{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/gt5fb4zp7f/manifest","type":"Manifest","label":{"en":["Dr. John Saultz"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["2021-10-05 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Dan Ostergaard (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","Family Medicine","Family Physician"]}},{"label":{"en":["Subject"]},"value":{"en":["John Saultz M.D. (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer: The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: 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/collection_resource_files/thumbnails/000/294/245/small/SAULTZJOHN%2810-5-21%29.mp4_1759934537.jpg?1759934539","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245","type":"Canvas","label":{"en":["Media File 1 of 1 - SAULTZ_JOHN_(10-5-21).mp4"]},"duration":7069.48,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/294/245/small/SAULTZJOHN%2810-5-21%29.mp4_1759934537.jpg?1759934539","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/294/245/original/SAULTZ_JOHN_%2810-5-21%29.mp4?1759934451","type":"Video","format":"video/mp4","duration":7069.48,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245/transcript/85167","type":"AnnotationPage","label":{"en":["Sr. John Saultz interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245/transcript/85167/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Daniel Ostergaard: Today is Tuesday, October 5th, 2021. And this is the day that the Center for the History of Family Medicine is doing an oral history on one of the luminaries in our specialty, Dr. John Saultz. I am Dr. Dan Ostergaard. I am here in Olathe, Kansas in my home office. You can see the map behind me. John looks like he's in his home office in Portland, Oregon.\n\nJohn Saultz: Ye.\n\nDaniel Ostergaard: It's a particular privilege for me to introduce Dr. Saultz because I've watched him all of through much of his tremendous history with the specialty. And I'm glad to introduce him further. Now, unfortunately, his CV is so long I didn't even read it all, but I know a few chunks of it. So John, what we'll do as we will go through your pedigree all the way from being a kid and I think it was Ohio on through many of your roles. And if you just start with that, you're growing up, family back home.\n\nJohn Saultz: Well, I grew up in a small town in outhwestern Ohio that still to this day has two stoplights. y father worked for the air force in a civil service capacity. My wife and I went to high school together. We started dating when we were juniors in high school and we've been together since then. We got married in 1976. So we'e 45  three children. But growing up, I think it's fair to say I wanted to be a teacher. I was very interested in mathematics and I thought I'd be a math teachery father had a lifethreatening illness in my junior high years nd I was very frustrated with the healthcare that he . It was not a problem with the family doctor in our little town. It was a problem with the plethora of specialists that referred my father to, who took a very long time to finally make a diagnosis of celiac disease. He stopped eating gluten and got well I wondered why it took five years to figure that out.\n\nJohn Saultz: So I probably got into medicine because of that. Although I wouldn't say that I decided to go to medical school until I was in college at Ohio tate majoring in math on ROTC scholarship with a commitment to the military. I  undergrad in three years and then medical school in three years so I was young23 years old and had a service commitment to the . I did my residency in the army and then spent four years paying back that service commitment before I started my career .\n\nDaniel Ostergaard: And where did you go to med school?\n\nJohn Saultz: I went to undergrad and medical school at Ohio state. I was in an early interview program there. Ohio tate accepted me right after my interview in the early fallso I canceled all of my other medical school interviews. I actually only had one medical school interview in my life, and then I sent rejection letters to the other schools I had applied to.  I can't say I a lot of experience with that, but it was an interesting interview. I was interviewed by a faculty member from neurology and by the chair of the anatomy department at Ohio tate. he anatomy was a beloved faculty member ultimately somebody that most  really liked. I don't remember very much about the neurologist except  asked me what I was interested in doing with my career. one in my family had been in medicine\n\nJohn Saultz: I thought I wanted to go to a small town like the town I grew up in and be a general physician there. So I told him I was interested in being a small town family doctor. And the neurologist said to me, these were almost his exact words. \"Well, John, we've looked at your academic record here and you don't need to tell us that, because you'll probably get into medical school anyway. So what is it that you really want to do?\" And I was really shocked because  was what I really wanted to do was my first experience with the fact that the academic world doesn't always respect family . And  in those days, that was a prevalent attitudehen I was a medical student, the epartment  amily edicine at Ohio tate was still very new. This was in . I don't remember anything else about that guy, but I remember that question. And it was sort of an interesting beginning to talking to people about family medicine.\n\nDaniel Ostergaard: Well, unfortunately we still hear that kind of bias today from folks such as your neurologist and I guess the assumption was on his part, you said you wanted to go into family medicine so you'd have a better shot at getting into med school. And he said, \"Well, what do you really want to do?\" It still makes me mad to hear that, but [crosstalk","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245#t=0.0,363.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245/transcript/85167/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Saultz: Well, I wasn't overly harmed by it then. I was amused\n\nDaniel Ostergaard: So you are now in med school and you have a commitment to the army. So how did you choose family medicine in the army? I mean, was that back to the GP and then on forward from there?\n\nJohn Saultz: I'm not sure whether as an applicant to medical school I really knew that family medicine was becoming a specialty, something separate from general practice. I may or may not have known that. I don't\n\nDaniel Ostergaard: What year was that?\n\nJohn Saultz: I was applying to medical school in 1975. But by the time I got into medical school, starting in the summer of '76, there was a department of family medicine at Ohio state. it was not something that I had much of a chance to interact with as a student. There wasn't curriculum time. There wasn't required rotation.  w kind of invisible in the academic health center. I finished the preclinical curriculum, which is usually the first two years of medical school 10 months. o I started the clerkship at the start of my second year of medical school.\n\nJohn Saultz: I liked all of the clerkships a lot. I thought that the surgeons stood around in the operating room too much, and my feet got sore. I didn't like the standing, but I really like what they did. And I liked all of the specialties. I would say by the time I finished the core clerkships, I didn't want to give up anything in medicine. I wanted to do all of , but I wasn't sure whether family medicine was for me, because I hadn't really seen a family doctor doing things that were the sort of practice I wanted to have.\n\nJohn Saultz: arly in my last year of medical school, I had a pediatric infectious disease elective at the Columbus Children's Hospital. I was one of two medical students on a team with a secondyear pediatric resident, a firstyear pediatric resident, and a family medicine from the rant ospital program in Columbus. is name was Bill Morris. And this would've been in February , which means it was about halfway through Bill's internship. I was pretty well on the road to being a pediatrician, kind of a hospitalbased pediatrician because I really thought that work was important.\n\nJohn Saultz: One night, they brought a 17-year-old  man who was in cardiac arrest in the ambulance. And they brought  to the children's hospital because it was the closest  and he wasn't 18 yet. ur team was called down for the code and the pediatric residents were trying to figure out how many milligrams per kilogram of epinephrine to give the patient.  took over the code and ran it, because he had just done adult medicine and it was an essentially an adult code from a physiological point of view. Okay? And a light came on for me that night that I always saw family doctors playing on other people's home turf. I saw family medicine residents on obstetrics and on medicine and on surgery, but I never saw them on their home field.  that when you took pediatrician away from children, they were almost useless. \n\nJohn Saultz: So if  a surgeon with chest pain  or an internist  a thrombosed hemorrhoid, they're lost, and yet they claim that the family doctor is the one that's lost. And so that vision of comprehensiveness  I wanted to be able to be the doctor that took care of everybody no matter what that seemed like the coolest thing you could do with a medical career.  I know a lot of people are attracted to family medicine because of service ethic. here's a lot that are attracted to the notion of continuity relationships with families. I've done a lot of my research over my career about continuity of care and the importance of relationship in healthcare. But I went into family medicine, Dan, because it was the hardest thing you could do in medicine. And I thought to be a great doctor, you shouldn't  the excuse of giving up whole areas of medicine because you're too lazy to study them.\n\nDaniel Ostergaard: Wow. That's a great impetus and also a great story. And I haven't read everything you've written, but I assume you've written up that history in the ER, when the family medicine intern took over the code, because that's really fantastic. Have you written that up?\n\nJohn Saultz: I've not I've told that story to generations of students why early on in my career in Oregon, we put so much energy into having required rotations in frontier communities in Oregon.  would tell the, \"You need to go to a place where there's a 30 bed hospital and three family doctors that take care of everyone with no, because if you see that, you see  the foundation of the American healthcare system should work everywhere. It's more efficient, it's more humane and the outcomes are better.\" And I mean outcomes in terms of  community , right? I think there's reasonably good evidence of that.\n\nJohn Saultz: I  at the root of a lot of Starfield's data. Barbara would tell you if she were here, that comprehensiveness is the key thing, that accounts for the outcomes and efficiency that she found comparing communities with high primary care scores. So I've told the story a lot I've never written . Maybe someday I will. I've never really talked to Dr. Morris again, but he had a wonderful career as a family doctor in suburban Columbus, and I've given him a lot of credit at a distance because that was a transformative experience for me. I might not have gone into family medicine anyway, but I was not going to  anything else after that night.\n\nDaniel Ostergaard: Well, I think it'd be good to have you talk a little bit about your metamorphosis then from that life changing, transforming moment into your residency in the military. But before that, I  to ask you, in those early days at Ohio state, was the first chair Tennyson Williams?\n\nJohn Saultz: Yes. Yes.\n\nDaniel Ostergaard: Yeah. I remember him. Well, he was the founder. Okay. What about Eisenhower Medical Center residency and then you did some more work in the military.\n\nJohn Saultz: n the spring of 1978, I had an elective to do, and I had decided that although  did not require me to do my residency in the army, there was substantial risk if I didn't that I would be brought into the military as a general medical officer after my internship year. I had a strong desire to finish my residency right out of medical school and not to divide up my residency with a one year internship and then a general medical officer stint with the troops someplace. I wanted to do the whole residency. And the best path to do that was to do a military residency. But then the question was, am I going to be happy with the training in the military? What did I know about army family medicine training?\n\nJohn Saultz: So in May of 1978, I did a onemonth elective at Madigan Hospital at Fort Lewis Tacoma. It was my first trip to the Northwest. I had been to California as a kid, but never to Oregon or Washington. My wife was newly pregnant with our first  and she was back in Columbus. And so I  the bachelor's officer's quarters . I worked with some magnificent military family physicians there and thinking, well, Tacoma looks like maybe the place to be.\n\nJohn Saultz: And I asked everybody that I met , \"So where's the best army family medicine residency? Which one is the best program?\" And  people told the place where they was the best program. But everybody said Fort Gordon in Augusta, Georgia was in the top two because had astonishing leadership then, and the program existed at a window in time that was completely serendipitous.\n\nJohn Saultz: he chief that built the program there was a guy named Mike Scott. ou may know Mike Scotti because as he eventually became eaker  the Aand  general in the army.\n\nDaniel Ostergaard: No, I knew him well. Unfortunately, he's no longer with us.\n\nJohn Saultz: He's not, but everybody there revered him. e had built this program  the most family medicine program  and  to do everything. Now, Eisenhower had been in a military community hospital and about 1973 or so, they built this big academic health center with the goal of making a  like Walter Reed and Brooke and Fitzsimons. he plan was to take some of the referral load off of Walter Reed by sending the patients coming out of the Southeastern United States and the Caribbean to Eisenhower instead.\n\nJohn Saultz: hen  became a medical center, had a family medicine program that had started in the early '70s and a psychiatry program, but there was no medicine, surgery, pediatrics or . And so it had the characteristics of an unopposed hen I arrived as an intern in 1979, the army was starting internal medicine and surgery residenc . So during my internship year, there was a 12, 12, 12 family medicine program that was . Okay?\n\nJohn Saultz: There were four first year and four second year medicine residents who were mostly people who didn't get into the internal medicine residencies in the . And there were four surgery first years and four surgery second years. And so the family medicine senior residents ran the hospital. As a resident there, I was the officer of the day in the emergency department. There was not emergency medicine yet. So I would be overseeing the adult provider and the pediatric provider that were on call schedules. You remember back, we used to have call schedules and all of the physicians in the hospital had to cover the ER.\n\nJohn Saultz: So as a third year resident, I was supervising the chief of the orthopedics department who was one of the people seeing patients with a family medicine intern. He comes to me and says, \"There's this kid in here that has a rash and he's really, really sick.\" I went in and said, \"Well, Colonel So and So, those are spots and that's a morbilliform rash and this child has measles.\" And he said, \"But he's really sick.\" And I said, \"Yeah, people with measles are really sick. It's a bad disease. We don't see that that much anymore.\" I don't know why there was a measles case there because the vaccine was already available at that point.\n\nJohn Saultz: But anyway,  a five year window, the two classes ahead of me, my class and the two classes behind me, I think that program produced  a half a dozen family medicine department chairs. Gerald Cross was in my class. He became undersecretary of veterans affairs for the VA health system. Jeannette South-Paul was in my class. Greg Blake was two years ahead of me the chair at Tennessee. Dave  was a class behind me the chair at e had a lot of reallysuccessful people. We were  there because we wanted to partake in what Mike Scotti had built.\n\nJohn Saultz: oday, s much more like a army medical center because there's fully developed medicine and surgery residencies. But I was there when it had all of the subspecialties to become academic health center, but no trainees that could compete with  family medicine . So we were actually the dominant special specialty there, not the only one, but the dominant one, which was pretty  in the late '70s and early '80s.\n\nDaniel Ostergaard: Well, you mentioned some other luminaries particularly you twice mentioned Jeannette South-Paul and she as maybe many who watch this or listened to this or read this know, she also went to the Uniformed Services School in Bethesda and had a long career there before she went to Pittsburgh.\n\nJohn Saultz: Ye.\n\nDaniel Ostergaard: Let's transfer to off residency to your post residency career and its trajectory. And in that, of course, we'll spend most of this time at OHSU, but kind of talk about that transition, will you, please?\n\nJohn Saultz: y plan when I went into the military was to do my residency, pay back my four year obligation and go to a small town  a family doctor. That plan changed pretty fast in the first three or four months of my second year of residency. Because when I was the senior resident with a team of interns and medical students working with me, it sort of dawned on me that my destiny was to be a teacher in medicine and not a who taught. Now, John Fry and I have talked about this a lotll good family doctors have teaching in their blood because we teach patients and we are as a specialty pretty welcoming to students work with us.\n\nJohn Saultz: And so I always thought that was part of the professional obligation of a physician. That's what's included in the oath of Geneva, the oath of Hippocrates teaching the next generation. But I really fell in love with the teaching role. And by the time I was done with my second year of residency, I wanted to teach family medicine for a living and practice as opposed to practic family medicine and teach, if that makes any sense. And so I was then thinking, how can I finish my residency and get involved in teaching as soon as ?\n\nJohn Saultz: he army use its teaching programs as tools to have people .  they'd send you out to some place to practice for a couple of years and then offer to let you be in a teaching program if you would agree to re-up and stay. There was not any chance under any circumstance for any reason that I would re-up in the military because I was not a happy camper. I was a devotee of the TV show MASH and I was really ready to be done with as soon as I could, although I would have to say my experience in the army was wonderful and I made great friends. The patients were terrific.\n\nJohn Saultz: But the Army's primary mission is not its healthcare system. It's defending the country. Right? And I thought that healthcare was what I wanted the job to be about. So I  residency. My residency director during that time was a guy named Dale Carroll. And he was joint boarded  family medicine and preventive medicine.  Dale got promoted to be the department chief at Fort Benning the year that I finished my residency  me with him to be a faculty member there was a big deal because not that many people got to go into teaching programs right out of residency. I \n\nJohn Saultz: Now, I was a brigade surgeon for the first year I was , which means I was seeing patients a lot. It wasn't like I was doing one half day a week of patient care and running a residency. I was very clinically active during that time. But by the time I was in my second, third and fourth year out of residency, I was primarily working in what amounts to a community hospital residency as a team leader and attending on the hospital service precepting in the clinic and seeing my patients and the like. he army was kind enough to send me to do a faculty development fellowship at the University of North Carolina  several of our departments like WashingtonMissouri North Carolina Duke federal grants to do faculty development.\n\nJohn Saultz: Those were HRSA faculty development grants, and Chapel Hill built a program that had both civilian and military faculty coming from community residencies. You didn't move to Chapel Hill, you went there for I think five week weeks during the year and then you had all these takehome projects that you would do when you went back to your program. So my second year out of residency, I was a fellow at Chapel Hill and that's where I met Bob Taylor. He was  then, and he came over to teach a workshop on writing for publication. I was impressed with how he did that workshop. Bob has a very characteristic way of doing teaching workshops. He would write down a map with the names of all the people around the table on it, so that he would call people by name. And I thought that was very clever. I'd never seen anybody do that before, but it made the session feel a lot more intimate.   the  in Oregon.\n\nJohn Saultz: hen I was ready to get out of the military, I had a early IBM computer and I printed up a  and sent out my CV  asking if there were available faculty positions. I sent  to 82 places, all of the community programs in Ohio,  all of the medical schools in the northeast. I wanted to be in the northeast within driving distance, because remember, Sherr and I went to high school together and I wanted to be close enough to be able to go home for holidays and stuff like that. \n\nJohn Saultz: I had decided that maybe the thing for me to do is to teach undergraduate medical education for a while because I'd been working with residents for four years. And I was most frustrated about that we weren't getting the best medical students to choose family medicine because the medical schools were not where our strongest programs were. n my view, it's particularly stupid to have your weakest residencies where the medical students are. Okay? So we  fix that, which means some people that are really serious about need to go to these medical schools and turn around, right? \n\nJohn Saultz: The only letter I sent west of the Mississippi River went to Oregon. I'd never been to Oregon before. I'd only been to the northwest for that one month elective back in medical school. But Bob Taylor was the chair herend I thought, \"You know what? I'm three years out of residency now. I'm a pretty good family doctor. I'm a pretty good teacher, but I don't know much about scholarship. And if I'm going to be at a medical school, then I'm going to have to be able to write and publish enough  survive there. And I need to go somewhere where somebody can teach me that.\" And this guy, Taylor writes books.  I c learn that from him.\n\nJohn Saultz: So I sent him the CV and literally Dan, I'm not kidding. I efore I put  in the mailbox I showed my wife and said, \"Now, we shouldn't mail this if we're not serious about it. Would you be willing to go to Oregon if this out ur plan was Ohio or Michigan or Indiana or Pennsylvania, right? And she said, \"Well, it doesn't hurt anything to mail it.\" So that was not exactly a yes, but it was not a no either. And so we put  in the mail. And about two or three months later, I got a call from . It was at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245#t=363.0,600.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/162022/file/294245/transcript/85167/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"eastern time. e called me on the phone and he said, \"John, this is Bob Taylor. I got your letter here. And I want to know if you would be willing to come out here and interview for the job of residency director.\"\n\nJohn Saultz: And I said, \"Well, Bob, I'm only three years out of my own residency. And I'm only 29 years old. And my experience thus far has entirely been in a military program. I'm not sure I'm ready to be a residency director at a university program like Oregon.\" And he said, \"Well, I've\n\n\ntalked to a bunch of people and we think you are. So, if want to come out here, you can bring your wife and stay for four or five days and learn about the area.\n\nDaniel Ostergaard: Okay. So go ahead.\n\nJohn Saultz: I figured, well, what the heck?  got my parents to watch the kids and Sherr and I came . They put us up in a nice hotelhey wined and dined us gave his credit card to the residents to take me out anywhere they wanted. I thought that was pretty cool. He had me meeting with chairs of other departments and with residency directors in .\n\nJohn Saultz: He really had a vision that was quite appealing, but the residency wasn't  strong . He had two of the intern class that were not having their contracts renewed and the founding program director because  hadn't seen any patients for four or five years.\n\nJohn Saultz: Bob did not think a residency director should be clinically inactive, so he decided to replace him and did this search. I will tell you one story about that interview week that probably as much as anything got me to Oregon. Because I know you and Bob Taylor are friends and you may or may not have heard this story. While I was there as a candidate interviewing for the program director job, I sat in with Bob on a interview session w residency applicants. This was in November of .\n\nJohn Saultz: The applicants  would show up and Bob would talk to them for a little bit, then they'd have their interviews and a tour of the place. e gets to the end of  why this is a good residency, and why Oregon is going to build this strong program. He asked if there're any questions, and you know if you've been involved with any of these things, there's always some  that want to ask a question to impress the chair.\n\nJohn Saultz: This student said, \"Dr. Taylor, what is the most important attribute you're looking for in a resident in your program?\" Bob said passion, and the student said, \"You mean compassion?\" Bob goes, \"No, I want people here so passionate about family medicine they have trouble thinking about anything else.\"\n\nDaniel Ostergaard: Wow.\n\nJohn Saultz: I thought, you know what, I'm kind of like that, I really am. The student look kind of surprised, but ultimately, that sort of approach determined a lot about who was there. Bob decided he was only going to recruit residency trained, experienced academicians into faculty positions as people retired. That was ahead of its time because the prevailing wisdom then was that you should practice for five or 10 years and then go to your academic career with seasoned and well-developed clinical skills.\n\nJohn Saultz: Bob said, \"You should have well-developed clinical skills, and you should use them throughout your academic career.\" The idea that you're going to practice a lot and  teaching flows from practice. I would say that scholarship also flows from practice. Okay. So, our ethic out here has been that we're not going to sit around and precept residents all the time, we're going to deliver patient care with them. Does that makes sense?\n\nDaniel Ostergaard: Yeah, total sense, and as I've watched you, that is exactly what you've done. You're still taking care of patients that you took care of throughout entire time  Portland. But I  to do one interpretation, and then one personal note. The interpretation is, because there's two Robert Taylor's within the family practice background, the one of which we're speaking, which everybody who knows academic family medicine will know is Dr. Robert Taylor who wrote the series.\n\nDaniel Ostergaard: I think it was six different ditions of amily edicine, and he started when he was in practice and New Paltz, New York. He didn't start as an academic. He started writing his books from the practice perspective. The second is a personal note. Sometime in the '80s, you, and I, and Bob Taylor were together at some meeting. Bob sought me out, he dragged you along, and he said to me, \"I got to introduce you to John Salt. He is going to be a major leader in our specialty. I don't know if you remember that, but I certainly remember that. Do you remember that?\n\nJohn Saultz: I do. Bob said that kind of thing a lot, and in fairness, he also promoted people like Scott Fields, and Bill Toffler, and Eric Wall that way. He was very passionate about mentoring and developing people. I arrived here to be on the faculty and discoveredn addition to an RRC site visit that was happening three months after I became the program director, \n\nJohn Saultz: So, in addition to being a residency director brand new in the job, I had these three major writing projects that all had to be done in the first four months I was here. I came here to learn to write. So, here's a grant and a book chapter, and a program information form, let's see how fast you can produce those. We didn't have . Bob had a system of dictating and a typist that would transcribe what you dictated.\n\nJohn Saultz: Then the editing was done off the typewritten page, it was not word processing. I remember, I would edit  then I'd give it to to look at. The first drafts of these things came back looking like a murder had taken place, there was so much red on those pages. I, \"You take too many words to say too little.\"\n\nJohn Saultz:  is one of the  editors that discipline has produced. I am the product of what I was able to learn from him as a mentor and as an editor. o the extent that people like Scott Fields and I have had successful careers, we owe a great deal of that to Bob. I  thinking that  from Bob, and he did not disappoint.\n\nDaniel Ostergaard: You have been talking about your first role at Oregon Health Sciences University as the program director. But take us through more. You've talked a little about being the PD. I don't remember how long you were the PD, and then at some point, you went into the dean's office or the president's office. Kind of go through that chronology with us, because I'm pretty sure most people don't know all of that.\n\nJohn Saultz: Bob's recruit started with Eric Wall and Bill Toffler the year after he arrived as the chair. He came in 1984. Bill and Eric came in '85, then he recruited Dean McGinty and I to  in '86. I was sort of the last of the pieces. When I arrived, there were a couple of existing faculty members from the previous administration. There was Bob, and Eric, and Bill, there were like six faculty members  Bob. We sat around the table and didn't eat all the dozen donuts when we had a faculty meeting.\n\nJohn Saultz: Now, there's now over 200 faculty members in our department. That was a pretty humble beginning. We all had a job. Eric was the research director, and Bill was the clinic director, and McGinty was the medical student education director, and I was the residency director. The residency then was an 888 program, and it was me and a half-time administrative assistant. There were no associate residency directors.\n\nJohn Saultz: Everybody precepted in the clinic, we all had to support each other's roles. Eric was only going to be successful as the research director if all of us did research. Dean was only going to be successful as the medical student education directory if all of us taught students. I was only going to be successful as a residency director if all of us taught residents. Well, you can imagine, there was a lot of tugging and pulling about exactly to do all of that.\n\nJohn Saultz: y first two or three years as the residency director, I won the resident teaching award. People look at that on my CV and say, \"That's an impressive record of teaching awards one year after the next.\" But I was the only guy Pretty soon, we started getting grants and  clinical practice revenue we were working  hard all the time.\n\nJohn Saultz:  HRSA grants allowed us to bring in a couple of associates residency directors. By the end of the '80s, I had three associate residency directors. Glenn Rodriguez, Patrice E who became well known in sports medicine for her fracture book. The department was beginning to fill out, we  skeleton.\n\nJohn Saultz: Bob had an illness in , and I became the vice chair of the department when he had to take a medical leave. I was still an assistant professor at the time, but one of us had to go to the meetings . I had more interaction with the other departments because the residency was more outward facing than research or medical education. We continued to grow.\n\nJohn Saultz: A bunch of things happened  that are stories for another day university all at once decid that rural Oregon really mattered. We had lost our university president and a couple of family doctors out in the extreme Northeast corner of the state in a town called Enterprise did a survey of doctors in Eastern Oregon. They were all burned out, unhappy, and feeling unsupported, and they got the attention of the Oregonian.\n\nJohn Saultz: There was a big Sunday feature in the Oregonian about the death of rural medical care in our state.  documentary, The Death of Rural Practice by Oregon Public Broadcasting. The dean of the medical school a really wonderful guy was the dean that hired Bob Taylor, but he was a research endocrinologist. He was really scared that the university would get blamed\n\nwe were the only academic , only producer of doctors  Oregon  an orphan. California had a network of residencies that John Geman set up in Northern California, and of course, there was the WAMI system that incorporated all these other states. \n\nThe Oregon Medical School was founded decades before, in 1876 I think, and the people here did not want to be part of WAMI. Yet  training philosophy  It certainly not communitybased. There were no community residencies, all the residencies . \n\nJohn Saultz: Anyway, the dean was worried that the niversity would lose its funding, so he wanted to make a trip out to reassure these doctors  Enterprise, and to listen to them about what should be done. He wanted somebody from the family medicine department to go . Bob couldn't go, so he said he .\n\nJohn Saultz: Enterprise is about a sixhour drive from Portland. t was the dean and associate dean of the medical school, and me in the car for six hours, way. We had lunch with those guys, we stayed the night, and then we came back. It's a pretty good faculty development opportunity to spend 12 hours alone with your dean. It was a really interesting time to talk about why family medicine could fix this problem.\n\nJohn Saultz: Because there isn't anybody else that can practice in a town like Enterprise. You need general surgeons and you need family doctors in those towns, and you need something that can pass as a mental health system, but you certainly don't need dermatologist out there. So, it's sort of like, maybe we need a bigger family medicine program, maybe we need to rural training sites.\n\nJohn Saultz: Spokane had a rural training program that time, and there were successful rural training programs in places like Duluth and Greeley, Colorado. I knew about all those places because I went to the PDW interacted with program directors. . Andthe was a meeting with the legislators from that area.\n\nJohn Saultz: The senator from that area was a man named Mike Thorne who was a rancher from Pendleton, and the person from the house of representatives there was a guy named  Timms who was a rancher from urns. Both epublicans, and both went  talked about the importance of adequately the medical school to solve the rural health crisis.\n\nJohn Saultz: Mike Thorn became the chair of the search committee that hired the new university presidenthe new university president was brought here with a mandate to fix rural health. If you're the department of family medicine at OSHU, that is a really good thing for you, because he's got nowhere to turn but us. Most of the other departments attitudes w, \"That's just stupid, that's just a political problem you have. It's not an academic problem.\"\n\nJohn Saultz: But ultimately, a grant was obtained to completely overhaul the school of medicine's curriculum. We got a statewide AH grant the associate dean  empowered to change medical education to produce the kind of doctor our state needed. That really meant more primary care, more family medicine, and more generalist general surgeons.\n\nJohn Saultz: The state elected John Kitzhaber to be governor who was a physician and a graduate of our medical school. John and a group of people had this idea for the Oregon ealth lan, which was a universal access system before the Clinton Health Plan was . The ideas  to cover everybody in Oregon by expanding Medicaid and  an employer mandate.\n\nJohn Saultz: This was actually happening. Kitzhaber was electedand it clear that the state was going to expand Medicaid up to 100% of poverty  00,000 new people in state coverage.  1993, long time before the Affordable Care Act. I felt like I did not know how to operate a residency if all of the patients were going to be in managed care systems. Because that felt to me like it was going to  a population health focus that was really different what we were doing.\n\nJohn Saultz: I had been the program director for seven years, I think. This associate dean and the resident wanted me to help this happen at the level of the president's office. The  university decided to partner with the county health department in Multnomah County in Portland to start a managed care system, to implement the Oregon ealth lan in Metro Portland.\n\nDaniel Ostergaard: John, before you go into that which I just asked you to do, the whole inside the president's office stuff, which is pretty impressive. Back to that drive from Enterprise back to Portland. Six hours. Were you able to convince them, the dean and the associate dean that family medicine was the only way to fix that? Or was the fixing the political activity you talked about later from the Republican docs out there, legislators out there?\n\nJohn Saultz: I would say both the dean and the associate dean where people who had grown up in small towns. Although the dean was a research endocrinologist from the VA, he had grown up in a small town, and knew why you couldn't really do small town medicine without general practice. They mostly wanted to talk about how hard was going to be to convince the faculty of the medical school to do.\n\nJohn Saultz: How are we going to get this through the faculty senate or through the school of medicine's curriculum committee ow are we going to get those things done? I would say they didn't need me to convince them that family medicine could help. What they needed was to understand that the needs of the communit.\n\nJohn Saultz: The needs of communit are viewed from the medical school as an outside force.  needed to change the medical school needed to  the citizens our state. The minute you ,  you can write these small towns off and say, \"Just send all the pregnant to Portland. That'll be fine.\" B that's what people in departments at the medical school would tend to say.\n\nJohn Saultz: We're fine here, our job is to take care of the people in our and to train doctors to do that, and if rural Oregon has a problem, that's not the medical school's issue. I would say they really  that, and that flows from the fact that a lot of leaders in medical schools come from private medical schools. f you want to be a dean, go to Harvard or Yale. But Harvard  Yale don't really have a public mission. Do they?\n\nJohn Saultz: These guys show up in these positions and it's sort of like, \"Well, I don't understand why people in rural Oregon think that their lack of healthcare is  medical school's problem.\" You have to say, \"It's everybody's problem, the medical school is part of everybody, isn't it?\" So, how do we talk about this? But the thing that was not very far below the surface  get the other members of the faculty to think that  is an intellectually rigorous thinghat we're not trying to train second rate doctors so that they'll go to Enterprise.\n\nDaniel Ostergaard: Now that's a tough challenge. Of course.\n\nJohn Saultz: Well, we need to get faculty out to see what the doctors in Enterprise do, because not one of the could last a day out there. There had been several departmental connections. he cardiology division at OSHU had a working relationship with he hospital out there had one of its 30 beds that was a coronary care unit with a monitor bed.\n\nJohn Saultz: The academic legitimacy of  department was a really, really important part of . Now  we were working on academic legitimacy,  we had unequivocal clinical legitimacy because we . in my second year on the faculty, \n\nhe ophthalmology chair announce in a department chair's meeting that they going to send all of their preoperative medical assessments to family medicine and not to internal medicine because the internist \n\nFamily medicine to do all of pre-op evaluations 0 years. moved their business away from internal medicine because we had evening clinics at the timee had evening clinics in the 1980s. We covered our practice, 24/7. We went to the ER and saw all of our own patients there. y the early '90s, we were our own C-sections. So, we were not seen as a bunch of docs that  patients to specialists all the time.\n\nJohn Saultz: I remember when we the first  C-section privileges. argument was, how can  train a resident to go to Enterprise and do a C-section with no backup if the family doctors here on campus with backup from you guys cannot safely do one? We must be able to show residents that this care is high quality, and safe, and you have to help do that. Otherwise, we'll  go out there and do procedures that you \"let us do here\".\n\nJohn Saultz: We don't want you to let us do anything. We want you to care about what we're able to do when we leave here so that the C-section rate and perinatal mortality rate in state goes down and not up. You see, we have this problem in the country now, don't we? The perinatal outcomes for the country are getting worse because the training programs are happy that things are good inside of their .\n\nJohn Saultz: heir stupid solution to these problems is, well just send everybody here. But see, you will never get the outcomes you want if you're not out where the people are in the community, that's a basic principle of family medicine. I didn't find it that hard. The administration was not hard to convince. The specialty faculty were not that hard to convince. Our biggest problem was the basic scien who did not think that we were serious scholars, and they didn't see credible research happening with us.\n\nJohn Saultz: And the research we did, they didn't understand. I  accused once in a chairs meeting by basic  chair of not caring about the basic sciences. I said, \"I care a lot about the basic sciences. I just think we have the wrong ones here, because there's no department of anthropology, or sociology, or cognitive psychology ou guys do really great basic training for physicians, but it doesn't help me in practice because family doctors are social scientists, not biological scientists. How come  have nobody here that understands the kind of science  do?\"\n\nDaniel Ostergaard: What was the answer?\n\nJohn Saultz: The answer was, medical schools have always had departments of biochemistry. We've created the biomedical revolution that way. I said, \"I'm not arguing that you should be gotten rid of. I'm just saying that my partners are actually down at Portland tate and at the University of Oregon.\"  methods are different and the  different if you're asking population  questions,  if you're asking biological questions oes that make sense?\n\nJohn Saultz: Ultimately, I  start this managed care program. I get put in charge of all of the university's primary care practices. I have a title of ice resident for regional education. I report directly to this president who had been rec. I was  rising star here who was going to do great things, but it didn't really turn out like that.\n\nJohn Saultz: I would say it didn't turn out like that for several reasons. The first is, the more I got involved with , the less happy I was. I have never in my career been as lonely as I was between 1995 and 1998, because I wasn't around learners. I was around legislators, and insurance company people, and hospital executives. I found myself in meetings arguing about money all the time people who mostly thought that that's what matters.\n\nJohn Saultz: I felt like I was not doing what I had come there to do. I'm becoming an administrator and I didn't really like it. I think I was good at it, but I wasn't happy at it. So, I jumped at the chance when Bob decided to step down in '98 to come back and be the chair of the department of family medicine. The university president was unhappy with me about that. And it was kind of like, that's going to make it really hard for you to do anything else after this, because you're outside of your department, going back to your department is a step back in your career.\n\nJohn Saultz: I think if you look at academic progression of university presidents and deans, that's probably true. That was probably good advice. But ultimately, I was reaching the point where the last thing I wanted to be was like him. I had meetings with him every month. I have a letter I wrote him in 2003. Which was a really polite letter telling him that he had lied to me and to the legislature, and I .\n\nDaniel Ostergaard: That doesn't sound too polite.\n\nJohn Saultz: The letter said, \"I have a problem I need your help  figur out how to explain the problem to the members of the rural caucus and the AH boards from around the state. Attached is a memo in which we promised a $500,000 investment in the next biennium to the A program. It is clear that not in budget, and you've told me that can't be .\n\nSince  have  letter promising them that we going to do , and  not going to, I need your help to explain why we're not living up to our promise.\" Now that's a polite way of saying, \"You've broken your promise.\"\n\n\n want me to go to meeting and explain why, but I didn't make the decision. Okay? Now this goes back to a little bit about all of the accusations going on in the political world right now about people who work for Trump and whether they gave away their integrity doing .  need to be loyal to the president, but at some point in time,  integrity  So it was that sort of thing. I saw it as an integrity problem and he saw it as a loyalty problem. \n\nDaniel Ostergaard: That is what we're going through now.\n\nJohn Saultz: It is. It is. And I actually think there's just no substitute for telling people the truth. Right? Telling people the truth.\n\nDaniel Ostergaard: And having integrity.\n\nJohn Saultz: Yeah. So  I stayed in charge of all of the primary care systemnd I came back to the Department of Family  I was extremely happy being the chair of Family Medicine from 1998 until 2016for 18 years. During that time, the department grew. The year after I stopped being the chair,  moved into the number one spot in the country in U.S. News \u0026 World Report. I was able to get somebody who was the exact right person to take over the position when I stepped down. And I stepped down when I was only 60, because I didn't want the position to be the defining thing, right? I want to move into the . f we're serious about having women leaders and having minority leaders thn white guys need to get out of the way sometimes.\n\nJohn Saultz: And it was an opportunity for me to go back to ssentially all my professional activity at OSHU since 2016 has been clinical work. I attend the patient service I see my own patients and I t residents I want to see. I don't need the money. I'm practicing because it's a worthy endeavor it's fun to do and I like it. And I want to see it as a choice that you make, not something that you have to do.\n\nDaniel Ostergaard: Well, that's one of the things that has so impressed me and many, many others about your entire trajectory during all of those phases. And I want to get to some of what, after stepping down, not only from the chair, but stepping down from the editorship of Family Medicineell me a little bit more about some of your other, if you will, political things. You were president of the Oregon Academy. You won the Tom Johnson Award from the academy for a lifetime commitment to education. Tell us more about that as well as, oh, other things I may not know about.\n\nJohn Saultz: I teach this course in leadership for our residents here in which I use different quotes and talk about how differently I would define leadership at different stages of my career. I mean, I started off as an ROTC student learning about military leadership and how the army train officers to think abouturing the 80's and 90's when I was a residency director and in these various roles I the belief that administrative leadership was important and that if you got in charge of something, you could do good. Okay? So I wanted to get in. When the directors association first formed, the program directors were mad that there were no residency directors on the RRC and that we were not able to get the RRC to listen to things that thought were important.\n\nSo there was originally an idea  an association of Community Hospital Residency Directors. Al Haley and Dick Layton and Chuck Peyton and Norm Kahn w involved in.  I  called because I was a university guy, and I obviously did not think it was in special best interest to have an association of Community Hospital Residency Directors. I thought it should be an association of all residency directors. And so I eventually became the fourth president of AFMRD. \n\nJohn Saultz: Now at the time, the executive director of the AAMC and a legendary academic internist. An Oslerian hero to the internist. I've always found that really funny about interns, the way they have these heroworship things about their field. It's really veryt's just a characteristic they have, right? But I figured, well, what if we invite Petersdorf to come out here and be a visiting professor? e intentionally the visiting professorship a week that the University of Washington ha a home football game because  was in Seattle before he went to the MC and his son works at the . And I bet  got a free ticket to out here that we could convince him to come to Oregon in order to visit his grandkids if we were really smart about it.\n\nAnd wouldn't that fog the internist glassesBob Petersdorf c here to be a visiting professor in  What could happen? He tell us no, right? ell, he came out here and it was a very successful professorship and I got to  him. At the time, the AAFP was threatening to try to link the production rural physicians with NIH funding priorities. I don't know if you remember those days\n\nDaniel Ostergaard: Yeah.\n\nJohn Saultz: And the AAMC were terrified that that was going to happen. So when I had my meeting with Petersdorf at the end of his professorship, I said, \"What advice would you give family medicine about how to be more successful in academic ?\" And Petersdorf said, \"Well, first of all, give up on this thing about NIH funding and rural production.\" He goes, \"You're going to be a pariah in the academic world if you pursue that.\n\nYou have no idea how that will piss everybody off and it will harm your peciallyfor a generation. When you're in these meetings, you can say anything you want. I said, \"Well, you seem to think that the Academy of Family Physicians cares about NIH funding. They don't care about that. They're trying to get your attention. And they think they're being ignored about this rural health problem. And to be honest with you, they have reason to think that. So if you were to actually do something about that, take that seriously, they'll abandon  in a heartbeat, but you have to show them that the medical schools collectively care about th problem of access to care in communities around the country. That's what they're looking for.\n\nJohn Saultz: Well, remember he started the office of the generalist  right And he talked about his visit to Oregon from the podium  AAMC meeting he came up to meand said, \"I've decided to appoint you to the ACGME.\" So I thought, \"Well, okay  I didn't know what that meant. I knew what the Residency Review Committee for Family Medicine was, but he wasn't talking about that. He was talking about the ACGME. At that point, the AAMC had four appointees. So I got appointed to the ACGMEhe other three people were the dean at West Virginia, the dean at Emory and the CEO of the UCLA Health System.\n\nI was 20 years  all of them nd I got a political educationhat did I learn from that? Well, the main thing that was accomplished during my tenure on the AAMC was the 80hour work week. It was not something we could have stopped  we wanted to stop it I actually think it's done more harm than help to the profession of medicine. Okay? So I'm not particularly proud that I was there and was one of the 23 people that voted that. I voted for it because I didn't think there was any choice. \n\nJohn Saultz: But I was starting to get disenchanted  being the dean or the president or the RRC chair or the STFM president, or the academy president really g you the chance to hether it was worth all the travel and all the timeecause when you're off doing that, you're not with young people and the things that have mattered in my careerI am sure  the people I've spent time with not the roles I've been in. That Scott Fields was a resident in my programthat I helped to train Jen Devoe. There was a year where the STFM president, the AAFP foundation president and the AAFP president were all former students of mine. That s what matters\n\nJohn Saultz: aybe it isn't what matters to everybody, but it's what matters to me. I will tell you one other  about organizational leadership. n 1993, I was the AFMRD president. And a couple of years later, I was the Oregon State Academy president and then  a member of th Congress of Delegates from Oregon.  in 2013, I elected STFM president Now, what is the significance of this? Well, when I went to the working party meetings in 2013, I was in the last 10 years of my career. When I went to the working party meetings in 1993, I was in the first 10 years of my career. I went to working party meetings 20 years apart as an organizational president. And it was really interesting to look at how pecially had changed he working party in 1993 was a friendly group of people that got together.  cocktails that we talked about common problems.\n\nDaniel Ostergaard: John, I got to stop you a second. For interpretation, explain the working party, the family of family medicine.\n\nJohn Saultz:  going way, way, way back to the early days of the pecially. ou would be more well-versed in the history of this than , but there was a twice yearly get together of the presidents of the ABFP, now ABFM and the cademy and SFMNAPCRG ADFM, AFMRDhepresidents, president elects, past presidents and executives of those organizations all would come together for eeting hostingthe meeting from organization to organization. But it's an attempt to get together and talk about shared problems and the future of the pecially. A lot of our big strategic efforts like Family Medicine for America's Health or the Future Family Medicine Project were launched at the working party.\n\nJohn Saultz: Maybe it's no longer called the working party because people didn't want to of as a party I think it has a new name, the Family Medicine Consortium or something like that. But it's an opportunity for the leaders of these organizations to meet with the other organizations and to try to hammer out a common approach to things even though the organizations have different memberships different priorities. But it was really interesting for me  \n\nDaniel Ostergaard: Sure. Yeah, I can certainly,  won't comment in detail about the very beginningit was extraordinarily collegial and it was all about talking to each other. And I was of course, there in an executive role, not in a presidential role. And we would talk about, what are the issues? Not so much fighting between us, but what are the issues together we should all address for the good of the Specially. So I was not there at the end when you were there in the 2013 timeframe. So just a quick note, what was the major change you saw when you went back the second time?\n\nJohn Saultz: I wouldn't say that there was acrimony. I don't want to imply that. There was a disagreement. There was debate. The pecially ha become very big and it struggles to think about itself in a unified way. hat does a research faculty member who's a member of NAPCRG have in common with a rural family doctor from Colorado rural family doctor is a member of the Colorado Academy and the AAFP, and  a diplomat of the board. So they have some agency in those organizations. The NAPCRG researcher may not even be a physicianay or may not be a member of STFMa voice at the table about what family medicine's priorities to be. Right? So to make a tent big enough to represent all those points of view. It's always been fascinating to me.\n\nJohn Saultz: hen I was STFM president, I tr to explain to the working party a third of the members of STFM are not physicians. They care a lot about whether the Affordable Care Act works or not. And they want voice in that. STFM is their voice. The academy is not their voice because they can't be academy members. s a physician, I want the academy to be my voice because to have STFM doing that  disrespectful to community family doctors. So why is it that we argue about whose voices ? hy can't we sing like a choir? Why can't we agree that the lead in each piece of music is going to depend on the expertise that we need from the singer. Well, I just think that it becomes hard when get really big and diverse.\n\nJohn Saultz: I started off here in Oregon, use our department as a metaphor. There were six of us in Bob Taylor, five of the seven were men. All of us were white. e did everything with each other, but today we operate seven or eight clinical practices four residency programs. We have over 200 faculty and none of them know all of the others. So to lead an organization like that becomes a much more of a corporate thing and much less of a family business thing. \n\nJohn Saultz: I was part of taking the department through that transition  BobBob would get us all together and we'd . You can't get them all n the same room now. And yet they are all part of our department. o, to build a culture  requires a different approach to leadership skills, if that makes any sense.\n\nDaniel Ostergaard: Yeah, absolutely. And even within the academy, I retired in 2013 and in the last several years there, that was becoming apparent. In that, we had to become more of a business entity. And to my chagrin, we became less of an educational entity. And I'm so pleased at the other organizations within the working party do that because the academy wasn't as interested in that anymore. I need to take you to a couple other ways. And then I'm going to ask you a couple of provocative questions. As if none of the others have been provocative.\n\nDaniel Ostergaard: Tell me about your books. The one that I'm most intrigued with is your most recent book about which you and I have talked before. And it's the only book I am aware of written by a family physician that's really designed for your kids or kids. And that's about, yeah, if you will, knowledge, if I am not messing this up. Knowledge and belief, what is known and what is believed, but which in a theological term as epistemology not a  and neither are you, but nevertheless, epistemology is just very important for right now. And maybe in the current time of the last six years, what is knowledge and what is misguided belief. Talk about your books. First of all, that one, and then just at least mention the others.\n\nJohn Saultz: So, if you grow up in a department with Bob Taylor, you get opportunities to do books ecause he ha lots of connections in the publishing industry. I was writing chapters in his books. Saunders had  Rael and Springer Verlg McGraw-Hill is a publisher and all the other pecial wanted to do ndSo I signed a \n\nto provide 2000 manuscript pages in 18 months.\n\nDaniel Ostergaard: Oh.\n\nJohn Saultz: And I did provide 2000 manuscript pages in under 18 months. Now, a lot of th chapters , but I wrote the first section of the book myself. hen I came to Oregon, I wanted to learn enough about scholarships so that I could survive in academic medicine. I saw scholarship as a ticket to punch, as something I needed to do in order to be able to do what I really wanted to doI wanted to be a teacher and a cliniciannd I wanted to influence students and residents I needed to do enough scholarship. \n\nJohn Saultz: I had become the chair of the department . here were lots of people that were influenced by . I did a book on healthcare and spirituality with a faculty member in our department who was a theologian about how to talk to patients about faith. It was a medical book for physicians and for mental health professionals about how to recognize spiritual crisis and how to  people ignoring the fact that religion matters to a lot of them\n\nJohn Saultz: When I  chair of family medicineI wanted to start some writing projects. y grandchildren were reaching the age in which they go through confirmation in the church\n\nnd I was hearing in the news confusion  what it means to believe things versus know them.  If I tell you I know something, but my  knowing is really different than your  if you're going to write a book about  you're not a philosopher, the first thing you do is  I've got a whole shelf of books  epistemology text writings about moral philosophy. I just spent a lot of my new found time reading about . And then I decided that I wanted to write something that would be understandable at the high school levelI wanted to be able to hand this to my grandchildren when they eighth or ninth graders.\n\nJohn Saultz: he most important thing you can do to have a happy life is to decide what you truly believe in and then live . I'm not talking religion here. hen I came to Oregon I was asked to give a talk to the residents. he talkas The heology of Family Medicine.he point I was trying to make is family   by what we believe  what we know. Bob t me, \"Well, that was a wonderful talk, John but you had the wrong title because talking about that belief versus knowing is not theology, it's ideology or it's a epistemology because theology is about the study of God. And you didn't talk about God.\"\n\nJohn Saultz: So theology is not really wh. what it mean to believe something ow  I choose beliefs and then either change them or retain them over time  defining characteristic of what's really important in my life I wanted to be able to s my grandchildrenI tr to include a lot of stories and quotes in itI wrote the first section of the book about how children believe things. I'll give you an example.\n\nJohn Saultz: ost American families, the children believe in Santa Clausarents encourage them to believe that Santa Claus comes on Christmas Eveand leaves presents in the stocking.  tell children thats a lie? e tell them  that a real being comes down the chimney with gifts, right? When children discover that Santa Claus is not a real person, do they think their parents have lied to them? No, not at all. hey understand that the story is a metaphor. It's a metaphor for the spirit of giving at Christmas. Little children don't understand metaphors. They think that stories are real. o you believe things as a child because adults that you respect, usually your parents tell you.\n\nJohn Saultz: But part of  growing up to be an adult is to decide what to believe and what not to believe based on other things your own experiences the foundation of . I want my grandchildren to find important beliefs scrutinize theand then live . I don't bring these things up in professional work very much\n\nbelief an important part of who I amI want my grandchildren to be able to believe things deeply and live according to their beliefs I  to explain to them why that's important.\n\nJohn Saultz: I found  independent publisher in Eugene, Oregon, which has just been a wonderful partner. I a theologian to  me as editor of the book to help   religionI'm proud of it. I've given it to my oldest grandson, and it will go to two others this year that are in the eighth gradehe two fifth graders will get it in a couple of years. \n\nDaniel Ostergaard: Tell us the publisher.\n\nJohn Saultz: The publisher is Wipf and Stock. If you  johnsaultz.com, there is a link to the publisher. can find the book there.\n\nDaniel Ostergaard: Okay.\n\nJohn Saultz: Norm Kahn read it, and we had a couple of really wonderful philosophical discussions about it, about religion, and how religion has been important to Norm.\n\nDaniel Ostergaard: Well, you've mentioned several people. I talked to Norm as a very knowledgeable Jew, and I as at least a somewhat knowledgeable Christian, we have those talks frequently. I'm not at all surprised you did as well. As long as you mention a name, I  to go back to a couple that you've said, both Scott Fields and Jen DeVoe. Both absolutely stars that I have encountered over the years as well. You certainly done a good job with your progeny. Let me go forward and ask you about some people. I'm just going to throw out a name and I want you to, even if you don't know them, because some of these people are no longer here ay what you think about the person, if you know them, Laurel Case.\n\nJohn Saultz: I actually knew Laurel Case really well. He was the founding chair here in Oregon. I tell Laurel Case's story to every class of residents here, because he was the president of the Oregon cademy of  with one of the state's most successful general practices down in Medford in 1968, when the specialty was starting.\n\nJohn Saultz: The legislature in this state mandated that OHSU the University of Oregon Medical School a family medicine department in the next two years, or they would  state funding. The dean who was not a supporter of the idea, didnt know what to doe didn't want to lose state funding.  called the current president of the Oregon Academy and ask if he'd come up here and be the chair of a family medicine department at a medical school. Laurel Case went to medical school at the niversity of Kansas. He was a quiet, gentle, loving unassuming family man with a wife and two sons happy in edford.  asked  his practice move his teenage sons from Medford to Portlanda 280mile move to become a faculty member in a medical school with no qualifications the medical school mostly not want  Laurel agreed to do that.\n\nJohn Saultz: I our residents all the timehat have you  ? Everything we' do is because Laurel Case . Frankly, there were a bunch of challenges that he faced. He was really proud to  on the residency review committee for family medicine\n\nJohn Saultz: did the job for about 10 years, then he stepped down and they recruited Bob Taylor. The way I know Laurel and Betty Case is at the end of their lives I was their doctor. Betty died four or five years after Laurel and was herself a formidable person. She wrote books about parenting twins because she was a twin and they had twin boys. We started the Laurel Case visiting professorship here when I was the chair of the department. Although Laurel never belonged at a medical school, by the time he finished, respected his humanity, his kindness and his honesty. I consider him a  great man.\n\nDaniel Ostergaard: I knew him when he was on the AFP ommission ducation while he was the founding chair, but I did not know much of what you just said, including the fact that you took care of them in their final days. That's pretty\n\nJohn Saultz: I knew him pretty well personal.\n\nDaniel Ostergaard: How about Marian Bishop? You know, we've talking about physicians and non-physicians, Marian non-physician.\n\nJohn Saultz: I remember being in awe at what a force of nature Marian Bishop was mostly interact with her  STFM meetings early in my career. She would always wear these bright colored dresses and  such an outspoken and passionate advocate for the beliefs of what matters most in family medicine. We talked about  book about beliefs. I've always believed that what holds our specialty together are th beliefs. You don't need to have an MD degree or a DO degree to . Marian Bishop belonged in our familyia Taylor belongs in our family.   as passionate about as anybody . I was a Bishop ellow with a fellowship in 2003 that was funded by the Bishop family, with the hopes of producing more deans and vice presidents for health fairs.\n\nJohn Saultz: she thought the world would be better if a lot of best leaders became deans and vice presidents for health affairs. I don't personally believe that. Family doctors that enter positions of leadership are .\n\nDaniel Ostergaard: That's a huge statement.\n\nJohn Saultz: In other words, you get to be the chief medical officer of this health system and you find that your values get lost in the transition, if that makes sense. I don't think that's always the case, obviously Norm Kahn and I have had great debates about this because Norm really believes that getting into positions of leadership are opportunities to make things better.\n\nJohn Saultz: I . I just think that, from an academic sense, when I'm in the C-suite arguing about the budget, I'm not in the classroom talking to studentshe long-term impact o one. I told you hat made me a family doctor, that was a really big deal for me. Bill Morris probably didn't even know what was happening at the time, but it's good that he was on call that night. Do you see what I'm saying? Marian really se power. I admire that a lot in her. I very much admired that what a talented mentor she was. She would call me sometimes. \n\n\n\nDaniel Ostergaard: That makes me go back to your discussion about Bob Petersdorf, then the CEO of the AAMC, because watching him from the beginning of his time there to his final time at the AAMC, he underwent a conversion. I have a feeling though, the story you described about him coming to Portland, to be a visiting professor, then going up to Seattle where his son was at Hutchinson. you probably caused a conversion, are you an evangelist or something that I wasn't aware of?\n\nJohn Saultz: I think there were probably a lot of things that contributed to it. The trip to Oregon probably helped. I also think that, like a lot of people, he went into role estimating. Petersdorf encountered  the New York teaching hospitals around health reform issues. he AAMC has constituents, but the council of teaching hospitals is the council of deans. The council of deans think that they're really important, but when it comes to throwing money around the ing hospitals have killed more good ideas at the AAMC.\n\nJohn Saultz: I think Petersdorf actually got fed up with that. the social mission of medical school the financial performance of . I think it got to be too much for him, if that makes sense, because  was a decent guy. He hard to , but he was a smart \n\nDaniel Ostergaard: Well, John, I need to get a couple of more things in before we make it too long, nobody will read this. One more name, one more name. The first two were no longer with us, but this one is, and is vibrant. I see them very frequently here in Kansas City, Bob Graham.\n\nJohn Saultz: Bob Taylor Bob Graham in extremely high esteem, he you. I met Bob Graham much the same way I met you. I was introduced to him by Bob at a meeting.  really decent who. I admire  most for his consistent integrity. I think the academy had integrity while he was there. Sometimes you notice these things more when they go away than when they t would have been really hard to fill Bob shoes  the academy. he frustrations I have with the academy over the last 10 or 12 years mostly  away from the things that I cared .  education social advocacy that's neither nor conservative, but values based family doctors .\n\nJohn Saultz: It's not hard to tell the difference between self-advocacy and public advocacy, I think. In a member organization, like the academy, it hard to resist self-advocacy because your members are paying dues and they want you to go and fix . Bob Graham   c hold coalition together and do the right thing in ways we all proud of. I don't want to say that necessarily all went away when Bob Graham left, but I will tell you that it's not been the same since. I give him a great deal of credit for having kept it that way as long as he.\n\nDaniel Ostergaard: I have an observation about administration and you clearly determined while you are doing that stint in the president's office at OHSU that you didn't feel for you, that administration was where the decisions are made or the impact could be. Bob Graham is clearly somebody who made impact at the federal level at Cincinnati and certainly in the 15 years he was here at the academy as an administrator, that was his niche. He did that very well. I guess the takeaway from that is, I think, and it goes back to your thought about it in that book to your grandkids, think about what you believe and what you know, it may be different for each of us, but go for it.\n\nJohn Saultz: You're right about that. I finally talk with residents about leadership. ffective within organizations is like the tumblers of a lock.  at every level. When I was the residency director, I needed to count on Bob to get resources that I needed for the residency to be successful. If Bob didn't do that, I would be frustrated about the department not getting me what I needed. When I was the chair, I could not fix anything at our Scappoose Clinic because I not at our Scappoose Clinic. I can only pick the right pe to be there. As a leader, Bob was able to empower people at other places in the system, from individual family medicine offices, state academies, and staff e was able to get all th to line up.\n\nJohn Saultz: That is an amazing skill, but no matter how good you are a, if you haven't got the right people, it doesn't happen. You're just preaching to people who can't do what you're asking them to do.  was successful  getting the right people in the roles and inspiring the. For me, it's not that I'm not good at those things, but I'm happiest whe I am where the p are, if that makes sense. I've been working with since he took over the Bishop fellows the last three or four years. ou watch him at a Bishop fellows meetinge never e ask that provoke discussion in the right way..\n\nDaniel Ostergaard: I was going to ask you John Gyman. Instead of asking you about John Gyman, as the name to which I want you to react, you and John have written stuff about generalism, about family medicine and internal medicine. Of course, John Gyman has been saying ever since I was a puppy, that there ought to be one specialty of primary care, which combines family medicine and internal medicine. Comment on that and where you find yourself in that trajectory, if you will, from our roots as a general practitioner in  edicine and where we might go, if there were a single generalspecialty.\n\nJohn Saultz: We had a estern egional STFM meeting here in Portland in 1988. department planned itne of the was an intergenerational debate. John was to argue that one specialty for primary care would make primary care stronger. I was asked to argue the counterpoint as the young guy. John and I have been good friends since the. I've visited his home  e sends me copy of every book he writes.\n\nI think he's one of the great people that our specialty has produced. \n\nMy thinking about  has moved in the direction of agreeing with John more and more over the course of my career, but I have a caveat about it. I think there already is only one primary care specialty and   insist being recognized in that way. If people don't want to recognize that and don't want to join what we're doing, then I want to compete with them, not collaborate with themI think competition is good. I played sports in high school. I don't have any problem saying if you don't want to do these things, then let's practice next door to each other and see where the patients go. Let's have departments next to each other and see where the students go. Because I not comprom that rimary care should be organized by family. I think caring for adults and children is important to quality primary careI  compromise about that just to be nice to pediatricians and internists.\n\n\nJohn Saultz: When we got our first endowed professorship at OSHU,he man I recruited to fill it was  named Rick Deyo who was trained as a general internist was an extremely successful researcher about back pain. Much of what know about  back surgery for people with backaches is Rick Deyo's work.  was .  an endowed professorship in an internal medicine because he's a health services researcher.  looking for leadership for young scientists in department,  Rick came as a professor of family medicine. By the time he retired, he would say that family medicine is where he belongsbecause he  intellectual . He belongs with us. It doesn't have anything to do with specialty .\n\nJohn Saultz: e have one primary care at OSHUfamily medicine. I think should do family oriented care in every practice. If we have internist in a practice, we also have to have pediatricians and family doctors there because we do not turn children away. We do not turn pregnant women away. If the isn't comprehensive the practice has to be. On the other hand, having some internist in the group  really helpful because they bring another set of perspectives that I think enrich department. scared to family doctorsthey're worried that they won't be seen as legitimate by other people in the department.\n\nWe should be equally hospitable to people from other specialties. Hiram Curr was a neurologist Jack Caldwell was an internist a big tent early on. I like having a big tent. I'm even okay with changing the name, but I care about core principles. Does that make sense?\n\nDaniel Ostergaard: Sure. That makes sense John. Our time is about up. I need to tell you that this has been a fascinating time with you. Your contributions from the very beginning, your history and where you're going in the future are very, very impressive. I am so pleased and honored to have been able to interview you. It occurs to me that at the beginning, I didn't say anything about your CV. At least you can tell us your current emeritus titles. I think that's plural.\n\nJohn Saultz: I'm a professor emeritus in the department. That's a fancy way of saying you're a famous old guy or a famous old gal. It's an honorary title that doesn't mount too much. The university gives me free coffee anywhere I go, but that's because I'm old not because I'm an emeritus professor. I will stop being the editor of the Journal Family Medicine next ay after 12 years in that role. I plantotally retired then.\n\nJohn Saultz: I've had a grand time.  allowed me an opportunity to work with wonderful peopleto write and comment about the evolving nature of our field. I'm really proud of how the journal was grown and gotten better over the 12year time that I've been there. ts previous editors include people like Lynn Carmichael and Barry Weiss. I think I'm the fourth editor of the journal in 0 years. bout six months after I stepped down as the chair,  decided to rename and endow the chair  family medicine  as the John and Sherr Saultz hair of amily edicine.\n\nDaniel Ostergaard: I did not know that. Congratulations\n\nJohn Saultz: One of my former students holds professorship in my name and in department. The university did that wasn't an outside gift\n\nDaniel Ostergaard: John, thank you so much. We could've gone on for another couple of hours, but this is a really good synopsis. It's a cataloging if you will, of your posterity. Hopefully a lot of people will look at it. I'm going to recommend it to a few whom you've mentioned as you've been talking and I hope you do the same.\n\nJohn Saultz: Okay. Well, thank you, Dan. 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