{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/8g8ff3np6p/manifest","type":"Manifest","label":{"en":["Dr. Gayle Stephens"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1987-04-26 (created)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","family medicine","family physician","Dr. Gayle Stephens"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Gayle Stephens (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["english (primary)"]}},{"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"]}}],"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/3180/collection_resources/150923/file/278319","type":"Canvas","label":{"en":["Media File 1 of 2 - Stephens_Gayle_1987.04.26_-_Side_1.mp3"]},"duration":1948.616,"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/3180/collection_resources/150923/file/278319/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/278319/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/319/original/Stephens_Gayle_1987.04.26_-_Side_1.mp3?1750861736","type":"Audio","format":"audio/mpeg","duration":1948.616,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/278319","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/278319/transcript/81401","type":"AnnotationPage","label":{"en":["Dr. Gayle Stephens interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/278319/transcript/81401/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"What we really want to do is to find out a couple of things. One is some sense…I’d like some personal information from you about how you got involved. And I know you’ve talked about this before and I know something about it, but if you could think back to when was the first visceral inkling that something was going to happen vis-à-vis moving into whatever you see family medicine to have been.  \n\nWell, I think it was somewhat chancy. I’d been in practice about ten years in Wichita, and it seemed like a new decision was called for at the end of five years. At the end of ten years, my partner and I were involved in thinking about a new office, whether to build or rent and if we rented, our landlord wanted a ten-year lease; so it seemed like I was making some kind of ten-year decision in 1965 or thereabouts, and there were lots of possibilities open. One of the things was…I guess it was a time of ferment, of thinking about the next ten years. I remember thinking about taking a fellowship in psychosomatic medicine at the Menninger Clinic in Topeka, and I actually went so far as to apply for that. That was one of the early fellowships in which you got paid a thousand dollars a month. I went to Menninger’s, was interviewed and actually was accepted for that and it turned out they didn’t get the grant, so I didn’t go.\n\nWas that to train? In psychiatry?\n\nThat was to train general practitioners in psychosomatic medicine. No, it was specifically not to train them to be psychiatrists.\n\nOkay.\n\nIt was for people who intended to return to practice. I think, as a matter of fact, it did seduce a number of people out of general practice.\n\nBecause that was one of the things that is always brought up about one of the nails in the coffin of general practice, is a lot of people were going back and being psychiatrists for some reason.\n\nWell, that was partly because there was training available, money available, in a greater amount than was possible before, and that it had some relevance to perhaps some of the frustrations of general practice. You know, there was a lot of emphasis on the mental health movement in the late ‘50s and early ‘60s. That was probably the heyday of the mental health movement in this country. There was a lot of activity between the American Psychiatric Association and the American Academy of General Practice around teaching psychotherapeutic skills to general practitioners.\n\nWhy was that? I mean, why was there?\n\nWell, I think it was a federal initiative that grew out of the mental health movement, which was a post-World War II development, perhaps partly initiated by the number of draftees in World War II that were presumed to have mental problems. Either were rejected or…\n\nThey felt like there was this untapped group of people who had mental health problems?\n\nAnd this was the time of research studies. You know, community studies, the Midtown Manhattan Study and the Health of Regionville, (?) other kinds of community surveys indicating this big mental health need. So, part of that was…now, I wasn’t involved, at least at that time, in the relationships between the Academy of General Practice and the APA, but there was, actually, a liaison committee at that time, headed by a guy named Howard Kern from psychiatry that put on a number of seminars at the Menninger Clinic in Topeka that largely Academy officers, state officers, attended and got turned on to psychiatry. Well, that was part of the ferment, though I was not directly involved in that; so taking a fellowship in psychosomatic medicine was one of the elements that I was considering by the end of my tenth year in practice, which would have been 1965.\n\nAnd how old were you then?\n\nWell, 37.\n\nAnd was that particularly portentous for any other reason? Was there anything else happening?\n\nWell, thinking about building a building instead of renting. So, my partner and I – I was in a two-man partnership.\n\nSo, it represented a big commitment for you?\n\nSo, we were looking for some real estate on which we could build a building. I remember also considering at that time trying to raise money to buy an abandoned hospital on the west side of Wichita to…\n\nFor an office?\n\nWell, I had in mind some ideals around sort of short-term hospital stays for common problems that didn’t involve a great deal of technology. Really, some things that have probably become worked out now in extended, I mean, in one-day surgical procedures and so forth. The short- term, high turnover, well-paying stuff. There was a hospital called Wichita Hospital(?) that had been abandoned on the west side, and I could see the possibility of getting some things that we would now undoubtedly consider ambulatory, but at that time, people went into the hospital for it. I can see short-stay, high-turnaround, common procedure, sort of thing. I was also in commun- ication with the executive officer of the hospital that I was mostly connected with which was Wesley. A fellow named Roy House, who was the first fully-trained hospital administrator that Wesley had ever had. Prior to that, like many church-related hospitals, it had ministers as hospital administrators. But I had come to the attention of the hospital staff. I’d been elected Secretary and Treasurer. I was beginning to sort of move up in the committee hierarchy, and I had been talking to him for perhaps a year about possible roles for me in the hospital as a paid physician doing something connected with the hospital, but it wasn’t clear exactly what. The hospital was running out of solutions for the emergency room, for one thing.\n\nBecause it was crowded in the emergency room?\n\nYeah, probably not crowded by modern standards, but they were having 70 visits a day, and that had been staffed before with interns and we had an uncertain recruiting success with interns, and it was beginning to be clear that the hospital staff was going to have to start taking turns covering the emergency room. But it was unacceptable at that time for a hospital to pay a physician to do something. The medical staff found that unacceptable.\n\nUh-huh.\n\nThey might pay a radiologist. They might pay a pathologist, but they weren’t about to pay a doctor to work in the emergency room. The idea of a professional charge for a patient coming into the emergency room was just emerging as a possibility; so, I had been carrying on these conversations over occasional lunches with Roy House about possible roles for me at Wesley Medical Center and, as I recall, it wasn’t that I was dissatisfied with practice or with my partnership arrangement, it was just that this was a time for thinking things over. I’d been there ten years. What did the future hold? Or what was I going to do with the next ten years, and, I think, because I didn’t own a building, or didn’t have a lot of indebtedness at that time, that I was relatively free to think about a number of possibilities including the fellowship at Menninger’s. So, it was within that context of thinking about the future that somebody – I really don’t remem- ber who, put a copy of the Willard Report in my hands, and I didn’t even know that the Willard Committee was going on. I was not politically involved with the Academy of General Practice on a national basis. I’d been a member of the Academy since 1959. I went into practice in 1955, and I was a preceptor for KU. \n\nSo that you had students?\n\nOccasionally. But, basically, I was naïve about national medical policies, but when I read a copy of the Willard Report, it was really like a revelation. It was like a light going on in my head.\n\nSt. Paul.\n\nYeah.\n\nThe lightning bolt. What about reading…well, do you remember what struck you as you were reading it?\n\nWell, it was an outline of a plan to train family physicians, and all of a sudden it became clear to me what kind of role that might be to direct a family practice training program. Now, Wesley had a general practice residency for a number of years that had come onto hard times. They had a hard time recruiting, although they did have maybe a couple of residents a year in this GP residency. The director of that, who was a volunteer, was a guy named Jack Tiller, and he was getting weary of that and, interestingly, the straw that broke the camel’s back for him had to do with obstetrical supervision of the GP residents. Wesley had a small obstetrical residency and a small GP residency plus an internship, and the OB staff was giving Jack a hard time about being physically present in the delivery room when the family practice residents were delivering babies, which was a requirement they did not make for the obstetrical resident. We’re not talking about high-pressure programs here. So, that was kind of the final straw, I think, that made Jack willing to relinquish the GP residency directorship in favor of a “new style” family practice program. So what we attempted to do was to transform the GP residency in to a model of the Willard Report because there was no mechanism of approval for a family practice residency at that time except approval as a GP residency. I mean, there was no Residency Review Committee [for Family Practice].\n\nAnd you were already approved?\n\nWe were already approved, but at that time, the whispers about board certification in family practice were rumors, but there was interest. I finally became aware that there was interest in a Board. So we were really betting on the outcome that there would be a carrot for people who took this new style residency. So, the deal that was struck with the hospital was that I would become essentially an employee of the hospital and that part of my duties were to organize some kind of medical coverage for the emergency room and that’s what the hospital ownership was interested in…\n\nWas taking the burden off the --?\n\nYeah, and my interest was directing a family practice residency, so essentially we worked out a trade, that if the hospital would bankroll the residency, which at that time, as I remember, amounted to about $200,000 a year, the plans for all this that I would organize some kind of staff coverage of the ER, and we used something that was called the Pontiac Plan, which came from Pontiac, Michigan, where they had formed a corporation of medical staff members who agreed to work in the emergency room so many hours a month, and that they would charge a professional fee for seeing patients and the hospital would act as their billing agent; so that’s what we did. We formed something called Emergency Services, P.A., which had 28 physicians, each of whom agreed to work 12 hours a month in the ER for $10…well, we started out for $8 an hour, and that got increased to ten, and we had a contract with the hospital that they would pay us an amount of money equal to a certain proportion of our charges each month and we sort of came out to $8-10 an hour. The genius of that idea was that we incorporated in it from the beginning, something that was called a money purchase pension plan, where a quarter of our earnings could be set aside for retirement.\n\nReally?\n\nAnd that you had to work three years to get vested in that. Well, we weren’t talking about big dollars, but it lent stability to that corporation, because nobody wanted to quit and leave their proportional funds for somebody else; so I think our membership of 28 went down to 21 at one point and then back up and I think part of it was because there was a small retirement plan built into that ER corporation and we had surgeons and GPs, I think a pediatrician or two, almost no internists, who became ER physicians. Now, that had nothing at all to do with the family practice residency. That was a separate deal, but that’s what the hospital seemed to feel was their Achilles heel. The residency was what I was interested in, and so we worked this exchange and I essentially became a full-time employee of the hospital.\n\nWhat was different about your sense of what you were doing that made you…? I mean, going from a fee-for-service physician to an employed physician in those days was pretty unusual.\n\nWell, it wasn’t a complete transition, because what the hospital agreed to do was furnish me an office “on campus.” That turned out to be a house that they remodeled that was just across the street from the hospital, and my practice, which was about five miles away from the hospital, a certain proportion of those people agreed to continue in my practice in the new setting on the basis of a postcard that I sent out explaining the change. There were several hundred families or people who agreed to transfer to the new setting; so I was carrying on a part-time practice as the teaching base for the residency. I got paid an administrative fee from the hospital for…I mean, all of my services to the hospital, I think I got paid $25,000 for, and I was allowed to earn a certain amount of money from this practice, which was roughly equivalent to what I had been earning in private practice. Now, this was also the time of Medicaid, or Medicare and Medicaid, which was 1965; so this was a time when, in spite of the opposition to Medicare and Medicaid, doctors’ incomes were increasing proportionately by quite a bit at that time. So, it was kind of a horse trade, and I think I was motivated by the circumstances of my life, that I needed to make at least an intermediate decision about the next ten years, by my interest in medical education and by my fortuitous reading of the Willard Report which gave a sense of direction to that.\n\nSo, how did you connect what you were doing in Wichita for the first time to there was something else going on somewhere else, other than through the Willard Report? Where did that connection…?\n\nWell, I became aware of Lynn Carmichael in Miami who had written an article in the AMA Journal about what he called a family medicine internship. I also became acquainted with Gene Farley who was doing something in Rochester, New York, at Strong…not at Strong, at Highland.\n\nYeah, right.\n\nHighland Hospital, and then there was a guy at Oklahoma named Roger Lienke who’d come down from Minnesota. Those were the four people that I got acquainted with.\n\nAnd how’d you get acquainted with them?\n\nI think through…well, I got acquainted with Lynn through reading the AMA Journal, and I don’t remember exactly how I first heard of the others. It may have been through a fellow named Ned Burket, who was in Kingman, Kansas, who was involved with the Academy on a national level and who became the President of the Academy. Ned became aware of what was going on at Wesley, and in a sense became my patron. He’s the guy who gave me certain opportunities to talk. Like, I appeared at the State Officers’ Convention of the Academy in 1968 to talk about the Wesley program, which had gotten started in October of 1967. So, I think it was through Ned Burket that I began to become aware of the Millis Report and some of the issues that were going on at the national level, and then I met Lee Blanchard who was employed, at least part-time by the AMA Council on Medical Education. Because in order to get…I was unaware of the political implications of this, but in order for the ABFP to get approved through the various bodies, it had to have some programs in existence. So, how do you get programs in existence when you have no carrot? So, there were several programs that were undergoing these transformations from what was general practice approval to family practice, according to the Willard Report, and there were about 15 of those across the country that Lee Blanchard and Lynn Carmichael were con- cerned with promoting and facilitating. So, we became one of those programs that got continued approval as a general practice residency with the understanding that we were conforming to the new standards, and this became part of the application of the Academy and the Section on General Practice of the AMA to get the Board approval through the appropriate bodies, the Liaison Committee on Medical Specialties and what was then the Advisory Committee on Medical Specialties. There were a couple of committees that had to vote to approved the Board, and we should remember that ABFP was the first new board that had been approved since 1949.\n\nI remember that story at Keystone about the search for the rules and regulations of how you apply and finding it in somebody’s office in a file drawer?\n\nRight, no one had tested the system, and, you know, it appeared that we were 20 years out of time.\n\nAs you think back, what was the thing that…? A couple of questions: What was the biggest difference in what you were doing in training what were going to be called family doctors and what was being called GPs?\n\nWell, to me, the biggest difference was inclusion of training in office practice.\n\nSo, the outpatient, the ambulatory?\n\nYeah, that was the most obvious difference, because prior to that, the GP residencies were entirely hospital-based. You know, in the first year you spent in some form of internal medicine for six months and probably at least three months in pediatrics and three months in psychiatry. It was non-surgical.\n\nRight.\n\nAnd the second year was surgical and obstetrical and maybe a little bit of elective, but it was all hospital-based, so the clearest difference was the inclusion of an office practice. Then there were all these new words that I really didn’t know much about, such as behavioral science, community medicine, that we were supposed to train people in, and at that time, behavioral science to me meant psychiatry.\n\nEspecially with that Menninger application?\n\nRight. Now, we were strongly influenced in Wichita by the Menninger Foundation and the Menninger School of Psychiatry. I had gone up there to attend meetings and was acquainted with some of their staff, and they were a kind of broadly-based, analytically-oriented, but broadly- based psychiatric institution, that had reached out to cross-cultural stuff and psychosomatic medicine and pastoral counseling. They were very strong in pastoral care, which proved to be one of our strong resources. \n\nI remember you talking about, the first time I heard you talk, was when you talked about behavioral science and family medicine at some meeting in ’73, one of the first ones I went to. And you talked about balance and clinical-pastoral education and all the different resources and stuff and we had a CPE program at Worcester and I had no idea what, exactly, it was and I went back and said, “There are the guys we’ve got to get involved.”\n\nYeah, well, Wesley had had a long tradition in the clinical-pastoral education, maybe for 20- some years prior to the mid-1960s where everybody who was anybody in the pastoral care movement had been to Wichita for something that was called Ministers-Physicians Day once a year, and the various people at Menninger’s – Stuart Hill --, Russell --, all of the big names in the early CPE movement. So, I had been involved as…I was the chairman of the Ministers- Physicians Day committee for the medical staff; so I was familiar with some of those people and some of that activity, but that kind of got all mixed up together with what was supposed to be behavioral sciences for --.\n\nWhen did you first realize, in some way, that whatever you were onto was really going to be something bigger than a change in your local situation? I guess, what I’ve been asking myself is where did the kind of connection start to happen between what you were doing and other people were doing and what was happening with a lot of other issues in society and so on. Do you remember when that started to become clear to you?\n\nWell, I became aware of the Millis Committee work through the journal of the Academy, the American Family Physician. So, the…\n\n[End of Side One.]\n\n…Folsom Report was actually a study of health care in various typical communities across the nation, and that report had the largest breadth of recommendations, but when those three reports came out in the fall of 1966, it was like three gunshots, all of whom said basically the same thing: the country needs more family physicians, primary physicians, or personal physicians, and that medicine needs to have a greater community orientation. There needs to be elimination of the internship as a freestanding year. There needs to be coordination of ambulatory training and in-hospital training. We need to expand training from strictly hospital care to include the behavioral sciences, community health skills. So, it was like a revelation, and this occurred in a decade that was a pretty turbulent decade, but also a decade that was pretty optimistic, and a decade that on the whole was a very prosperous decade. This was a time of relative prosperity for the nation.\n\nBut why did you, what always is interesting to me is why did you believe that – I was a medical student then – but why did you believe that people in medical school who you’d maybe been dealing with for a number of years as students, in your office and things like that, would buy into that idea? Did you see it as something that…in order to make residency programs work, you had to have students who would buy into it. Why did you believe that they would? That we would?\n\nWell, I only knew one who said he would, so I designed the program for him.\n\nWho was that?\n\nHis name was Victor Vorhees, who was a kind of a late student in terms of age, at KU. I’ve thought about this many times since, but I think in the most secret places of my heart, I was designing this program for Vic, thinking that he was maybe prototypical. That there was a good deal of student idealism. Kansas, for instance, had always had a, well, for many years it had a required rural preceptorship.\n\nUh-huh.\n\nAs part of their senior medical student experience. There was some evidence of student unrest at various medical schools around the country, that they were manifesting more interested in generalist vocations, so, I guess it was a leap of faith on the basis of very limited evidence, namely, one medical student whom I knew.\n\nHave you told him that?\n\nYes.\n\nWhat’s he doing now?\n\nWell, he is now retired.\n\nReally?\n\nHe made it a rather successful…well, as a matter of fact, he completed the program and directed, was co-director of the Wesley program after I left to go to Alabama for about six years and then he got involved with a health maintenance organization and it was sold and he made a lot of money after 13 years in practice.\n\nAfter ten years in practice you were starting everything all over.\n\nRight. But, as a matter of fact, we did attract the best quality medical students, at least, that I ever attracted within the first five years of the program. Three of the first five residents in our pro- gram were AOAs at KU. There were students who had all been counseled against going into “general” practice, who were told that they were wasting their lives by medical school faculty.\n\nNothing’s changed.\n\nOne guy who had taken out an extra year for pathology and it was thought that he was going to become an academic pathologist and the medical school faculty went into mourning when he chose to come to Wichita and go into family practice. They thought it was a terrible, terrible waste, but these were people who, for whatever reason, were willing to swim against the grain. They had all been advised not to do it by important people at the medical school level, so they were a unique breed of students who…you know, Vic Vorhees, the first guy, first of all had gone to medical school late after he was married, after he had a seven-year career as a high school science teacher; so he’d been doing things that people told him he shouldn’t and couldn’t do for a long time; so family medicine became one more thing that he couldn’t and shouldn’t do. Part of that, perhaps, was the climate of the times.\n\nI had this funny experience up in California that was I met a guy who was practicing up in Ukiah. I think it was Ukiah. Yeah. After this party that – this guy comes up to me. Turns out he’s a cousin of a guy I went to high school with from Milwaukee. He has this Milwaukee accent. He’s been out there for 25, 28 years and he said this wonderful comment. He says, “You know, back then, I’d look at these students. I’d look at you guys and I thought ‘These people are crazy,’ but I realized that for some reason or another you were interested in what I was interested in and I didn’t quite figure it out why and it was one of those things,” he said, “that if you hadn’t done that, then I would have been a dinosaur.” I mean, there’s a kind of, that leap of faith. I don’t know what it was. It was a very strange…\n\nI think even by the mid-1970s we were getting students into the residencies who were more ordinary and less rebellious, because it took a very short period of time for students to begin to see family practice as simply another choice.\n\nUh-huh.\n\nIt was not something you made against the grain; it was just there. You know, “eeny, meeny, miny, moe,” and I think a lot of the fierce idealism was dissipated early, and it became more of a common, ordinary thing to do. But early on, the people who chose family practice were a little different.\n\nOne of the things we’re trying to do is to get some ideas about people to talk to who were around, who were involved in those days in the days of the origins of structure and some of the process around training and stuff, and I have a whole list of people who were at Keystone; so I’ve got those names. Are there other people? Who do you…? I know Ned Burket is somebody you’ve mentioned before, but who were other people, say, after those original four folks that really kept you going, or kept the whole thing going.\n\nWell, I’ve mentioned Lynn and Lee Blanchard and Roger Lienke and Gene Farley, who were the people that I got acquainted with within the first year or so, and Lienke, who was at Oklahoma City, was a rather strong influence on me, because Oklahoma City and Wichita are only, you know, 150 miles apart or thereabouts. I remember going down to Oklahoma City three or four times. Roger was a pediatrician from Minnesota. I think from Minneapolis. I mean, I don’t know what got him interested. I think it may have been Dick Magraw who was a psychiatrist at the University of Minnesota, who had organized some sort of a comprehensive medical care clinic at the University of Minnesota for senior medical students and which he was trying to teach comprehensive ambulatory medicine. There were antecedents to the family practice movement in various medical schools. Cornell had a comprehensive care clinic that was run by a guy named George Reader.\n\nCornell?\n\nCornell. University of Colorado had one that was run by a guy named Silver.\n\nSilver, I’ve heard of him.\n\nThere was another one by…there’s a literature out there. Hammond and Kern are a couple of others that I don’t recall exactly where this took place, and then there was the Harvard…\n\nJaneway, Charles Janeway was the person who…\n\nAt the Harvard Family Health Care Center.\n\nI thought it was. I keep thinking of his name for some reason.\n\nWell, when I first heard about Harvard, I think it was through Lynn Carmichael, and it was Robert Haggerty.\n\nHaggerty was --.\n\nThen I got acquainted with a pediatrician at Yale named Jerry Beloff who published some articles in the JAMA on family health care, particularly on the record. There was a Department of Behavioral Science at the University of Kentucky, headed by Robert Strauss, and I ran across an article by Strauss in a journal that I used to read called The Bulletin of the New York Academy of Sciences or something like that, and he had a faculty of 17 people at the University of Kentucky in the mid-1960s which I think may have been the first or perhaps the only Department of Behavioral Sciences in a medical school in the nation, and purely on the basis of reading an article by Robert Strauss, I wrote him a letter and asked him if he would consult with us at Wesley. You know, a very brash, presumptive thing to do, and I’ll never forget his response, which was very kind and he sent me the Department’s “teaching book” which was the curri- culum of everything they taught at the University of Kentucky and that became my most prec- ious possession, because here was an example, and not only that, he gave me the name – he said he couldn’t come to consult – but he gave me the name of a guy named Gene Gallagher who was a medical sociologist on the faculty of the University of Texas, and Gallagher was my first consultant at Wesley. He came and spent two days and looked over what we were trying to do and said, “What you need is really a psychiatrist to teach with --.” I’ve always appreciated that about Gallagher because he was straight. At that point, I tried to sell the Menninger people on teaching psychiatry in the family practice residency at Wesley. Now, Menninger’s is 120 miles away from Wichita, but I remember going up and spending about three days in Topeka explain- ing and trying to convince them that they should take over this training program and, you know, I really had nothing to offer them, but they didn’t turn me down abruptly. They eventually said, “Well, we’re interested in this, but it’s too far away and we really can’t do it, but one of our graduates is getting out of the Navy and is coming to Wichita in July.” This is 1967. “And he’s trained in community psychiatry and he’s going to be the director of the new community mental health center in Wichita.” That was the heyday of mental health centers; so this person’s name was Gary Porter, and he became, then, the Director of Psychiatric Training for the Wesley Family Practice (Residency?). And quite by chance, in 1968 another young psychiatrist came to town. His name was Dale Gulledge, who’s now on the…he’s a member of the American Board of Family Practice representing psychiatry. He came to the Wichita Clinic, which is a big, multi-\n\nSpecialty group clinic in Wichita, and he had had a year of internal medicine before taking his residency in psychiatry; so these two fellows, Gary Porter and Dale Gulledge, became the behavioral science faculty for this residency and I remember we got probably the first NIMH grant for training family practice residents.\n\nNIMH?\n\nNIMH grant, a grant for $27,000. Probably in 1969 or thereabouts. So, there was a lot of, you know, searching for like-minded people and finding them in strange and mysterious ways. Some close to home, some at a distance. I did a fair amount of traveling. McMaster University was getting started about that time. You know, Canada was ahead of us by probably two or three years in having actually started some kind of training in general practice, as they called it; so I became aware of people in Canada; Andy Hunter, and I made an early trip to London, Ontario, before the days of, I think, before the days of the – Clinic, when Andy Hunter was there, and then to McMasters, Toronto and then down to Rochester to see Gene Farley; so there was a kind of network of people who made acquaintance in the late 1960s who seemed to be interested in the same things.\n\nBut that wasn’t formally any organization?\n\nNo, the only organization was…well, my connection with the bureaucracy was Lee Blanchard, with the educational bureaucracy, was Lee Blanchard, who represented the Commission of Education of the AMA, and that’s where the authority was coming from to transform these 15 programs into something that would qualify people to take the boards that we thought were going to come to pass within the next two or three years; so all those residents who came into the programs in those days were betting on the outcome, but it was very exhilarating. \n\nYeah, really. I mean, it’s really hard to understand how all that energy got generated, because there was a lot of energy. You can’t, the thing that is most stunning to me to this day is to look at that graph. You know, when you graph out the exponential increase. I mean, it wasn’t just something that worked its way along over a period of 10 or 15 or 20 years. I mean, it just took off and it wasn’t really clear why, what all the forces were coming together.\n\nAnd, then, you know…well, once the Academy of General Practice decided to get off the dime and support the Board, then they also moved to hire the first full-time director of the Division of Education who was Johnson, Thomas Johnson.\n\nRight, right.\n\nAnd I have some notes in my files. The first Directors’ meeting for all the people interested in family practice education at that time was originally planned to be in Wichita, because I was interested in getting a Sears and Roebuck Foundation grant to support an educational meeting, and when Tom Johnson was appointed, the focus of that got shifted a bit…we had the first one in Kansas City, but it was sponsored partly by Sears and Roebuck Foundation grant money, because at that time the Sears Foundation had a program of sponsoring medical office facilities in rural cities.\n\n-- rural health.\n\nYeah, so I think the first workshop for the new style family practice educators was held in Kansas City in probably ’69, ’70. I’ve forgotten exactly when it was, but the Academy then quickly became the focus of energy to get people together and to talk about “how to do it.” And there were not only these 15 programs, but then others started joining in. I think we have to remember that there was a reservoir of GP residencies throughout the country. There were also some experimental family practice internships of two-year duration around the country. I think the, you know, the sad state of affairs of general practice education had been apparent for most of the 1960s and that the AMA Committee on Medical Education had addressed that in a number of more or less desultory ways, but they had appointed the Sperry (?) Commission in the early 1960s. You know, the Millis Committee was appointed in probably – I don’t know – 1963 or ’64. The Willard Committee about the same time or maybe a year later. But those committees had been going on for at least three years, so there was a certain ferment. I was just unaware of it. \n\nWell, that’s a good start. What we’re playing around with is trying to see…\n\nMIT and Harvard types. A guy named Rashi Fein, F-e-i-n, wrote a book called The Doctor Shortage.\n\nHe studied at Chapel Hill.\n\nAnd there was a book by David Rutstein that was very influential to me, that was called The Coming Revolution in Medicine, published in 1967, I think. And I believe he was with MIT.\n\nYeah, Fein was down at Chapel Hill and then he finished his dissertation and went up to Harvard.\n\nI would say The Coming Revolution in Medicine and Ferment in Medicine were the two most important books I read. Then I got acquainted with the literature of the comprehensive health clinic that came into the medical school – Silver, and Reader and Hammond and Kern.\n\nHaggerty wrote something. I found this…Haggerty wrote a piece in ’69, on medical schools and community health centers. It was in the New England Journal. They talked about we have to experiment by getting out and working with communities and things like that.\n\nAnd Lynn was familiar with Haggerty, but I didn’t know anything about him yet. Still I’ve never met him to this day, but Lynn talked about Haggerty, and Joel Alford.\n\nUh-huh, and Charney?\n\nWell, Alford more. It was Alford who, I think, was a contemporary of Lynn’s in the Harvard Family Health Program. \n\nRight, I think they…\n\nAnd then Jerry Beloff was at Yale who had been on the faculty at Miami, right?\n\nHe was one of my teachers when I went there.\n\nI visited Jerry Beloff in New Haven.\n\nI visited them in Miami.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/278319#t=0.0,1948.616"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/283348","type":"Canvas","label":{"en":["Media File 2 of 2 - Stephens_G_87_b.wav"]},"duration":1551.15118,"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/3180/collection_resources/150923/file/283348/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/283348/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/283/348/original/Stephens_G_87_b.wav?1753286331","type":"Audio","format":"audio/wav","duration":1551.15118,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150923/file/283348","metadata":[]}]}],"annotations":[]}]}