{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/bk16m3520x/manifest","type":"Manifest","label":{"en":["Dr. Lars Peterson "]},"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":["2017-05-17 (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"]}},{"label":{"en":["Subject"]},"value":{"en":["Lars E. Peterson, 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: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286736","type":"Canvas","label":{"en":["Media File 1 of 2 - PetersonLars_02_Access.wav"]},"duration":684.3298,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286736/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286736/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/286/736/original/PetersonLars_02_Access.wav?1755096854","type":"Audio","format":"audio/wav","duration":684.3298,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286736","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286736/transcript/82478","type":"AnnotationPage","label":{"en":["Dr. Lars Peterson Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286736/transcript/82478/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1\n\nDr. Young: This is side 1, tape 1 of the oral history with Lars E. Peterson on May 17. I’m Dr. Herbert Young, a volunteer in the Center.\n\nDr. Peterson, welcome. Thank you for doing this. \n\nDr. Peterson: Thanks for asking me Herb.\n\nDr. Young: Could you start by giving us your full name?\n\nDr. Peterson: Lars Eric Peterson.\n\nDr. Young: Can you tell us what your current positions are?\n\nDr. Peterson: Primarily the Research Director of the American Board of Family Medicine and I’m also an associate professor of Family and Community Medicines at the University of Kentucky in Lexington, Kentucky. For both in Lexington, Kentucky, I should say.\n\nDr. Young: Any other major professional activities?\n\nDr. Peterson: None that haven’t named. I mean I’m involved in a bunch of other things in family medicine. Those are the main two I list..\n\nDr. Young: Perhaps we can hear more about those other activities in the course of the interview. This is an interview as a part of the project of Family Medicine for America’s Health. Can you tell us what your position has been in regard to that program?\n\nDr. Peterson: I was a member of the research core team and the core team leader from inception in late 2014 until, I forget if it was June or July of 2016 I resigned from the core team and FMA Health.  \n\nDr. Young: How did you learn about Family Medicine for America’s Health and how did you get involved?\n\nDr. Peterson: So being involved on the board, originally the seven members of the Family, I think conversation started at FMA Health from the working party, so obviously I was hearing about this through my natural working position, hearing about what was going on with this Working Party from Jim Buffer (?) and Bob Stolis (?) who were there. And then kind of hearing the rumblings about what was being called The Future of Family Medicine 2.0 at the time. And it was now the time to revisit it, look at the things that were left undone from the first Future of Family Medicine and seeing if there was really a chance to strike again. And had heard about the process all along in terms of the first, I don’t know if they called it a strategic planning meeting but they had a big meeting I think in early ’14 where they had kind of people from multiple generations kind of talk about the future. I’d given Bob Stolis some feedback on his article about “Defining the Roles of the Family Physician” that was posted in The Annals, I think, in 2014 – or The Annals of Family Medicine in 2014. And then hearing about stuff from the Leadership Foundation meetings and just kind of hearing about it all along. And then I was fortunate enough to be drafted to go to one of the organizing writing meetings. I think it was in Chicago in June of 2014 where there were representatives who’d been at the Working Party and had gotten involved in FFM 2.0 and were talking about writing papers identified at the time, I think, as seven tactics or seven areas including like an overarching paper and then having a payment on workforce and payment practice research, etc. And through that I was involved with the writing of kind of the overarching paper that was released with the announcement of the movement in 2014 of FMX. And then I was also on the writing of the Workforce Paper that came out in the special issue of Family Medicine, about Family Medicine for America’s Health, I believe, in 2015. So through a course of my jobs just knew about it as a byproduct of it. Then got pulled in through, I guess, my research productivity at that point and kind of already aiding into the future of what we know about family medicine education, particularly the role of certification. Then Bob Stolis, who was my boss at the American Board of Family Medicine, recommended, talked to me about wanting to be on a core team and then thought the research portion would be a good idea. And he thought I should apply or say I was willing to be the leader of the core team as well. So I mostly applied at his urging – strong suggestion, I guess, that it would be beneficial for me career-wise and then just be good to have more kind of board representation on the committee.\n\nDr. Young: This would be a good time then to hear more about you and your professional development and how that led into what you’re doing now and how that made sense for this core team. So can you just talk a little bit about why were you interested in family medicine and was that always the case and how about research in particular within the specialty?\n\nDr. Peterson: That could be a story in and of itself. How did I get interested in family medicine? I grew up in a small town called Richfield, Utah. So, Herb, if you got on I-70 from where you are and drove west, about forty miles from where, depending on your perspective, either dead end or start on I-15 in the middle of Utah, that’s where I grew up. So it’s a small town of about 5,000, 5500 people when I was growing up, about 20,000 in the entire county with the county hospital. I think we had one OB/Gyn at one point that everyone had as a family doc. So I originally wanted to be an astronaut. Then in the third grade, I was a very tall person, the tallest in the class, and then I had glasses. And I think it was my third grade teacher who told me you’re never going to be an astronaut because you’re going to be too tall to sit in the plane and you already have bad eyes, so just forget that. And so I literally, and I don’t know why because I don’t really have any history of medicine in my family, said, well, then I want to be a doctor. And thinking you wanted to be a doctor where I grew up meant  being a family doctor because that’s really all we knew and those are all the physicians I interested with and they took care of us everywhere – in the emergency room, in the office, when you got hospitalized, nursing home, etc., and delivered all the babies, did everything where I grew up and that’s just kind of what I wanted to do. So I then went to college at the University of Utah in Salt Lake City. The high school I went to wasn’t very challenging, so I could pretty much do nothing and get straight A’s very easily. And when I went to college I applied that same level of effort. Then for whatever reason back then when I started getting worse grades I just thought the problem was with them as opposed to with me. And so I figured, well, life works out for me and school will work out and I’ll still get into medical school. So I did get all the way through college with about a B+ average, I think. Took the MCAT, did okay the first time. Then I realized if my grades aren’t good I really need to get a good MCAT score, so I think that’s when I really learned how to study – the second time I took the MCAT and applied myself. Got a vastly better score. Applied for medical school but did not even get an interview the first time around. So when I went to go meet with the director of admissions at the University of Utah to get feedback on what happened, he said, well, we don’t know what to make of you. He said you have this not great GPA but this really great MCAT score and we don’t know which is the real you. So if you really want to get into medical school, you need to go back to school and get better grades. So I went back. I was working full time in a laboratory in Salt Lake City and was able to interact with -- pathologists at the time mostly and kind of got some interest in doing bench science and things there, but never to the point that I wanted to do that as a career or even clinically. Still talking about rural Utah and wanting to move back to Richfield, Utah to be a family physician at the time. And then it was in the second round of courses that I took to get better grades to get into medical school, I ended up … I asked the admissions director, who gave me advice on what do I need to do, which classes would you want me to take. And she said she didn’t really care. She just said I need get better grades. And so I figured if I was taking about two years of courses part time I could change my original minor in anthropology to a major so I could get another degree out of it because I had to have something to show in case it didn’t work out again the second time. So I started taking like medical anthropology, then I took a health economics class and a biostatistics class and kind of the more social sciences but around medicine courses. And it really got me thinking more about public health and kind of the systems and how systems affect health and healthcare. And the second time around I was looking to apply to MD.MPH  \n\nprograms and I found one at Case Western Reserve University and right below it, it had an MD and a PhD in health services research. I didn’t really know what health services research was, but I thought it sounded really interesting, the little bit of Googling you could do back then. It was only 2001, so I guess I could have done a lot of Googling. So with the little bit of searching I did, it sounded interesting. I ended up scheduling a call with the program director of the program and talked to him, kind of told him my story about who I was, what I was interested in. You know, interested in rural health and outcomes. And he encouraged me to apply. Then I got an interview there and I was accepted at the University of Utah to go into medical regular school and I was trying to work on getting in the MPH program as well. Then after a few months I got accepted into the MD PhD program at Case Western. I then turned down Utah and went to Case to get a PhD, which was quite a departure from I’d been two or three years before that. But going to Case was really great. I was doing full time night school, full time grad school. Almost immediately got involved with getting to know the family medicine faculty. At the time they had a Robert Wood Johnson Foundation funded program called The Primary Care Track. Case isn’t a very family medicine-friendly environment, I guess, like most academic medical centers. I think when I graduated there were five of us who went into family medicine and there are probably usually like five to ten. But I was on the primary care track. Did some extra exposure to family medicine there, some extra training. Got to know the faculty, became a student leader relatively quickly in terms of the Family Medicine Interest Group. President of the Family Medicine Interest Group for a couple of years. I got involved in the Ohio Academy of Family Physicians. Actually became the student representative to their board for a couple of years. Then also moved on to the American Academy of Family Physicians Commission for the Students. I think the one I was on with you was the Commission on Clinical Policy and Research in 2005. Or was that the Commission on Science. Yeah, Clinical Policies and Research. And then I think I was on the Commission on Practice Enhancement in 2007. Yeah, I did another one in 2007. And through that, too, I got to meet obviously like Kurt -- and George Stacano and Steve Izansky (?) from the faculty at Case. Progressed in my graduate school work focusing on access to healthcare in rural areas. And then also went to the Graham Center as a student in 2005. That’s when I first met Bob -- and Andrew Basemore (?) and Steve Patterson and did a couple of projects there. And then successfully defended by PhD in 2007. Got back into medical school. And another way I got on board’s radar was I successfully won the Pisacano Award back in 2008. So then I got involved in that program and won (?) the other Pisacano. Then when I was a fourth year medical student I went back to the Graham Center for a second stint and wrote another couple of papers with Bob and Andrew looking at the -- of geriatricians in the United States. I don’t remember what was the second one I did – and visiting house calls. So I think I got on the radar then. Then I ended up going to residency in Charleston, South Carolina with the Trident/Medical University of South Carolina program. There’s a whole story of how I ended up there that might be too long for this. But basically I met my wife on that track. She was a fellow down at MU-SC and a family physician and I was in my last year of graduate school and we did a long distance relationship. Then I interviewed all around the country but ended up going where she was on faculty for residency, which was as good place to be. It was a good residency, a good experience. And then just kept working on my clinical training, trying to finish some of the projects I had started at the Graham Center, working on other research. I did a few papers with Peter Karrick at Chip Menos when I was at MU-SC. Then started looking for faculty jobs fairly early. Like midway through residency, I think it was January/February of 2011, there were a couple of meetings in Charleston. I forget if they were Working Party meetings or like an ABFM  meeting. I think it was the AD Department of Family Medicine meeting where I actually went and talked to two chairs on the same day, one at lunch and one in the evening, about possibly being faculty there and just praying that the other one wasn’t going to walk through the lobby and see me sitting with the other one. And fortunately that didn’t happen. And probably a week or two after that I got an email from Bob Stolis (?) who was still the director of the Robert Graham Center at the time, telling me that the American Board of Family Medicine was looking for a research director and he thought I would be a good candidate. I didn’t laugh. I was kind of like really? I was still in residency and figured an organization like that would want a more seasoned person with a track record to take that position on. I talked to Bob on the phone about it and he said, oh, no, there’s not a lot of track with record research there. They’re really kind of looking for someone with your skill set in terms of having a PhD and knowing more about research and your experience with the grants kind of methods and your data set, so I think it would be a really good fit. And Bob had known about this because, and I found this out later, but the ABFM had made an attempt to – they’d never had a research director. They had apparently made an attempt to find someone I think in 2008 or ’09. And the way the story was told to me was that they were unable to attract someone because there wasn’t a history of research and no one kind of wanted to take that leap into a position where you don’t even know what data you have, what you can do with it, etc. So that’s actually what spawned the collaboration between the ABFM and the Graham Center, was the ABFM talked about if we send you our data could you do some of that scoping work and kind of figure out what we can do with the data we have and use it for not just reporting aback to the board, talking about what was going on in the specialty in aggregate, but actually kind of you would be doing some more advancing and getting some papers out of it. And by the time I started hearing about the position at the Graham Center, I had already published maybe five or six papers about participation and certification in the scope of the practice of family physicians, etc. So fortunately for me, after bob convinced me this was serious and that I should really look into it, I think it was the working party meeting was also in Charleston, so Jim Puffer (?) wanted to meet me. Anyway, I went down and talked to him and Craig Czarsky. So I met them in the lobby of a hotel in Charleston and talked to them for like a half hour, something about the job and about me. Then I was invited to do the next round of phone interviews and then I interviewed in person. And it was my last day of my second year of residency that Jim Puffer called me to offer me the job. And they were willing to wait for me for a year, obviously, until I finished residency for me to start. So then I started in my position August 1, 2012, my first day of work as the research director at the board. And working with the Graham Center because they were still doing collaborative research during that time and continue to this day as a collaboration with them. But then growing our own research shop which now includes myself as the research director, I have a medical anthropologist. He has a research assistant, I have a research assistant. We have another PhD level quantitative health services researcher on the team. And so it’s been really neat getting there. I told you, I think before we started recording, that I am very fortunate that the board has fully funded the research enterprise so I’m not constantly chasing money and chasing what’s fundable, what kind of research I want to do. I can do some wide latitude to look at what issues family physicians are facing, what their scope of practice is, what the practice organizations are like, how they’re interacting with the board in terms of participation in our certification activities in terms of taking the exam and doing the different continuous certification activities. It’s been really fun. I’ve been able to publish a lot. I just presented to this our board two weeks ago. I think since 2010, since the collaboration with the Graham Center we’ve had … Since collaboration with the Graham Center started, they’ve had over 100 publications and my name has been on at least over fifty of them. And then I was recognized last fall, I won the NASCRAG New Investigator Award last year, kind of a recognition of that. So that’s kind of how it ended up. And then also through other things I do professionally. Being at the board also opened up other avenues of leadership and liaisoning or liaising (I don’t know what the proper word would be there) with other organizations. So through that I’m now the ABFM’s liaison to the NAPCRAG board of directors. I’m on the CERA, the Cafam (?) Educational Research Alliance, on the steering committee as an ABFM representative. I’ve been to a lot of other kind of ad hoc meetings where they want someone from the board there. I help work with the Association of Family Medicine Residencies, or AFMRD. The AFMRD and the board got together with other stakeholders and we worked to create the National Graduate Survey for family medicine graduates three years out of residency that meet the ACGME (?) requirements and feed data back to the residencies. The first report went out a couple of months ago and that’s been pretty cool. And I still see patients two afternoons a week. And I’m giving a board review lecture to the residents on renal physiology in fifty-five minutes, so …\n\nDr. Young: So obviously you’re well-prepared for the task that came to you in terms of the research core team. Why don’t we back up a few steps and refocus for a moment then on Family Medicine for America’s Health. In your view, what’s the value and the purpose of the overall FMA Health? And then if you would say more specifically about the research component of FMA Health?\n\nDr. Peterson: I was excited at the beginning, going to that organizing meeting kind of meeting about the writing in Chicago and thinking about how you would want to remake the world and kind of recommit the specialty and think about some of the research we’ve done about the declining practice of family physicians and how you can think about reversing that and really honing in on payment kind of being the difference. And kind of thinking about why was the promise of the first Future of Family Medicine unfulfilled? Was it really because they didn’t gain traction enough to change the way we pay for care and really kind of flip the equation to valuing primary care and family medicine over subspecialty care. And that’s what it really started off with from a lot of the other meetings. People talking about, you know, everything kind of hangs on payment, payment, payment. And thinking about my specific task, being involved with the research team and kind of thinking about growing the research enterprise of family medicine and getting physicians engaged and interested in research, that was of interest to me. I remember when I was a student on the Clinical Policy and Research, I clearly remember having a discussion with a couple of chairs of family medicine who were on that commission and people talking about family physicians go into family medicine because they don’t like research. They don’t want to do research. Maybe if we convince them to do something and we don’t call it research, maybe they’ll get interested in it. And kind of having those discussions resurface and kind of looking at the research enterprise and where research is being done and trying to think differently about research isn’t just bench science or randomized control of clinical trials and drugs and practice organizations and implementation of science is kind of cool. Rather thinking about can we actually effect for change kind of the funding equations and try to grow the capacity of family medicine research – was really interesting and exciting.\n\nDr. Young: Can you clarify a little bit … Was that trying to involve all family physicians in research in some way as gatherers of information participating in studies or was it more being more intelligent consumers of research or what?\n\nDr. Peterson: I think it was a little bit of all of it. So helping family physicians realize that doing quality improvement in your practice is a form of research. When we talked a lot about the big R research and the small r research, so people who think about I don’t want to do research are usually thinking like the big R research in terms of NIH funded grants or drug trials or things like that. But thinking about looking at how things work in my practice or studying what’s the best treatment for my patients or how to best organization my practice, et cetera, is engaging in some way in kind of the small r of research. So we were thinking about how you could engage physicians in terms of thinking about that – because it’s not just the big R, but other kind of activities could be considered research and getting people kind of thinking about that in a positive way as opposed to thinking about it as I don’t want to do research but I’ll try to figure out how to organize my practice better or work on a quality improvement project and getting them thinking in different ways, I guess. \n\nDr. Young: So bringing a methodology to their practice, to be curious and seeing a need that needed to be addressed and then how to approach getting the information and involving the organization to meet those needs?\n\nDr. Peterson: Yeah, I think so. That would be accurate.\n\nDr. Young: Any names come to mind in terms of who you were talking to back then?\n\nDr. Peterson: Well, I think those were mostly kind of my thoughts before it started. And those are some of our organizing, some of the conversations we had early on, on the core team. Which the core team, at the time I was on it, was Perry Dickinson, Alex Chris, Andrew Basemore, Ronna Nue.\n\nEndavu (?) was our liaison for the board of directors and Caroline Busen and Aaron Glickman were our -- staff. I think that was the core team – unless I’m totally blanking on someone and they’ll hate me later. We can edit in. I don’t have the list, unfortunately, in front of me. \n\nDr. Young: So as a core team you had the sessions early on. How did you decide what your goals were and how to achieve them?\n\nDr. Peterson: That was one of the interesting things about this. I was told this is what FMA Health wants to do and they’re having core teams related to different tactics. So at the very first all hands meeting, I think it was December of 2014 in Tampa, Florida, I wasn’t quite entirely sure what to expect. We get there and I remember basically handed packets. I remember having the impression and I remember other core team members kind of had the impression that we would kind of be given somewhat carte blanche – or I thought we were kind of being carte blanche, kind of doing what we wanted in terms of research or thinking about making our own kind of priorities. And then we were given like four tactics that we were told had already been vetted and approved and the board had gone over and over the wording and approved kind of here’s the four things that we think research should be doing. And your job is to kind of pick which one or two or three you’re going to focus on like in the first year and maybe which one you’re going to get years later and then what specifically are you going to do underneath those … I forget all the phrasing now because it’s been like a year since I’ve been out of it. But what tasks are you going to do to serve the tactics – or something like that. And it was really somewhat kind of … A little bit deflating first, like, oh, we’re going to be somewhat told what to do and kind of get some freedom to do things within these boundaries. And maybe that will be okay because we can kind of  bend things, kind of fit what interests us, the way we think it could be best done. And we were originally thinking about if where are we going to do this, because we have day jobs and we’re supposed to be gathering information, effectively almost doing other research studies to serve the needs of FMA Health, but we need the resources to do it. And then being told that the budget’s already been made. There’s no extra money and you’re going to have to do it in your own free time and goodwill.\n\nDr. Young: What were the things that they were asking you all to do?\n\nDr. Peterson: Oh, my gosh …\n\nDr. Young: Were they in sync with any of the discussion you all had had before?\n\nDr. Peterson: I’m trying to remember the timeline. Because I think we had one video conference meeting maybe before we met for the all hands meeting. So what I told you initially was kind of my own thoughts about it before, from being at some of the meetings and trying to start working on the papers. And like I said, I kind of had the impression that we’d have more latitude. Then we were given kind of like these high tactics that were already kind of handed down. And we were like, well, who decided these? What if we have different feelings about these? And we were told, no, these have been vetted, these were good, you need to work on those. And there was a little bit of resistance. I think my team successfully negotiated to reword some of their tactics based on some strong rationale, which I’m forgetting, and I apologize. But I know we reworded a few. I remember kind of leading that first meeting a little bit like what did we just get into.\n\nDr. Young: Especially if no resources seemed to be offered to you on top of the busy lives that I’m sure you all had.\n\nDr. Peterson: Yeah, everybody on there was busy. That was one of the issues when we would go a month between … We had a core team meeting every month. And a lot of times it seemed different things hadn’t been done because we were trying to do the FMA Health stuff in kind of the margins of your day in terms of getting your day job done and other people getting your grants done … It kind of takes priority over some other FMA Health stuff. So things were kind of stop and start and how much bandwidth you had to take things on to kind of move them a little bit. But, yeah, it was kind of difficult. Then we were able to convince the FMA Health board, we were able to go back and they rearranged the budget a little bit to give the core team some extra money. In terms of what I called the slush fund, I think we were able to get $10,000 we kind of used as we saw fit. And then the research core team was able to lobby to get a summer intern. I think that was in 2015, who was at the Graham Center, who had done some great work in terms of had been handed (?) bibliography on the value of primary care. I was looking at the top research studies. Not looking at them real systematically, but in terms of doing some searching, then talking to some of those research leaders and kind of icons in family medicine like Larry Green and Kurt --, -- and I’m sure Bob and Andrew. And I think they even talked to me too about kind of what studies would you identify, who are the researchers that have really made a contribution. And then trying to find some of those studies and write these bibliographies that I think are still up on the Graham Center’s website and I think they’re actually on the FMA Health website. So that was kind of a big win early for us because I think the Graham Center might have paid him to be Graham Center intern. I don’t think those monies came from FMA Health.\n\nDr. Young: It sounds like a lot of research – being able to look around and be innovative and finding how to get support to do the things they really want to do - such as the Graham Center, in this case, providing that funding. Can you put sort of the core team for research and what it was doing at this point in the context of what the American healthcare system seemed to be facing and how Family Medicine for America’s Health was going to address that from our specialty’s perspective? For instance, I’m assuming you didn’t come to the conclusion that there was an abundance of research being funded and done that addressed the issues faced by the specialty?\n\nDr. Peterson: No, I kind of had a Gestalt that they were definitely underfunded and undermanned. I mean I don’t think there’s a groundswell of family medicine researchers out there who are able to get funding – and they would do more if they could get funding. So I think we looked at the research needs initially. One of the first things we did do, and I’ll hopefully answer the question in saying this: One of the things we initially decided on was scoping work. And no one could really think of any publications that looked at the scope of family medicine research or was actually shown these are the places where there is like high quality family medicine research being done and this is what it takes to do that. So we set off first to do what we were calling kind of like a landscape analysis to look at how much family medicine research is being done in terms of publications, in terms of research dollars, and chased that idea for a while. And then realizing that was probably going to be too hard, we were then thinking about doing a bright spots (?) analysis in terms of looking at where is it being done really, what does it take to do family medicine research really well, kind of trying to do some work to figure out what characteristics of a department or a school or a stand-alone center, like what does it take to make that. Could that be either savable or replicable in other areas. And then really tried to find some funding and some different ways to do that – which I think is still ongoing. There was an effort kind of out of the core team and also out of the Robert Graham Center who had attempted something like this before, did get a grant from the ABFM Foundation to do -- metric analysis, to do a scientific analysis of like publications. They will do a methodology to identify publications by family medicine faculty, to be able to track that. Because the American Department of Family Medicine, the ADFM was interested in doing that as well. They’ve been working together on that and that’s still ongoing as an outgrowth from FMA Health.\n\nDr. Young: When you say family medicine faculty, is that across degrees? So would an anthropologist or a sociologist working in a family medicine department be part of that?\n\nDr. Peterson: Yes.\n\nDr. Young: Because I’m wondering how pure is research these days that you say that is this specialty? And particularly one like family medicine that is so much interactive with so many other parts of medicine?\n\nDr. Peterson: Yeah. And we had some of those discussions too about what is family medicine research. And you can’t say, well, it’s research done by family physicians because that would exclude PhD’s working in family medicine and that excludes behavioral scientists. That would exclude a lot of things that go around family medicine. So we were really … From a pragmatic way, the easiest way to do it is to say faculty in departments. But then that ignores stand alone residencies where they’re doing different scholarly activities. They might be publishing some of the quality improvement stuff or systematic reviews. And even trying to count some of what I referred to, the small r research, earlier. I think for the purposes of what they’re doing now, they ended up settling on faculty. Probably because it would be too hard to figure out the other stuff. So at least it’s a start. And I think part of the bibliography, too, was looking at the core features of primary care and kind of summarizing the current state of knowledge in terms of what we know about paying for comprehensiveness or paying for continuity of care and knowing about how to work together. Yeah, comprehensiveness, continuity and I’m not sure what else was in the bibliography.\n\nDr. Young: It sounds like finance is somewhere in the background in a lot of this.\n\nDr. Peterson: Yeah. And to revert back to what I said in the beginning, I think from just conversations I had with people about the need for FMAH, I was kind of left with the impression that a lot of why it didn’t succeed was that the payment mechanism didn’t change. If we could talk about what’s in the research about showing the value of primary care and then hopefully you could use that to build for … You know, demonstrating the value and then saying we need to pay for these functions. They can’t be done for free under the current model. But if you pay for it, these will be the outcomes of the system based on what we know from studying other healthcare systems. That would hopefully drive those conversations.\n\nDr. Young: So that would be a type of research that informs policy?\n\nDr. Peterson: Yes.\n\nDr. Young: As opposed to something that is much more clinical. Well, the one that is financed is drug studies but …\n\nDr. Peterson: So saying clinical just triggered a memory for me. There was one of the tactics I think that we were struggling with was something about the research core team will find answers to common clinical questions or something facing family physicians. And we took the position that we are here not to do research for family medicine but the core team is really to try to understand the research infrastructure needed to answer the questions and advocate for that. And we also got some internal – not pressure, but I think we were all trying to figure out what we were doing in terms of the core teams and our relationships to each other and what  you do. I think a lot of the other core teams said, oh, we’ve got a research core team. So I need to know like these things to help my workforce team to build and really help me. Hey research core team, can you research those for me? And we had to push back on that a little bit and say, no, we’re not the researchers of FMA Health, we are the research core team of FMA Health. And part of using that logic was trying to lobby to get like a full time fellow to be able to do some of the work, either some literature searches or find some data or do some small scale studies to help the other research teams, the other core teams to meet their needs. Because we weren’t going to become the research arm of FMA Health, if that makes sense.\n\nDr. Young: That leads to a question: In your understanding how is FMA Health structurally? Is it something to be here forever? Is it something to just make some important conclusions, initiative some programs, but then the other organizations somehow will take on that work?\n\nDr. Peterson: Well, I already know the answer. I know what’s going to happen. That would be good to hear. Oh, you don’t know? They’ve already had the organizations kind of decide … like the functions of the tactic teams are being absorbed by the members of the family. So I think the entire research core team, most of the functions they’re doing are going to be moved on to either existing NAPCRAG committees or taken on by NAPCRAG. And like the American Board of Family Medicine, we were talking about some of the functions or continuing tactics along payment. Not payment but quality measures of primary care, clinical measures. I think the board was going to do some of that. I think the Academy was going to do a few of those. And I think ABFM was going to work on workforce. It’s already being wound down. And I think the last days of FMA Health are maybe the end of ’19 or the end of 20, it’s going to go away. \n\nDr. Young: So that would explain, for example, who the new chair is of the research core group?\n\nDr. Peterson: Yeah, that was kind of fortuitous. I’ll get to that. So in addition to doing the monthly core team meetings, I was on the core team leaders meetings which were also I think close to once a month. And at the time with my day job, I let the research assistant go, kind of like an early – I think it was June 2015 I ended up firing her. And so I had a smaller team then. I didn’t have my other PhD researcher. So the research team at the ABFM at that time was me and the medical anthropologist. And I went through some struggles finding new people because I was trying to hire for the PhD position and hire for the research assistant position. And I went nearly a year without a research assistant while also being on FMA Health and the other things and having pressure to write papers and get other research projects done all by myself. I was falling way behind, I’ll put it that way, on a number of things. And just in conversations over a couple of months with Bob Solis (?) who was my boss, he was asking me when is this going to get done or when is that going to get done. And I said, Bob, I have no time. I’m in a lot of meetings. FMA Health is eating up a lot of my time. And I said if you wanted to get me off FMA Health, I could probably get a couple of these things done. But short of that, I don’t think it’s going to happen. It’s not going to happen for a while. And that’s when he said, well, why don’t we get you off FMA Health? And I said because I thought the board thought it was valuable that I be on it and continue representing ABFM’s needs and viewpoints. He said, no, you’ve been on it long enough. You’ve done your term. It’s time to rotate off.\n\nDr. Young: In fact, if what you’re saying about the assuming of the major leadership in terms of these core groups’ activities is not the new chair, the lead staff for NAPCRAG?\n\nDr. Peterson: Yeah, Tom is the executive director of NAPCRAG. So at the time, the -- FMA Health wasn’t known. I think we had conversations about NAPCRAG. Tom was asked to join the core team before I resigned. They asked him to join because so much of what we had talked about involved NAPCRAG that we thought it would be good to have him on our core team to get kind of the input from NAPCRAG and let NAPCRAG kind of have a closer involvement with what they were doing. And it was just fortuitous that Tom joined and I resigned. And they said, well, not only do you want to join the core team, but how do you feel about being the core team leader? \n\nDr. Young: It seems to have some advantage if NAPCRAG is assuming a great deal of what the research core team has been working on. But let me explore this: Over the years, I was twenty-eight years with the Academy professional staff, then I’ve been retired a few years … One of my projects here at the Center has been trying to look at sort of milestones within family medicine, just an outline, within research and evidence-based medicine. And it’s real clear that the specialty has had voices saying we have to have a vigorous research activity as a specialty. But who has spoken, which organizations have stepped forward, at which points in time, what resources have been available – seem to be a fluctuation over time with peaks and valleys. At this point, you have pointed out that the Graham Center is clearly involved in research of a particular type. Another part of the Academy, the National Research Network, has been very involved in more clinical questions, although not exclusively at all. NAPCRAG I think has stepped forward. They finally took over from the prior endeavor where we had ten objectives. They stepped forward to assume the Generation of New Knowledge component. And I’m not as familiar with where STFM is or the department chairs or the residency directors in activity, which you mentioned that. It seems that research maybe has things going in multiple organizations. Is that true, in your opinion, and are the steps forward that you see with a strong lead within research going to be able to facilitate some    \n\nof these individual activities, bring them together in some ways – like the Graham Center and the American Board have been doing?\n\nDr. Peterson: Oh, gosh … Maybe it’s an unfair question? I don’t know. In talking about this I heard from people kind of a generation or two before me, I think Herb Staney (?) had talked to me about there had been previous attempts to get together to talk about the combined or shared family medicine research agenda. And even we had struggled a little bit at the core team level with people kind of talking to us saying, hey, we’re doing this project and we think it serves the needs of FMA Health – can we get branded as an FMA Health initiative? Or can we say we’re doing something that supports FMA Health in an official capacity? And we didn’t know how to handle those requests because we didn’t want to say that something wasn’t supporting FMA Health and we didn’t want to get into the business of saying, yes, you support it, you don’t support it, because that would draw some of those lines about, well, you’re not doing family medicine research or you are doing family medicine research. And also that we were a collection of volunteers. Like we could say, yeah, we support you doing the project but we don’t have anything to offer you in terms of either staff time or commitment time. Because you couldn’t buy 10% of my time to be on your research project through FMA Health. You would do it through ABFM because that’s where I work. So there were things like that, that I wasn’t sure was ever going to happen. So to get back, I’ve been told by older generational researchers that some of these attempts have been made and that kind of family medicine has this, not inferiority complex, but it doesn’t have the need to kind of define themselves over and over again and try to define research agendas. And maybe we should just get on with doing the work as opposed to worrying about all the systemilogical or existential questions and just go do good work. I don’t know if that makes sense, but … But I’m not sure. I know organizations can work together for a common purpose. I mentioned earlier in my description of my professional development or my professional roles, the ABFM, in a way, works with the Academy on a lot of levels. And then we work specifically through research with the Graham Center and have for seven years now, or eight years. And since I’ve gotten involved here, we’ve, like I said, created the graduate survey with input from a lot of parties in family medicine. But then have continued to work on it with AFMRD. Yeah, I think there’s a lot of room for organizations to work together to help build research capacity and kind of raise all those effectively in terms of trying to build fellowship, try to promote research methods and rigorous NAPCRAG and SPFM’s. I think it’s possible. I think it’s also going to take a little bit of a cultural change in who goes into medicine and who thinks about research – and also funding. If we talk about funding for payment in terms of getting the whole medical enterprise to change toward value in primary care, what we really need in family medicine is that kind of change in capitated payment or paying for value – which I think would allow family medicine or primary care practices to be funded to do what we need to do to take care of patients rather than chase service after service after service. I think the same goes for research. ARCH (?) tends to be the main funder of primary care research and family medicine research and it’s always on the chopping block, always threatened to be cut. It’s totally under-funded. It could do a lot more but it’s not respected. I kind of made my big audacious goal with FMA Health when they said what would be the BHAD, the big, harry, audacious goal? I said I want there to be a National Institute of Primary Care at NIH. There’s a National History of Complementary and Alternative Medicine, for heck’s sake, but there’s not a National Institute of Primary Care.\n\nSide 2: Dr. Young: This is side 2, tape 1, interview with Dr. Peterson, being done on the seventeenth of May.\n\nDr. Young: Let me ask this question: How do you see the healthcare system changing at this point and what are the implications for where family medicine research needs to be going?\n\nDr. Peterson: I think family medicine is still struggling with this, or medicine in general is struggling with the idea of kind of the doctor is a silo and everything is kind of under the doctor’s control. Where increasingly we know care is delivered in teams, physicians don’t want to be the stereotypical rural physician who is on call twenty-four/seven, who is having to work 120 hours a week and typically not have a personal life or a family life. So care is being done more in shifts, being done in teams. We have so much work to do in primary care, we’re kind of off-loading some tasks to other professionals like nurse practitioners, PA’s are in well over half the practices where family physicians work now. So I think kind of follow those trends and how we can preserve the value that we provide and show where the skill and the training of the family physician is needed and can provide value. I mean it personally interests me and from a research side really would add value to payment discussions and practice discussions and really get people thinking about, well, if you get all this training, do four years of medical schools, three years of residency and you’re training to be this full scope physician, you can provide care in multiple settings to all age groups, then there’s value in continuity with your patients and value in the comprehensiveness of taking care of your patients broadly, so we can show those behaviors and those outcomes affect cost of care, have higher quality care, and hopefully patients are more satisfied with that kind of care, what kind of payment needs to go to promote that and how do practices have to organize to insure that can happen? And I really hope that’s where the future lies in terms of what I’m interested in researching and where I hope the practice goes. I can tell you the practice of family medicine does not function that way at all. I don’t have any time to do anything other than see the patients I have and write some notes and do paperwork. I don’t have any time carved out to do population health management or panel management or huddle with behavioral health specialists and a home health nurse or someone and talk about patients in common and come up with a shared plan. I don’t have any time carved out to go do courtesy rounds on my patients who are in the hospital. When my patients go to the hospital I’m never called about it. I sometimes get emails through the hospital system, but those come as an automated thing. I’m listed as the patient’s primary care provider in the system, not because the actual inpatient team is calling me saying, hey, your patient so-and-so is here, this is what’s going on, here’s the PCP’s recommendations.\n\nDr. Young: Is this unique in what you’re proposing; that is that systems would be actually designed based on research as opposed to perhaps what happens in most systems now, which I’m just guessing is a little bit more ad hoc?\n\nDr. Peterson: Yeah, I would hope that science and evidence would inform policy and payment. But, again, this is being recorded in May of 2017, we know the current state of belief in science in our political arena.\n\nDr. Young: The waters have not risen to reach the building here in the Kansas City area.\n\nDr. Peterson: So my hope is that we will be able to show some value. Not just me, in particular, but the family medicine enterprise will be able to show value for what family physicians do and that eventually the preponderance of evidence beyond what already exists … I would think that any politician, health insurer, hospital CEO, anyone who becomes familiar with Barbara Sharpnell’s (?) work in terms of areas where primary care is stronger, functions better, has lower healthcare costs, people live longer, people are healthier – you think everybody would be all in on buying that, but they’re not.\n\nDr. Young: So does part of the research endeavor include an understanding of decision makers and decision processes within large system?\n\nDr. Peterson: I think it could be because I think it’s time to understand where … I guess that makes me think about research, policy research, dissemination and implementation research and then like advocacy. So I hope that every researcher thinks that what they’re doing is going to impact some change in the real world. So I’m thinking about bench science, someone studying the metabolism of a protein, you would hope that that research would then somehow inform an advance of knowledge that may or may not improve life in terms of making a new compound or for medical research being able to cure a disease or treat a disease. For health services, when I think of the kind of research I’ve been doing, I hope that my work would be used to incentivize physicians to do more in terms of broadening their scope of practice and not letting it erode. But I also know that some of the reasons why we’ve been discovering that physicians are not practicing broadly tend to deal with payment issues, lifestyle issues, health system issues in terms of just most physicians are employed now, so if you’re employed by a healthcare system that has like ea pediatrician’s group, they’re going to try to funnel kids to the pediatricians rather than see you.     And if they have a group of OB/Gyns who deliver babies, then they want them to deliver the babies and they don’t want you to see them. And they don’t need you to go to the hospital anymore because they have hospitalists there and they think those are more efficient and run things better. So then you’re left with parts of your practice chopped off and you effectively become an outpatient internist. So why did you learn everything else if you’re not going to do part of it to show value of your training and the value of family medicine? I would hope that some of our evidence could be used to lobby for payment that can help family medicine do what it needs to do to meet the primary care functions. I think we’re definitely the medical discipline, the best physician to do that.\n\nDr. Young: I must admit that sitting in some medical school lectures, I wondered why I was being asked to learn some things. It didn’t seem to apply to medicine as I perceived it.\n\nAnything else that you would like to share in these last moments?\n\nDr. Peterson: I’m interested to see how this ends up. My worry about FMA Health is they put so much money into the Health Is Primary advertising campaign. It seems like most of the budget went there as opposed to the core teams and the tactic teams to try to do some of the work. And the big advertising thing and they were doing these city visits and the billboards and Facebook and everything. And I’m not sure the advertising made any difference in terms of people even knowing what Health Is Primary was or anything. So I hope that we did enough that we put the resources where we needed to, to actually effect change. I know we haven’t moved on the payment. I don’t think they’re hitting their goals they set out in the beginning in terms of this many percentage of family physicians being in a comprehensive payment mechanism. I haven’t seen evidence in that in my readings and kind of following the market. I mean I hope I’m proven wrong and we’re able to hit those targets. I think everything else is going to follow payment. But I sure hope in 2026 we’re not gathering a call together to think about Future of Family Medicine 3.0 and what we’re going to do and try to learn the lessons of what we did wrong this time with FMA Health. But I don’t know if it’s going to be too much on advertising and not enough on the core teams and the work. But if that is the case, that’s probably what will happen, that we spent too much on advertising and not enough on the actual functions of what we needed to do in our work with other stakeholders.\n\nDr. Young: Did the project recognize how dynamic society was at this point, whether in terms of healthcare, politics, etc.?\n\nDr. Peterson: Not explicitly that I remember from my perspective on the core team – not specifically that I remember.\n\nDr. Young: Deeply appreciate your sharing your thoughts regarding Family Medicine for America’s Health and I appreciate all the work you’ve done for the specialty.\n\nDr. Peterson: Any time. Thanks for taking the time to having an interest in talking to me. I hope it was useful or will be useful in years later.\n\nDr. Young: Indeed.\n\n(Recording ends.)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286736#t=0.0,684.3298"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286737","type":"Canvas","label":{"en":["Media File 2 of 2 - Peterson_Lars_17.wav"]},"duration":4177.70096,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286737/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286737/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/286/737/original/Peterson_Lars_17.wav?1755096954","type":"Audio","format":"audio/wav","duration":4177.70096,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156786/file/286737","metadata":[]}]}],"annotations":[]}]}