{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/bc3st7gz5t/manifest","type":"Manifest","label":{"en":["Carolyn Gaughan"]},"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":["Description"]},"value":{"en":["\u003cp\u003eIn her extensive interview with Dr. Young, Ms. Gaughan speaks about her experiences in the health care system and the issues that face it, especially in Kansas. She is a lifelong Kansan and has worked for the KAFP for 30 years where she has aided the state of Kansas in its health care system. Among many other things, Ms. Gaughan talks about the FMAH initiative, issues in Kansas, her thoughts and feelings on health care topics, and where she thinks the state of Kansas and the nation need to move toward in order to push the health care system in the right direction.\u003c/p\u003e (summary)"]}},{"label":{"en":["Date"]},"value":{"en":["2018-02-01 (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":["American Academy of Family Physicians","family medicine","family physician","Family Medicine for America's Health"]}},{"label":{"en":["Subject"]},"value":{"en":["Carolyn Gaughan, CAE (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eIn her extensive interview with Dr. Young, Ms. Gaughan speaks about her experiences in the health care system and the issues that face it, especially in Kansas. She is a lifelong Kansan and has worked for the KAFP for 30 years where she has aided the state of Kansas in its health care system. Among many other things, Ms. Gaughan talks about the FMAH initiative, issues in Kansas, her thoughts and feelings on health care topics, and where she thinks the state of Kansas and the nation need to move toward in order to push the health care system in the right direction.\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: 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/162447/file/295875","type":"Canvas","label":{"en":["Media File 1 of 2 - GaughanCarolyn_01_Access.mp3"]},"duration":2458.8027,"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/162447/file/295875/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/875/original/GaughanCarolyn_01_Access.mp3?1761145886","type":"Audio","format":"audio/mpeg","duration":2458.8027,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875/transcript/85505","type":"AnnotationPage","label":{"en":["Carolyn Gaughan Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875/transcript/85505/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tape 1, side 1\n\nDr. Young: This is side 1 of tape 1 of the oral history of Carolyn Gaughan, a member of the Board of Family Medicine for America’s Health. We are recording this on February 1st, 2018. I’m Herbert Young, a volunteer at the Center for the History of Family Medicine. \n\nMay I ask, Ms. Gaughan, do we have permission to record this interview?\n\nCarolyn Gaughan: Yes, you do.\n\nDr. Young: Let’s start out by asking you to give us your name in full.\n\nCarolyn Gaughan: My name is Carolyn Gaughan and I’m Executive Vice President of the Kansas Chapter of the AAFP.\n\nDr. Young: And how long have you been in that position?\n\nCarolyn Gaughan: My goodness, I am in my twenty-ninth year, Dr. Young. Good heavens. Time has flown, I’ll put it that way. Indeed, indeed.\n\nDr. Young: How did you get involved in Family Medicine for America’s Health?\n\nCarolyn Gaughan: You’ll be interested in this. I was on the Commission on Health of the Public and Science. I think my first year was five years ago and was on there subsequently for three years. And it was during that time that the FMA Health Board was formed and the genesis of the idea came about. And I was very much intrigued with the public health. I should back up a step: By then public health had just captured my heart. I have been interested in it without naming it as that for many years. Involved in a lot of tobacco related issues here in Kansas and also immunization issues. So being on that commission was a huge eye-opener for me and I was really drawn to the idea of the link in with public health with the FMA Health Board was putting forth. You know, the monthly activities and the focus on educating into the public. So honestly that’s the first thing that kind of grabbed me and led me towards applying. So the application process for chapter executives, they wanted one chapter executive representative to be on the Board. And whenever it was first proposed, I did go ahead and apply. I was aware that at the same time one of our very prominent Kansas members was applying for the Member at Large position, and that’s Dr. Jen Brull. And she had selected for that and I was not selected out of the gate for the Chapter Exec position. And I totally understand. I think there was perhaps a concern there might be a little too much Kansas-ness on the Board at that point. And so my dear friend and colleague then from the Illinois chapter was selected to be the Chapter Executive representative on the Board in the first go-round, so to speak. And then a year ago, just about a year ago right now, the end of the cycle was coming up. Vince had said that he needed to step down and had pressing things going on in his chapter and he just needed to devote more attention there and less at the FMA Health Board site. So there was an opening again and chapter executives were invited to put their name forward. So I actually spoke with Dr. Brull and said I am still interested in this, but what is your perception after the Board has been in practice now for however many months? Would there be an issue on having us both being from Kansas and being on the Board? And she said not at all. I just think that we’re beyond that at this point. And so she encouraged me to apply and I did. I think I turned that in almost exactly a year ago in February of 2017 and was selected. And my first Board meeting that I was participating in was a tele Board meeting on June 15th of 2017. So I haven’t been at it quite a year yet.\n\nDr. Young: Let’s learn a little bit more about your chapter and size, direction and so forth because indeed you are known as a chapter that’s very active in tobacco control and in immunizations.\n\nCarolyn Gaughan: You know, the Board was giving me that direction many years ago. I can’t even tell you how long ago, but early in my career with the chapter I was getting inundated with, Carolyn, we need a representative on this group, on that group, on the other group. We’re putting together a coalition for A to Z, Alzheimer’s to Zika, although I don’t know that we had Zika at that time. But in any case, I got many invitations to participate in public health related activities. And as you are no doubt aware, being a chapter executive, it can be as demanding as you let it be as a physician. So I went to the Board many years ago and said I’m getting all these invitations, help me prioritize. I need to know from your point of view as a clinician what you feel would be the two most important things for me to spend the limited time that I do in coalition work to help to participate in. And so without hesitation they said tobacco and immunizations. So that kind of set the stage. And we are considered a large chapter at this time. We have just over 1,000 active members and that’s the threshold being a quote large chapter. So it’s sort of a small, large chapter because we have like 1,070-ish active members. And our total membership with residency life, inactive, and other sort of categories is right around 1730, 1760, something like that. So it has grown. When I first started there were 545 active members. And so it’s just about doubled in these years. The other thing I would say as far as craft (?) and being able to feel that I could take on this additional role is that our chapter made the decision – again, this would have been almost two years ago, in the spring of 2016, to hire a Deputy Executive Vice President. So we were able to bring on a new executive colleague for me. Her name was Michelle Corcoran. She started May 2nd of 2016 and has been a very valuable player in both taking some things off of my plate and in enhancing things that we were already doing. And so giving me a little more bandwidth, if you will, to be able to take a role like this. Does that help answer your question?\n\nDr. Young: Absolutely – and raises some others.\n\nCarolyn Gaughan: You mentioned tobacco. I do want to say in addition that we also, our Academy became the CDRR grantee, which is Chronic Disease Risk Reduction grantee, for Sedgwick County. That’s the county that Wichita is in, for the state of Kansas, July 1 of 2016. That was a year of a lot of change. And the history is that we had been so active and so involved and our county took a severe turn to the right politically with some elections at the Sedgwick County Commissioner level the prior November, that would have been in 2016. And we went from having a five member Commission of three moderates and two kind of ultra conservatives to having three ultra conservatives and two moderates. And they basically said we don’t want to be, in so many words, I guess you could say, but not in these words: We don’t want the county to be the CDRR grantee anymore. Find somebody else. And so KDHE, that’s the Kansas Department of Health and Environment, in its wisdom, kind of looked around. And the Academy, as I said, had been very involved and active in Tobacco-free Wichita, Tobacco-free Kansas coalitions for many, many years. Worked pretty closely with the CDRR grantee in place. And so they came to us and said would the Academy be willing to become the grantee for Sedgwick County. I took it to the Board. We talked it over and said indeed we would and it all came to be. So we garnered two additional employees that summer, July 1. And, gosh, it’s just been a blur since then. They have been excellent. You know, the Academy is their employee, I am their supervisor and they have so much initiative and so much just great drive on their own that I don’t feel like I have to do a whole lot. You know, just attend meetings and try to be a good employer and provide my input and so forth when I can. And my goal along the whole way has been to inject more family medicine into public health in this form and more public health into family medicine.\n\nDr. Young: How do you think the makeup of the healthcare system in Kansas has impacted the role of the Kansas Academy? And then think a little bit more broadly – what has that allowed you to bring to the overall national Family Medicine for America’s Health activities?\n\nCarolyn Gaughan: I would say a couple of things. I think healthcare in Kansas is entirely and completely very much primary care driven. And when I say primary care in Kansas I’m saying family medicine. Pretty much the same thing. I view it as fortunate in that we have a very close relationship with the Department of Family and Community Medicine here at the Wichita campus and close relationships with both the Kansas City campus and the Salina campus. And yet it’s just one school. It’s three campuses but it’s one school. So around 60% of our members are graduates of either the KU School of Medicine and/or an affiliated residency program. So we have some\n\n-- as far as roots and as far as, I would say, values as well. I think we have extremely strong training programs. The attitude in the training programs as people come through them and graduate is that they will be expected to teach and to be volunteer faculty and take preceptors and take students and take residents. And they do, they pass it on. I know it’s not that way everywhere and I feel so blessed and so fortunate to work with people such as Dr. Kellerman and his faculty and the other leaders elsewhere. I’m clearly quite biased, so I will say I think the Kansas chapter is really the heart of family medicine. Our members exemplify the very best in all matter of things. They’re clinically very sound. They are very involved in continuing medical education. They are very involved in teaching themselves. And as I said, have extraordinary values and very positive and for the most part pretty upbeat. Do we have people who are burned out? Yeah, we do. We had a Webinar yesterday on the topic of burnout (our first in a series of four), and I had thirty-nine registrants. Which out of 1,080, that that many people registered first out of the gate, I think that’s probably something that is, yes, we do have issues with burnout and people are considering what do I need to do for my well-being. But, still, at the same time, we have a fabulous leadership chain within the Academy. I find that as I talk to my colleagues, this is unusual, we have elections in which there are two people running for office. It’s not just vote in this slate of candidates. You have a choice. And I just think that’s indicative of a lot of engagement and participation of extraordinary leadership and interest in seeing the chapter and the Academy at large as being relevant to practice, to life, to family medicine. And, of course, I’m all in favor. That’s exactly what I hope to build on be able to continue to hold the chapter to that standard.\n\nDr. Young: Do you think that some of the issues that Family Medicine for America’s Health across its very set of goals there’s some things where Kansas has already gotten a long way in achieving it? And I’m thinking of such things as understanding by the public or by industry, for example, of, well, what is family medicine and what’s its role and advantage within our healthcare system.\n\nCarolyn Gaughan: Yes. I think that’s a little bit of a double-edged sword in that family medicine is so prevalent and we have such a robust cadre of family docs. I mean we could use more, don’t get me wrong. We definitely have some shortage areas. But we’re pretty blessed in that as well. And I think the general public’s mind, when they think of a doctor who sees people, they’re not thinking about a specialist, they are thinking about a family doc. And so that’s the good side of the sword. On the other side, I don’t know that they’re necessarily identifying, yes, that’s family medicine. So I think we’ve got a really strong basis to work from. I don’t know that the general public is quite as informed that that’s family medicine and that it is a specialty in medicine. So there’s definitely two sides to it.\n\nDr. Young: It sounds almost like you’re saying, well, to the public you are medicine. Yes, well put. \n\nTell me your reaction to Family Medicine for America’s Health as you have come aboard. And it’s my understanding that FMAH has had to make some changes along the way because of a variety of changes in our always rapidly evolving healthcare system.\n\nCarolyn Gaughan: It’s been a little bit like drinking from a fire hose. So FMA Health Board uses, I don’t know if you’re familiar with Basecamp, an online platform where you can post discussions and documents. And when I first was selected to be a participant on the Board, I was given access to the FMA Health Board’s Basecamp page. And I went on there and there were something like 300 open, active discussions. And I don’t know how many documents, Dr. Young. So my eyes got really big and I thought what have I gotten myself into! And honestly, it’s been challenging really to get my feet on the ground. And the folks at CFAR (?) did an onboarding session with me and tried to help me with that. And I may not have really known what to ask at that point. But be that as it may, I know and respect Dr. Stream (?), who is the chairman, very highly. And also now O’Connor who is the CFAR. I guess he’s an executive, I don’t know, person, representative who we work with most closely. And they’ve just very kind and compassionate and understanding people who put up with quite a bit from me when I’m like where is the agenda posted. Things like that. But as far as the scope, it’s just a huge, perhaps almost too huge scope of work that the Board has been involved in. And the core teams, the working parties, the all-hands meetings, you could just go from team meeting to team meeting and hear something about everything from practice models and transformation issues to reimbursement and payment issues and technology and the voice of the public and social media. It’s really, really a big scope of work. So honestly it’s taken me … I’ll say I feel a little uncomfortable just in being interviewed about this because I don’t feel that I know enough. But I’m happy to be interviewed and to talk about what I do know. I just will say it’s been overwhelming. \n\nDr. Young: Do you find that as a chapter exec that you have some understanding of certain issues or processes that other board members who may be principally clinicians or principally faculty have? I think it was very wise that in the conceptualization of this that a chapter exec slot is there.\n\nCarolyn Gaughan: Yes. You know, I think I would say – of course, I was on the other side of the table when Vince was the exec on the Board. And he would come to one of our regional meetings, like a multi-state meeting, and we would do a little exercise that was similar to some of the things that they were working on at FMA Health early on. And I was like, huh, well, okay – but where’s the product? So I think Vince kind of got in on the hardest part of the work which was getting a lot of projects rolling and determining which projects and deliverables or products would be brought forth. And that I’m getting in on what I would consider to be kind of the more fun side of it, which will be rolling those out, disseminating the information to my colleagues, trying to help them understand and share it appropriately with their membership so that we’re kind of sticking with one voice and we’re all coming from – whether it be from Doug Henley or from somebody on the Foundation board or whatever of the affiliated organizations that the products and things that come forth out of FMA Health are explained in the appropriate manner. And so I think my chapter execs, colleagues, when it first was started, like yeah, yeah, that’s all fine. When you have a product to bring forth get back with us because then we’ll kick in, we’ll get involved. I don’t think they necessarily wanted to be involved in the conceptualization process. Except with dear Vince who is that kind of guy. I mean you know him since before me. So he was ideal for that, in my opinion. \n\nDr. Young: So the role of the chapter exec on the Board involves communication with the chapters?\n\nCarolyn Gaughan: Yes. And interestingly, it’s not just Academy chapters. It’s also the DO, the family medicine DO organization chapters as well. So I don’t know any of those people on the DO side as far as their organizations. Dr. Paul Miller is a past president of that organization. He is on our FMA Health Board. So he has helped a great deal with dissemination for that group. So an example, Dr. Young: Last summer the FMA Health in concert with the PCPCC, which I’m going to have to look up what all those initials stand for because I cannot ever remember, but it’s got Patient-Centered in there somewhere. They came together and put out the shared principles of primary care. And so Dr. Henley sent a note to chapter execs that was shared through our Checks Mix (?), which is our chapter exec weekly e-newsletter that comes from Chapter Affairs at AAFP. And I think there have actually been a couple of direct emails to executives as well asking each chapter to have our boards consider and sign on to the shared principles. And there was a deadline given. I believe it was early September. And then that deadline was extended until October. And then the PCPPC board did whatever they did and had a rollout actually within their organization. And that was kind of it. And so I took the initiative to contact Dr. Stream now with CFAR, as I mentioned earlier. And also they put me in the touch with the right person at the PCPCC, whatever that is. And I found out who had and who had not, as far as our chapters were concerned, signed on. And so I just did a personal reach-out to everybody who had not. There were a couple of chapters who had really taken the time to consider it and had some issues with the principles. I don’t personally think that they were necessarily right. But I can certainly respect that they looked at it, they gave it  consideration and decided not to sign on. But there were a ton of chapters who … Well, I won’t say a ton. There were a number of chapters who either had missed that original thing or they saw the deadline as September 1st or whatever it was in early September and thought, oh, I missed that. Didn’t realize that it had been extended and indeed that it was extended beyond that. And so I reached out to each of them. We got a number more chapters to sign on. And then the other thing I would note is the Guam, the Puerto Rico and the Virgin Islands chapters all had hurricanes. So Maria swept through and whatever that other hurricane was that was before that. It kind of almost gets to be so many hurricanes in a row, you can’t remember it. But they were just devastated. And they, for that reason, of course, did not consider and have the time. And frankly we didn’t want them spending what time they have on this consideration. They’ve got very serious infrastructure issues. We helped raise money for the Puerto Rico chapter to buy generators. So that’s the level of decision making issues they need to be dealing with. Like the Maslow (?) hierarchy thing, they’re at the very base level of existence in electricity and clean water and we don’t need to burden them with worrying about signing on to the Shared Principles. So that’s just an example that I felt like I was helpful in further the mission of the FMA Health Board.                   \n\nDr. Young: This is, as you are pointing out, a very complex, wide ranging activity. Are there any other things that have happened in the past that you’re aware of or in the process now that particularly grab your attention? And think of that, if you would, both from what a chapter like Kansas is looking for and also just as family medicine continues to operate in this larger United States milieu.\n\nCarolyn Gaughan: Well, I have be involved on the Engagement Team. Now, you referenced earlier that there are some teams that are being folded into responsibility of other organizations. And so that whole process has been … Well, we spent the whole Working Party back in January, we spent a great deal of time going through in detail what responsibilities and who’s taking what they call the Big R and who is taking the little R and who is taking the consulting -- responsibility and who is in a consultative role and that sort of thing. So I started out on the Practice Enhancement and Payment Team. And honestly I was over my head there. That was stuff that Dr. Bob Phillips and I’m trying to think who was the leader of the other core team. I apologize, I’m not remembering exactly who it was. I know Dr. Weita (?) was on it. Oh, Dr. Miller was another leader on there as well. So, in any case, that was beyond my pay grade. But I think it’s some information and some things that are going to be very profoundly interesting to our members. So the whole transformation issue and getting to measuring value and not volume is always going to be a big issue for any chapter’s members. I might have lost the thread a little bit of what you were asking there. I apologize if I wandered a bit.\n\nDr. Young: No, I think you’re pointing out one of those significant evolutions in the process, as I understand it. You were saying some of the teams have already moved to who’s going to carry forward, who’s going to have lead on these activities. Exactly. And do you know any of the history of why in fact that is being done now?\n\nCarolyn Gaughan: You know, I wasn’t there, so it predates me. But my understanding is that at the Working Party before I started, so that would have been a year ago January, the executive group of those at the Working Party made a decision to end parts of the FMA Health early. And so that was what the wrap-up now versus – you’re leaving some open and continuing and some wrapping up now. That’s where that came from. What the reasoning behind all of that was I’m not entirely sure. I could conjecture, as you referenced earlier, that, gosh, so much has changed in medicine and it’s just such a fast moving and fast-paced environment that perhaps they felt that some of the teams were working on … I don’t know if they thought we’ve got other vehicles to get to where we’re trying to drive. I’m not absolutely sure. \n\nDr. Young: I think you’re correct that having had experience with Future of Family Medicine in the past and trying to see as that rolled out with its ten recommendations then how did things proceed afterwards. That there was a concept by some, at least, that there needed to be some clean handoffs with clear, as you say, who has the Big R, but who else needs to be involved. Because there are so many different organizations making this up, and even beyond family medicine to include a public member, for example. Exactly.\n\nDr. Young, could I put you on hold for just a moment? I have a message that I need to speak to one of my family members who’s not feeling well. I need to check in on him. \n\n(Recorder paused.)\n\nDr. Young: Continuing now with our interview.\n\nCarolyn Gaughan: I did want to mention as well, in response to your last question, that I referred to being on the Engagement Team and one of the goals that that team had put forward was to try to get the public more of a public voice into the boards of the various organizations. And we actually invited onto the FMA Health Board a representative of the public. And Diane Stollenwerk (?) started at the same time I did, so we were both the newbies at the same time. And that’s been nice to have somebody with whom I can share my commiserating in trying to think where are we now. But also to get her perspective which has been very rich and very helpful. \n\nAnd so as an example of what you were talking about earlier regarding the role of the chapter executives on this board, we were able to have … There were a couple of chapters, our chapter and the Oregon chapter who put forth resolutions at the Congress of Delegates last September 2017 about the role of increasing the voice of the public to the cuing of the various boards. And, of course, the one that we were most profoundly involved in at that time was the AAFP. There’s been some friction about that along the way. And again, that predates me. I’m not exactly sure what all happened to cause it. But I would say that these brought forth a pretty soft resolution. It didn’t say there will be, that we urge AAFP to put a member of the public on its board, but just to increase the voice of the public that the board hears. And we got a very good hearing and it got forwarded on to the board I think from the action of the Congress of Delegates. It was not in the action that was taken, but it was in the write-up about it that one thing that could be considered would be to have a member of the public on that board. But it has been such a contingent issue apparently due to some past interactions that we’re not pushing it forward. But that’s just one way in which our chapter and also the Oregon chapter were involved in trying to push forward the goals of FMA Health.\n\nDr. Young: Do you know if that idea was also considered by the other types of organizations that are represented in this such as Society of Teachers of Family Medicine or the North American Primary Care Research Group, et cetera?\n\nCarolyn Gaughan: Yes, it has been, I believe, at each of the other four board groups. And I’m sorry, I can’t read off with this group, it might be NAPCRG that is kind of going to do a case study and put a board member on there. Part of the issue with some of these organizations that are pretty small and you have a really limited budget is paying for an additional person to come and participate on the board – travel and lodging and whatnot like that. So we made some funding available. And I’m sorry, I don’t remember for sure which organization it is. But one of the smaller organizations is going to do like a case study and put a member on there and do an evaluation. So before, during and after and provide perhaps a little bit of guidance on what works and what doesn’t work and how to make it work better and kind of an evaluation, a wrap-up after the whole thing is over.\n\nDr. Young: Do you have any comments on the involvement of non-physician groups or non-faculty groups? By that I mean outreach to other primary care clinician groups within medicine or nursing or allied health.  I’m not sure I’m getting where you’re going with that question. At one point, at least, I believe, in the activities of FMA Health there was discussion about outreach to other non-family physician clinical groups who might be supportive of the principles that are in primary care but aren’t family medicine themselves. Yes, thank you for clarifying. That is very much what the PCPPC and the Shared Principle discussion was all about because that’s a huge group that has a lot of non-clinicians involved. It has a business side to it. It has, as you say, allied health professionals and other even non-physician and non-clinical people. So I think the Shared Principle document is kind of the culmination of that work. \n\nDr. Young: And I believe there had been activity that involved outreach within selected metropolitan areas.\n\nCarolyn Gaughan: Yes. That has been refocused. There were city tours in kind of the first half of FMA Health, if you will. And, of course, the Health Is Primary effort has been, I would say, sharpened and focused more and more within the Beltway in Washington, DC to try to show the city tour thing. Actually, our chapter and the Missouri chapter went together and had a quote city tour. And it was the AAFP’s National Conference for the medical students and the residents in the summer, I think, of ’16 (it might have been ‘15.) And that was the last quote city tour. So they refocused and kind of … They weren’t quite getting outside to the outer groups that we wanted. It was like preaching to the choir is the way I understand how that decision … Again, it predates me. But that’s how it was explained to me, that the people that are coming, that are participating, the news, where it’s getting picked up is going to a lot of family medicine places. So as I mentioned, the Health Is Primary effort, which is a lot of sort of the outreach facing, the public phasing voice of the FMA Health Board has been sharpened and refocusing so that you see inside the Beltway national policy making corridors, if you will. And there has been a lot of social media, which it goes everywhere. Social media, you don’t have to be inside the Beltway to see. But a lot of the advertising. And like they have had bus banners and I don’t even know what all. Metro banners and things of that nature, a lot of that has been focused into the DC area.\n\nDr. Young: We’ll pause the tape now so that I can turn it over and then we’ll continue, so to speak, on the other side.\n\nTape 1, side 2\n\nDr. Young: This is side 2 of tape 1 of the February 1st, 2018 interview with Carolyn Gaughan, Chapter Executive of the Kansas Academy of Family Physicians.\n\nCarolyn, could you talk a little bit about chapter reactions to FMA Health and just the challenge in terms of working with chapters that are so busy?\n\nCarolyn Gaughan: Yes. Thank you, Dr. Young. That’s a huge issue. And I will just say getting on the radar is always something you just don’t take for granted. So, for instance, we get the Checks Mix (?) chapter newsletter every Thursday morning in our inbox from AAFP Chapter Affairs and they pull together a multitude – twelve, fifteen, eighteen different things that they share with us each Thursday. And some are repeats but a lot of it is new stuff. So, for instance, this morning, today happens to be a Thursday and the first day of the month of February. So we got a reminder that applications were being accepted for the student externship Mac and Grant (?) Program is tomorrow. We got information about the AAFP’s planned social media content for the month of February just in case we want to know what their plans are for February. We got an offer to that AAFP had put together each state’s census data summary for it. So they do questionnaires to members each year when they’re up for re-election, in a three year moving cycle. And they pull all that together after the year is over. So I haven’t yet looked at it, but I got from them our Kansas census summaries as of the end of December of last year. So it’s just a multitude, everything from membership to the topics mentioned to the Congress of Delegates speakers have sent out a letter and have the tentative schedule now – you know, do we want to conserve (?) fellows at our Annual Meeting. Just a multitude, so many things that come across our desk that we need to deal with. And so information about FMA Health has been in that vehicle, the AAFP’s Checks Mix, and it’s there alongside of a lot of other very pressing and impressive and important things to know and to do something about. And so getting on that radar is going to be a challenge. I think, as I referred to earlier, that -- has sort of the rough road into the road of her, if you will, of this experience as a chapter exec on FMA Health in the conceptualization of projects and products that will be helpful to chapters. And I’m going to have the opportunity to help to disseminate them and say, here, look what we did, isn’t this great and here’s a suggestion for how to use this within your chapter. So that’s the way I see it. But I think it’s going to take some doing and not just me putting it forward. Dr. Henley, as I spoke earlier about the Shared Principles document, actually took the lead on it, the initial role of rolling that out. And everybody takes Dr. Henley seriously and when he says something nine times out of ten they’re going to look at it and give it serious consideration. So we will partner up and altogether we will manage to hopefully get on some people’s radar and have give serious consideration to the things that come forward out of FMA Health that could help the members. And honestly, that’s what we all want to do. We’re all trying to help our members and help them to be the best clinicians and the best family physicians that they can be in every sense. It’s sort of like our own quadruple aim. And so with that in mind I’m confident that when the time comes that we have additional things to put out there and to put forth that it will be taken seriously. And a variety of vehicles will get people’s attention and get them onboard with it.\n\nDr. Young: Excuse my ignorance, but do the chapter execs have their own meeting?\n\nCarolyn Gaughan: Yes and no, I guess I would say. So we did meet together during ACOF-NCCL (?) in the spring. There’s usually a luncheon during that. And then there’s a luncheon at CAB. And then there’s one meeting a year that’s called the Chapter Execs Leadership Conference that the Foundation has graciously started funding. It’s just been in the last I want to say three years. So it’s a separate, stand-alone meeting of just chapter execs. The other two meetings, ACOF-NCCL and CAB, we have doctors with us. So we’re in Kansas City or we’re in whatever city the CAB is in. Maybe we’re running a candidate. Maybe we are speaking. Maybe we are participating a panel or whatever. We’ve got other demands and roles to play. Whereas at the Foundation funded Chapter Exec Leadership Conference, it’s just us without physicians who might or might not need any material support from us. So that has been a really great thing and that’s another great vehicle for kind of spreading some of the FMA Health gospel, if you will.\n\nDr. Young: Let’s turn to the national scene and as you’ve been part of the discussion of FMA Health and as you’ve had discussions with colleagues in other parts of the nation, is there agreement on what the big challenges are for the specialty or are different parts of the nation facing different issues?\n\nCarolyn Gaughan: I’ll tell you, there seem to be similar regional issues. There was a starting to me presentation at our most recent Working Group. Bob Phillips was providing some information about numbers of family doctors who are doing OB, who are doing hospitals, seeing our own patients in the hospital and some other things of that nature. And again, I think we’re in an apparently unusual situation. But I think that the specialty is changing fundamentally in very profound ways that it’s different. It’s maybe growing stronger in a certain region on this issue than that issue. But I think there’s just a general sense of movement and change away from … I hate to say this, but it’s almost like the scope of the practice battles that we’ve found in the past, it’s almost like the family doctors in some areas, at least, are voluntarily restrained in their scope and making decisions that on a personal basis one physician might or might not make that much difference, but then you multiple that out over a larger group and all of a sudden only 8% of the family doctors in the United States, if I remember the figure right, are doing OB. So that’s just one example. And you might be far more … Anybody who reads this or listens to this might be far more aware of those kinds of issues. But I just sense an almost shrinking of the specialty’s scope that frankly was alarming and concerning to me.\n\nDr. Young: This has come up in some other oral histories that I’ve done. And some of the points that have been made, and you can think about Kansas as I raise these – but, yes, that obstetrics has been shrinking, that procedures have been shrinking. The role of the family physician in dealing with community health issues has been growing for which there are some incentives economically -looking at the quality of your overall panel, what outcomes that you have. And then all sorts of things in between including a larger percentage of family physicians are employed. Yes, that’s another great one that he talked about as well. And yet it’s less than some other specialties such as pulmonology or cardiology. And that the approach of team care which may require different skill sets than being able to deliver a baby, having more to do with how do you coordinate your team. And I’m sorry, a larger percentage being employed, but also the other reverse is direct primary care with contracts directly with patients as opposed to being under a traditional insurance approach.\n\nI’m assuming that FMA Health has been struggling across all of those at least in discussion if not in actual actions taken. Yes, I think that’s safe to say, absolutely.\n\nDr. Young: So in Kansas are you seeing all those shrinkages of scope of practice?\n\nCarolyn Gaughan: You know, we do. And I think they’re a little bit inflated, Dr. Young. So just by the rural nature of the state, and every state has rural areas. What they may have is rural areas that are closer to each other and closer to metropolitan areas than we have. So you know Kansas as well. I mean you’ve been a Kansas member for a long time yourself. And so I don’t know if you’ve ever driven out in between Ness City and west of there, Tribune. We have 105 counties in this state and not all of them have a family doc. And some of those little towns, as I would drive through I would see a hospital that’s in a really small community and the hospital looks like it’s about ready to close or else it already is. And maybe we don’t need hospitals in every county. But I think the citizens of the counties really feel that if they don’t have a post office and they don’t have a hospital and they don’t have a school, they’re really not a community anymore. So it’s that kind of rural-ness that we have here. So for OB, for instance, we still have a lot of family docs who do C-sections, operative obstetrics, but not in metropolitan areas as much. So I think yes and no to your question. Yes, we do see some shrinkage. It tends to be more in metropolitan areas. And, interestingly, the relative age of the family docs in the rural parts of the state is younger than the ages of doctors in the more urban parts of the state. Is that reflecting the educational efforts of the medical schools and residency programs? I think so. And the success of the Kansas Medical Student Loan Program, the -- Program, the Pre-Med Kansas Rural Scholars Program. So we’ve got a really good pipeline. Yeah, I think it reflects all of that. It’s the efforts of the Departments of Family and  Community Medicine. And actually our Academy works really hard on the pipeline issues as well.  \n\nDr. Young: Is that something that other chapters know about?\n\nCarolyn Gaughan: It’s interesting, I think some of them do. And they look at us with a little envious eye. I’ve gotten calls from colleagues from several other chapters saying how does your Medical Student Loan Program work and how did you get it funded? And then we have the Bridging Program which is then to place … So the Medical Student Loan Program helps medical students meet their tuitions and then the quote loan is forgiven when pay back with service. And then the Rural Scholars Program is even pre-med. So it’s a funnel. So that’s the pre-med funnel. Then the Medical Student Loan Program is during med school. And then the Kansas Bridging Program is for residents who then find within a specific community. So they say, okay, I’ll go out to Garden City.  And they get some nice bonuses. A signing bonus. And the state pays part of it and the community pays part of it. I think it’s half and half. I’ve talked to a few of my other colleagues and they have been a little envious. How did you get that in? How did that work out? And how do you defend it. And it has been all of those things. You know, trying to initiate it and work with the university. And actually we’ve been involved with the Governor’s office a number of times in years past. Not Governor Brownback, but before his administration to protect it. And it hasn’t seen what I call serious threats recently, but there have been efforts to put sub-specialists into the Medical Student Program and we have successfully fended them off. But other than that, there hasn’t been a real, what I would call a threat to the program. \n\nDr. Young: Are there any other thoughts that you’d like to share regarding FMA Health?\n\nCarolyn Gaughan: Well, I feel like we’ve got a lot left to do. I have thoroughly enjoyed the personal relationship building that has come for us out of this and getting to know and hobnob, if you will, or brush elbows with some pretty amazing leaders and speakers in family med. And I have gained a lot of knowledge about some organizations that I didn’t even know the initials of before. Like the North American Primary Care Research Group, I’m kind of proud I can even say that now. NAPCRG. Yes. It’s such an important organization and I sort of knew there was a group out there that did some research in the area and stuff. But I am so impressed with them. So that part of it has been very enlarging to my world, to understand better all of the organizations involved in the family of family medicine. And as I said, the personal relationships I’ve thoroughly enjoyed. Without going into too much personal detail, I’ll just say that Dr. Paul Miller is a very kind and compassionate man who, as it turns out, was at the hospital where my oldest brother who passed away this summer was a cancer patient. And when he found that out he gave me his personal cell number, Dr. Miller did, and wanted me to call upon him if there was anything that he could do. And he sincerely meant that. And he has followed up every time I’ve seen him since and asked about how are you doing. It’s just an incredible group of people and it’s a very high level yet a very human group who each one is so individual and so thoughtful and caring. Of course, I’ve known Dr. Brull for many years and I’m so proud to see her defining in this organization. I’m humbled and I’m grateful. And we still have a lot to do, so I look forward to working with them to get it done.\n\nDr. Young: Well, it has some time ahead of it as an overall project and you all are certainly giving thought to how to carry forward in each of the crucial areas and who will be the Big R – which excuse my background, I immediately thought of research. But in fact that is one of the tactic teams that I believe already has sort of transitioned in terms of its new chair and all.\n\nCarolyn, thank you ever so much for taking time out of I know what is a very busy schedule.\n\nCarolyn Gaughan: Well, thank you. I’ve enjoyed it very much and appreciate the opportunity. And it’s great to hear your voice. What is the audience for this? What do you intend to do to preserve the transcripts and all that sort of thing? \n\nDr. Young: The Center for the History of Family Medicine has a fairly large oral history collection. And the ones that I’ve been involved in previously have usually been individuals who are retiring from the Academy such as Dr. Perry Pugno or Gordon Schmittling who headed the Research and Information Services Division. But they also have tapes that have been done with practicing physicians who haven’t necessarily been as involved in the being on staff type roles. And it was suggested by, I’m going to forget the name, but an individual who was part of the Curator group for the Center that, oh, gosh, there should be an oral history not at the end, like five years later, looking back, but also there should be oral histories done while the project is in operation. And that’s been very interesting because of the things that have changed over time just because the world has changed or new thoughts have come up as to how to move forward. So essentially you’ve granted permission for anyone who would want to hear the tape to do that or to read the transcript once you have approved it. I’m not sure they’re promoting the fact that this is going on right now. I think they do want to wait till the project is over. But Don Ivey would be the person to ask with certainty.\n\nCarolyn Gaughan: Great. I think it’s wonderful. Thank you for doing that.\n\nDr. Young: Well, I didn’t know what I would do in retirement but I guess I’m mixing my prior radio work with this. It’s a good thing you have that undergraduate experience. Well, also as a graduate doing my masters, it was in radio, TV, film emphasis for biomedical reporting. Wow, there you go. Perfect. \n\nThank you again Carolyn. And I hope whoever in your family needs a family doctor … We got through to his family doctor and he has a couple of prescription that I’m going to run over and pick up and get home to him. Thank you so much. And don’t catch the flu. Yes, sir, I’m with you on that.\n\nThis is my privilege. I appreciate it. Well, it’s so good that you were desirous to serve in this role because the perspective of the chapter just has to be part of this whole process. I appreciate that recognition of that role.\n\n(End)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875#t=0.0,2458.8027"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875/transcript/85508","type":"AnnotationPage","label":{"en":["Carolyn Gaughan Information Sheet [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875/transcript/85508/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Gaughan, Carolyn\n\nInterviewer: Dr. Herbert Young\n\nInterview Date: February 1, 2018\n\nBiography\n\nMs. Gaughan grew up in McPherson, KS and attended school at Central Christian College and then Greenville College in Greenville, Illinois. She later received her Masters degree from Wichita State University. For many years, Gaughan was a high school teacher in the science department and was also President of the Wichita Federation of Teachers until she joined the Kansas Academy of Family Physicians and executive director in 1989. She has worked in her position at the KAFP since 1989 and continues to work in public health because she says it is her passion. She is closely involved with the AAFP and their visions as well. In her county of Sedgwick she hopes to further expand Medicaid in order to give the people of Wichita, and surrounding areas, a better healthcare experience.\n\nOral History Summary\n\nIn her extensive interview with Dr. Young, Ms. Gaughan speaks about her experiences in the health care system and the issues that face it, especially in Kansas. She is a lifelong Kansan and has worked for the KAFP for 30 years where she has aided the state of Kansas in its health care system. Among many other things, Ms. Gaughan talks about the FMAH initiative, issues in Kansas, her thoughts and feelings on health care topics, and where she thinks the state of Kansas and the nation need to move toward in order to push the health care system in the right direction.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295875#t=0.0,2458.8027"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295874","type":"Canvas","label":{"en":["Media File 2 of 2 - GaughanCarolyn_02_Access.mp3"]},"duration":1371.9204,"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/162447/file/295874/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295874/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/874/original/GaughanCarolyn_02_Access.mp3?1761145884","type":"Audio","format":"audio/mpeg","duration":1371.9204,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162447/file/295874","metadata":[]}]}],"annotations":[]}]}