{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/9w08w3b119/manifest","type":"Manifest","label":{"en":["Dr. Larry Green "]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eThis is an interview with one of the most productive and visionary leaders and thinkers in family medicine. Dr. Green's experiences cover his involvement in the specialty since its early days. He relates the experiences that led him to do many of the things he did. He met some of the important \"fathers\" of family medicine early in his career and they helped convey a vision of what the specialty could become. His leadership includes serving as president of the American Board of Family Medicine, the Association of Department of Family Medicine, and the North American Primary Care Research Group. His interest in practice-based research led him to form the Ambulatory Sentinel Practices Network while he was chair of the Department of Family Medicine at the University of Colorado, where he spent 25 years of his career. He was recruited to take a leave of absence from his Colorado position to serve as the first director of the A AFP's Center for Policy Studies in Family Medicine and Primary Care (now the Robert Graham Center). He is a prodigious author and much sought-after speaker. He is always in the mix whenever a group is assembled to discuss the future of the specialty. This is a fascinating, in-depth interview with a storied contributor to the history of family medicine. \u003cbr\u003eLocation: Colorado \u003c/p\u003e (summary)"]}},{"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":["2012-04-26 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Michael Deavitt (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family physician","family medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["Larry A Green, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eThis is an interview with one of the most productive and visionary leaders and thinkers in family medicine. Dr. Green's experiences cover his involvement in the specialty since its early days. He relates the experiences that led him to do many of the things he did. He met some of the important \"fathers\" of family medicine early in his career and they helped convey a vision of what the specialty could become. His leadership includes serving as president of the American Board of Family Medicine, the Association of Department of Family Medicine, and the North American Primary Care Research Group. His interest in practice-based research led him to form the Ambulatory Sentinel Practices Network while he was chair of the Department of Family Medicine at the University of Colorado, where he spent 25 years of his career. He was recruited to take a leave of absence from his Colorado position to serve as the first director of the A AFP's Center for Policy Studies in Family Medicine and Primary Care (now the Robert Graham Center). He is a prodigious author and much sought-after speaker. He is always in the mix whenever a group is assembled to discuss the future of the specialty. This is a fascinating, in-depth interview with a storied contributor to the history of family medicine.\u0026nbsp;\u003cbr /\u003eLocation: Colorado\u0026nbsp;\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281632","type":"Canvas","label":{"en":["Media File 1 of 4 - 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Do I have your permission to record the interview?\n\nYes, you do.\n\nWould you please give your name in full?\n\nLarry Alton Green. \n\nWhat is your present title?\n\nProfessor of Family Medicine at University of Colorado and have the good fortune of being an Endowed Chair that is called the Epperson Zorn Chair for Innovation in Family Medicine and Primary Care. \n\nAre you married?\n\nI am.\n\nWhat is your spouse’s name?\n\nHer full name is Margaret Joyce Lull (?) Green and she goes by Margie. \n\nHow did you two meet?\n\nWe met during my freshman year in college. \n\nWhen and where did you get married?\n\nWe got married in 1971 in Houston, Texas. \n\nDo you have any children?\n\nWe have two children. \n\nWhat are their names?\n\nNathaniel Alton Green is my son and my daughter is Katherine Noel Green. \n\nWhen and where were they born?\n\nNathan was born in Van Buren, Arkansas in 1976. Kate was born in Colorado Springs, Colorado in 1980.\n\nWhat do your children do?\n\nGood question. My son is basically an entrepreneur. Sales person, runs his own business. It’s an S corp called New Level Radio. My daughter is actually at the moment, between jobs. She is an artist and has been working, actually, in public health in the malaria vaccine initiative and survey development for the CDC. In this time of stress for government and the recession, that contract played out. She’s presently pursuing, quite enthusiastically, to work with the Smithsonian in Washington, where she lives.\n\nFor some personal information on yourself, when and where were you born and where did you grow up?\n\nI was born in Ardmore, Oklahoma. Just about the only person in the family not born in Texas. Thirty miles across the Red River. That is also where I grew up. I lived there until I graduated from high school and went to college. \n\nWhat year was that?\n\nI was born in 1948. \n\nTell us a little bit about your family. What are your parents’ names?\n\nMy mother’s name was Mary Lou Gaunt Green and my father’s name was Thomas Alton Green. He went by his middle name, Alton.\n\nWhat did they do for a living?\n\nMy mother, her principal employment was as a school teacher. She virtually loved teaching first grade. My father initially taught school and at that point in east Texas, with a new baby, my sister, he concluded he couldn’t make a living that way and went to work at the post office. Thirty-plus years later, retired from the Postal Service system as Director of the Postal Services office for Oklahoma, Kansas, and Nebraska. My mother also retired from teaching when she was about 65. My father stayed in the U.S. Navy after World War II, in the Reserves and also retired as a Navy Captain. After he did those dual retirements, he spent about 15 years building houses. He’d buy land, get water and electricity to them and build a house. He’d do about one house a year, he’d just do it all. He was quite a carpenter, plumber and electrician. \n\nThese houses that he built, were they for people in the area or was it just to develop the land?\n\nHe enjoyed building things, particularly building houses so it was just a post-retirement way to stay busy. He loved to work, loved to exercise and you get a lot of exercise building a house. He would sell a house and make enough money off of it to buy what he needed to build the next one and turn a little profit. He supplemented his income that way also. To say that he did it to make money post-retirement would be a miscommunication. He did it for the love of making things. \n\nWas this also in the Ardmore area or where was this located?\n\nHe did most of this in Oklahoma and east Texas. He built the house I grew up in from using lumber milled from timber on the farm he grew up on. He also built two houses that my mother and he lived in after their retirement in east Texas. One was a lovely home on a gorgeous lake and then yet another one in a smaller town that they lived in until their older years. \n\nWould you consider your parents to be your role models when you were young? Or did you have any other role models when you were growing up?\n\nYes and yes. Feel very fortunate to have had the parents I had. I think the key things they role modeled was a respect for education and a very strong work ethic. Also, they had grown up in a strong religious tradition and they felt the church was quite important as a community institution. All of that was role modeled for me throughout my life and I’m grateful for that. An additional role model really, I grew up in the town of my paternal grandparents, living just a few blocks away. My maternal grandfather also was a good and gentle man. \n\nI’ll ask you about your grandfather in a second. You had mentioned that you also have a sister. Do you have any other siblings and do you want to talk about them briefly?\n\nNo, I have one older sister, six years older and we have the same birthdate, born six years apart on the same calendar date. I think it would be obvious for most folks, a girl going into a young woman, six years older than a boy growing up, when she was 12, I was 6 and when she was 18, I was 12. That led to just the sort of relationship you would expect. We were not ever in the right age group to play together. She adopted my parents’ love for teaching and education and spent her whole life teaching school and just loved it, was an outstanding teacher in Texas. She married a teacher and was also a musician. They’re still alive and live in Grant, Texas. They have two children, one of whom is a family physician and one of whom is a mathematician.   \n\nDo you want to tell us a little bit about your grandfather as well? You said he was a gentle man.\n\nHe was just a great grandfather for a young boy. He did a lot of things with me. Living as close as he and my grandmother did, I never had a babysitter the whole time I was growing up. If my parents needed to be out at night or something, I would stay with him. He was just always very kind and very nice. Took me places, taught me how to fish, took me to the circus. We’d play dominos, checkers, work out in the garden, grow bantam  chickens, get in trouble together, make my mother mad wondering why a grown man would let a boy do what he was letting me do. We were good friends. \n\nI take it some of the adventures you had with your grandfather, you probably have certain memories or stories from your childhood. Would you care to share any of those with us, anything that stands out to you?\n\nNo really dominant, particularly constructive stories. Examples are going fishing, saying we would be back by dark and getting back at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281629#t=0.0,660.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281629/transcript/81603/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"at night and always annoying my mother. I always enjoyed it. This is back when Barnum \u0026 Bailey Circus came to town on a train and they had circus grounds and they put tents up we’d go. Being a five or six year old boy in southern Oklahoma and having a circus in town with cotton candy and elephants was great fun. Very entertaining. He loved roses and had quite a rose garden and he loved to read. Many, many people I’ve heard throughout the years, talk about the National Geographic. The way they smell, the print and the ink. I think he read every National Geographic published during his lifetime. I have fond memories of sitting in a chair in his living room with him reading and talking about stuff, showing me stuff in those magazines. I think my penchant for reading, to some extent, comes out of that relationship. \n\nI was going to ask if you thought that sort of relationship and the love of reading, if it had any effect on you, but it seems like you already answered that question. Did you have any sort of goals or special dreams when you were growing up?\n\nProbably no and yes. I had a relatively idyllic childhood, in my opinion. I was in a loving family, I never felt insecure, was never hurt or abused, always knew I was cared for. We were, I think, a fairly typical American family post-World War II, trying to live a good life, improve the family’s position. We lived in a little two bedroom, frame wooden house that my daddy built. When I was growing up, my dad would repair cars, repair radios, build stuff to make supplemental money and pay bills. We were a lower middle class family, cut the parents right off of assistance farms, trying to create advantages for the family. I guess my dreams growing up were just to be able to get a good education, have a good job, make a good living for family. Not very sophisticated at all, very fundamental. On the other hand, my parents held very high expectations for achievement and I was quite fortunate, I had a reasonable head on my shoulders and had the ability to think and learn and was a good student. When I was in school I had aspirations to excel, wanted to do something that was hard to do, that was meaningful and would make a difference for people. So I did have a dream of becoming something that mattered. In a small Oklahoma town, physicians were held in very high regard and revered. They were easily the most educated people in town so I respected that and it seemed to me that being a doctor would meet my criteria, my dream of doing something that mattered and would be challenging. From very early years I felt being a doctor was a good idea. I attended public schools in Oklahoma. These days a lot of people have great concerns about public education and public schools and think that a private education is essential to achieve. I totally disagree with that and am totally grateful for the strong public school system that I attended for twelve years. The teachers were simply fantastic and they challenged me in many, many ways. ---- to those teachers, created an expectation that I could be whatever I wanted to be if I just did the homework. Then I had a family doctor who was the family doctor. In fact, I had to go to medical school before I realized that there was anything other than a family doctor. I had no family history of doctors and really no physician mentor or tutor that would say, you can be a psychiatrist or a urologist or whatever. All the role models were family physicians and I just thought that if you were going to be a doctor, that everyone would want to be a family doctor. I came to that honestly and openly just by being a kid in Oklahoma and I’m grateful for Dr. Cunningham who was our family doctor. Whenever I got sick, he was the person I saw. When my mother or sister or dad needed anything, they would call his nurse who was the mother of one of my two or three best friends that I grew up with. That really cemented, in my mind that it would be a good thing to go on to be a doctor. \n\nWas Dr. Cunningham the only physician in town or were there other physicians if someone got really sick or needed an operation?\n\nThere were other physicians in town at a small community hospital. ---- local board of directors but most of the doctors were GPs and most of them did surgery, so for surgeries like tonsillectomies and appendectomies and gall bladders, the GPs in town were doing that kind of work. If you got sick you went to the ---- clinic in Temple, Texas or to Oklahoma City or to Mayo Clinic. \n\nHow far away were these places from Ardmore?\n\nOklahoma City was about 100 miles, Temple, I don’t know how far away, probably about 250, 300 and May Clinic, 1,000 miles. \n\nSo you were pretty isolated in a way.\n\nThat’s what it sounds like but you’re only isolated if you feel like you’re isolated. I never felt isolated. \n\nI’m going to circle back around real quick and ask a little bit more about high school. You talked about the public school system and how good it was. What was it about the school system that impressed you?\n\nI’m sorry, I didn’t understand. \n\nYou mentioned the public school system that you went to growing up and how the teachers emphasized the importance of studying and doing your homework and that you could achieve great things if you applied yourself, if you studied hard and did well. What kind of impression did that make on you?\n\nAgain, I had no comparison, had no alternative. I didn’t know any other way. The impression it made was, it was very consistent with the classic American dream. If you try, work hard and play by the rules and apply yourself, America is a place where you can be what you want to be and fulfill your dreams. That permeated the school system from soup to nuts, from first grade to graduation. The teachers were…this was not a tiny town but it was a small enough town that there was a strong sense of community. To illustrate that, when I was ten years old or so, my two or three friends and I would get on our bicycles and we’d ride all over town for two or three hours. No one would have any clue really where we were or what we were doing but it was safe and no one thought anything of it. Wherever you went in town, there’d be someone who knew you. It was a strong community. The school system was an absolutely critical part of that, the hospital was a critical part of that, the churches were a critical part of that, the Lions Club. It was that sort of an environment. Excellence and achievement was admired and respected, rewarded, talked about. As a kid growing up there, if you were caught in the act of doing something that you shouldn’t be doing, chances are your parents were going to know about it by nightfall. And if you were caught in the act of doing something right, chances are your parents are going to know about it by nightfall. A lot of immediate feedback. Teachers really matter and probably just dumb luck, but the teachers…I had four outstanding English teachers in high school for each of the four years. I had a Latin teacher, I took four years of Latin in this Oklahoma school system and tested out of ten hours of college credit in Latin when I went to college. The math and science teachers were just outstanding. The chemistry teacher pointed me toward a National Science Foundation summer fellowship sort of thing that landed me up in Northwestern University when I was a junior in high school at the Engineering Institute. It was that type of school system and those types of teachers and the trouble they create when ---- see the state of public education here, really needs attention. \n\nIt doesn’t seem to be the same that it was. The other people that have been interviewed in this series have kind of touched on the same topic, that there was this real emphasis on education. You had communities, the people and the different institutions, they sort of looked out for each other and they strived for excellence. They wanted to push children and students to do well. There doesn’t seem to be that as much today as there was thirty or forty years ago.\n\nI think that sounds like other interviewees and I would agree about that. To just add to that, there was the expectation that we’re sort of all in this together. \n\nUnfortunately you don’t see a whole lot of that nowadays. That’s sort of getting off topic. We’ve talked about high school a little bit and we talked about the teachers. Are there any particular teachers, someone that stands out to you? You mentioned this engineering program in Northwestern. Science program, sorry.\n\nThere are a handful of teachers I can still name that had a large influence on me. There was a lady named May Ross and she was my first grade teacher. She was just fantastic. Meeting my mother, going to school, she just made me feel welcome in school and helped me learn and seemed to be able to match what we were doing up to what I could do and always felt safe and welcome and respected by her. I think we’re all lucky if we get off to a first start in first grade. I mentioned these English teachers. There was a woman named Kaylin Dupree, she probably made me think more than any other teacher in grades one through twelve. The math teachers and science teachers, they were just so good. They could teach, they could explain geometry, they could explain physics, they could explain chemistry and they were patient with you and work with you and help you do experiments and learn. The band teacher, a guy named Albert Fitzgerald, he expected you to practice and know your part and show up and rehearse. Marching band season, you were supposed to be out there on the field on time and dressed properly for it and supposed to memorize the music, you’re supposed to have it memorized. All these teachers, I remember, they had expectations and made them clear to us as students and they expected you to meet them. When we did it, they basically rewarded you with their respect. \n\nIt sounds like the teachers, all of them did a good job of preparing you for what you experienced later on in life, college and adulthood. Do you want to talk a little bit about your college years? Can you tell us where you went to college and what you majored in?\n\nI went to the University of Oklahoma and majored in Psychology. I majored in Psychology because it was interesting, for one thing, but more importantly, it was just practicality. By virtue of taking relatively heavy class loads and also getting advanced credit for stuff, I was able to graduate in three years. The graduation requirements for Psychology could be met with what I’d done in the first couple of years, so in the third year, amongst a number of acceptable choices to me, I could complete the graduation requirements for Psychology and graduate three years later with a Bachelor’s degree with a major in Psychology and go onto medical school. \n\nYou already had things planned out a little bit by the time you were in college, you had already planned on going to medical school?\n\nYes and well before that. By the time I was in third or fourth grade I was on the lookout for anything better than being a physician. Just wanting to be a doctor. I would do whatever the next step was in becoming a doctor. \n\nSo you knew, basically by grade school that’s what you wanted to do for a living.\n\nI didn’t really think about it as a way to make a living, it just seemed to me that it would be a challenging thing to do that was worthwhile. As I matured and grew up, coming into high school, I realized that I really liked art and music and I really liked science and I really liked people, I enjoyed being around people. Being a general practitioner in a community just looked like it was a very obvious union of all of those opportunities. There were no dissenting votes, no discouragement. It please my parents, grandparents and my teachers, mothers, they thought that was a good idea and they reinforced that idea. Once I got started it sort of came along and it sort of stuck. Of course in college, I was blessed with being able to be a good student. College professors ---- complete sense too and would help.\n\nSort of off subject a little bit. What about the professors you had in college? Do you want to compare them to the high school teachers in any way? Any differences you saw? Anything like that?\n\nI don’t think I can name a single college professor. I didn’t have the sort of personal relationship with college professors. And it was a different style of learning. It was a large public state institution and a lot of classes with 300 or 400 people in them. Again, I’m enough of an introvert and I learn very well by reading, looking things up on my own. I don’t really have any comments to make about college professors and any great influence on me. I remember and really appreciated a geology professor, learning about geology and how interesting he made it. Also a sociology professor who really introduced me to the powerhouse influences that social and economic circumstances have on all of us as individuals and our families. In later years, I was quite grateful for the perspective ----. Doing college in three years also meant that I really never stayed in any particular class, so I started in one class and graduated with another one. I had acquaintances and friends across…I was always sort of betwixt and between. \n\nYou graduated from University of Oklahoma. Where did you go to medical school?\n\nI went to Baylor. \n\nYour specialty, did you go immediately into family medicine?\n\nFamily medicine, when I was starting medical school…I started medical school in 1969 and that’s the year the American Board of Family Medicine was established. Family medicine basically did not exist in medical school. In fact, Baylor was like a ---- highly specialized medicine already. (Inaudible) so medical school had almost no connectivity to family medicine or general practice. The main connections were professors telling you that it was a huge mistake and that it should not be done. Part of their job was to protect the public from general practitioners. \n\nThese other professors thought that this new specialty was a mistake?\n\nAbsolutely. \n\nWhat was their rationale for that? Did they ever go into any real detail about why they thought there shouldn’t be this new specialty?\n\nRemember, there’s a pretty reliable history here that I think explains why that’s the way it was. The specialty movement in the United States actually began in the 1920s and really picked up steam in the 30s then World War II comes along and being a specialist in the military was a lot better than being a general medical officer. And then NIH gets funded to support biomedical research in a way that’s unprecedented. All of these developments coalesced from the 1950s to just being the age of medical specialties right and left. Specialized knowledge was developed around an organ or a particular disease or particular treatments. The fundamental intellectual idea was medicine’s knowledge base was expanding so rapidly and there was no choice but to specialize. Anyone who didn’t specialize was condemned to mediocrity and its agency. People who were professors at the medical schools were the products of that and they were masters of narrower and narrower slices of medicine and the science underlying it. It was just incomprehensible to them that anyone with a thirty- or forty-year career in front of them would do something so retroactive, to aspire to going back to being a general practitioner when they’d just escaped from the throes of general practice. \n\nSo being a general practitioner or wanting to specialize in that was almost considered taking a step backward it sounds like.\n\nMore than that, it was a mistake. A personal story that is absolutely true and unexaggerated. After starting to go into family medicine and going into match, to match into a family medicine residency, when the Dean’s office learned of that, there were two or three of us that were interested in family medicine. Larry Culpepper, Chair of Family Medicine, just retired Chair of Family Medicine at Brown, he and I were in the same class at Baylor and we both wanted to match in family medicine. They were very displeased with that. Basically we were summoned for corrective counseling. I got sent to the Chair of Internal Medicine. It’s 2:00 in the afternoon, I have very clear memories of this. He was very nice and gentlemanly about it, very paternalistic and fatherly about helping me avoid going astray here. After re-explaining my misdirected ways and why it didn’t make sense and how I would be able to complete for residencies in just about anything and I could do this or that and I really ought to go into internal medicine and he would help me, quick, quick, do what was necessary to recover so that I could be in the Match properly. Forty-five minutes of that and I told him I have my mind made up, I want to do a family medicine residency. It was like a switch flipped and he got upset, got angry. After another five or ten minutes of trying to insist that I change this, just completely exasperated. Got up and took me to the door and told me that I was making a huge mistake, explicitly said that I was on the verge of wasting a Baylor education and then as I walked out the door he said, “You know, we just made a mistake in letting you enter this medical school.”\n\nHe actually said that to you.\n\nYes.  \n\nWhat was your reaction?\n\nAnother of my character flaws is reverse psychology stuff. If someone would tell me that I couldn’t do something, it got my interest and wanted to see why not. I liked doing it. It really pretty much convinced me that I was onto something. If what I was doing could provoke that sort of hyperbolic response from the Chairman of Internal Medicine, there must be something to it. Anyway, I really hated medical school. My first year in medical school, I went after staying the summer in Queens, in New York City, where I had joined in with a mission group, running a school for immigrants. It was an amazing multicultural community. There were 300 languages being spoken. The idea was ---- during the summer, running a preschool in the mornings and a school, first through sixth grade in the afternoons until 4:30 and then opened up a pool hall for teenagers at 6:00 until","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281629#t=660.0,660.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281629/transcript/81603/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"These were immigrant families with kids and they were trying to work and make a living. With school out they needed a place for the kids and that’s what we were doing. It  was a very rich and rewarding experience, a bunch of college-aged kids, after","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281629#t=660.0,660.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281629/transcript/81603/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":", we’d head downtown New York City and mess around until 2:00 or 3:00, sleep for a couple of hours and do it again. I went from that to basic sciences and drinking from the fire hydrants of physiology and biochemistry and anatomy. I wasn’t ready for it, wasn’t prepared for it. It was very challenging, very hard and by springtime, I was exhausted, tired, it looked like nothing I dreamed of doing or being. I hadn’t seen a patient, studying hard and not always keeping up and not ---- experience. I was a very unhappy person and by the end of the first year I was really very, very serious about ---- that I should drop out. Wise father of mine, when I went home during summer break, just exhausted, he listened to that and instead of trying to talk me out of it, he just said, well, it’s entirely up to you. At that point he was building one of his houses. He tossed the keys to his pickup to me and said, why don’t you just spend the next eight or ten weeks helping me build this house at Fort Towson, Oklahoma on a reservoir? It was a house in the middle of nowhere. All that was out there was peanuts and crows. I spent that summer getting up at sunrise and going to bed just exhausted, building a two-story house, pretty much soup to nuts. ---- my wife at the end of that summer. But at the end of 104-degree days, five meals a day, hard manual labor, I decided I’d go back and try another year.\n\nSo your father convinced you in his own way, basically.\n\nHe didn’t actually convince me, I worked out the anger, I took a break, used the rest of my body, not my brain. It was recreational in a peculiar way. I didn’t like the second year much either, although pharmacology was a lot more interesting. We started our clinical clerkships, we were on a quarter system and in March of my second year, I started on an OB/GYN rotation and by noon that day I was in heaven and really never looked back. I just loved clinical medicine and still do. Anybody who gets a chance to do clinical medicine is a lucky person. \n\nThe summer that you spent, the time in Queens, is that what led you to your residency in New York?\n\nNo, not at all. By the time I got into the third-year clerkships I accepted the culture of the school and advice of my teachers, the residents, all the other students doing the same thing, that there was no hope for practice and really what I should do was go into a specialty. In the second year of medical school I made a living by babysitting kidneys that were destined for transplantation as kidney transplantations were being developed. Tied off dog ureters in the dog lab to make them hydronephrotic and steady hypertension. I debated surgery and I also really liked internal medicine a lot. There were a couple of professors that I admired because of their skill sets in internal medicine. I had it down to going into surgery or infectious disease and internal medicine. I’d gotten married to Margie. From the time she had met me…we married just as I started the clerkships in medical school, she had heard me talk of nothing but wanting to be a family doctor. As this eroded and I headed in this other direction, she was very influential and just basically said one sentence. She said, “I really think you should talk to someone who thinks family medicine is a good idea before you make this decision.” I went to the library, that was back when you went to the library and looked up in the index, the words “Family Medicine.” There were only seven entries that I could find in the previous decade and four of those entries came from Rochester, New York. It turned out my wife had a sister who lived in Rochester. We were not rich by any stretch of the imagination, so between quarters I planned on driving up to Rochester, New York, where I had a place to stay. Looked up the Rochester Family Medicine Residency faculty. I was looking for a guy named Gene Farley, or Jack Froom. Ignorant as I was, I showed up on June 30, the day they were orienting the new residents. I had written them a letter saying I wanted to talk to someone about family medicine in early June, but in the old-fashioned mail system, took awhile for the letter to get there, took a little while to respond to it and they sent me a letter back saying, “Don’t come, it’s a mistake because we just can’t handle this. We’re not in an interviewing season, we have our new residents, we need to work this out some other time.” I’m grateful for their tolerance. They accepted my silly optimism. A guy named David Metcalf from England, who had come from the University of Nottingham to help them develop the residency, was just concluding, was leaving the residency the next week to go back to England. He was seen as expendable. While the rest of the faculty was working with the new residents, he came out and talked to me and shared with me what general practice was like in the UK and Europe and the vision of what it could become in the United States. It was very appealing. As I peppered him with questions he finally said, “Hold on here, just wait.” ---- he went away a few minutes, took me to Gene Farley’s office and told me to sit there and wait until Gene could get free. Gene walked in and as he’s said seven million times in his life, “Hi, how are you?” Sat there. I told him, I’m sorry to bother you, and if he would just reassure me that family medicine was a lost cause I’d be out of his way and he could get back to his residents. He said “Oh no, it’s not a lost cause. Here’s what it’s going to be” and he laid out his vision in about twenty minutes and it was what I’d dreamed of being. So it was a done deal and never looked back after that. Gene told me where to go interview with the intermediate seven programs. Larry Culpepper got him down to Houston, Texas at Baylor and started a family practice club. He was our first speaker ---- seven students out of four classes showed up. Gene thought that was a wildly successful visit and probably was, he got seven recruits. Then I had the very, very good fortune of ---- matching into the Rochester program ----.\n\nSo you were very fortunate, in a way, a lot of different coincidences here that ended up with you going to Rochester.\n\nYes. A father that managed me well and a wife who actually knew me and offered good advice and support and then the dumb luck of running into Gene Farley and the opportunity to ---- absolute first-rate medical school. Seven thousand teaching beds in a class of ninety students, just an immersion in clinical medicine. Super-sick people. I had the good fortune of just learning a lot of medicine and they ---- high level community in Rochester, New York for people who operate ---- specialty worked there. With visionary leadership and effective leadership and wonderful faculty, just a lucky, blessed person.\n\nTell us a little bit about the residency. You mentioned it was 7,000 beds, is that correct?\n\nNo, that was medical school. In medical school there was a class of ninety students and Texas Medical Center…there was only one medical school at that point in time and all these hospitals, they were all part of the teaching system so medical students were just covered up with clinical experience and opportunity. A lot of other medical schools would have 300 or 400 teaching beds and a class of 150. They’d be out doing an OB/GYN rotation and delivered five or six babies, maybe. All of us delivered hundreds. We would do operative OB. I did my surgery rotation with Michael DeBakey. He’s the guy who taught me how you’re supposed to hand a cardiovascular surgeon ---- an aortic valve. We didn’t realize that all the medical students in the country weren’t getting that type of learning. I’m enormously grateful for the educational systems that I went through. Found no complaints about them.\n\nSounds like you had some really interesting opportunities, chances for learning that a lot of other students wouldn’t have had at that time.\n\nAnd through none of my own making, really, just pretty much dumb luck. \n\n(Tape 1, Side 2)\n\nThis is Michael Devitt, this is Side 2 of Tape 1 of our oral history interview with Dr. Larry Green. Dr. Green, getting back to what we were just talking about, tell us a little bit about your residency at Rochester.\n\nRochester was one of the first thirteen or fourteen accredited family medicine residencies in the country. It just struck me as I was thinking about this, in the current 2012 milieu, I’m really struck by how advanced that residency was, how far ahead. The residency I did, the day I walked in I got a partner, his name was Dr. Calvin White, an African American man that now practices in Louisiana. He and I were partnered for all three years. We did our rotations at the same time and the same places, except for ---- we shared a practice. We were in the practice, a family medicine center, frequently, from the beginning of residency until the end. We didn’t have long period of time not on hospital services. We had a practice from the get-go and the residency and the practice was designed so the patients saw us as their doctor. We saw each other as each other’s partner. We did not leave town at the same time for the duration of the three-year residency. We cost-covered each other and saw each other’s patients in the hospital or wherever. We were then part of a team where there were two second-year residents and two third-year residents, our team that we joined as first-year residents. There was excellent [?] practitioner named Barb Arnold that was our nurse practitioner. There was a social worker named Matt Hake that we had access to and a dermatologist that had just retired from the Air Force, an internist, pharmacologist available to us. You get the picture here. That was all well-organized and well-run. The four teams were architecturally [?] the ---- center, had our own receptionist, her name was Phyllis Piager [?]. I spent my whole residency working with those teams and those staff. Now today, where I was yesterday, there are these national calls for each doctor, how to work in partnerships and teams, how to get doctors to work better with nurses. There was no choice, there was no other way, it was just obviously the way to do it. We’re talking about quite a long time ago now. That residency was well-supported by a community hospital and the local board of directors that wanted the residency, thought family medicine was a good idea. The hospital welcomed us and the residents from other fields and disciplines that were working with us, there really wasn’t a hierarchy or a sense of a surgery resident being better than the internal medicine resident, being better than the OB resident and family medicine resident. We were sort of one big happy community. It was just a fabulous experience. Our faculty provided fantastic role models for us. They were all accomplished family physicians who had succeeded in practice. They had different interests and different skills and we took full advantage of that and they were comfortable with it. That practice was geocoded and now everyone’s talking about GI assistance [?] and stuff. It was geocoded and registered by family. All the family’s charts were filed together. They had individual charts, they had medication lists, database sheets, problem lists, all the stuff that EHRs have yet to achieve. It was all on paper and it all worked and it was all convenient. Kept morbidity indices, we had a book called an ebook [?] where at the end of residency you just had a list of all the patients you see and all the problems and ---- registries. ---- index cards, pink ones for girls, blue for boys. Take your index cards, count them up and that’s how many patients you had in your practice. You could see how many males and females. You get the point here. It was a very sophisticated program.\n\nAnd this was all almost forty years ago.\n\nThat’s correct. Gene Farley, I’m forever indebted to that man for his vision, his inspiration, his leadership. I was on his team. He was the faculty member on the team I was with. When he would go off talking, giving talks and stuff, we would cover his practice for him. His patients loved him, you could see that and they would tolerate me. He was my doctor, my wife’s doctor. Later we worked together for years thereafter on various family medicine projects. I had this biological father that was really good to me and a good role model, but Gene Farley was clearly my medical father. If it weren’t for Gene Farley I wouldn’t be talking to you. His wife Lindy, they were inseparable partners. He would be loath to accept any credit for anything but he gets what he deserves and his wife is correct, it’s true. He and Lindy and the faculty he recruited changed my life and set me up to have an absolutely gratifying career. I was well-prepared medically, to go into practice. I had absolutely no regrets, only admiration and appreciation for getting into that residency. The residents were stunning people. Many of us still stay in touch and are friends for life. Our weives and spouses, there weren’t that many women in the program at that point, they became friends and will do things together. Wonderful. I’d do it again in a heartbeat.\n\nYou were able to name most of those people without even thinking about it, you were able to rattle off the name of the receptionist and your partner and all these other people and this was several decades ago. You can tell that it really meant a lot to you.\n\nAgain, I thought all residencies were like that and of course they aren’t. \n\nI have to ask, since you went to medical school and completed your residency during the late 60s and early 70s, did you serve in the military at all during that time?\n\nI did not. I was in college when the lottery was started after difficulties with the draft and the Vietnam War issues and that sort of stuff. At that point in time, if you wanted to be a physician and were making good grades, you’d get deferred. The lottery replaced that with just random luck and I got a high number and I was never…just the timing of how old I was when and where I went to school, the whole Vietnam War situation and going into the military, played out during the course of my medical education. By the time I was done with residency, ready to go into practice, the Vietnam War was ending. What I did, which is related to this, but of course, quite distinct, I would up being a commissioned officer in the Public Health Service. That was an accident. After I met Gene and after I confirmed I was going to do family medicine residency and be a family physician, I really, really, very desperately wanted to serve in an underserved area, preferably a small, rural community. The National Health Service Corps was legislated into existence, I think during the third year of medical school for me and I read about that and heard about it and so tried to sign up immediately because it provided a way to identifying…it would be part of a system or something, that was its purpose. I wanted to go to Oklahoma, Texas or Arkansas and they had hugely needed communities. You could look on the contact [?]: “Immediate doctor” here and here and here. I got all excited about that, but they were badly run, badly operated, underfunded, had very weakened administrative structure. It was very hard to find them and deal with them. They didn’t really have a way to get me signed up except for a program called the Costep Program, which was a commissioned officer program that allowed you to become part of the Public Health Services, potentially CDC or NIH, elsewhere in ---- enterprise. So they sort of signed me up for that and there I discovered that I was a commissioned officer and I discovered that it was very much like current time programs, military programs, that would pay for part of your education in return for service. Talk about being an idiot, I didn’t understand that until…I just heard, can I go to a small little town and work? They said, yes. I said, I don’t really care what program I’m in, so they signed me up. The next thing I knew, I started getting a check each month for about $200 to pay for going to medical school. Wound up being commissioned. After residency, going to Arkansas in the Public Health Service. That’s the only thing like military service I ever did.\n\nYou kind of transitioned into my next set of questions and that was going to be about the NHSC. What was that experience like, going from Rochester to, I think it’s Van Buren, Arkansas?\n\nCorrect. Well, it was absolutely formative. I’ve told many people over the years, I learned more in Van Buren than I did anywhere else in my life. Faster, and the main way I learned was, I made more mistakes in that year than probably the rest of my life put together. I was extraordinarily well-prepared to be a doctor in that community but I was completely unprepared for the culture clash and the reality of Crawford County, Arkansas. This residency I did that, in my opinion, at that point in time, outperforms most modern-day residencies in terms of its sophistication and data management and that sort of stuff. I went from that to a county of 26,000 people, the largest town was 7,600, next was Alma with 1,700 and Mountainburg with 560 people. Everyone else was scattered about the hills and ---- mountains, goes to the Ozarks. The average education level was disputed, but somewhere between fifth and seventh grade. The hospital was under threat of closing. There were three doctors in the county. One of them had a drug problem, one of them was a new Oklahoma, Family Medicine Residency Program, hometown boy and he’d come back home to practice medicine where he grew up. There was a medical father [?] at the county who was a lovely man, not to be disrespectful or unprofessional, but who did not know a lot of medicine. In fact, he had been trying to pass the family medicine exam for a couple, three years before I got there and finally gave up. He never did get board-certified. I and two other National Service Corps folks showed up there together to form a second practice. Neither of them had completed residency, they both had an internship and were doing this before completing training. There had been six doctors in town and 26,000 people and a lot of them were really sick or undereducated. The local politics were well beyond my ----. I just immediately ----, stay Catherine, stay Catherine, stay (?). Very embarrassing. If you were to ask if I’d go back and change something, I would do a better job in Arkansas, is what I would change. I worked with the Robert Wood Johnson Foundation while in residency, to align the National Health Service Corps opportunity in Van Buren with a new program where they were trying to set up countywide or regionalized healthcare systems that would be hospital-based and they were working with this little hospital in Van Buren. RWJ staff and I and a hospital director down there had gotten to know each other in my third year of residency and we had written this proposal and grant together to develop a countywide system. That’s what I wanted to do, I wanted to elevate the health status of that county and make a difference. A few months before my residency was over the RWJ folks called and said they were pulling out because it couldn’t be done and then my character flaw showed up and said, hell, I’ll just go anyway.  It turned out RWJ was right. Anyway, I pointed my word and my newfound knowledge, my youthful enthusiasm on the real deal and did it pretty much all wrong. Within months, I had made so many mistakes and offended so many local people. I didn’t belong. I’d come there from all places, New York and everyone knew New York was a horrible place and I didn’t talk like everyone else, I didn’t look like everyone else and I didn’t practice medicine like they were used to. Trying to do hospital coverage on patients in the hospital ---- about leaving patients covered by the other practice in town that was desperate, the doctors wanted to get some sleep and have the night off and having no confidence in those other physicians. It was a very, very challenging situation. Once I understood it and once I got older and once I had other things that I’ve done in my career, I look back at it and of course I was a total idiot to think there was any chance of doing this. I went eloquent and unprepared, didn’t have the proper health and didn’t do things in the right sequence and the right way. The good news in all of that, the lemonade came out of it. If you can make all those mistakes soon enough in a young career, you get them behind you, you lose your fear of failure and it sets you up very well to do things like become a department chair or residency director.          \n\nSounds like it was a huge learning opportunity for you, however you want to look at it and like you said, it set you up for the next stage of your career. That was at the University of Colorado.\n\nThat’s right. I went from Arkansas to Colorado. The gentleman, Perry Warren, who had been the practice manager administrator for the residency I did in New York, had moved to Colorado shortly before I went to Arkansas. He was developing a number of things with Gates Rubber Company and employer-based health promotion programs. Also with the University with a rural outreach program. I so wanted to work on rural health issues and after the Arkansas experience, I had a very keen appreciation of the size, depth and breadth of the problem.  I decided that maybe a university in a state that had a large rural population might serve as a platform in which I could work on the rural health problem. Again, I have clear and present memories, as the lawyers say. At that point I thought, maybe if I could go work at the University for two or three years I can learn enough to come back and try again. They had a program called Mountain Plains Outreach Program. One late February evening after seeing patients all day, the very last patient had taken the very last prescription off the pad and there was just a little gray cardboard thing sitting there on my desk and I was sitting there, pretty depressed about everything I’d screwed up and all my dreams had crashed around me., it was just a mess. I flipped that cardboard over and wrote on it, “Screwed up, need a job,” put his name on an envelope and mailed it to Colorado. Three days later my phone rang and he said, “When do you want to interview?” A week or two later I flew up to Colorado, spent the night with him, they were just trying to start a Department of Family Medicine and had no residency training family doctors. The faculty consisted of two people and they were desperate. Desperate times, desperate people in desperate situation. Everyone was in the same boat and they just said, “Why don’t we try this out?” and so at the end of that year I headed for Colorado. It’s been my home ever since.\n\nYou had another opportunity and you took advantage of it.\n\nIt was terrific. My first job was helping build a distributed data system amongst rural practices in Colorado’s residency program. Helped develop the residency program, they were just being developed at that point. I traveled the state ----. All about building the infrastructures necessary to be great family docs and take care of communities. I loved it and it turns out I was academically inclined for it. I didn’t know it, I didn’t do proper training, never did an academic fellowship of any sort. It wasn’t like I longed to an aspiration, I just stumbled into it because I wanted to develop ---- and make it better and solve the problems -----. To get that clarity of what you want to do, you can do it a lot of ways, you can do it in Colorado. That first job was very satisfying. It wasn’t that I was so talented or any smarter than anyone else. There were no…the body count was very low. There was a lot of work to do and about three people. If you would step up, it was yours. That’s how I wound up being the residency director ---- in a very short period of time. Somebody had to do it. That’s also how I continued to learn more medicine. Those first years I was on call every other, or two nights out of three with residents of teaching services and again, with my great love for clinical ----. That was a lot of fun. We had great residents and wonderful learning opportunities. I really enjoyed those early days. I’d been on the faculty about ten years before all the residents were older than I was. That was always a little interesting. The residents were quite a bit older than you were.\n\nI was going to ask, regarding the program itself, what types of challenges did you face? Getting it built, getting the infrastructure put together. What types of obstacles did you encounter?\n\nI believe people in Colorado had worked that period of time. I’m pretty sure, not just my opinion, I’m pretty sure they would agree with this. We had two major problems. One was the very, very poor understanding of what our goal was and what family medicine was and what we were trying to produce and do. Very poor understanding. The second was extremely toxic political environment. The Department had been rejected by the medical school as superfluous and a waste of time and not in their strategic plan. What happened was the Colorado Legislature basically shoved it down the University’s throat. The way they basically did it was the Joint Budget Committee basically just killed the University’s budget and ---- and it said, will not be picking up again until you have a Department of Family Medicine at your medical school. About a month later it was Department of Family Medicine at the medical school. It’s a little bit like a stepchild being thrown into a family with twenty other kids that no one wanted. Colorado political ---- University of Colorado had a long proud tradition of being a private school masquerading as a public institution. Almost no funding from the state. To this day, people still think that the faculty are largely paid off of the tax dollars. It’s a good year if we get 10% of our funding out of [the] state. We were not welcome, and yet we had residency requirements where we had to have rotations on internal medicine, obstetrics and gynecology, etc., etc. The going was a little tough and being insinuated into what the rest of the medical school thought were strong programs and had a future, versus a new weak program that they had to help in spite of the fact they knew they were wasting their time. That kind of environment. It was not all that easy. What could happen was the Department of Internal Medicine could see this as a feeder system for them and their subspecialties and to provide a new set of bodies to cover inpatient services so that they could provide more electives to internal medicine residents. As long as we would sort of be their colony it was okay. Pediatrics had pretty much the same attitude. When I became a residency director, again, not being well-culturated to the respect that department chairs are attuned to, I just pulled the residents off their services and put them I a teaching practice the way they were supposed to be doing and the way they had to do, to learn how to be family doctors. The main challenge I had was fighting wars. The war of inserting ourselves into the mainstream of medical school. That took awhile, both as a Program Director and as a Chair.    \n\nWhat was the reaction when you tried pulling the family residents, the students? How did the other departments react to that?\n\nMost of them just reacted like normal politicians, let’s see what’s possible, we’ll work something out. Pediatrics threw us off their services for seventeen months and wouldn’t let any family medicine resident into a pediatric service. And then their own residencies opposed it, they wanted the family medicine residents back and finally their program director and chair was in hot water internally and so they let us go back.\n\nYou told me a little bit about the types of patients, maybe that you saw at Colorado, compared to the patients that you’d seen in Arkansas.\n\nIt’s amazing. People the world over, from the Ukraine to Australia to Colorado, we’re all Homo sapiens and we are much more alike than different. Medicine has many, many similarities sort of, no matter what. People are people and trying to create advantage for themselves, trying to have a decent life. Most of them have two kidneys, etc. The patients were more alike than different. But what was distinct really comes from two things. One is, my practice was always part of the University and universities attract different people. Two distinguishing features of university practices that my practice expressed was, we had poor patients that couldn’t get care in the local community ---- University in some way. Then we also had really well-educated patients among the faculty and residency students and the nurses that were on campus and part of the University. We would have well-educated and advantaged people and we’d also have very poor, disadvantaged people. I always really liked that, enjoyed that, having just a very rich biopsy in the human condition of life. It was like living a novel every day. The second feature was, part of our identity and character was caring for the underserved populations and immigrants as they came to Colorado and often had very challenging times getting care. Prior to the collapse of the former Soviet Union, our residency was sponsored by the hospital. It had been created decades before by the Jewish community, rights, wrongs and some portion of the circumstances. It was an outstanding teaching hospital. There were very strong Jewish community ties there and the Soviet Union would release Russian Jews in a program that they developed in the 80s. These people were usually old and very sick. They shipped them to three cities in the United States and Denver was one of them. Very quickly, over a period of a couple of years we got 400 or 500 Russian or Ukrainian Jews in our practice. Then as the years went by, their families came and when things changed politically, just south of where our practice was for years there was a community of 15,000 Ukrainians. Because people appreciate health and they really need it, our practice was a reliable target for those people as they acclimated to the U.S. Our practice also had this peculiar Russian, Ukrainian population. With the migration into Colorado of people of Hispanic ethnicity, also a very interesting, diverse population that came through. Just a wonderful practice to be in. I was there for twenty-five years. I know that most Chairs disagree with me about this, but I thought that it was really, really important for the Chairman of the Department to have a practice and to continue to be someone’s doctor. I saw patients four days a week, not for whole days, not for half days even, but I had some appointment hours four days a week all the time I was Chair.\n\nYou mentioned that you really enjoyed the clinical aspect of medicine. What was that like? You still got to see at least a few patients each week, sort of keep your feet wet, I guess. You must have enjoyed that part of the practice as well.\n\nRight. One of the distinguishing features of family medicine training programs are that almost all patients get two opinions and sometimes three or four. I’m a sucker for learning and it was always a rich learning environment. I was always surrounded by smart people who would help me think through a problem. It doesn’t take you very long when ---- education to realize the students keep getting smarter and the residents keep getting smarter and pretty soon, you’re learning more from them than they are from you. I really enjoyed that.\n\nYou talked to me about learning here. How did you learn to be a program director? When you were putting the program together and even after it was up and running, who did you turn to for ideas on how to improve the program or who did you talk to about past experiences? That sort of thing.\n\nRemember, there weren’t very many people that had any past experience with the family medicine program. That’s the problem with innovation, you can’t find someone that did it before, so there weren’t a lot of those folks around. The real answer to your question is through trial and error and then phone calls to the men, they were virtually all men, who had waged the fight to establish family medicine. Called Gene, called Tom Nicholas, called Neil Chisholm and he’d talk to you about a problem. There was a lot of craftsmanship in it. Like being an apprentice. You call them and ask them how to do it. Very rapidly, as we developed other family medicine residencies in the state, we talked to each other. There was an informal club that we set up. What happened when you did that? We’d sit down and have a cup of coffee or on the phone. That’s how it happened.\n\nWhat was your biggest pleasure or satisfaction from your experiences as a program director?\n\nThat’s easy. It’s watching the residents learn how to be a great family physician and graduate and go out and take care of folks. It’s hugely satisfying. They tend to be very, very nice people who are very smart. It’s the association with the residents and having the privilege of creating the infrastructure and the situations under which they can learn and then watching them take advantage of that and realizing their aspirations. It’s very, very satisfying.\n\nWhat about disappointments? Any that you experienced during that time?\n\nOh sure. The gap between what was possible and needed and what we could actually accomplish was a constant disappointment. Starting at the end of the 80s, into the 90s, the failure of healthcare reform and the dissolution of any hope of a properly organized and balanced healthcare delivery system was just devastating. The return to the marketplace fee-for-service, a specialized free-for-all was just antithetical to what they were teaching people to do. Watching that play out, right to the president ----, watching that lead to a low performance, high cost, ineffective healthcare delivery system. To have that happen on your watch and knowing what to be done to contravene and abort it has been a huge disappointment.\n\nWhat do you feel that you did right as a program director and why and what do you feel you may have wrong as a program director and why?\n\nI have a suggestion. Why don’t we switch out Program Director and turn it into Department Chair?\n\nOkay.\n\nMy real answer to the Program Director is a little arrogant. I think what we did right is, we established the programs, we made them pretty darn good, we graduated good docs and overcame the obstacles. What we did wrong was not very much. We pretty well got it right, in my opinion. It’s a different story for chairing.\n\nIf you could, what’s the difference between being Program Director and then having the responsibility as a Chair? What different responsibilities or difficulties do you face as a Chair of a department?\n\nA Program Director really has a product line of business, they produce family physicians and they may use their infrastructure for other purposes, just to train medical assistants or something. Their world revolves right around just the residency, its requirements and the residents. When you get a resident and you graduate them three years later and you stay accredited and you haven’t broken any laws and your sponsor is happy, you’ve done your job. A Department Chair is actually the CEO of a business that has multiple production lines and is responsible for the production of knowledge, production of physicians and the provision of service and the maintenance of the institution called the University. Wildly different and hugely more complex. Is that a fair answer?\n\nYes, definitely. This would probably then tie back to the question of what you feel you did right as a Chair then and why and what you feel you may have done wrong.\n\nI think what I did right was I picked the right battles. There were lots of them. I think what I did wrong had to do with pacing. I think I wanted to get to where family medicine needs to be at a rate that the University as an institution, simply could not stand. As a consequence, I sometimes led the Department in situations that made problems and trouble for friends and for ourselves out of my, sometimes, stubborn insistence that it was the right thing to do and they weren’t going to fail doing anything, we weren’t going to put it off for another five years until ----. Very pleased and satisfied with the development of a full-service academic department of family medicine in a research-intensive university. Very satisfying part of my career. I got enormous satisfaction. But your question about what I did wrong, I probably could have stood less ----. There were alternative tactics that could have been used. When I dissect on it and reflect on why I didn’t take those, it mostly came down to patience and wanting to be a little more aggressive and do it now rather than later. Rather than giving the environment longer opportunities to adapt. A very concrete thing that is a huge disappointment to me was that I was not able to salvage a sophisticated health information system that when the ---- practice plans hit the universities and computerized billing and all that stuff happened, we had been operating for seven or eight years, a very sophisticated data system that allowed us to know who our patients were, who had what problems, what services they were getting, who their doctor was, what practice they were in, what the system said about it and do a comparison ---- effectiveness ---- had 86 registries, summary service reports and ---- service reports and then we got the new electronic record systems that couldn’t even get the bills out right and we lost all of that. I failed at being able to keep that piece of the infrastructure in place. It supported our predoctoral programs, our residency and our research. It really, really hurt. It was a major loss and we still haven’t recovered from it. We still can’t…they have not yet restored the University of Colorado’s Department of Family Medicine to have the research capacity along those lines that we had in 1989 ----.\n\nDo you think that’s had any sort of effect on patient care or anything along those lines?\n\nOf course, to the extent that improving patient care requires measuring stuff and describing what’s going on in your practice and being able to audit it. It set ---- back. Now we have the AAA (?). Everyone has been on the phone ----. It’s coming together. I was at a policy forum in Washington, DC yesterday afternoon where one of the podium speakers said, “We have got to get to the point where doctors can know who their patients are and what their problems are and what services they provide” and he’s exactly right. Then he turned around and said, “The problem is ----.” That’s really the main regrets. I will talk from now until midnight about all the wonderful memories I have of that.\n\nThat is actually one of the questions, if there are any other stories from your work, either with the residency program or as Chair that you would like to share. This is an opportunity for you as well.\n\nI think I’ll decline to pull one of many out there ---- more credence than any other. Just a global statement that I hope people realize what a privilege it was for us guys that were in the first round of residency training family physicians. We had opportunities to build and develop things that were important and unprecedented. Those important opportunities attracted wonderful people My life has been filled with wonderful people working on important problems that really matter to people. It’s been relatively conflict-free in that regard. My stories are about being united in common cause and taking on a problem and wrestling it into submission and having a party afterwards ----. A lot of my stories have to do with particular people. A woman named Linda Niebauer, I met when I just had a wonderful shared life ---- worked with residency students and on projects. Maribel Cifuentes, managing programs. Harry Brown was stumbling around it for years ----. There are just stories galore, just stories galore.\n\n  \n\nIt’s nice having relationships like that, ones that last decades and you get to see the same person and work through those large problems together. That’s got to be pretty satisfying.\n\nIt is.\n\nIf you could do it all over again, or if you could start from scratch and do things differently, what would you change?\n\nI wouldn’t change much of anything. I wouldn’t wish it on myself to live that year in Arkansas again but it proved so valuable that I’m hesitant to say that I would want to go back and erase that and not do that. I’m not being cavalier and I’m being cute or trite or unreflective. I am very satisfied with my career. I would be happy to do it again. I’d be happy to do it pretty much in the same sequence and be happy to do it in the same places, I’d be happy to do it with the same people.\n\nWould you like to start over again now, with all of the advances in technology and all of those new developments that have occurred? Or would you have preferred to go back to the same exact time?\n\nI don’t have any desire to go back to the same exact time. I wish there was a magic wand that you could pass over me that would extend my lifespan such that I could have another 35 years to develop family medicine and primary care, to improve population ----. I would love to continue working on it. It’s just full of opportunities. There are technologies and there are now knowledge available that make it plausible and possible to ---- performance on, in ways…if I had to go back to 1970, we wouldn’t be able to do that, that would be very frustrating. What’s really going on here, in my opinion is, we are in the last days of Phase One of Family Medicine in the USA. It was a forty-year run and that phase is over. We are now well into, or a few years into Phase Two and it has many of the same characteristics as the beginning of Phase One, many of the same challenges. The difference is, back then there were no departments. Back then there were no residencies. Back then there was no undergraduate family medicine curriculum. Back then there were not 81,000 board-certified diplomates of family medicine. Back then there were no microchips, there were no computers. Back then we didn’t know about the genome. Back then…it just goes on and on. We didn’t have the pharmacopeia we have now, we didn’t have the diagnostic tools, we didn’t have the social science knowledge base we have. We now know how to change behaviors. It just goes on and on. To be able to do a Phase Two in family medicine would be an enormous gift. I would take it immediately. If you’ve got that magic wand, come by.\n\nI’ll see what I can do for you. If it’s okay, there are a group of questions that will cover other aspects of your professional career. If it’s okay, we can start to talk about those a little bit.\n\nOkay. \n\nOne of your first chairmanships was with a group called the Ambulatory Sentinel Practice Network. Could you talk a little bit about that group and the role it plays in family medicine?\n\nSure. APSN was born at the University of Colorado in the Department of Family Medicine in the late 1970s. The Department had built this wonderful urban, rural data system I described before in the Mountain Plains Outreach Program and demonstrated the feasibility of a regional practice-based network that did research, ask and answer questions about patients and problems and work with family doctors. Gene Farley, my medical father and the Director of my residency, had been recruited to be the Chair of the Department of Family Medicine, here in Denver, at the University of Colorado at that point. I had been recruited as I described before. His arrival was just full of the likelihood of vim and vinegar enthusiasm. We were dreaming big dreams and had large aspirations. Gene said, “Why don’t we see if we can take what we know about these networks and turn them into a single practice system?” Others of us looked at systems in Europe and elsewhere, particularly United Kingdom and the Netherlands and he was kind enough ---- junior faculty member named Larry Green, “Why don’t you take that on and see what you can do?” He was good ---- department chair in a hospital environment. So he let me do that, another reason I’m forever grateful to him. I went to work on it and through the North American Primary Care Research Group, we found some kindred spirits, seven or eight of them from around the country. We started by developing prototypes, a model for a prototype, national network and we initially called that work the Ambulatory Sentinel Practice System Network project or something. Some long name. NAPCRG said it was a horrible idea and told us we should kill it. We came back and worked on it another year, took the critiques on it seriously and made some changes and we went back again and they said, you know, we might be able to do that. We established an interest group that NAPCRG…and that interest group served as a steering committee to develop what later became known as ASPN. A guy named Milton Seifert, from Excelsior, Minnesota, named it one day in the basement of the Department. He said it’s kind of cute to have an acronym that spells ASPEN in the state of Colorado. That’s how it happened. It took off. We recruited 38 practices from regional networks. Maurice Wood, down in Virginia and folks all over the country. Some from New England around the co-op practice. This one still exists today. First thing you know, we had 38 practices that were doing research. Over the next decade we basically tried out every research method known to God and worked with most federal agencies and most foundations to do projects of various sorts. It was the first national practice-based research network in the United States and it then seeded the second one, which the American Academy of Pediatrics developed, called PROS, which still exists, still operates, still has the same director that it had when it was started. We had ---- Haggerty, a pediatrician, famous, wonderful pediatrician ---- ASPN and we basically just ---- file to the Academy of Pediatrics ---- and they ---- our first five years in the states. Then one of our jobs for the next two years was regional departments, chapters of the AAFP and others would call up and say, how do you start a network? We didn’t know that we should start a business and charge people, we just did it. It basically spawned Practice-Based Research Network years later after we managed to get a federal agency created to work on network and take primary care seriously with research ---- later became known as AHRQ. AHRQ took practice-based research on as a prime ---- and now they have a regular stream ---- the networks to do practice-based research ---- just announced today their first grantees. All of those, in part, grow from the root of deciding that there were important questions in practice and the methods of science could be applied here as well and that they could never be answered in the hospital or in the academic centers and that the research enterprise had to move out into the community and out into doctors’ offices. It ---- weird and strange now but in the 70s, that was just a rotten, lousy idea that made no sense to anybody. Research could be done in the average ----, they could get it right, they would then instruct the family doctors what to do and then the family doctors would do it. When the ivory tower learns something new, they should change it, they would call them up and tell them that they need to change their practice. Of course, we know now that you can’t do that. It doesn’t work, it’s a totally failed strategy. That’s what ASPN was all about. It was impossible to finance so the Department of Family Medicine, University of Colorado, basically footed the bill for us in various ways over the years. That really explains why I wound up chairing the steering committee. When we incorporated it ---- when we hired Paul Nutting…Paul Nutting is our…he was our second…I’m getting old. Larry Lutz and Paul were the first and second hired directors for ASPN. We had the cash flows and the revenue streams that were sufficient to basically have hired staff. But this woman, Linda Niebauer, she was really the mother of ASPN. It was through her good graces and unbelievable skill set that it actually came to be. Linda and Larry worked together on this, initially under Gene’s auspices and when I became Chair, we still did it under our auspices. It was a wonderful ride. One of those things that you look back over with enormous satisfaction. Take an idea that is thought to be almost impossible and perhaps unnecessary and eventually prove that it can be done, demonstrate it can be done and then to apply it in different ways and actually develop knowledge and realize that it does matter and it is important and then have it replicated. ---- it’s all over the world now. To this day, our phone rings and someone in some country or some state wanting to know how to get started. \n\n(Tape 2, Side 1)\n\nThis is Michael Devitt, this is Tape 2, Side 1 of our oral history interview with Dr. Larry Green. Dr. Green, you were talking about ASPN.\n\nYes, to close this out, I just will mention two other things that might be noteworthy about this when reviewing about the historic development of family medicine in the United States actually. After initial successes and early publications, the Kellogg Foundation saw a great opportunity for this type of research network to be a bridge into improving community life in communities. They really liked it a lot. That was where the first big funding for practice-based research came from. A nurse named Helen Grace was our project officer and we thought we’d gone to heaven when we got the support of a big, national foundation and to some extent, we had. That allowed us to really expand the recent stuff, the number of studies being done. Then as foundations are known to know, they change directions. The portfolio that we were in, their board of directors discontinued it and literally a couple of weeks before they were going to renew our funding, and this was back when $1 million was actually a lot of money, a renewed $1.5 million grant that’s going to start in two or three weeks and we had to work for three or four more years lined out. They basically called up and said it was dead and it wasn’t going to happen. We had payroll to meet. That was pretty challenging. Anyway, to cut to the chase, Bob Graham at the American Academy of Family Physicians and Nicolas Pisacano, the CEO and President of the American Board of Family Medicine, were kind enough to take calls from me and when I explained our situation, both of them just wrote us a check as transition funding until we could get another grant, another contract. Otherwise it would have died then. We’ll be forever grateful for those two organizations and particularly the leadership of those two men and I think it’s quite ironic that a decade or more later, ASPN, after it was spun off as an independent corporation and really had nothing to do, technically, with the Department of Family Medicine other than good will and good wishes and shared goals and interests, projects, it got into financial trouble and the American Academy of Family Physicians bailed it out. Basically, while it wasn’t conducted as a bankruptcy proceedings, it had some of the features of that so they sort of acquired ASPN and then renamed it the National Research Network. That network is ASPN II, operating this afternoon, they’ve been wildly successful, $20 million in grants and contracts, I think last year. Headed up by Dr. Wilson Pace, who was a resident in Rose Residency Program when I was the Residency Director and he was a faculty member when I was the Department Chair, and is here a faculty member here today. He operates that for the Academy and spends quite a bit of time in Kansas City with Network staff there, there are quite a few of them. His office is around the corner from me here. I think that’s a very interesting blip.\n\nAnother one of the organizations you’ve been involved with is the Association of Departments of Family Medicine. You were on the board for a number of years and served as its president from 1987 to 1989. Can you tell us about that group and some of the major accomplishments of that organization?\n\nSure. Have very fond memories of that group. Earlier in the interview you asked about when we were first starting residencies, how did we learn how to do it. I’ll just bring that question forward to this part of the conversation. The ADFM, basically was a place where you could go as department chair, to get some help. At that point in history, mid-80s, there were many fewer departments than we have now. It had become clear that it was quite a different enterprise from developing a residency. ADFM was very, very important as a watering hole and sort of functioning like a club where you could stumble in and out of the rain and they’d throw you a blanket and they’d hand you a beer and sit there and warm you up. It took chairing seriously so it was really fun to be part of that organization. Tom Nicholas and…I’ll think of his name when I quit trying, momentary. The founder of it replaced Nick Pisacano as the head of the ABFM, Paul Young. And Paul Young had started ADFM and I was happy to join in as a young chair and having someone like him and others to talk to. Joined the group and it had to have a little bit of governed structure and it was lightly governed, [not] micromanaged and it was easy to be on the board and easy to continue it. After being on their executive crew for awhile, they needed someone to be their public policy representative and I’ve always been interested in policy. I’ve gone to the Family of Family Medicine as many k now, is called the Working Party. So I’ve stayed associated with that group for quite an extended period of time, from being on their executive committee, being an officer, being a president, past president and then later on, board member that represented them to Family around policy issues.   \n\nSomething I really enjoy recalling is Jim Puffer, who was the President after me. He and I really cemented our friendship there. We’d been introduced by Nick Pisacano when we were just kids. We really cemented what’s been a lifelong friendship, through ADFM. I was with him yesterday, for example. He’s now President of the American Board of Family Medicine and I’ll see him again Saturday night at the American Board of Family Medicine Foundation meeting. We’ve slain a lot of dragons together. That all grows out of ADFM and that type of friendship and support that ADFM provided to department chairs back then. I’m very happy to report that that’s not what it is today. I would be hugely disappointed if it had remained that way. It’s not really quite a sophisticated organization. It’s filled a huge educational role for chairs and provides a powerful voice for family medicine nationwide that we would not have if it weren’t for our chairs in that organization. It’s quite different now, but for that period of my life, I think it’s most accurately characterized as being part of a small club that needed each other.  \n\nSo it’s different but in a good way.\n\nRight. \n\nYou were also president of NAPCRG, North American Primary Care Research Group, and you joined that organization back in the mid-70s, 1976. Not a whole lot of people know about the organization. Could you describe the organization and what it does in the context of family medicine?\n\nSure. Actually millions of people know about NAPCRG and the majority of the people that know about it are outside of the United States. It is known worldwide at this point as the premier primary care research organization on the planet. People, when they have an annual meeting, people from at least twenty countries will show up. It’s 40-something year at this point in time, but it, like ADFM, started as sort of a club for that small number of family physicians in the U.S. that understood research was going to be important to family medicine. I’ll say this very bluntly and I’ll have to beg forgiveness for anyone that it offends in any way and sometime in the future. Frankly, the American Academy of Family Physicians was anti-intellectual and it played such a key role in getting family medicine started in the U.S. We’re so occupied with meeting the needs of the communities and people and actually taking care of folks that there was great disregard for research and development like that. That necessitated that there be some other place to go if you wanted to get serious about applying the methods of science to study family medicine. That’s really what NAPCRG was. It’s a source of great satisfaction to me that Gene Farley, Maurice Wood, Jack McDowley (?), some of the real giants of family medicine’s history, formed that out in Virginia and New York. Ted Phillips out in Seattle joined in with that group. Some of the real leaders of early family medicine started NAPCRG. Maurice Wood deserves all the credit for doing what it took to see that it survived in managing it. He basically was its President and leader for about 25 years and he still attends meetings now and is still vibrant and vital and full of energy and ideas and unanswered research questions. NAPCRG now is a watering hole for people worldwide. Some of our youngest and best family physicians and the most intellectually inclined and the ones best trained to do research, they have reunions there. They’ll buy out a restaurant, go to a bar and sit down together for 30 or 40 people and close it down talking about their work and their projects. It is simply, at this point in my life, if I’m going to go to one meeting a year, I have a dilemma. I have to decide if I’m going to go to the annual meeting of the Institute of Medicine or if I’m going to go to NAPCRG. I’ve only missed a couple of those meetings since I was born, professionally. It’s a wonderful organization and it’s designed to meet the needs of researchers. That means it respects --- it welcomes ridiculous ideas it expects the issues of errors and bias to be addressed and it’s always looking for a new idea. It is just a fantastic place to be. I look back over my career and there’s no organization I have greater affection for.\n\nThe Center here is actually planning on doing an exhibit, a presentation on NAPCRG for its 40th anniversary, I think in October or November, so you’re always welcome to contact us and see if you’re interested in helping out with the exhibit or if you have any questions about it, you’re always welcome to let us know.\n\nThat’s great. Stacy is fully endowed and whatever Stacy says is the thing to do, is the thing to do. \n\nWho is Stacy?\n\nShe’s the Executive Director of STFM, which is the managing partner for NAPCRG. Stacy oversees a delightful woman in a position that actually runs NAPCRG from an administrative point of view. It’s got an international board of directors and an intergenerational board of directors. Has very young people and very old people on it. \n\nLet’s talk real quick about the Robert Graham Center. You are the Founding Director of the Center. Can you tell us how that agency came into existence and what role you played in it and how the Graham Center has affected the practice of family medicine?\n\nThat’s a lot but I think I can do it pretty quickly. One caveat, make sure you ask Robert Graham the answer to that questions, as part of your historical interviews. As is always true, we only see the part of the event that we participated in. He could augment what I’m about to say, but my version of this history is that Bob Graham was the difference-maker for the AAFP, bar none. He really turned the AAFP into an important national, international organization. Visionary leader who’s a very effective administrator. On his watch, he recognized that the advocacy role of the Academy would be well-served if it had better knowledge, better information about what lay beneath the surface on policy issues and what generated conflicts and what options were viable and not viable and projections of what would happen if we did A versus B and those sorts of questions. We had no one that knew how to do that kind of stuff, so he thought they should have a policy center with research capacity to do that. He was never able to see the Board or get the funding together to do that for extended periods of time. There was a lawsuit about unrelated business income and a potential tax liability related to the journal that the Academy had been publishing that got the Academy’s attention. They, with good reason, started budgeting money to pay off a big tax bill, should that prevail. Then they disputed the IRS claim and over a period of time, I don’t recall exactly how many years this worked out. They had put in the bank enough money to pay off the tax bill, should they have to be required to…then they won the suit and Bob was sitting there looking at what was undesignated money and he put the undesignated money together with his idea about a policy center and took the idea back to his Board. The Board of Directors approved the idea. Then they set about trying to create the Center and I had a very tangential role there in that I agree to help them find someone to direct it. I did, I sent him some terrific people and helped him recruit. At the end of the day, the search committee could not find anyone to hire, that wanted to do it, that was willing to do it, I guess. Dr. Graham, being the persistent soul that he is, relayed this to me again and sort of gently laid out that maybe I should consider doing it and I was happily ensconced as the chairman of a very successful department in my favorite place, Colorado, having a wonderful time and I saw no reason to screw up my life by taking on the establishment of a very high-risk proposition that had never been done before, in Washington, DC, a place I’ve visited forever but where I didn’t want to live. A little more time went by and with continued failure, eventually one day Bob Graham called and said, basically this: “I think this is just not going to happen. You’re going to have to live with the fact that you could have made a run at this if you’d wanted to.”\n\nHe said that to you. He tried to guilt trip you.\n\nYes. Going back to that phrase, clear and present memory. The message is absolutely correct and accurate and true. The precision of those words may be a little off but the message was clear. You got the idea right there. A little bit of a guilt trip. He was frustrated. He was really frustrated because he knew what an opportunity it was. What happened was, that night I went home, was living about ten blocks from City Park in Denver, Colorado. After dinner, I asked my wife, Margie, would you like to go for a walk through the park again, we did this often. She said sure, so we took off, we walked around the lake there at the park, probably a 45-minute walk. At the beginning of that walk I said, I want to just ask you for your reaction. What if I were to resign as Chair and worked in Washington for awhile? She asked a bunch of questions and by the time we got back from the walk Margie said, “I think we ought to do this.” So I called him back the next day and said, “How do you vet me for this and what do we do?” So I had to go and meet with the search committee, negotiate a budget and all that sort of stuff. Took a few weeks and I took all of this out of sight and no one in Colorado knew what was going on. It was a done deal before more than about ten people knew about it. Came home, announced my resignation effective right away, got a search committee set up to replace me. That year I worked forty days for the Academy to prepare for it and then I left the chairmanship when Frank deGruy was recruited in here. Lived in Washington for two years to start it, created just a stunning group of people, Lisa Smith from the American Legion in Indianapolis, Ed Fryer from the University of Colorado, an analyst, a statistician, a brilliant man who can make any data set sing. Found Sue Dovey down in the University of Dunedin in South Island in New Zealand. The four of us went to work on that thing on June 8, 1999 and we were in print, had our first accepted publication in August and had our first two interns by August. One of those was Freddie Chen and now is a senior advisor to the director of ---- and another one was Bob Phillips who is now the Director of the Graham Center. We simply had a blast. Never had a more productive period in my life. Literally hundreds of publications that we turned out of there over the next five or six years. After living there full-time on leave of absence from the University of Colorado for those two years, I went back on the payroll of the University of Colorado and they sold me back to the Academy to keep doing it part-time. Over the next three or four years, went from sort of three-quarters in Washington, one-quarter I Denver, to half in Washington and half in Denver, to a quarter in Washington to three-quarters in Denver, then I backed out and Bob took it over and lived happily ever after.\n\nA couple more organizations to ask you about. The American Board of Family Medicine, you mentioned them previously. You were Chair of the Board of Directors on that group from 2009 to 2010. What memories do you have of that organization?\n\nThat is the most effective, presently, most important family medicine organization in the United States, bar none. It is the best-run, has the best business model. It is in charge of setting the standards that family physicians have to meet to call themselves a board-certified family physician. It has fully digested, understands and is committed to the founder’s vision of family medicine and family physicians. Everything it does aligns with that vision and mission and they’re just wonderful. I can say that now without hesitation because I’m no longer a board member, I have no fiduciary obligations there at all. I’m a has, was, board member there. It is simply a stunning organization. It’s a source of great satisfaction to me that through such a short period of its history, I had anything at all to do with it. Very proud of that. Looking back at it, feel like I would have missed a huge satisfying part of my career if I hadn’t been lucky enough to participate.\n\nThere’s also the Future of Family Medicine Project and you were on the steering committee that helped develop that. Who came up with the idea of the Future of Family Medicine Project?\n\nLike most ideas, it has multiple paternity. I’m quite clear about how it happened. This is a result and consequence of the Graham Center’s creation. After Bob Graham left the Academy, he took a sabbatical and spent that sabbatical at the Center. At that time it was not called the Graham Center, it was called the Center for Policy Studies in Family Medicine and Primary Care. Bob and the Graham Center crew are holding fort there together. We had our first couple of rounds of policy writings under our belt and it was quite clear to us that family medicine was in a lot of trouble, in a world of hurt and it was also clear to us that this was not well-recognized or appreciated and a lot of people were just trying to get through their day and run their organizations. We got to talking about what can we do about that? What we knew about it was organize a meeting that built off of Gayle Stephens’ Keystone meetings. He had done two of these, Keystone I and II in Keystone, Colorado. With his permission and with his help, took the name and organized what was called the Keystone III Meeting. The Graham Center ran that meeting and organized it. Bob Graham emceed it, the Keystone Quartet organized it, that was John Frey, Gayle Stephens, Bob Graham and me. Out of that meeting came several publications, a book, all sorts of things, but a fundamental realization that the future of family medicine was insecure and that we’d better reassess and get very strategic if the aspirations of family medicine were going to be realized and the benefits to the public that really lay at family medicine’s doorstep. Those were going to be realized. There was a duty to get going and the get going got called the Future of Family Medicine Project. The AAFP was funding the Graham Center and had a sense of ownership of the Graham Center’s ---- and were receptive to this. Doug Henley made it a priority issue, so the next thing you knew, the Academy was putting millions of dollars on the table to organize a project to study the future of family medicine, thus it was formed. A group was put together to steer it and I was one of that group, then it was organized into five task forces. The first, Task Force 1 as it was affectionately called, was the task force to study and develop a new model of practice. I chaired that one. That was some of the hardest work I’ve ever done in my life. Just an outstanding committee there and it was multidisciplinary outside of family medicine. We had the benefit of the contracted quantitative and qualitative research that was done by a Madison Avenue/42nd Rockefeller Center crowd. Did marketing research and they aligned with Greenfield Associates for the qualitative stuff. When we got the results of this research, bottom line on it was, there was no future for family medicine, but the Academy just could not digest that, nor could the rest of the Family. The bottom line got digested into, there is no future for family medicine unless we immediately and rapidly do some serious redesign work, which was, I think a really good way to frame it. That really came out of the Future of Family Medicine. The other task forces recognized that we needed to do repair work on the residencies and do a better job with research and leadership. That all got written up and that is really the roadmap for family medicine this afternoon. We’re still living off of that exercise and it’s been now, a little more than a decade. It’s my opinion and I sense that other people are beginning to realize that it’s time to revisit that and take stock again and see how we’re doing. That’s what that was all about. That new model of practice got branded and renamed the PCMH.\n\n           \n\nNow you’re talking about the Patient-Centered Medical Home model.\n\nThat’s right, which is a temporary code for modernized platform for the primary care function. That’s the platform off of which modern, outstanding family physicians will operate. A conclusion from the FFM work was, they will not be able to execute the work of the best family doctors if the practice itself is not redesigned. That’s been very hard work and it’s still hard work and it’s going on, we’re never going back, the boats have burned, that PCMH model is emerging, it’s going to continue to emerge. It will be the platform that the family doctors in 2025 will be operating it, driving it like a high performance jet airliner or something, and looking back and saying, those guys back in the 80s and 90s, they were total idiots. How did they think they could possibly be a good family doctor going about it the way they were? We’re betwixt and between right now. The old model isn’t dead, the new model is not fully functional, but it’s coming and it will happen. \n\nThis model might be the wave of the future in the same way that the residency program that you intended was decades ahead of its time.\n\nActually, catching up with that program. That’s right. \n\nTaking a look at your CV, there are, even in addition to the organizations we just touched on, there are several others that you’ve been involved in, either as a committee member or director or executive. Would you like to discuss any of them? Are there any accomplishments or memories that you have from being a part of some of these other organizations you’d like to talk about?\n\nI’d call out two. One that we haven’t talked about is the World Organization of Family Doctors, WONCA. It’s a rather old, international organization that is still trying to find its way. I’ve never been a director of it, but I have been an advocate of it over decades and it has been important as a way to connect up to ideas from outside the United States, where in many instances, general practice is stronger and where they have systems that are different from ours from which we can learn. That’s an organization that I’m just grateful exists and that I had friends in. The last three presidents have been personal friends and I just wring out of them everything I can. That wouldn’t be possible without that organization, so I’d call that one out. \n\nThe other one is, you really can’t be a director of it, the Institute of Medicine is an independent, non-governmental organization in Washington. It has an elected membership. I was very fortunate, very lucky to be elected…I was pre-medicine (?), I was relatively young. That put me in touch with outstanding scientists and policy people and thinkers for the last 20-plus years. I’ve served on several of their committees, testified before their studies. I’ve been on their membership committee. It’s an outstanding organization that I’m honored to be part of. When they call up and ask someone to do work I say, sure. \n\nWhat role does the Institute of Medicine play in healthcare? Do they help set policy? What’s their role in all of this?\n\nAbraham Lincoln, in 1863, established with enabling legislation, the National Academy of Sciences. An immediate motivator for it was trying to end the Civil War with some sort of new technology and to bring the methods of science to bear on an important national policy problem, called the Civil War. As the decades went by, it was made independent of government. It is not funded by the government. It floats on its own bottom, it raises its own money, but it’s like a country club, you have to be elected into it. The issue is, you get elected into it because of achievement and willingness to volunteer your services. Microbiologists, computer scientists, neurologists, psychiatrists, health policy leaders, family doctors, get elected to this thing. Its structure makes it the most independent organization that cares about medicine or the politics funding and policy of medicine that there is in the United States. It owns itself, it has rigid, very high standards for conducting its work and business. It doesn’t do work for hire. If you want them to study something, you tell them what it is. You may fund it, you may give them a contract to do it, but you relinquish any authority, control over it. What the Institute of Medicine comes out with is what you get, whether you like it or not. That’s its key role in the United States. It basically is the most independent, most authoritative advisor concerning health policy that the United States has. \n\nI just thought it might be worth noting for our listeners, exactly what role they play.\n\nIn the old days it was very unusual, almost unheard of for family physicians to be elected. Curtis Hames was elected early on, Bob Graham was elected early on, Maurice Wood was elected early on, John Geyman, Jack Colwill. But for years there was just a very small number. ---- about a thousand members total, but now there’s 40 of 50 family doctors over this first phase of family medicine, have been elected. It’s another of family medicine’s success stories at the end of the twentieth century, to establish itself as a discipline with leadership and knowledge develop, people developing knowledge that really matters, whereas that didn’t exist in the first half of the twentieth century.\n\nThat’s a good way of recognizing what family medicine has to offer too.\n\nRight. \n\nIn addition to all of these different organizations you’ve worked with, you have also served in a number of teaching positions. Can you describe some of your experiences as a teacher over the years?\n\nI often introduce myself, if someone is trying to figure out what I do, I sometimes say, I spend most of my time teaching. But I’ve never been a classroom teacher, I’ve never been a lecturer and I’ve never really focused on curriculum development for the “Course Number 50110.” Almost all the teaching I do or teaching I enjoy is in small groups or one-on-one, or trying to figure out how to communicate a policy issue. For those three ways, I have spent my teaching career. I really enjoy presenting new information to an audience that is interested in it. Lecture-style stuff, I enjoy doing that and I particularly enjoy doing it with photographs and figures as opposed to words. I’m in love with metaphors to help people know and understand. I just have so many fond memories of being privileged to be a visiting professor somewhere and being invited to lectures, talking about stuff and where they’ll be anywhere from 30 or 40 to 3,000 or 4,000 people sitting in the room. I’ve really enjoyed that. What I have most affection for and what I really prefer is working in a small group of people. Ideally, about six or seven, for most of my career that’s what I’ve done, I’ve worked in small groups and seen teaching as mostly being about learning. I think the best way to teach is to learn and the best way I have of learning is working in small groups. You take the Graham Center. Five staff people and then we would seat that with a young resident or student, some field, a fellow from someplace and they’d come and visit with us, live with us for a month, anywhere from 2-3 or 6-8 weeks, have a deliverable in mind and we would learn everything there was about that deliverable and we would teach each other what we could find out about it and what we knew. I’m very fond of that and still doing it today. I’ve got six or seven projects now that are organized in that same way, small group and we teach each other, that ----, there is just nothing I enjoy more than being with a resident. I like residents better than students. I love being with a resident with a patient. The resident is the patient’s doctor and I love being a direct observer, either behind a one-way mirror or in the room with the resident and just observing and watching what goes on as doctors and patients try to get the patient’s problem solved. I still do that now. They’re kind enough to let me into my old practice ---- residency. Once or twice a month I’ll get to spend some time with one resident and seeing that resident’s patients. Very different ways over the years, but what I’m going now at this point is just between me and the resident. I don’t fill out a report, there’s no scoring here, this is a personal, professional relationship. There is a young colleague here with an old ---- guy who knows ---- you’re knowing about, but just spend a little time with him, with our mission being, after we see a few patients, they’ll debrief together and I will see if I can make at least one, maybe two or three suggestions about how they can have more fun being a family doctor during their career. I find that really satisfying and partly because  the feedback from residents is instantaneous. They like it, they like having someone actually pay attention to them, attend to them and not have their own agenda and not being in a judgmental situation. It’s just an opportunity for two colleagues to learn together. That’s the top floor teaching opportunity I get to do.\n\nYou get to share all the knowledge and the experience that you’ve gathered over the years too.\n\nUsually it’s not very dramatic or very impressive, it’s often, you know, you really ought to hold the otoscope differently or, if you just took the arm of the CRT and pulled it out another four inches and rotated it thirty degrees, here’s what you could do. It’s really little stuff like that, that the residents really like. The very next patient they see the next afternoon in the office or whatever, they often can just try it out. They like that, they like the pragmatism of it.\n\nAnd you’re not being judgmental either, you’re just offering advice, kind of showing them the ropes, in a way.\n\nRight. \n\nIn addition to all the teaching that you’ve done, your practice as a physician, you’ve authored or been the coauthor on a number of papers and different studies and book chapters. You mentioned some of the projects from the Keystone III Conference. What is your writing process like?\n\nGoing back to the beginning of the interview when I talked about those four English teachers, first of all, I’m really grateful that I had a lot of help and a lot of instruction in learning to write. I’m not the best writer in the world by any stretch of the imagination but I can write and I enjoy it, it’s not a burden. There are a lot of doctors that writing is just a pain and that they actually have to create some sort of process or means to sort of force themselves through it. I’ve never had that problem. My main writing process is, I have to get clear about what the issue is that we’re going to write about, or what the question is that we’re going to write about and write the answer to. That is hard work. That occasionally involves taking a few notes or so, writing down on a little piece of paper, sticking it in my pocket or maybe starting on an iPhone or a file on a laptop, notes about a possible paper. That sometimes happens, but most of the time I just think about it. There’s new neurological information coming about how the human brain works. It’s been a bit of mystery and also a little embarrassing and troublesome. But throughout my life I’ve been able to go to bed thinking about a problem and then sleep well and wake up, often having an idea or two about what the solution is, without any effort whatsoever. That’s a key part of the way I write. Once I’m clear about what I’m going to write, if I can sleep two or three nights, I sometimes just wake up in the morning and walk over and I can outline a paper from soup to nuts, it’ll just roll right out of my head and I have no idea how that works.\n\nDo you keep a notepad on your nightstand or anything or do you ever wake up in the middle of the night and all of a sudden you have that idea or that phrase or something like that, for a paper you’re writing?\n\nThere have been two or three events where something was so dramatic that I’d literally get up and write it down but usually it’s just you wake up after a normal night’s sleep and without intending to, you just suddenly realize, I know how to write that. Then I do lots of versions. I’ve talked about two of the most important men in my life, my father and Gene Farley and I’ve talked about my career mentor and the third most important man in my life, that was Kerr White who really invented the terms “primary care.” I met him in NAPCRG actually, when I was still in residency. He adopted me and looked after me and I sort of had a lifelong fellowship with him. He’s still alive, lives in Charlottesville, Virginia right now, he’s 95 or 96 now. He taught me a lot about writing. I remember the first clinical research study out of ASPN, I had been working on writing it up for two months. It was awkward, I didn’t like it, I took it to him and said, help me with this. The next day he sent me an email back and said, this is so bad it can’t be done. Throw it away and start over, which was stunningly good advice. Then over the next few years, every now and then, he would help me frame a paper, get clear about what it’s going to be, write two or three introductory sentences here or there and other sections and then leave me with it. He really was crucial in me learning how to write successfully for scientific audiences and for peer review publication. One of the lessons there is, a lot of people do two or three versions, do one draft, two drafts, three drafts and say, let’s turn this in and get a review on it and then we’ll respond to reviewers. I don’t write like that and that’s because of Kerr White’s advice. He said, you know, don’t send it off until you’re proud of it and then you can use the reviews to polish it and make it really good. I really agree with that, I think that’s good advice. That’s what I do these days. And these days, I’m really much more thrilled to be the last author. I’m a little tired of writing. In my opinion, writing is the hardest work I did in my career. It’s far harder than taking care of patients. Maybe I’m just getting a little tired and little old but I’m much more selective in what I want to write these days. I would much prefer to help teach someone else to analyze a problem and write it up and be in more of a mentoring role and do repair work and just generally support young faculty, young doctors, young PhD candidates, whatever. To help them get their ideas straight and be able to communicate in writing, I enjoy that as a teaching function. For me, it usually took 20-30 versions before it would be good enough. I never found a way to avoid just going back and revising it. Revising the revision and the revision and the revision and the revision. Every now and then I get lucky and about the eighth or ninth time you look at it and you know that’s it. There have been a couple of instances where I was able to write a paper in one sitting. I wrote a piece that came out in JAMA in “A Piece of My Mind” about the first day I was back in my practice after being in Washington for those two years. That paper rolled out of my head in about 45 minutes in one sitting. I did a little bit of doctoring on it, sent it off to JAMA, they took it in about three days, sent it back with just a couple of suggestions and that was it. That was unusual. I bring it out as an exception. Most of the time writing is very hard work for me.\n\nIs there anything that you’re working on now, any papers or chapters that you’re writing?\n\nI usually have about ten papers that are in various stages. I worked on one earlier today, came out of the P4 Project. It’s about time to develop an instrument to measure the identity of family physicians and how it’s formed. We’re a long way away yet to getting that one done and may never see the light again. I’m working on a policy piece, a one-pager that is headed toward the end game, that looks at the quantitative relationships with the way to come up with physicians in the United States and then the way to come up with people. Try to divide by adults and kids. Pediatricians, their growth rate has been 30 or 40% growth rates in the number of pediatricians. That was during the decade when the growth rate of kids actually dropped, it was a negative growth rate. And then they go around and complain that we don’t have enough doctors. We’re going to take a nice, juicy swat at this misunderstanding about the physician shortage in the country, that’s one thing I’m writing now that I’m excited about.   \n\nThe last set of questions, talking about philosophy and just the practice of family medicine itself. How has the practice of family medicine, in your opinion, changed over the years since you first started practicing?\n\nActually I don’t think the philosophy of family medicine has changed. I think what has happened is the implementation strategy has dramatically changed and the environment in which family physicians work has dissolved into an abyss of disaster. What changed since family medicine was born in 1969 is really horrible. Medicine, as a profession, ceased being a profession. Gave away its birthright, handed its license to Wall Street. The hospitals quite being locally-owned and –governed philanthropies and became a principal driver of for-profit business run in an industrial model. Insurance companies became the Bank of Medicine and secured and consolidated most of the capital. Medicine itself fragmented into over 150 specialties that siloed themselves off from each other and started spending time protecting their turf and boundaries. This turned out to be the perfect storm, the absolutely toxic environment to be a family physician. A family physician, fundamentally accepts any problem that a person in their town wants to drag in off the street and present to them. Any problem. They commit to sticking with the person as long as the person wants them to, until that problem is understood and dealt with. A commitment to whatever they need. That’s all relationship-based and it requires coordination and integration of care. When that is done, medical expenditures drop, less care is rendered, costs go down, there’s less need for specialists, etc. That’s what family physicians are good for. During this last 40 years, what the United States has really wanted is not a healthcare system but a wealthcare system. The philosophy of medicine to not serve patients but to serve consumers. Not to say, I’ll take care of you regardless of your ability to pay, but we can’t take care of you until we know that’s you’ve got a credit card and an insurance card with numbers that are currently active. Instead of family doctors being part of a medical fraternity where surgeons and obstetricians and everyone talk to each other, those other branches of medicine, ---- of not dragging anything that was profitable, out of family medicine and turning it into a commodity and selling it. And then they’ve brought the MBAs and the bankers and the accountants in, to establish the biggest, meanest, most successful economic engine that presently exists on Planet Earth and that’s the United States healthcare system. It was recession-proof, it is still recession-proof, it did not shed jobs, it added jobs right through the recession and it’s draining all the money out of the school system, the transportation system, the defense system, parks and rec. It’s awful, what we’ve done. And it is all antithetical to what family medicine was created to do. It’s not what family physicians want to be or do. It puts us in just a horrible position at this point in time and that is not a philosophy of family medicine that changed, that was a national philosophy that said, the most important thing in America is the dollar. What we’re going to do is conduct a competitive game and see who can get the most money. If you lose the game it’s because you didn’t move fast enough, were not adaptive enough, you didn’t deserve to win. Meanwhile, family physicians get up and go to work and they see a young mother with a new baby and the mother is being abused by a boyfriend and neither of them have a job and now the family doctor finds themselves working in a practice where someone, maybe a state, an office that might be 2,000 miles away, saying you can’t see that mother anymore because she’s bad for business. It makes family doctors crazy and this is where their fatigue and depression comes from and why there are so many now, family physicians in their 50s in the United States that are in despair and wonder what went wrong, etc. Actually nothing went wrong with family medicine, what went wrong was around family medicine. Family medicine is stuck trying to be itself in a toxic environment. The good news is that toxic environment has just about run its course. There’s really only one of two choices. We got back to having a healthcare system or the wealthcare system bankrupts the entire country and there can’t be an Army and a Navy. It’s really not hyperbolic, it’s not an exaggeration. You can see the end of the United States in only 30 or 40 more years if we decide that we’re going to spend every dollar on healthcare and on the commodities that healthcare can make for this insatiable desire of people to live forever and get all the healthcare that someone else will pay for. I think that there’s abundant evident right now at this point of 2012 that this has been figured out. The ---- has articulated. We’re not going after a better healthcare system that actually produces value for the dollar and actually improves population health at a rate and level that we can afford, while having money to fund our churches and our schools and our highways, our museums and our ballet companies. This next second phase of family medicine is already proving to be very, very engaging to the brightest and best 24, 25, 26 year olds. They’re much better educated, they’ve got much better tools and they’re ready to rock and roll again. It’s very much like 1969, 1970, 1971, 1972, 1973 again. One of Kerr White’s adages was, it’s very dangerous to make predictions, especially if it’s going to be about the future. At the risk of screwing up and not learning that lesson, I think by 2020, between 2020 and 2025 it will be completely clear to everyone that Phase Two of family medicine is launched and it’ll be thriving, it will be important, it will be fun and it’ll be a privilege to be a part of it. Our young people will flock to it again and people will appreciate it. The old principle, principles that go back to 400 BC, we have a shot at remanifesting them again and stopping the wars among medical specialties and returning to the fundamental philosophical ---- that we exist to solve people’s problems that are health-centered to the best of our ability and use all the knowledge and technology and skills that we are fortunate enough to get to learn. First and foremost to their benefit and their behalf, even if it’s not in our best interest. The restoration of medicine as a profession, I think will happen, I think it will come back.\n\n(Tape 2, Side 2)\n\nThis is Michael Devitt, this is Tape 2, Side 2 of our interview with Dr. Larry Green. Dr. Green, we were wrapping up the interview with some final questions about philosophy in family medicine. What, in your opinion are the qualities that make for a great family physician?\n\nI’m quite opinionated about that, I think first of all they have a broad education. Secondly is they are comfortable with ambiguity and don’t require high levels of certainty. They actually like people, they think people are sort of nice. They’re nice to be a human being and be around them. They tend to be exquisitely good listeners and they avoid being judgmental. That ---- on a confidence that is based on just knowing a bucketload of medicine. They just have to know and learn a lot of medicine. It’s not how little medicine can I know to make it through the day. Really great family physicians have those characteristics, those attributes and features and the with those features in place, they know enough medicine to take any problem of any patient of any age and usually in a matter of minutes, sometimes no more than six or eight minutes, accurately and correctly conclude whether or not there is a problem; if it is, whether it’s an important problem; if it’s an important problem, is it something that medicine can do anything about? And if they can do something about it, be on their way to helping this patient get the help they need to solve that problem. That’s the best family physicians.\n\nDo you think family physicians are born or are they made?\n\nNo, they’re made. We know an awful lot from neurosciences now that every human being is the consequence of an interaction between a genetic endowment and their environment. The twin studies makes that so clear. How is it that two different twins ever can be different? Well the answer is, two individual members of the twin can’t drink the same glass of water. Only one of them can drink that glass of water. As the events of their lives go on, their nervous system actually is designed differently, it reacts differently, the shape of their brain changes. We know this, we all do this. Family physicians are only people, they’re human beings and their capacities, their cognitive and emotional capacities are shaped by the interaction, the gifts they got in terms of DNA they got from their mom and their dad and the trillions of interactions they have on Planet Earth. It’s an acquired skill set. \n\nLooking back over your career, what are some of your fondest memories, personally and professionally?\n\nThat’s really a hard question. I’ve got about a million of them. The day I met Gene Farley, the day I met Kerr White, the way my marriage went. I had good luck for Margie to fall in love with me and live with me and the partnership we’ve had all this period of time, it’s just riddled with memories, day after day, year after year of wonderful experiences shared together and I’m extremely fond of those that include Margie. I have some very fond memories of relief when a very challenging clinical situation threatened a patient and the outcome was uncertain and a lot of self-doubts and wondering if I’ve done enough, done the right thing, done the wrong thing. Doing a lot of “What ifs.” And then watching the patient start to get better. It’s those moments where you realize we’re going to get through this, we’re going to make it. I have very fond memories there.\n\nI remember with great satisfaction and much joy, knowing that ASPN was going to survive thanks to the leadership and generosity of two men. I remember many, many times being surprised by someone who I didn’t quite recognize talking up and warmly greeting me, maybe giving me a hug who turned out to be a student or resident that I’d worked with or someone that was in an audience of a talk or something and said, “I want to thank you for that.” I’m just a blessed person, there’s no way around it. I’ve got lots and lots of fond memories. Conversations with Gayle Stephens, they’re to die for. I can go on forever. We’re getting in trouble here, I will fill up another tape with fond memories so why don’t we call it a day.\n\nOkay.  Just in the interest of being balanced, what about not so fond memories that you would have.\n\nThere have been some patient outcomes that still cause me pain. As we discussed early on in the interview, that year in Arkansas, it cannot be labeled a fond memory but I’m grateful for it, nonetheless. Surprisingly, not very many things come to mind. I think one of my approaches to living life is that if something is going on that’s unsatisfactory, I have a propensity to say, what will it take to recover from this or repair it? I’ve made lots of mistakes and I’ve hurt people needlessly. I’ve discovered along the way that often by directly confronting those situations and taking advantages of opportunities to try to repair them, that you can take things that otherwise would haunt you and make them sometimes turn into a fond memory, where you messed up and you recovered. I have many fond memories of being forgiven. What a great thing it is when others will forgive you for stuff. I don’t really have a long list. I’m not an unreflective person but as I reflect on stuff, as I said earlier, I don’t have a lot of things that I wish I could do over. I’m not looking for do-overs, I’m just grateful for the life I got to live. \n\nWhat’s been the most satisfying part of your career?\n\nNot running out of challenges. \n\nThere’s always another challenge ahead, there’s always another mountain to climb, so to speak.\n\nYes, and never running out of patients. There are always people for whom you can find an opportunity to do something of service. There are so many people who live their lives with restricted opportunities to help others and to work on things that matter. It’s just been so satisfying, where it would be this never-ending story of opportunity. It’s not just challenges, but a problem with a solution ---- not a problem and having a chance to work on problems that you really don’t know if it’s ever going to come out with anything that works, or if you’re ever going to understand this. I think being a physician to extend heartbeats for  hours and days and that sort of stuff has been enormously satisfying. To have the opportunity to do that, regardless of results. A lot of people don’t ever even know what I’m talking about. Source of great satisfaction. Another thing that’s enormously satisfying, I have been intentionally fairly quiet about my family, my marriage I mentioned briefly and talked about my kids briefly. It seems to me that I’ve had colleagues and friends and acquaintances and read biographies and stuff where there’s considerable regret about neglecting a family, enjoyable things, but I don’t have those. I hate to leave it to someone else to ask my children and my grandchildren whatever they feel like they’ve done that corrected (?) them, but when I’ve asked them that and I’ve been present when others have asked them that, I think if anything, they got more of a dose of me than they wanted. I have no regrets about the choices I made with my marriage, spending time with my wife, my children, spending time with them or making choices about my grandchildren, spending time with them and doing things with them. I’m pretty much, ridiculously, regret-free. Family medicine deserves a lot of credit for that. It opened doors and positioned me to become the person I became and live the life I live. Enormously grateful. I’d do it all again. It would be very difficult for life to produce another human being with more enthusiasm for family medicine than me. \n\nYou mentioned a bunch of people over the course of the interview who have touched you over the years, who touched your life. You mentioned your father and Dr. Cunningham early on, Gene Farley, Kerr White. Any other people that you would want to mention briefly or talk about and the impact that they’ve had?\n\nI could run off a list of 30 or 40 I think. Chris Van Weel, Henk Lamberts, John Skinner, David Metcalfe, Walt Reiser (?), Ann McCauley (?), Neil Chisholm, Hank Reid, Jack Froom, Selma Frew (?). I’m a little reluctant to start naming students and residents. There’s a set of residents, Kim Kennedy, just a bunch of them. More recently, the interns and fellows at the Graham Center: ----, Erika Bliss, Jen DeVoe, Sean David and other Robert Wood Johnson journalist scholars, Dick Nicholas (?).  There’s been a group of non-clinician women like I mentioned before, Linda Niebauer and Maribel Cifuentes, Margie Storms, administrators for the Department like Leon Rouler (?) and Anna John. The two deans that really helped me, Joe ST. JUNE (?) and Richard Krugman.  My current Chair, Frank deGruy who was willing to take the Department on ----, friends like Ray Culpepper. All those original ASPN practices, champions for practice patient services, those guys laid down in front of the trucks. They were hugely influential in my life and gave me hope. I’d better quit. I can just go on and on. There are patients I can name that just make life worth living. A mom would call back twenty years later, you’ve forgotten who they are actually, to tell you that the baby you delivered just got a Fulbright or a scholarship to Oxford or got drafted into the NFL. What are those worth? They’re worth everything. Lots and lots of people have been very, very influential. I’m the beneficiary of an awful lot of help in my cooperative collegiate relationships. Kerr White…[      ][….Barbara Starfield, I can just keep going, I’d better quit. \n\nYou don’t have any plans to retire any time soon, do you?\n\nCorrect. I’d probably pay to get to come to work. \n\nIf you weren’t working right now, what would you be doing?\n\nMy answer to that question is, if there’s anything I’d rather be doing, I’m doing it. I blend and accommodate my work demands with other things. If my cell phone had gone off while we were talking and my wife had said, our grandkids are going to go for a bike ridge, I would have shortened this interview to go take the bike ride. I’m not going to wait until I retire to go on bike rides with my grandkids. It’s all about balance and living an organized life and then having people like Margie, my wife, understand you or help you live an organized life. I am presuming that I’ll be unable to do the type of work I do for biological reasons at some point, or that something happens where it’s just not satisfying or there’ll be other needs or other demands like taking care of a sick family member or something where I’ll just say, it’s more important to do that than to continue working on this or that. I’m planning on stopping when that happens. \n\nYou mentioned Margie a lot in your interview. She must really mean a lot to you.\n\nOh yeah. Those of us who managed to have a life partner who understands is officially blessed. Jim Puffer and I were talking about this earlier in the week at the American Board of Medical Specialties meeting. Two other physicians joined in and about twenty other physicians stayed silent. The process declared the truth. If you’re lucky enough for that to happen, you’re lucky. She’s so much smarter than I am, so much more patient and a totally different skill set. We complement each other so well. I’ve got a lot of things on my CV, probably three-fourths of them that if you take Margie out of the equation, they’re not there. They just wouldn’t happen. A guy who wrote “Notes on a Country Doctor,” Will Pickles, back in the 1930s, there was a woman like that named Marty that he basically said the same thing about. Curtis Hames would say that about Betty Hames and Kerr White said it about his wife and ---- about Erica. Human beings are designed for life together and they’re really designed for partnerships. We’re lucky when we take them as they come. Margie is my favorite person in the world. \n\nWe’re lucky when they take us as we come too.\n\nAbsolutely. It’s a deal you make, it’s a partnership, it’s a sharing. It’s not finding a helpmate or someone who will do what you want or what you need, it’s someone that will explore what life has to offer with you. There are many, many similarities between an effective doctor/patient relationship and a good marriage. That sticking with you sort of thing, it’s a promise you make, even when it goes wrong, we’ll get through this one way or another. Very, very strong parallels there. We family doctors who had a couple of beers and are sitting by a fire someplace will talk about it with each other. \n\nAny final thoughts you’d like to add?\n\nWell, I’d like to apologize to you for running off at the mouth so much. I’d like to apologize to any unknown person in years ahead that listens to this and is offended by anything I’ve mentioned. I wish to express appreciation for being invited to do something that’s pretty unusual, to spend right at three hours just talking about oneself in a reflective way. Kind of a privilege to do it, I appreciate being invited to it and want to thank you for it. \n\nIt’s been our pleasure. Thank you again for agreeing to sit down and be interviewed. Really appreciate it and we will make a transcript of this and will send it out to you shortly. We have to send it off to a reporter. Once we have a transcript finalized we’ll send a copy off to you and have you proof it and see if there’s anything else you want to change or add, then we’ll save it for our files.\n\nThank you very much. \n\nThank you.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281629#t=660.0,1387.58646"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281628","type":"Canvas","label":{"en":["Media File 4 of 4 - Green_Larry_Pt2_12_b.wav"]},"duration":1362.45737,"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/153010/file/281628/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281628/content/4/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/628/original/Green_Larry_Pt2_12_b.wav?1752078338","type":"Audio","format":"audio/wav","duration":1362.45737,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153010/file/281628","metadata":[]}]}],"annotations":[]}]}