{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/b853f4nn6k/manifest","type":"Manifest","label":{"en":["Dr. Reid Blackwelder"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer: The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2017-09-08 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Herbert Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians","Family Medicine for America's Health"]}},{"label":{"en":["Subject"]},"value":{"en":["Reid B. Blackwelder, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882","type":"Canvas","label":{"en":["Media File 1 of 2 - BlackwelderReid_01_Access.mp3"]},"duration":2563.2288,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/882/original/BlackwelderReid_01_Access.mp3?1761148319","type":"Audio","format":"audio/mpeg","duration":2563.2288,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882/transcript/85516","type":"AnnotationPage","label":{"en":["Dr. Blackwelder interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882/transcript/85516/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1: Dr. Young: This is side 1 of tape 1 of the oral history of Dr. Reid Blackwelder, a member of the board of the Family Medicine for America’s Health, recorded on September 8, 2017. I’m Dr. Herbert Young, a volunteer at the Center for the History of Family Medicine.\n\nDr. Blackwelder, do we have your permission to record this interview?\n\nDr. Blackwelder: Absolutely.\n\nDr. Young: Could you give us your full name?\n\nDr. Blackwelder: Reid Bruce Blackwelder.\n\nDr. Young: And your present title and position?\n\nDr. Blackwelder: Present title is professor. And while I’m officially still the interim chair, as of today the dean has informed me that things are moving forward, so I am soon to be official permanent chair of the Department of Family Medicine at East Tennessee State University. Also a title that I’m proud of, that I carry along, is past president of the American Academy of Family Physicians. \n\nDr. Young: Congratulations on your new news.\n\nDr. Blackwelder: Yeah, that’s kind of exciting. So it will be in a couple of weeks.  \n\nDr. Young: Tell us about your professional background.\n\nDr. Blackwelder: I traveled an unusual path in that I had never really wanted to be a physician and was halfway through my junior year of college before I recognized that I wasn’t going to be happy doing research and that’s when I applied and went to medical school. I went to Emory which at the time was an orphan school. There was no family medicine. But it’s interesting that my path crossed Dr. Andrew Morley who was a very prominent family physician in the Georgia Academy. I didn’t know at the time and did not appreciate at the time that he was also in AAFP leadership and, in fact, at one point was on the board and likely could have been president of the Academy. So Andy was actually a mentor not only for family medicine but probably planted a seed for some of my subsequent work in the politics of medicine. So I graduated from Emory going into family medicine. I went to the Medical College of Georgia where I did a family medicine residency and there I was blessed to work with another icon in family medicine, Dr. Joseph Tollison,\n\nwho was my chair at the time and he subsequently has been obviously very important in the American Board of Family Medicine. And Joe and I are still good friends and he’s been a profound professional mentor for me. I stayed on one year to do clinical teaching fellowship, then I went to Trenton, Georgia to do a four year National Health Service Corp obligation. I got to be a small town family physician, absolutely loved it. But I didn’t have teaching available to me, so when an opportunity to come to East Tennessee State University arose from a medical school classmate, interestingly enough, who was a surgeon in Kingsport, I came up here and interviewed ’92 and came. Now, what’s also interesting are the little things that do and don’t happen. At the time, I was in Trenton, the closest town to me. The big city was Chattanooga. And there was no family medicine residency anywhere nearby, there was no college of medicine anywhere nearby, there were no osteopathic schools anywhere nearby. And so when I came in ’92 to East Tennessee State University, in about one and a half to two years later both the University of Tennessee and ETSU both opened residencies in Chattanooga. So had the timing been a little bit different, I might well have stayed in Trenton or gone to Chattanooga instead of coming to ETSU where I’ve been now for twenty-five years. So here I was a full scope family physician, still doing OB, until I ran for the board of directors of the AAFP. That’s when I gave up my OB privileges and because of the significant professional opportunities I’ve had through the Academy, I also have now gotten to the point where I’m no longer doing hospital medicine, although that was something I was doing up until about three years ago. So now with a lot of the administrative aspects I still see patients, I still precept but not longer am doing OB.\n\nDr. Young: You mentioned that you were headed perhaps into research before your journey turned to family medicine?\n\nDr. Blackwelder: Well, I was majoring in biology in a little place called Haverford College and I had a chance to work with a remarkable scientist, Dr. Chris Goluff (?), who had done some private work with Genentech which at the time, this is when cloning was just kind of being considered. And I actually took one of the, if not the first, cloning courses offered in undergraduate colleges, especially outside of major institutions. Haverford’s a small Quaker-based liberal arts college. And I was really impacted by the work there and was really moving forward with a degree in molecular biology. But then I realized that my subsequent options were probably a PhD program and doing lots of research and while I enjoyed that intellectually, it wasn’t going to satisfy me. So that’s when I started looking at what would my degree actually do. So I took that degree and decided maybe I would go to medical school.\n\nDr. Young: Were there any other things, back at that point in your development, that suggested you would be headed towards family medicine which at that point was probably not known for research?\n\nDr. Blackwelder: No, it wasn’t. So the research actually, because I wasn’t interested in the issue of whether family medicine did or did not have it, it really wasn’t a part of that process. What was a part of it probably is because I was academically strong and a lot of my high school teachers all say, oh, you’re going to go into medicine. And that rebellious part of me was saying I’m not, which is an adolescent response - when somebody tells you this is what you’re going to do, sometimes you say, no, I’m not. But I also had no mentors in my family. There were no physicians in my family. My dad had done the Medical Corp and had some interest in psych, but he was a high school teacher ultimately by training. So I didn’t really have any medical role models in the family. But I did work for one summer at Grady Hospital as a ward clerk, for a very large, underserved population. That was a very interesting experience that sadly reinforced that many people in medicine at the time were not necessarily the nicest people because I was seeing only one side. When you’re a ward clerk, you’re not the same as a patient. You’re actually picking off orders and watching the interactions and so much of the stereotype of physicians seemed to be reinforced to me. But because of that job, I was the only one who was in the middle of college in that role, so I became an assistant to a coordinator at Grady. And so the subsequent summer she was on maternity leave and they asked if I would take over her role. So still had a summer job as a patient services coordinator which meant I was running the budget for the department, the floor of internal medicine. And the irony of that is that two of the icons of Emory Medical School that I subsequently went to answered to me for some of their budget,  J. Willis Hurst (?) and H. Kenneth Walker. J. Willis Hurst had written the book The Heart. He was the editor of The Heart, a classic cardiology textbook. And so I didn’t know that at the time because I wasn’t planning to go to medical school at the time. But when it came back around, I was suddenly in school, on rotations with these two people who had actually sat in my office to defend their budgets. So it was kind of odd. Very interesting. Yeah, some of these, I hadn’t really remembered these connections until this opportunity to have this conversation. It’s like, wow, these little aspects here and there. So that’s kind of where I came. I was just enjoying college, didn’t really feel strongly to go on to research but enjoyed the intellectual aspects and then looked up and said, oh, my gosh. And what I discovered is that the reward of the doctor in those areas to teach. And my parents were both teachers. It turned out to be a lifelong passion of mine. And so being a physician has allowed me to really walk that talk in many different ways and that’s been the real blessing for me.\n\nDr. Young: When one is in family medicine, many doors open.\n\nDr. Blackwelder: Yeah. And at the time Emory was an orphan school and didn’t want to tell me about it. But once I found it, it was like, oh, my gosh, this is amazing. So, yes, it’s been a blessing in many ways.\n\nDr. Young: Let’s turn more to the current times. How did you get involved in Family Medicine for American’s Health?\n\nDr. Blackwelder: So my involvement with that was an officer of the AAFP. About the time that I was on the board, the recognition that the Future of Family Medicine had been about ten years previously, there were some things that did not get accomplished with that groundbreaking set of meetings. And there was a conversation happening among not just the AAFP, there were seven organizations in family medicine because the ACFP (?) was not part of that originally. But there was conversation about it at the time to do another Future of Family Medicine, so was part of the discussions of how that would get set up. Once it did get set up, originally Future of Family Medicine 2.0 then became the Family Medicine for America’s Health. At working party, as this was moving forward, there was an opportunity to begin forming the leadership of FMA Health. And I was the president-elect, Les Stream was the current board chair. And at the time, because of the expectation of time and what would be required, it was felt that those of us who were president-elect and president really would not (Jeff Cain was president at the time) have the time. So Les Stream ultimately became what now is called the president of FMA Health. He initially joined as the AAFP liaison. Once the board was formed, then the board elected him as president. When that happened, that was about a year, a year and a half later, there was a need for an additional representative from the AAFP because Glen was leaving his liaison role at the AAFP to take over as president. Opened that position, and the timing was right, as I was getting to rotate off as an officer and they asked if I would be willing to step up for that obligation. And so I was eager to maintain some connection with not just the AAFP but with honestly the fire hydrant of thought of knowledge that you get exposed to when you’re at that level of the Academy. So I was eager to maintain some connection and very happily signed on at that time. \n\nDr. Young: And in joining the board, what knowledge and skills do you think you personally are bringing to this overall project?\n\nDr. Blackwelder: Well, I think one of the key roles, of course, of the liaison from each of the member organizations was the perspective of that organization. Now, this had been and still is, in some ways, a bit of a tension and I’m not entirely sure if everybody is always on the same page and I think we all sometimes go back and forth from one page to another. And what I’m referring to in terms of that tension is that when you’re the liaison of an organization, depending on the nature of the organization you’re liaising to sometimes your role is to say this is the perspective of the Academy, this is the only thing I support, this is what needs to happen. Well, because of the nature of this role was while I’m a liaison to the AAFP I was also a board member with a very separate charter and a very different approach to our responsibilities, there needed to be a bit of a disconnect to represent the FMA Health organization as well. And that was a very difficult balance and I think it was for most of us on the board. As you talk with others, some may or may not have as much of a strain. And there were times when the positions an FMA Health board member might take that could be different than their sponsoring organization. So in terms of the skills that I brought forward, I definitely took a very extensive knowledge of the Academy and its workings as anyone who served as a board member and an officer would bring as their --. I also brought, I think, my own skill set of being able to more comfortably walk challenging tightropes of expectations. I think I brought some very good negotiation skills and an openness to perspectives that are obviously useful as an officer in the organization. But any one of us who ever served knows that some people do it well and some don’t do it as well. I’d like to think that I had a good reputation and learned well from others and brought those skills to the board. I think I brought a relationship with Glen that was helpful because Glen, having been the previous AAFP officer and now as president of FMA Health board,  because he and I worked together on the board and as officers, we had an outstanding working relationship, we shared perspectives. And because the AAFP is the most prominent sponsoring organization, particularly in terms of the money but also resources that went into the FMA Health project, I think that connection helps the AAFP’s perspective be clearly represented but also helped us in sharing perspectives and conversations with the FMA Health board as a whole. So I think that was a unique opportunity that I was able to bring because of that shared experience over – literally I’ve known Glen ever since he got involved with the Academy. So I think that was a very fortuitous connection.\n\nDr. Young: You’ve used the term liaison in terms of your role in being from the American Academy of Family Physicians. Is that a term actually used within the board?\n\nDr. Blackwelder: I think it’s probably not the best term. I’m trying to think now - because we consider ourselves board members but we are representatives of the member organizations. So whether it’s liaison or representatives. But there was quite definitely a need for each of the organizations to select someone to represent their perspective. And this is where I think there was, and still is, somewhat a tension in that if someone you have put on a board is representing your perspectives, you could assume that means that person is going to vote always in the way that you would vote on an issue as an organization. And as one example of that tension is the payment tactic team because the payment tactic team, made up of a lot of AAFP leaders, had some very strong perspectives on comprehensive payment that over time changed fairly significantly from what the AAFP’s perspective and emphasis might be and created some tension because as a board member you’re following our marching orders that payment was a huge component from all the member organizations, it had to be one of our tactic teams, we had to put time and energy into it. But the Academy at many points was then saying no, slow down, don’t do this, this is advocating. It’s we’re doing this, you’re not, you don’t have the infrastructure. And that tension is probably still the single most prominent challenge point as we are winding down the FMA Health work of the tactic teams. And so I think that’s where the expectation potentially of your representative from your organization is going to agree with the organization. And I had at times agreed and not agreed. And this is something to a question we might get to at some point which is what are the things I think we learned on the board really related to payment. It was a priority, but I don’t think anyone could predict how rapidly that process would change in terms of a shift from fee for service to pay for value and how rapidly the negotiations were moving back and forth with payers and with the AAFP especially who had been at the table they needed to be at. And the reality is the FMA Health board and the tactic teams, which are also volunteer leaders, didn’t have the same infrastructure ability to be as part of the same discussion. And I don’t know what I would have done different but I do think that that area has been the one that has created the most tension among the organizations and the FMA Health board. And I don’t know if we have been able to tap into the best use of everyone’s energy. I think we’ve succeeded with some things but I think that’s still an area of some tension. So the relationship of what a liaison role might be versus a representative, I’m still not sure the most appropriate title, although I think it would be as a board member. But at different times we might refer to ourselves as I’m representing this organization or I’m the liaison for this organization which may or may not necessarily fit the classic definition of those terms. \n\nDr. Young: And you’re pointing out, I believe, that the environment has changed rapidly in the roles of the different organizations obviously are differently. I mean they’re organized for different purposes. So this is indeed quite a challenge for the project.\n\nDr. Blackwelder: Yeah. And I think that’s to be expected, although it’s always surprising when it happens. I  mean you’re in one environment when you’re setting the stage. And I think the past history of FMA Health has been at a very different time and so the time table and the progress and the connections were slower. I think we’re now in a world where things shift incredibly rapidly and getting member organizations on the same page, moving in sync, is not likely. So I when you look back on it, I’m quite sure that --, who has helped us with much of the infrastructure organization, and Glen, before I joined – because I was not in the original discussions with the board, so I wasn’t privy to some of this and there may well have been some recognition that this was a very different playing field than it had been ten years ago. But I think that was something we really began to notice. Plus, and a very significant thing and I’m still not entirely sure where I fell down on it, a good or bad thing, I tend to think it’s a negative, is the decision of the sponsored organizations to ask FMA Health to wind down two years quicker than originally planned. And I think some of that was because of the time table recognition that things were moving so quickly that a five year plan wasn’t necessary. I think there was a feeling that some of the work was duplicated and I would agree. I think the challenge to trim what we did was very appropriate and we helped our tactic team focus. But I think the process of saying you all have done a great job, you’ve moved us forward, this is awesome, please stop two years early is a very odd message when you’re trying to tell people they’ve done a good job. I think we’ve done remarkable in making the transition. I applaud Glen especially for helping us maintain positivity and moving everything a much truncated timeframe. But that’s another aspect when you look at, I guess, the expectations of the sponsored organizations and what shifted at their level. Because I was not part of those discussions because  that was all at their own executive board level to suddenly decide stop the project early.                   \n\nAnd so that became a real tension for those of us who were representatives of different sponsored organizations yet who had been tasked with the FMA Health board strategic plan that we had done a great deal of work on for five years to suddenly have to redirect a lot of energy to pull it together in three. And I think that created challenges for every one of our board members where said, you know, we are here as part of the FMA Health board much more so than as a representative of the organization.\n\nDr. Young: So if you can clarify a bit, I know that the tactic teams were changing in terms of their schedule. Is the overall project also shortened?\n\nDr. Blackwelder: Oh, yes. The entire project was shortened. Several tactic teams are winding down this year. We have actually as a board recognized that part of our responsibility was to ensure these projects transitioned well, so we’re extending our board until every tactic team is done, so through I think January of 2019. But all the tactic teams will be done within that short timeframe. Now, I will say that some tactic teams probably needed to be done sooner. There certainly needed to be some work on the scope that teams were taking on and I think we did that. But we then also had to suddenly tell some folks, okay, these projects that you had that were perfect for another two years, we can’t do them now. So I think every tactic team had to do a great deal of work            to refocus in order to accomplish what they could accomplish in a short timeframe and some other projects had to be left on the drawing board.\n\nDr. Young: In your view, what has been both the initial concept as well as at this now evolved state, in those two points of time what has been the value and the purpose of FMA Health?\n\nDr. Blackwelder: I think there are many values and purposes. I think the original purpose was as clear as it could be which was the member organizations saying it’s been ten years, the PCMH, the Patient-Centered Medical Home as a concept has taken off. We did a lot ten years ago, however our PR work was not successful, people still don’t know who and what family medicine is and we need to refocus ourselves, we’ve all matured in the past decade. So I think the purpose was to create a different approach than just sending some leaders to the city of Denver and having a couple of big conferences and then a paper to two, was to say look at a very different way of handling this. And so I think the original conception of the organizations coming together creating a board, creating this large group was really well done. I think it recognized that the impact of the original Future of Family Medicine was more limited and there was a grand plan to have a broader impact. So I think that was sort of the purpose. And what that would mean just kind of had to formulate over some time. And, again, I was not as engaged in some of those early, formative discussions. But I do know that as a board member and officer of the Academy, there was some rumbling that while we’ve put a lot of energy into this and yet it looks like some of us what’s being done is duplicative. The reality is that is, of course, inevitably true. The FTFM is all about teachers and residents and student education. Well, the AAFP has an education division, so we have an emphasis on students and folks academic physicians are AAFP members as well. The ACOFP is all about its osteopathic members. Well, we have a significant number of AAFP members who are osteopathic students and we have probably more osteopaths who are members us than maybe ACOFP. So what I’m pointing out is there was this inevitable multiple layers where there would be gray and overlap and opportunities for discussion. And I applaud the member organizations for kind of knowing that ahead of time and be willing to say let’s jump in. As far as what happened after, I think there are some really remarkable results of the FMA Health process. First and foremost probably was the commitment to a communications and PR plan, the Health Is Primary. It’s been outstandingly successful. We’ve got a fantastic group, that actually the two leading it, mainly -- and Ann Seabolt (?), were so passionate about and dedicated to our process, they left their organization in order to create their own company to have us as their main client. That was their commitment to our mission. And I think that has been profoundly successful. I think all the member organizations have been very pleased with the success of the communications outreach. And one of the most important aspects and purposes of cutting the project more quickly is to see if money could be freed up to continue some of the communications work a little beyond its original plan, which has been done. This was particularly helpful, obviously, with the results of the recent national election and the change in administration and it was felt that we really needed to maintain this communications push to help educate an administration that did not have much experience. So the communications push was a huge part of the purpose of what was initially called Future of Family Medicine 2.0 but also some of our end result. \n\nOther benefits – I feel very strongly, having sat through some working party meetings, the working party being  the gathering of the family medicine organizations, previously had been everybody gets together and shares what they’re doing. You go from table to table and share a few ideas. And not much happening and quite frankly people didn’t really like the – the meeting didn’t seem productive in the ways that were meaningful. It was something you did. And that’s, again, just my impression. I didn’t go to a lot of them because one of my first ones as an officer was when we made a commitment to move forward with FMA Health. What I saw at that point was a very dramatic shift that many people attested to in that the working party truly became a much more cohesive group and started to share some goals that started to have some very important discussions. And it really did bring up some of the discussions about who was the academic focus. The Council of Academic Family Medicine became a topic of conversation that required some very difficult discussions between the STFM, the ABFM and the AAFP because of the FMA Health board and such things as the (I’ve got a blank on the acronyms now), but the EPA’s (it will come to me). But some of the movement of FMA Health challenged the organizations and the place for those discussions and that work was at working party. And many of us who’d been a part of that working party organization are noticing some things. And it’s not always easy to notice. The way that meeting works is that most sponsored organizations bring a limited number of representatives and it’s a rotating group of people because their officers shift every time. And it is entirely common that an organization may have every year a new representative because their president has moved on and so it’s a new president and that person may or may not have ever come before. The AAFP has a more stable group, a larger contingency, but you still have a rotation every three years. And what we have seen happen is that every time the group would get together some of the member organizations, we were almost starting over trying to tell them what FMA Health was all about because that recognition and leadership wasn’t as profound and their own internal communication might not have been as good. And even at the AAFP level, the people who understood it the most were the officers. And I’m not on the AAFP board anymore, but from my conversations it seems as if the AAFP board members are not as aware of what happens at FMA Health in the way I might have expected. So the issue of the internal organization communication is one that I think became an area of focus that working party had an opportunity for growth. The concern that many of us have on the FMA board now is that without FMA Health being a focal point, without our board being present to help lead discussions, we’re not sure whether working party has transformed enough yet to become a more efficient, functional, collaborative organization, but whether it will backslide to some older approaches in which everybody starts becoming more siloed again. I think FMA Health, and our board especially, has really helped the member organizations to work more closely together on areas of commonality and to help focus on areas where they have unique skills and I would like that to be a legacy of FMA Health. But once our board is no longer engaged in 2019, which is just around the corner, there is the potential that old culture shifts could come back. So that’s one area that I think we’ve seen a change and hope to see another. A really important one, from my perspective, and I selfishly benefited from this, has been the recognition that the AAFP has routinely done a phenomenal job of supporting and training its leaders. Once you’re on the board, the information that you’re exposed to, the training for efficacy and media relations, the recognition of the workings of the Academy, it’s a phenomenal three year training period. But what’s even more amazing is that once you’re an officer, that ratchets up in a way that’s hard to quantify. And so what happens routinely though with the Academy is you’ve got somebody now who spent decades getting to the point where they’re now on the board for three years, they’re an officer for three years and then they’re literally gone. So you’ve got the --, the Roland Gertz’s (?), the Michael Fleming’s, the Jim King’s of the world who disappear, who often only show up at the congress to sit in the chair and wave but who are not substantially utilized.\n\nWe still do some chapter visits but you’re no longer the voice of the Academy, the amount of media you do is less. You actually don’t get the information that you used to. Selfishly, for me, because I was the representative to FMA Health and I had one other liaison role which is on the CMS’s Healthcare Planning-Learning Action Network Guiding Committee, this was the CMS’s group to consider how to transition Medicare payment to pay for value. And the AAFP, at almost the last minute I was asked, when I was chair, to apply for a position and I was selected to represent the AAFP and I was the only practicing physician on this guiding committee and I’m still a representative there. And the reason I bring it up is that these two positions allow me, as a past chair, to still be on the forefront of a lot of the information. I still have routine discussions with Doug Henley and Shawn Martin about aspects that I had been getting as an office that I would not be getting if I didn’t have the roles that I have. So most everyone else who moved on … You can always contact vice presidents and Doug Henley, but you don’t have the same access to the information. And I think that’s a remarkable waste of resources for the Academy to have such highly trained spokespeople not utilized better. When I was on the board, Conrad (Inaudible names) and I really advocated for some things. And I’m proud of us that we were at the forefront of helping to decrease how much money state chapters would spend on campaigns and we were really a big part of cutting the paper and all the crap that happened. It was good crap but it was crap. All the papers and all the other stuff and we really moved away from that. We also found a way to challenge us to engage our past officers more, so we created a list serve. But that doesn’t do much. And so we’re still, I think, the Academy, and I would say every member organization has some highly trained people who as soon as they’re done are literally done. They stop being involved in the state level. They stop being a  national figure. And I think what FMA Health … I know what FMA Health did: By creating the tactic teams, I suddenly look at these meetings and I see Ted Eberly (?), Rick Kellerman, Tom Whita (?), Jane Whita (?), Jason Bees. Some people are who are still active in the Academy, obviously, like Kristina Kelly. But I could just go on and on of people who have risen to a high level, often these were board members or past officers who now had a focus. And I don’t think the AAFP quite recognizes how much bang for its buck it got by having tactic teams led by some of the best trained representatives in family medicine we’ve ever had who suddenly had a new passion and focus. Which is another reason I was disappointed when the projects were cut. You basically took away the opportunity to get a couple more years out of these incredibly productive, creative, innovative people. And so I think the reality is we don’t know what we lost because we lost two more years of Ted Eberly working our workforce because his tactic team is winding down. We’re losing that perspective. And I shared with Wanda -- \n\nand Doug through phone calls. I don’t think the discussion has gone further, but I think that’s a huge advantage that FFM 2.0 had that the previous one did not. But I’m sad that we’re now going to go back, more than likely, to a process where most of the past leaders just kind of fade away.      So I think that was a huge advantage and we got a ton done in a short amount of time.\n\nAnother profound success and legacy is that while every organization, including the AAFP, understands and has recognized the importance of diversity and the populations, the socio-economic determinants of health. The FMA Health board was more nimble and we recognized there was a huge issue and we had an opening and we were trying to fill it. We looked around and actually had somebody from the outside say, hey, on your website there’s nothing but white people. We said, oh, my God and we recognized that we, as an organization … The base of our organization, while obviously we’re from diverse backgrounds, never want to make decisions on someone’s background, experiences, skills, et cetera, based on how they look, there’s still a component of that, that when you look at boards you want to see a better representation of the organization or of the country. And as part of our recognition, we needed to create another tactic team. And we did, we put together a diversity workforce, now called the Equity Tactic Team, Viviana, Bianca Martinez became the leader of that group. We tapped into, again, some remarkable and powerful and dynamic people. And that paralleled some of the work of the AAFP who now has their own set for diversity and health equity which I’m very proud of. But I’d like to think that the work that FMA Health board did and the wisdom we had of moving forward with a separate tactic team to really push that … Out of that group came the Starfield Summit which had been just glowingly reviewed and should be a legacy. Once we’re gone, we just have to make sure they have a home and a sponsor. But some really amazing things came out of that tactic team that were not planned. The Starfield Summit was not a purpose. FMA Health was not put out there to say, hey, create the Starfield Summit. That came out of our board saying we’re missing a critical piece. We’ve got to put this group in. This group did their thing. They came up with something and they pulled it off. So I think that’s huge and something that I’m proud of. And I’m also proud that the AAFP especially has taken aspects of that and are moving forward and we look forward to some better interaction down the road of those groups. \n\nSo I think those were some of the really big impacts that came out of creating the FMA Health project. I don’t think all of those were necessarily purposes but I really … And when I look at it, I’m really impressed with all we’ve been able to accomplish.\n\nDr. Young: We’re going to pause a moment so that I can flip the tapes.\n\n\n\nSide 2: Dr. Young: This is side 2 of tape 1 of the September 8, 2017 interview with Dr. Reid Blackwelder.\n\nAs you do look to the future, since now Family Medicine for America’s Health seems to have a date of termination, what do you think you can do to address these important issues that you’ve just outlined such as continued involvement of the individuals who have gone through, at least in the Academy, such excellent training and education to be continued contributors to the discipline?\n\nDr. Blackwelder: Well, I think that’s become a focus of the FMA Health board as we look at our responsibility to ensure that projects are completed, projects are transitioned to sponsoring organizations. Some of our job is to do everything we can to hold those organizations accountable for something beyond just saying the project’s done. The reality is we don’t have much ability or power, truthfully, so it’s really going to be important for the organizations to, when it’s all said and done in two years, I guess share our passion and enthusiasm. We know that some things probably won’t move forward. For example, some of the areas, the focus of the payment team, while the members of that tactic team were passionate about their approach, the reality is it won’t fit with the Academy’s advocacy aspect. It may or may not have a home in some of the long term discussions that are going on. And the reality is the Academy is better positioned to address those issues because that’s what they do. They have an infrastructure, they’ve got continuity. However, one aspect of that team is going to be a payment calculator which is, we think, a very helpful tool for individual physicians and therefore AAFP members to start to understand how payments shifts might impact their practice and how to help them transition. So we believe that even if a major push from the FMA Health board or a tactic team isn’t picked up, that we will find a tool or something to help move a similar project forward. And that’s a lot of what we’re doing at this point; what is it that needs to move forward? The Starfield Summit, I think, was something mentioned, who’s going to take on that? Who will help direct it? How do we build on the success of something that probably can be a focal point for some of these kinds of discussions? And we haven’t really gotten to that stage at the board level meeting, but it may well be Starfield Summit could augment some of what may be happening at working party a little bit but with a different audience. I think that’s the other aspect that’s unique about FMA Health and its project – our connections are not just with the sponsored organizations but we’ve had outreach through other groups like the Patient-Centered Primary Care Collaborative, the Primary Care Progress. And these are groups that obviously the AAFP and others have some connections with, but if we’re able to be a part of some of those conversations. And what we hope is that through some of the work, especially what our tactic teams have done, that we may have planted seeds in other organizations or other people that can kind of grow and continue to be a focal point. It’s just that we’re not sure what all those are and how best to support some of that. We have such an outreach when you look at the different representatives, the different tactic team members. I know there are connections and relationships that are only just now starting to bear fruit – and that’s one of the strengths of family medicine, we know the value of connections and relationships and stories. And I think that’s been a lot of what FMA Health has done, is to give people a chance to start sharing those kinds of stories and make those relationships. So I think there will be a lot of good, unintended consequences that come out of all the energy that was here. I think even though we might to be better aware of it or direct it more, I think some of it will just be to watch and see what happens. But I do know the board is going to be spending a lot of our remaining time really focusing on team tactics and projects, ensuring that the folks who are picking them up have everything they need to make them successful, negotiating if we find some areas of uncertainty or disagreement and trying to be realistic in what we move forward.\n\nDr. Young: We are in a different world today than when this project started and certainly in a different world from some ten years ago with the Future of Family Medicine. What do you see happening in terms of healthcare in the United States in the next years?\n\nDr. Blackwelder: Great question. Obviously we’re all trying to figure that part out. \n\nDr. Young: Well, I’ll add in how can it be influenced?          \n\nDr. Blackwelder: Maybe I’ll answer the influenced part first. Member organizations need to keep doing what they’re doing but they need to find ways to continue to speak with a more cohesive voice. I think FMA Health has worked to do that, although there are times where, again, especially around payment there has been a concern that where we’re not having the same voice, it might create issues. But for the most part I think we’ve allowed ourselves to focus the voice of family medicine better. But I think in many ways the AAFP is still the best positioned organization for the kind of advocacy that will impact what you’re describing because it’s really about money and it’s about support at national and state levels. Now, the Academy is more national-based, the member organizations may have more state influence, but some of what we’re talking about really needs a national push, whether it’s CMS on directing payment reform toward value, whether it’s Congress decided that the -- Arch are worth funding than NIH. Those are things that I think the Academy is best positioned. As a component of that, we have failed sadly as a profession, so physicians as a profession. But family medicine and primary care especially in learning how to advocate well. And I can speak as someone who has been in academics pretty much my whole life, there is no training in medical school, no training in residency on the kinds of things that you and I are spending time talking about. I just went over some aspects of payment reform with students and residents and got lots of blank stares and anxiety and the response is they’re going to start studying for a test or read about a disease. The realities of how you’re paid to care for your patients, the realities of how your patients pay to get your care are really the major areas of focus and I don’t think physicians as a whole are as informed as we need to be nor advocate as well as we can. And so I think the AAFP’s role in that regard is critical but I’m afraid there’s still a disconnect between the Academy does and what the frontline physicians think the Academy is doing for them. And that’s a longstanding member organization challenge that FMA Health hasn’t fixed and won’t fix and I don’t see a quick fix on it. But that’s sort of some of the process. We do need to find a way to get into medical schools and residencies in a more profound way to emphasize these kinds of things because this is how change happens. And I’m afraid until things like the RRC or the ACGME change some of their requirements, you have limited opportunities to get into the curriculum because you have to push out something as the current requirement. So those are some of the challenges facing how we’re going to move it forward.\n\nI think we’re at some crossroads in some ways. I’m excited in many ways that I think people will realize family medicine as we have envisioned it and as we have committed to in terms of our comprehensive training. It’s what people want even if they don’t know it and I think that we are still poised to be able to answer many of the needs. Having said that, especially on the east coast, maybe not so much west of the Mississippi, I’m afraid that family physicians are more and more commonly choosing to limit their practice. We’ve prided ourselves on being comprehensive in our scope of care and yet more and more of my graduates are choosing not to do hospital, not to do call, not to do procedures, not to do OB. To do ER or to do just hospital, the things that are obviously not full scope. And so I’m worried that if somebody said, okay, family docs, you said you could fix it, take over, I know we don’t have enough in the workforce but I’m not even sure with the workforce are we really able to say we can do what we say we could do. And that’s a fear I have. I don’t know what direction that’s going to go. I think that if there is a shift, that suddenly there is better payment for the value we provide, that the salary gap does indeed start to close in some tangible ways, that payment reform recognizes that primary care is not to be a cash-based business, some of those changes would, I think, reinforce that family medicine especially was valued and I think people would then go into family medicine. But I think until some of those areas are addressed, we’re going to face a crises. And the crises is going to be augmented by the discussion of primary care. Many people are talking about primary care. They say they love it. And when I’m talking to state representatives or national and they say they love primary care, the first thing I say, because I’m a polite southern boy raised properly, is thank you. But then the very next thing I say is what do you mean by that – because the definition of the words are critical and I’m afraid right now primary care is one of those words that people say easily, can’t define well and usually define in strange ways depending on who they represent and where they’re coming from. So primary care is often felt to be what you get at the pharmacy or the retail clinic or in your OB/Gyn’s office. Primary care is provided by the nurse practitioner or the PA or the telemedicine from a doc who is somewhere else. And I think that’s a real risk to us. I think we need to make sure that while all of those are important and critical parts of the team, that none of those parts are interchangeable. You can’t replace a family physician with a nurse practitioner or a retail clinic or a teledoc. And I’m afraid a lot of the people who are responsible for making decisions at a legislation level and often about payment tend to lump them together. And one example of that is the danger of being a PCP when that is defined as a primary care provider because the provider can be a physician, an advanced practice RN, a physician’s associate. Some states are looking at a physician’s assistant. Some states are looking at whether pharmacists should be independent providers. So it’s a really dangerous and slippery slope. So while I’m excited about the opportunities because I know that we as family physicians cannot be replaced, that we have been replaced in many areas and a lot of legislators are very short-sighted and see decreased output costs like salaries or how much it costs to train someone and ignore the downstream costs of the inappropriate referrals, the duplicative tests, the initial testing that’s done because everybody’s in sort of a hamster wheel environment. So I guess in this very long answer to that question, I see the country starting to try and make some decisions about what is primary care, what roles do physicians have, how does team-based and community-based care manifest. And this is another place I think family medicine is better posed than most to manage, is just continuing our information push. While Health Is Primary has been an outstanding success, we’re still faced with the public who doesn’t always understand what we do. We’re still faced with residents and students who don’t really understand what we do. And I’m speaking as a very experienced and involved faculty at a school that’s routinely recognized as one of the top ten rural (?) primary care schools in the country. And yet we don’t graduate enough of our students into family medicine, our primary care graduation rate, all deans define it as 55 to 60%. The dean’s -- unfortunately manifests here as well. And when you really look at those people who stay at true primary care, who do not sub-specialize, we’re still extremely low. Last year we graduated thirteen of our seventy-two students into family medicine. It was the best year we’ve had in probably twelve to fifteen years. We got close to 20%, that’s maybe one of the top in the country. But that was an unusual year. This year, a few months ago I only had four or five of our students going into family medicine. I’ve had two or three more somewhat interested, but we’re going to cut down to probably 10% or less. And the executive associate dean this year, he thinks that our … Even using the dean’s -- to call primary care any student going into family medicine, internal medicine, pediatrics, in Tennessee, OB/Gyn, he thinks will be barely at 40% total, which will be devastating.    \n\nSo I’m worried that even at primary care school we’re failing in walking our talk and fulfilling our mission. So these are the challenges facing not just FMA Health but obviously our country and where we are in trying address the quadruple aim. And I see opportunity but the reality part of me is not seeing change as fast as it needs to be. And I had one great example yesterday with a faculty, an outstanding faculty. She’s been here a year. She’s tremendous. She’s exactly what we need. She’s still doing OB and she’s probably going to leave and she told me she realizes that she’s making the decision because it’s a millennial thing. And she said she’s embarrassed about it but it’s a millennial thing. And so as we talked about it, it was she doesn’t like hospital, doesn’t like call, wants to be home. Wants to be paid more, work less, have more flexible hours. And the bottom line is she does not see that as a calling. I’m a baby boomer, I also use that word, and I think we’re facing generational shifts where calling doesn’t mean the same thing as it used to - and I’m not saying it should. And I think we all have to figure out what balance means because I’m afraid we’re starting to get people into the healthcare workforce who honestly aren’t comfortable with seeing what many of us have done and spent our lives doing as a job. And not wanting to call it that doesn’t change the reality that many of the docs that we’re producing see things as a job and they’re comfortable changing jobs every few years if they get better pay or they get more of what they need. And I think this is another aspect that we’re going to have to figure out how do we address that philosophical shift and what it means.\n\nDr. Young: Is that more at a societal level, a generational, cultural level and how does Family Medicine for America’s Health or any of the organizations within it address that?\n\nDr. Blackwelder: Well, I there’s a societal component because your society is made up of folks who have generational changes. There’s a lot of sociology and historical work that’s done and not everybody agrees on all aspects, but there are generational differences. And that societal component is, in medicine, augmented by our lack of tangible value for primary care and family medicine in particular. So those societal factors are huge and are impactful. I think, however, in medicine we’re not nimble about this. Medical schools and residencies are not nimble, so I think as a whole trying to figure out what does this mean for how we train people, what does it mean for the selections they make as different generations come into medicine. And, again, I’m just going to say – when you ask people, hey, you’re following a calling because you couldn’t talk yourself out of it and the answer is more often than not, well, no, not really, I could talk myself into and out of whatever I want, but this feels good to me right now. That’s not a bad mindset but it’s a different one. And I think business as a whole is struggling with how do you handle generational difference. I think medicine has been behind, as a whole, those kinds of things for a lot of reasons and I don’t see that changing quickly. I don’t FMA Health board or the FMA Health project really can address that well. I think the challenges will be what changes in how medical schools and residencies function through STFM, through ABFM, through the AAFP are going to be the more important issue – and they’re aware of this. So I think the recognition that we have to look at different emphasis on what we expect in training, of how we train people in a professional and team-based care and how we inform them so they can be better advocates for what they do are all critical components and are going to depend on those organizations that are actually representatives of the members who are in those situations. So I think part of what we can do as a board is just maybe emphasize some of these shifts that we have seen over time and make sure people in leadership and those groups have it on their strategic planning or their radar, at the very least.\n\nDr. Young: Future of Family Medicine came, made its recommendations, time passed, Family Medicine for America’s Health came into existence and will pass. Will there be something else that follows?\n\nDr. Blackwelder: Oh, absolutely. I think the wisdom of the family medicine organizations is fifteen years ago coming together to do Future of Family Medicine 1. So that was really smart and wise. It was smart and wise to look a decade later and say, wow, we didn’t change our landscape as much. We made a few impacts. Let’s try to do it bigger and better. Let’s focus on communication. And I think we did it bigger and better, we focused on communication. And I think the organizations are wise and will revisit and say, okay, now what do we do. And I think a ten year timeframe is a good one, so I fully expect that the organizations will say, okay, what do we need to do now? Where are we? What do we accomplish? What didn’t work? Where do we go next? I do believe that aspects of what FMA Health has put into practice will find homes and be around and be a focal point for growth. I think like the Starfield Summit, I think the emphasis on diversity, I wouldn’t be surprised if these things come out of our tactic team there. I think some aspects of payment of practice will find their ways into some of the organizational structures as tools to help move things forward. Obviously a lot of what happens next is going to depend on the national and societal changes. What does happen in terms of healthcare. Are we truly committed in the country to honest-to-God healthcare reform because so far all we really have done is health insurance reform. That’s, from my perspective, what the ACA mainly did. And it did some profound things there that were much needed. But we really haven’t impacted the quadruple aim. I mean despite all the talk about it, we still have poorer outcomes than we should for the amount of money we spend. We’re still dealing with what you want to call it, burnout or resiliency, in all our providers, not just our physicians. There’s a crises right now. You see it every day, there are aspects about it. The issue of patients still not being satisfied, that’s a big thing. Sadly, people are misinformed and feel so many of the problems right now are due to the ACA. And part of what I try to tell my learners is the issue of rising costs, decreasing access, decreasing satisfaction, narrowing networks, high deductibles, this was long proceeding the ACA. And, in fact, the United States has tried about every twenty years to do healthcare reform. But interestingly enough, in this strange media age many good people who are incredibly intelligent, who should know better, believe all of the problems are because of Obamacare. And I’m afraid that one of the real factors that we’re going to have to get a handle on in this country for anything is the role of the media and how do we stem the tide of everybody says fake news but I can’t help say it – fake news and some real assaults on core aspects of what has made our country great. And I know that sounds dramatic, but I think we’re in the middle of some real challenges in which the focus while should be on healthcare isn’t because we have too many other things going on that the status quo is about what you get. Actually the status quo isn’t about what you get because we’re going to go backwards depending on how much we do or don’t stabilize the insurance markets and make other changes. And we’re going to go back to, and we still are at, patients basically waiting until the last minute, showing up in the ER, and society as a whole paying for that. So we really haven’t fixed anything and it may well take that crises to continue to move forward before something dramatic happens with honest-to-God healthcare delivery reform.\n\nDr. Young: So you had indicated that it might be in ten years it’s time to look at it again in terms of the organizations working together. Can it wait ten years?\n\nDr. Blackwelder: It may not. The reality is that some of the FMA Health work was impacted by a rapidly changing timeline for payment, for example. And so a ten year impact, many of the strategic plans from FMA Health initially, there was work on a three year plan, a five year, ten year and twenty. And then it became sort of like twenty is a joke, ten years is a joke – especially with rapidly changing technology. Five years may be unrealistic. So the reason I say ten is if you’re going to do an organized process from a number of different member organizations who have different goals and funding opportunities, I don’t see that you’re going to be able to do that more quickly with a huge investment of time and money, which impacted the Academy, which has tremendous resources compared to some of the other organizations. So I don’t see this kind of a process happening too often. On the other hand, it may be that the organizations say, you know, we can’t wait another ten years to decide to do something. Let’s see how we can make working party a mini FMA Health process. Let’s see if maybe the working party wants to reflect some of the tactic teams and do some of this work on an ongoing fashion, in a collaborative way. Let’s see if maybe the Starfield Summit or some other workforce summit can become a focal point. So I think it’s more realistic to think that some things that are in place now could be modified to become more useful in real time. I think waiting blocks of time and then say, okay, let’s gather together to have a big event is really not a practical way to get a lot done in a rapidly changing, speeding up environment.\n\nDr. Young: We’ve covered a great deal of ground. Are there any thoughts that you have that need to be added before we finish?\n\nDr. Blackwelder: The main thoughts are I just think this is an incredibly visionary thing to do. Of all the member organizations, I was very proud to be part of the Academy where we committed during a time of financial uncertainty and stress, we were willing to commit a great deal of money to something that was an ideal. And I think that exemplifies family medicine and how we lead, that we are willing to see something good, try to move toward it and put our money where our mouth is even when members might not understand it. So I’m very proud of the Academy, I’m very proud of the other organizations for saying this is the right thing to do. It is a good cause. And I think that there has been stress from it, that there’s been disagreement, has really emphasized that it was a good and needed thing. Because if everybody agreed to everything we were doing, was there really a purpose to do it? So I think for us to have created some tension, for the organizations to have had some challenging conversation, for us to be having this debate about should we cut the project short or not is really a healthy part of this process. And I know it’s uncomfortable for folks and I know that we will never accomplish everything we want, but I think we have accomplished a tremendous amount in a short time. And I’m really excited that as we’re talking, and that’s the really important thing for others who are reading or listening this to recognize, we’ve still got some time to make an impact. And what I’m excited about is having had this chance to articulate some of these thoughts and I’m looking forward to sharing some of it with other board members that I know have been a part of this process and conversation too. And I see the Center for the History of Family Medicine and this project as being a piece in the puzzle of helping us get the most total bang for this buck. So I appreciate the opportunity to bring us together, to think through things in ways we don’t always do at a board meeting. It’s very rare that I’m at a board meeting where I get an hour and a half of time to talk, so I appreciated that opportunity and I hope it’s been useful.\n\nDr. Young: Thank you very much.\n\nDr. Blackwelder: Thank you.\n\n(End)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882#t=0.0,2563.2288"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882/transcript/85517","type":"AnnotationPage","label":{"en":["Dr. Blackwelder Biography [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882/transcript/85517/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Blackwelder, Reid B. ( \n\nInterviewer: Dr. Herbert Young\n\nInterview Date: September 8th, 2017\n\nBiography\n\nDr. Reid Blackwelder is originally from Atlanta, GA. He graduated from Haverford College in Pennsylvania. He then went on to earn his medical degree from Emory University in Georgia, cum laude, after realizing that doing research Biology was not what he truly wanted to pursue. Upon graduation, Dr. Blackwelder moved to Trenton, GA to become a rural doctor in a town of only 1,400 people. This is where he learned that he loved to practice medicine and help people in his rural community. After his tenure in the medical field he transferred back to the academic side of medicine where he is currently a professor at East Tennessee State University. Dr. Reid Blackwelder has served with the AAFP for many years and is currently on the board of the Family Medicine for America’s Health (FMAH).","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295882#t=0.0,2563.2288"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295881","type":"Canvas","label":{"en":["Media File 2 of 2 - BlackwelderReid_02_Access.mp3"]},"duration":1852.2909,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295881/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295881/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/881/original/BlackwelderReid_02_Access.mp3?1761148318","type":"Audio","format":"audio/mpeg","duration":1852.2909,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162452/file/295881","metadata":[]}]}],"annotations":[]}]}