP – and that was the Future of Family Medicine program which took a fundamental look at family medicine in, I think, 2002 to 2004 when the Future of Family Medicine initiative transpired and there were a series of task forces that were created. And I staffed the Future of Family Medicine Task Force No. 1 which developed a New Model of Family Medicine and was chaired by Larry Green. And the significance of the entire effort, in particular the New Model of Family Medicine, led to the whole movement of the primary care patient-centered medical home model which fed into the whole redesigning of the family medicine practice, promotion of the electronic health record, support for measurable improve-ments of the quality of care and new payment reimbursement models to support the higher value delivered by the patient-centered medical home. And eventually the AAFP developing and sup-porting what came to be known as TransforMED, which is today doing the hard work in the field working with practices to help them become patient-centered medical homes. I have also had I guess the unique responsibility and honor to staff the effort with Dr. Steve Spann . . . he and I worked to develop the original feasibility and business plan for what became TransforMED, which was approved by the Board [of Directors], and resulted in that program being established.\n\n    \n\nWay back in the very beginning, when I came to the Academy there was the beginning of what became the regulation of the physician office clinical laboratories. And the Academy got ahead of this whole change in the regulatory environment by establishing with the American College of Physicians, the College of American Pathologists and the American Academy of Pediatrics an organization called the Commission for Office Laboratory Accreditation (COLA) which would eventually become an alternative to the federal government for our physician offices that had clinical laboratories who had to have them certified by the federal government in order to contin-ue operating. And COLA received deemed status from the federal government. So it was a physician-run organization, accredited physician-run laboratories. And that organization still exists today as an alternative to the federal government’s regulated physician office labs. And at the same time, the Academy, under Dr. Graham’s leadership, saw a business opportunity because all physician office clinical laboratories would be required under this new law to do proficiency testing, which is an external quality assurance program that they would be required to do on an ongoing basis in order to continue to be certified and therefore continue to operate. So the Acad-emy set up what is called an AAFP Proficiency Testing Program as a small business which was run within the health care services division. And I was charged with developing that program and writing that business plan and hiring Barbara Mitchell who continues today to be the manager of that program. And it turned into a program that generates $2 million to $3 million a year in income for the Academy so it’s always been a small business running within the division.\n\nSomething else that I think was transformational that I had an opportunity to be a part of developing: I participated in the first what was called Policy Conference for Women, Minority and New Physicians (NCWMNP). That was another idea of Dr. Graham in 1990 to make sure that we heard the voices of minority populations within our membership. And that first confer-ence in 1990 eventually turned into the National Conference for Special Constituencies (NCSC) which still runs today and which over the years was staffed out of the Socioeconomics Division. And as I became Assistant Division Director and Division Director, I was responsible for the oversight of that conference and even at one point, due to some personnel issues, was the confer-ence manager. But I believe that has been a major voice for minority constituencies within our membership. And again, kind of as with that Administrative Interchange, the effect that it had, the special constituencies have produced so many, again, leaders within the Academy at the national officer level – Board of Directors, Presidents. It just has been highly successful and I feel very honored to have been a part of it.\n\nI guess if I think about what I might have brought to all of this, I’ve given it a little thought and I don’t know if I have it right or not…but I think one of my strengths is working effectively with groups of AAFP members and staff to set and achieve goals by constantly paying attention to the big picture. So often our members can get hung up in self-interests. And clearly that is one of their responsibilities to the membership. The volunteer members who are serving the Academy is to serve the interest of the members. But sometimes the interest of the members, you kind of miss the big picture. And I think it’s a necessary perspective to have, without losing sight of the members, that having that big picture and understanding how family medicine fits into things be-yond the scope of their practice. And it’s sort of a give and a take and there’s always volunteer members with a similar viewpoint that can look beyond self-interests to find balance. But I think I just have that ability to help them work with a little bit broader perspective and be more successful because of it.\n\nA division obviously is broad-based, but it typically has departments within its organization. When you left, and I know the original ones by your CV, but what were the departments that reported to [you]?\n\nWhen I left, I was a division director. So I was responsible for it all. So there were people that reported to me who supervised other groups of people. So at that time, Jane Krieger was Assis-tant Division Director and she supervised all of the quality activities in the division. Barbara Mitchell reported to me – and we’ve talked about her. She was responsible for the Proficiency Testing Program and all those related activities. And Kent Moore reported to me and he was responsible for payment, reimbursement issues, practice management and private sector advo-cacy. Those were the areas of responsibility. Kind of how they were organized at the time that I retired.\n\nPhilosophically, any changes you saw in the specialty that were particularly important? I know you mentioned, for example, the non-clinical educational programs both at Assembly but also within the scope of your day-to-day activities. Any particular one that you’re most proud of or that you enjoyed working with the most? And conversely, the least? \n\nSomething that we have not talked about that probably was as big a responsibility throughout my time at the Academy than anything else was serving as staff executive to the Commission on Health Care Services which was one of the handful of commissions that reported to the Board of Directors and made recommendations to the Board of Directors on policies and programming that the Board used to guide the organization and use of its resources. And from the day I started working at the Academy until the day I left, was the staff executive on Health Care Services which later became known by other names. The Commission met twice a year. But the Commis-sion drove, in large part, what we did as a staff, particularly the economics division, throughout each year. I believe that there was an evolution of how those entities evolved, matured, changed. How the work was assigned, accomplished. How decisions were made, how projects got done under the commissions. But that work I felt particularly rewarding and I thought was real work of the Academy and I felt very much a part of the Academy because of it.  And also the commis-sions had a dozen people or so and a certain number of them turned over every year. So that was one way I got exposed to hundreds of people, of our members, over the years and of course worked closely with the people who were chairs of the commissions and went on to become the president of the AAFP. So that is something that I am particularly proud of, that work. And then there seemed to be a very few other people on the staff of AAFP that enjoyed as much as I did staffing reference committees at the annual Congress of Delegates and at the National Confer-ence on Special Constituencies and even at the National Conference of Students and Residents. I saw each of those conferences as little mini democracies. I loved seeing people generate ideas, debate ideas and then be part of taking those ideas and those debates and working with the reference committees that they debated in front of and turning it into recommendations which would then be considered by the Congress of Delegates, each of those bodies. And then decis-ions made in setting the course for the Academy or for the special constituents for the students and residents. I just loved working with those groups, doing that work. Rosie Sweeney was another one that loved doing that work and we were two peas in a pod. At two occasions at the Congress of Delegates national meeting we teamed up to do two reference committees in the same conference. And people just thought we were ill because we liked doing it so much. But those are a couple of things that I really think are important and enjoyed doing and that I think I did well and through which I felt very much a part of the organization and people that comprised the organization.\n\nI want to capture that you remarried, because you have a beautiful wife. And secondly, I would like to know who within the Academy, whether it be a member or a staff, or there may be two or three that really influenced you and for which you have great respect. And again, this is not meant to be just three people. But I would assume you had some mentors within both the physician population and the staff? \n\nThanks for asking about Judy. I like to say that I was married to my son for the seventeen years that I was a single parent. Between working and taking my job very seriously and taking my number one job as being a parent even more seriously, there was little time left over for much else. So my priorities were being a parent and working and it just never raised to a priority until he went off to college. Then I had more time and thought perhaps spending the rest of my life by myself would not be something that I would ideally want to do. And lo and behold, one day there was out of the blue a woman at the AAFP who was a colleague of mine. Her name was Sarah West. She worked in Publications. And she sent an emissary out, a woman probably older than me even, to say “Are you seeing anybody?” Well, I was always seeing somebody. I always had a female friend, companion. Never anything very seriously. But I just said “No, not really.” And she said “Sarah West has this friend that she would like you to meet, to be able to get together.” I said “Sure.” She said “When?” and I said “Tonight?” So apparently she went back and told Sarah and Sarah got back with this person, so we all met at Humphrey’s which was a little restaurant bar on Bannister Road. This is when we were at 8880 Ward Parkway (our office). So I go over there and this woman shows up and we sit down and start talking. And about a half hour later Sarah gets up and leaves. That was in January 1995, and Judy and I got married in March of 1996. And as it turns out, Judy’s first job out of college, the University of Wyoming, she had moved here with her husband to Kansas City, and her first job was working for the AAFP in the Publications Division, working for Kathy Mayfield. And she was, I think, at the Academy from 1975 to 1981 or ’83 or something like that. And then why she knew Sarah West was because Judy had gone off and done a number of things but ended up owning a computer consulting company where she specialized in Apple computers. And in 1995, or thereabouts, she had been hired by Clayton Hasser, who was Publisher for AAFP, to take responsibility for converting the Publications Division and the Communications Division to Apple computers. And so she had been working in the building for an entire year, often in the same office space as I was in, and we never once had laid eyes on each other. But she was working with Sarah and had become friends with Sarah. So it was directly through the Academy that we met – and she had had an earlier career at the Academy before we ever knew each other. Judy has two daughters. One of them is the same age as my son Matthew. They are now both thirty-seven, soon to be thirty-eight. And her other daughter was five years younger, so she’s thirty-two, soon to be thirty-three. My son Matthew is married to a woman by the name of Robbi Behr.  They have three children currently: soon to be five, soon to be three and soon to be one. And Matthew and Robbi have a very unique business. They are a small publisher. They own their own publishing business. Matthew is a writer, Robbie is an illustrator, and they write, illustrate, produce, sell books through their own publishing operation. And Judy’s oldest daughter, the same age as Matthew, is Gina, and she has worked ever since she graduated from college, I think fifteen years now, for Accenture, a consulting firm, and lives in Brooklyn with her husband King and two-year-old son Wayland (sp?). Matthew and Robbi live on the eastern shore of Maryland And Courtney, the youngest, just finished her physician assistant training certification and is in her first job as cardiothoracic surgery physician assistant in Carbondale, Illinois. So that is the rest of our family.\n\nAs far as people who I highly respected and admired and from whom I learned the most, and I always hate to do this because by doing so you exclude other people. But one of the main reasons I felt comfortable coming to the Academy is because I had known Dr. Bob Graham when he was the director of the Federal [Health] Resources and Services Administration [HRSA] in Washington, DC while I was working at the state level of Pennsylvania. And I had greatly respected and admired him kind of from afar and in some meetings I had been in with him.  So knowing that he was Executive Vice President of the organization that I thought about coming to work for was very reassuring. And I could not have been more proud to work for a person than Bob Graham. I obviously did not work with him day in, day out, directly, but as a leader, role model. And when I did have the opportunity to work with him, I had the highest respect. Two people who I worked much more closely with, Mike Miller . . . after I had been at the Academy for a year or two, we moved to the 8880 Ward Parkway facility. And as the offices were being set up, because the Socioeconomics Division reported to Mike, we were placed in close proximity to him. I’m not sure exactly why, but I think that [the?] general counsel had been in an office right outside of his. And perhaps that person left the Academy. But anyway, I jumped at the opportunity to sit in an office right outside of Mike Miller’s office on purpose because I knew that just by my proximity to him, I would get a lot more exposure to him. And he was the one who all of the knowledge and experience that would most benefit me, that I had the most to learn from relative to the responsibilities that I had. And so for a period of a few years I had that position. And it did pay off in that I was able to get a lot more of Mike Miller, who was the vice president over Socioeconomics in our Washington office, than I otherwise would have. And then finally, my colleague, my boss, my mentor, my friend Rosie Sweeney, for the last ten years or so I was at the Academy and for many years before that, I worked with her closely as well. And again, with great respect, admiration, and as a role model for a manager, I would certainly single her out. I can try to think about members who stick out . . . but that is much more difficult there are so, so many. But there are probably four off the top of my head whom I, for various reasons but mostly because I remember, admire and respect them for the people they were as much as the members they were. I don’t know them as doctors. I know them more as members. But John Coombs from Washington state who I worked with on the Commission on Health Care Services. Darroll Loschen from Nebraska who I worked with on all those laboratory issues – CLIA, COLA, the PT program and the Commission on Health Care Services. Bertie Safford from Washington state who circled around commissions that I was associated with on many occasions over the years and became a close, personal friend as well. And Dr. Bruce Bagley who, again, came up through the ranks and I knew in many different capacities – up to and including he worked on the staff of the Socioeconomics Practice Enhancement Division while I was division director. And Doug Henley who I had the privilege of knowing when he was very young and involved in AAFP activities. And throughout his entire career, up to and including when he became EVP of the AAFP and was EVP when I retired.\n\nDo you have other things you would like to reflect upon? \n\nYou know, talking about my time at the Academy is one of those things that could go on for hours. But I think we have certainly gotten a good flavor for my time there and my observations and the people and all of that.\n\n(End)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284001#t=600.0,3391.00099"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284000","type":"Canvas","label":{"en":["Media File 2 of 2 - Swanson_John_12_b.wav"]},"duration":3354.28269,"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/2195/collection_resources/154851/file/284000/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284000/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/000/original/Swanson_John_12_b.wav?1754487642","type":"Audio","format":"audio/wav","duration":3354.28269,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154851/file/284000","metadata":[]}]}],"annotations":[]}]}