{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/h41jh3ft9v/manifest","type":"Manifest","label":{"en":["Dr. Jack Colwill"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1992 (created)"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","STFM","family physician","family medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["Jack Colwill (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: \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/3629/collection_resources/141776/file/262305","type":"Canvas","label":{"en":["Media File 1 of 2 - Colwill_Jack_1992.04.28_-_Side_1.mp3"]},"duration":1890.16475,"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/3629/collection_resources/141776/file/262305/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262305/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/262/305/original/Colwill_Jack_1992.04.28_-_Side_1.mp3?1739222047","type":"Audio","format":"audio/mpeg","duration":1890.16475,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262305","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262305/transcript/75727","type":"AnnotationPage","label":{"en":["Colwill Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262305/transcript/75727/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview of Jack Colwill by John Frey\n\nApril 28, 1992\n\nSt. Louis, MO\n\nQ. - John Frey\n\nA. - Jack Colwill\n\n________________________\n\nQ.  So, one of the things I'd like you to reflect on is kind of your origins and how the things that you learned in your life and in medicine got you to the point of getting involved with family medicine.  You have a bit of a different story than most folks do, I think.\n\nA.  I think your right.  You know, one's memory is always slanted.\n\nQ.  We can correct that.\n\nA.  I guess, if I went all the way back to college, at Oberlin, I had no plans to go into medicine originally.  And ultimately decided to go to medical school when my closest friend did.  That was what--because I didn't know what else I could do.  I finally proved to myself I couldn't be a good chemist, and that was what I was originally majoring in.  Even then I had this idea that I was going to be in academics.  And so I went into medical school kind of with that idea, and while I was in medical school I guess the two mentors that I had that were most fundamental in my own thinking was George Engel was one of them, I spent my summers working for him.  And the other one was a fellow by the name of Len Feninger, who was the associate dean.  And Leonard's orientation was always very broadly oriented in medical education, and in comprehensive care.  So the two of them kind of had me focused that way when I left medical school.  And Rochester was a unique place in those days.  I think the behavioral orientation--a Rochester graduate as a graduate looks different, or in those days looked different from a typical medical school graduate.  Where did you go?\n\nQ.  Northwestern.\n\nA.  Northwestern, geez--\n\nQ.  Very much like other graduates.\n\nA.  Except that John Frey is no typical Northwestern graduate.  And then I interned here at Barnes on the straight ward medicine service, which was the prestigious service back in those days where you worked your butt off and so forth, which had little of the orientations I was looking for.  And it was an incredibly intimidating environment, as classic internal medicine was in those days.  And I moved on from here and went to Seattle for my residency in internal medicine.  I guess maybe, you know, while I was there then the person who most impacted on me was probably Bob Williams, who was the chair of medicine and I was I guess the second chief resident at the University of Washington's teaching hospital.  And Williams was well known as a divatologist(?), endocrinologist, and his textbook we all remember, but he probably singlehandedly was the one most responsible for the development of the University of Washington into a first-class medical school.  In his own way, he ran the place.  And he did it very consciously.  He saw himself as the person that would build the place up.  I'll always remember having coffee with him one day, when he told me he was going to bring John Hokness(?), I don't know if that's anybody you know, I'll tell you more about him, who was a practicing endocrinologist in the community at the time and a part-time teacher.  But I liked the man a great deal.  He says, 'I'm going to bring him in and he's going to be medical director of the university hospital.  Then he'll be dean.  And gosh knows what's going to happen after that.'  You know, that was Bob Williams.  But back in that day, in his own way, planning the future of that institution.  Well, he did come in as the medical director.  He did become the--then he became president of the University of Washington.  Then he came to D.C. as the head of the Institute of Medicine.  And then he became the head of the Association of Health Centers, you know, the vice president's club, and now he's retired.  But you know, that was his history.  And I've always remembered that.  When I--and I guess I was already pretty much of a generalist in my philosophies, because I remember one time when Bob sat down with me and he said, 'What are you going to do after you graduate?'  And I said, 'Well, I'm planning on academic medicine.'  And he said, 'Well, what subspecialty?'  And I said, 'No subspecialty.'  And he said, 'Well, how do you plan to get into academics?'  And I said, 'Well, general internist.'  And he said, 'What is the role of a general internist?'  And I--this would have been in 1961.  And I responded at that point that all I could see was that the subspecialists didn't know how to care for inpatients outside of their own discipline.  And what the Department of Medicine in Seattle needed were full-time faculty who would be more than attendings.  And that was my concept of generalism when I was a senior resident.  We had two departmental meetings over the idea of whether or not they were going to establish the principle and bring in Colwill as the general ward attending.  And for the department it really got, each of the faculty had to really think about what they were themselves.  And the majority of the section heads felt that they were still generalists, and so they didn't do it and I--then about that time Larry Young in Rochester called me up and said, wouldn't I come back in medicine there.\n\nQ.  And he was the one person I think who probably had an idea of what a generalist was.\n\nA.  That's right.  So I went back to Rochester, and my role there was to head up the internal medicine outpatient department.  And between '61 and '64 in internal medicine I established continuity practices for the housestaff one-half day a week, which was the true continuity practice.  As a group we, what we always called desegregated the ER by having all first-year housestaff regardless of what specialty they were going into, seeing patients in rotation, so the surgeons would see MIs, internists would see kids with fever, and so forth.  We established gyn rotations and psychiatry rotations and ENT rotations for internal medicine housestaff.  All of the basic principles that you think about in terms of creating a person in primary care, even though the term primary care hadn't been coined.\n\nQ.  There's something about--I remember I met Larry Young(?) many years later, and meeting on Boston primary care, I forget who sponsored it, but what impressed me is how his, he really had a clear idea of what this was all about.  Everybody else in the room, for whatever reasons, were starting to get interested because there was some sense that education and money and other things would start flowing in that direction.  This is in the mid-'70s.  And to this day, when students come and talk about, 'Where should I go to be a general internist,' I always say at least one place you ought to probably look is Rochester.\n\nA.  That's right.  I think many of the things we put in then disappeared subsequently, and I don't know how much of it has come back.  Then I, the way I got to Missouri was I happened to run into Bill Mayer who was a pathologist and a classmate of mine, at the first AAMC meeting I ever went to.  And he had, he was then the associate dean at Missouri.  This was, he was in his early 30s and I was about, I guess 3 years younger than he.  Even though we were classmates, he had the military time before medical school.  He, I asked him how things were in the boonies, and it wasn't long before I had a letter from Vernon Wilson, who was the dean at Missouri at the time, and ultimately ended up going to, coming to Columbia.  And I think that this, again a serendipitous thing, Vernon was a member of the Willard Committee, Vernon Wilson.  So there I was, as an assistant dean at Missouri, head of student affairs, Vernon Wilson, being on the Willard Committee, and him talking about this new specialty of family practice and me thinking he was crazy, that would never fly.  So in a, again serendipitously, Vernon ultimately left the deanship, I guess that was about--I went to Missouri in '64 and I think he left the deanship roughly in '68 or '69, and Bill Maynard then became dean and I became associate dean for academic affairs.  And we were the youngest dean/associate dean team in the country.  I was I think 30--well, let's see if that was in '68, I would have been 36 at that point, maybe--yeah, I came in as assistant dean at 32.\n\nQ.  It must have been a very energetic-feeling place.\n\nA.  Oh, it was, you know, it was one of the new medical schools and it had a relatively short history and there was all this sense of movement.  And the way I ended up getting into family medicine was, we had Sherwood Baker--\n\nQ.  I met him.\n\nA.  --who you met here at this meeting.  Sherwood was, Vernon Wilson brought in to head a section within an old department of community medicine, which was then called community health and medical practice.  He had a general practice residency tied into that during the '60s with a 2-residency year taken into it.  And he then made it into the family practice residency in 1970.  And then I guess in 1971 or '72 Bill Mayer asked me to head an institutional committee to help Sherwood take it into full bloom.  And we brought together the appropriate chairs, and we had a whole series of sessions and got an institutional commitment, and the agreement out of it was that we would take the program and since it required input from multiple specialties we would take it out of any department and put it in the dean's office.  And so we then recruited somebody to come in, he turned us down, and it kind of de facto fell to me.  So you know, there have been very few things in my life that I've planned for.\n\nQ.  My favorite definition of a career, this is a wonderful--inscribed it on my wall, but there's a man who runs the Humphrey Institute who's, up in Minnesota, who was an assistant secretary of state of every administration on back into the days of the '40s.  He's a remarkable man, and he got up and he said, 'The definition--a career, people are always asking me what my career is all about.  A career is a series of accidental occurrences and unforeseen possibilities upon which you stamp a retroactive name.'  You can say 'my career has been to this point' but you can never say, 'my career will be,' because you don't know.\n\nA.  It is so true.\n\nQ.  So that was--what year was that that that happened?\n\nA.  Well, I picked up responsibility for it in 1972.  And so this is my 20th year as head of family medicine in Missouri.\n\nQ.  What contact did you have with other people in the country who were starting units in family medicine?\n\nA.  Well, as I picked up the responsibility I visited first Rochester and went and visited Gene, and at that point Ted was there, Ted Phillips was there.  And I met Terry Keane(?) for the first time, he was chief resident that year.  And interestingly with him as chief resident was a Missouri graduate who I had supported in his interest in going into family medicine and actually had directed him to Rochester, so I remembered, I still remember that visit.  And then subsequently I, Ted left almost immediately for Seattle, and I then went and visited him in Seattle with his program.  Those were the two programs that we really built ours, the model from.\n\nQ.  And those were from your own history?\n\nA.  That's right.\n\nQ.  Did, you know your background as an internist has put you in a unique position to have helped in the process because as I was saying before, I mean many of the people who helped get things started were pediatricians, and the internal medicine community was not particularly receptive.  I'm not clear why there was no receptivity, but--what was your sense about how you were regarded in your own original, country of origin?\n\nA.  Well, I very rapidly was not looked on as an internist any more.  I think the dilemmas I had, though, were much greater than concerns in family practice.  And it was really both within our own institution and outside of the institution, a lot of significant objection to my being there.\n\nQ.  Really?\n\nA.  I'll always remember, you know, when I came on--assumed responsibility there were two residents in the program.  And in the year that I came, picked it up, both of them were gone by the end of the year, which meant we were down to zero residents.  And one of them was gone because I fired him.  It became--he was a total disaster.  He was best known in the institution for moonlighting on the side by transplanting hair, gives you a little bit of an idea.  The other guy saw me, was very competent and actually has just been the immediate past president of the Missouri Academy, and we are now very good friends.  But at that time he saw me as clearly going to destroy the development of family practice at the University of Missouri.  I'll always remember sitting down and him looking me straight in the eye and saying, 'You know, Bill Bradshaw's going to get you.'  And Bill Bradshaw was a very strong family physician who practiced down in Clinton, Missouri, and kind of had a lot of political clout like Amos Johnson had for North Carolina.  I solved that one about a year later by recruiting him into the department.  So there was a--and then I really had a difficult task, because we had a department that was trying to be all things to all people and had to be focused over years, and that was very painful at times too, because it meant that directions had to change, that programs had to be closed that were existing, and we had to keep more and more family practice activity.  That was not easy to do.\n\nQ.  Do you remember what, you know, as you think back on that time, where when Dr. Williams asked you about which subspecialty you were going into, why it was that you were so sure that you didn't want to do that and there was some other way (?).\n\nA.  I don't know.  I really came out of the background which supported the concept, comprehensive care was the buzzword those days.  And I really saw myself in that arena.  I had the George Engel behavioral orientation, even though he hadn't coined the biopsychosocial model at that point, and I guess I was basically, even though, I don't know how you'd define it, I was a generalist in my orientation.  And I clearly always have been, that was why I--when I went back to Rochester, what did I do?  I ended up running an outpatient department.  When I went to Missouri, what did I do?  I became a dean.  You know, it's the, I guess the tendency to look towards integrated systems and must(?) looking at the isolated parts, my focus (?).\n\nQ.  But I'm just real curious, in people's lives, what are some of those factors that seem to--I mean it's, it may not even be something that's a conscious awareness, but obviously it's-- \n\nA.  It was there, and it wasn't conscious, I'm sure.  I may have gotten some of it from my dad, who was a social worker. \n\nQ.  I'm sure the stories he told were all about people's lives, and that's--\n\nA.  Except he was, again he was more of, it turned out he was more of an administrator than a practicing social worker.  He just administered social work programs.  I just don't know.\n\nQ.  So when did you start getting involved with organized family medicine (?)?\n\nA.  Right from the start.  Sherwood tells me that I was present at the original meeting of STFM.  He was just reciting that to me here at this meeting.  Sherwood has this incredible memory of, capability of recall detail.\n\n[tape paused]\n\nA.  Sherwood has this enormous capability of remembering detail, and he always, like we all do, tends to flavor it a little bit, but he was telling me the other day that I was at that first meeting listening with disdain and I left before the end of it.  I don't believe that.\n\nQ.  Especially older people, you wonder whether, their memories should be more flawed than ours.\n\nA.  Anyway, I was a part of many of the early meetings of the organization.  Interestingly, Marian--you should get Marian to reflect on these--\n\nQ.  Bill's got Marian to talk about it.  Obviously she sees herself as the historian of the organization, I think that's certainly true.\n\nA.  And Marian also was convinced that I was going to be a disaster.  Well, you see we'd had an interestingly relationship at Missouri, because she was on the faculty at Missouri--\n\nQ.  Alan had told me that, I guess either I forgot or didn't know.\n\nA.  And she and Bob had been very active in teaching a course which was called Human Ecology and Behavioral Science.  She, from her sociological perspective and he from his psychiatry background, and there I was, associate dean.  And she perceived I was giving her flak and that I obviously was an internist, so she was really questioning whether I should have been in family medicine at all in the early days.\n\nQ.  One of the things that always comes up is, to me anyway, is with the kind of (?) accreditation body starting to set up rules and regulations and the boards coming along saying what you should and shouldn't do to qualify.  But there's a beginning of the designing of the church, and the scepters(?) becoming less present.  And I, as you remember the kind of discussions that went on around, shaping the structure of residency training and education and so on, do you remember what some of those controversies were, what some of the points of disagreement were?\n\nA.  I guess I remember more personality conflicts than I do conceptual differences.  I really recall well, and some of the frustration I had as I watched some of the early leaders of the meetings were really coming at what was happening from my perspective and their own self-interest and out of their needs for ego satisfaction and so forth.  And I guess, you know, as I've come to have a little bit better understanding of organizational behavior and so forth, so much of what was there, the identity crisis that the discipline was having.  And the movement orientation that was clearly there, the mission orientation.  It certainly had as a part of it, you either were a church member or you weren't, and this was a very, very strong part of the interchange that you saw going on at many of the meetings.\n\nQ.  My suspicion also is that many of those folks, even though families and practicing in the communities and their kind of clinical practice was integrative of a lot of different parts of people's lives, what I learned from talking to a lot of the docs who had been 30 or 40 years in practice who would be their cohort, is that the sense of autonomy, the sense of doing things my way, very much of a--and I admire that in the right setting, but if you try and create an organization of people like that--\n\nA.  And I think that's a beautiful way of putting it.  Actually, it--I was equating that conceptual basis of general practice vis-a-vis family practice and I, in the early days of our program I just spent one heck of a lot of time with our residents saying, 'You can't be a World War I flying ace and do it all yourself.'  You know, well--this was really an incredibly threatening concept to many of our residents because their self-image was getting out there and doing major surgery, doing the C-sections, etc., which clearly the, you knew the future didn't hold that, and how you got that turned around.\n\nQ.  It is funny, because some people who I talked to, my image as a kind of Midwestern Easterner was of the West Coast being these kind of heroic doctors who, you know, were doing everything at once.  And when I talked to folks who were out there, they said they didn't have that image of what they were doing, they were trying to--it's very interesting, all this mythology that gets generated.  Very few places where there are people really doing the World War I flying ace.\n\nA.  That's right.  The--one other reflection that I have.  You were asking earlier how it, to a degree how it was I left internal medicine.  A part of it was true frustration with internal medicine.  I left internal medicine 'cause I didn't think internal medicine was ever going to get there.  I saw the progressive subspecialization, and I made this decision, and that was in 1972, 20 years ago.  \n\nQ.  I have a sense, as much as I know about internal medicine, is that's a braver thing to have done than probably to have entered into an academic milieu as a practicing physician.  It's really--\n\nA.  But I really wasn't a card carrier in traditional academic internal medicine.  I was just there for 3 years, I was a general internist and then I moved into the dean's office, and my research laboratory became my medical school admissions and things like that and I was no longer really a functioning internist.  Even though I made rounds and attended and so forth.\n\n[tape side ends]\n\nQ.  --organizations, how does--in your view, how have things changed in the various organizations involved with family medicine since you got involved with them?\n\nA.  Tremendous maturation.  I think each of the organizations, and going all the way from the academy right through each of the academic organizations, has developed--you know, they started off with a sense of mission but then due to the interfighting and a lot of spinning of wheels did very little for a long period of time.  And then began to, from their sense of mission to be able to develop operational programs that really took it the next step further.  And you know, that circle that Bob Davidson put up this morning about the stages of development of the organizations, it--we're right now, and I think each of our organizations, in that late adolescent, early adulthood stage with, and I don't think any of them are at this point at the disintegrating stage of that.\n\nQ.  The other thing I would like to get you to reflect on some is what are some of the generational issues in the discipline as you see it?\n\nA.  Hm.  I'm not sure I've thought about it that way. \n\nQ.  Someone the other day was saying that they were ready to make a transition now because they feel that with some exceptions the generation is ready to take over (?) other values (?) mettle has been tested and so on.  But I think there are some different--I mean I've dealt with fellows for so long, and I see things through their eyes and I don't step back and look at--\n\nA.  Yeah, I guess I do see some issues there.  You know, right now just about everybody would say that we're poised for major changes in the health care system.  And I think there is, within family medicine, along with mixed feelings, I think an acceptance.  Where I'm--and I think we've grown some absolutely superb people.  My concern is that I'm not sure how many true leaders we have out there who are willing--we have beaucoup people that have the capabilities of making all the rest of us look pretty unimpressive.  But so many of them are not willing to make the commitment.  And I guess I see that at least to a degree in the limited numbers that are really willing to be departmental chairs, as one example.  Like sitting in our department are seven or eight people that could walk out of there today and could be superb departmental chairs, and there isn't a single one of them who wants to be a chair.  \n\nQ.  I know of one in particular.\n\nA.  Yes, the one you talk to by computer daily.\n\nQ.  It's a big issue as far as--the irony is that at this time, when we're probably poised to have change be something we can manage as opposed to--we'll be buffeted, certainly, but I don't know why that is.  It may be the nature of the job or the nature of people's sense of self, I'm not sure.  But you're right.\n\nA.  So I see that as a fundamental generational piece.  On the other hand, golly, the--we've really grown a fair number of people that are going to be superb scholars as time goes on.  And I see the discipline maturing and growing, and interestingly, as you know, I've always--I've for several years been talking about trying to bring the three primary care disciplines together.  Well, I've--my reasons for saying that have been first based upon the perception that the task ahead of us is bigger than any of us, and that it really is going to require all of the manpower we can bring together.  Secondly, that I really see the general internal medicine and general pediatrics really as being so much more closely allied with family medicine than they are with their own subspecialties.  Do you know Bob Pantell?  He was at North Carolina at one point, and he's now chief of general peds at UC-San Francisco, and I just ran into him a couple of weeks ago at the primary care conference, and he was commenting to me about--he was ready for a single department.  He said, 'You know, I've got so much more in common with you guys than I do with my subspecialist chair.'  \n\nQ.  And anyways, the community pediatricians at UNC feel like people without a country.  \n\nA.  That's it.\n\nQ.  They have no--the only thing that they want to be around the pediatric department for is that there's some subsidy from the high-tech specialties.\n\nA.  Now the other thing that I'm beginning to feel right now, which--just in the last 6 months or so, to a year, along that line, which I have sort of mixed feelings about--earlier, one of my reasons for arguing what I was doing was I really think that any, once you bring those disciplines together, whatever comes out is going to look far more like family practice than any of the others.  It's the only way efficient systems will be able to evolve.  So I haven't found it threatening like many have.  The piece that I'm a little bit disappointed in is that it's looking to me that both internal medicine and pediatrics are going to abdicate primary care.\n\nQ.  Really?\n\nA.  And the first person I've heard that really has articulated that in public was Bob Waldeman yesterday.  But the reasons for saying it is that just--if you look across the country at primary care clerkships, how many of them do you know of that are dominated by internal medicine?  They aren't.  You know, internal medicine plays relatively small roles in them.  They've got so many other things and their values are so, continue to be so far different that I really think that it's by default going to be ours, and that scares me.\n\nQ.  I absolutely agree.  I just, as a, we had lunch with George Lundberg(?) over the summer, because one of the archives is edited in Chapel Hill, and the editor of the archives asked other editors to come and--it was a very nice lunch, and it turns out that it was a time when there weren't many other people around, so essentially I had a lunch with Lundberg and his staff at (?), and I was sitting and talking with him.  And he says, 'So how are you guys going to retrain 200,000 specialists?'  And I just kind of stopped and thought, 'I never even thought of that.'  I mean we're always focusing on the front end of the system and (?) and so on.  He said, 'You don't have the time.  You're not going to have the time to do that.'  And I thought, 'Beats me.  I haven't even talked about that.'  But it is something that if others abdicate and there's not a big enough opportunity to build coalitions that are going to increase the numbers and so on, you have to do that too, but the reality may be if things happen faster than they usually happen in the system, we're going to have to retool a whole lot of people because there won't be a lot of need for gastroenterologists, or neurologists or radiologists, for that matter.\n\nA.  And that's what I'm wrestling with right now with the Cogni(?), because I'm hoping, or I'm anticipating, I shouldn't say hoping, that we're going to be coming out with some pretty mind-boggling recommendations this year, and it's exactly what we all are agreeing needs to be done, but it's going to be fascinating the noise that's going to occur as a result of it, I think.\n\nQ.  Your general sense is that as a discipline we've done pretty well, as you say, growing our own.  That's really, that's nice, I like that term a lot.  It's--the thing that's been striking to me is how much, really at some level, which I finally have found a level which is the level of taking care of patients, how much the people who are being trained now and who are teaching now and the people who were in practice or still are in practice who came into teaching, that kind of conversation we could have and really learn from each other.  All the other stuff that we are doing or have done is different, each from the other, is what the (?) gets focused on, how different they are than we are, how different we are from the students who are coming into medicine now, which I think is a big difference, frankly.\n\nA.  Oh, yes.\n\nQ.  Which worries me even more in some ways, and it's reflective of society, society's trained students to read the rules about how you get into medicine and they all--this is an aside, but I'm trying to write something on this idea, that 25 percent of the applicants, I read all the essays of the people we discuss in committee, 25 percent of the applicants mention the phrase that they've always been fascinated by the human body.  And this is stunning.  That phrase is in a quarter of all the applications to medical school.  And I just, the first time I made a joke about it, and then after that--and I've got to figure out why.  And part of it is, some message has gotten out that this is what medicine is all about is this kind of curiosity about biomedical science.  But the bigger thing to me is that somehow that's the message that society's gotten about what medicine is all about, not just who's applying.  And how we're going to change that perception  'Cause we have to.  Because we can't have a logical system unless we change that.  It's really a challenge.  But I thought an appropriate place for that is an op-ed piece in the New York Times or something, just saying, 'You wouldn't believe what doctors--you don't like doctors now'--(?)\n\nA.  That is fascinating, John.\n\nQ.  Isn't it?  I mean the same phrase.  I mean I thought, is there cheating going on on a massive scale, or is there some book that says, 'If you want to get in, this is the phrase you have to use.'  I don't know.\n\nA.  David Schneider, who's one of our fellows this year, has done an analysis of the admissions interviews of Missouri's applicants.  And he was looking at trying to come up with whether there were things on interview that would be predictors of career choice.  And methodologically it didn't come through very well, but I can ask him whether he has any way of looking and seeing whether we have similar findings from what he's able to get out of that.\n\nQ.  So there are some future concerns that I have.\n\nA.  I, coming back to some of the things you were getting at earlier, I suspect that my disciplinary background has in many ways helped in terms of developing a strong academic department.  'Cause I, you know I grew up at Rochester with a very strong internal medicine--I was here at Barnes with what was viewed as one of the elite departments of medicine in the country, and then I went to Seattle with their, just when they were on their exponential growth rate to greatness.  And many of the expectations in terms of scholarship and the critical thinking, which really wasn't all that present in family practice in the earlier days, I kind of helped, I think I just had the vision of what a department of family medicine should look like, at least to a degree built up on some of the quality standards that the internal medicine had.  And I think that was probably an asset and made it possible for me to do things that I wouldn't have been able to do otherwise.  Even though I have always been handicapped as a clinician because I usually knew more internal medicine than most of the rest of the department, but when it came to kids I'm still a--if there's an orthopedic problem I have to continue to consult in a way that I would have as an internist.\n\nQ.  Your knowledge of traditions is really important.  And there were no (?), can't learn something you've never been a part of.\n\nA.  That's right, and so I knew what a scholarly department should look like.  I knew a little bit of the milieu that you created in order to do that.  And then I think the other thing that was really helpful at Missouri, the second big thing, was making the decision to bring in Jerry Perkoff, and that was again serendipitous.  But not a decision you made lightly, because Jerry, as you know, is not the sort of person that sits back in a corner.\n\nQ.  Actually, I interviewed him, he was a candidate for dean at the University of Massachusetts and I was on the junior faculty committee that interviewed him.  I remember him (?).  I mean actually our committee, I think, was pushing very hard for him to be one of the top candidates and we were very upset that he wasn't.  But I really remember him coming in, I mean he was very distinctive.\n\nA.  That's right, well, and you know, the discussions we went through in the department back then about whether to bring him in, and the most telling point of all came from one of our faculty, who said, 'Jack, I think he'll be too threatening for you.'\n\nQ.  That's been a nice relationship (?).\n\nA.  Oh, it's been wonderful, and Jerry really was the person who I think more than anybody else helped establish the academic standards of the department today.  \n\nQ.  The nice thing (?) about what you've been able to do is that it's clear to me that the focus of the work is the kind of clinical work that makes sense and connects with everything else that we're doing.  I mean it's not something that's often a secondary data set analysis of something that's maybe meaningful to epidemiologists but not to clinicians.  So that kind of connection is really, you should be proud of that too, that somehow the focus is not just in an academic, the high quality and high standards, but on things that are meaningful--\n\nA.  Yeah, on relevant topics.  \n\nQ.  I guess the other question I wanted to ask you about is if you can go back to what you had imagined at the time when they said, 'Okay, you're the head of this department,' if you had imagined at that point what things you wanted to happen, what was going to happen over the next 20 years, not only in the department but in the discipline, how far are we from what you had imagined?\n\nA.  Oh, golly.  I don't think I had in my own mind articulated, had my expectations that clearly defined.  I guess, again it's the way I tend to function, it's with great difficulty that I force myself into developing quantitative objectives to measure performance against--I saw, I've always seen the direction and had the vision, but quantitating it in terms of specific objectives, I haven't done that and so I'm not sure.\n\nQ.  (?) kinds of people, the kinds of programs, or (?)--\n\nA.  It clearly has moved in the way I was hoping it would.  And I guess the only thing that I would say is a disappointment and it's because I'm always too impatient, is that we haven't come as far as I would hope we would have come by now.  But I've also realized that within our own department, everything that I had hoped to accomplish, and in my gut felt we would accomplish in 5 years, invariably has taken 10 years.\n\nQ.  Something I keep thinking about Einstein and relativity and how time slows down or time speeds up, in some situations time slows down in academic life.\n\nA.  That's right.  And I guess the other piece that I am disappointed in that I guess I shouldn't have been is the fact that I really feel that our academic medical centers have become dinosaurs.  And it really is, one would have thought that by now they would have been far more visionary than what they really are in terms of their broader role in society.  I think Steve Schroder's health of the public activities and his article in JAMA was really an incredibly important article in addressing this.  \n\nQ.  It's going to be for us, I mean all this time been trying to, you know, one way or the other integrate family medicine into the fabric of academic medical centers and medical schools, and we've done that more or less well I think.  And then those centers themselves are becoming, as you say, dinosaurs and the kinds of changes that are coming along, the speed with which they're going to come, is overwhelming.  And we finally got into the country club just as they're about to close it down.  So I--well thank you, this has been a very nice time.  Anything we haven't talked, I mean before we stop is there anything that you think would be worth touching on?\n\nA.  I guess not, I think the relevant, what I'm sensing you're trying to do--\n\nQ.  I'm not sure what we're trying to do.\n\nA.  This is on the side, but 2 years now we've done something that, you know, it wasn't my idea it was Mike Hosakawa's idea at our shop, but it really has been exciting, and that's, we've had a workshop for new chairs or prospective chairs.  And last year we had five in and it was an incredibly productive 4 days.  It's just intensive discussions and I think somebody used the analogy, it was--what we really were running was a Balant(?) group for chairs.  And this year we had 11, eight of whom are new chairs and three were, Roger Sherwood had told me were looking at, so we invited them too.  And I think something along that line is, probably needs to be markedly expanded, and it may be helpful in addressing some of this reluctance of people that really pick up the leadership.  The other thing which is happening which I guess is good, although I have terrible ambivalences about it, is the movement of many of our younger leaders into managed health care.  You know, the Woody Warburtons of the world, and now Joe Sugar(?) has just made the decision, you heard about him--\n\nQ.  I don't know, you said something tangentially.  He's going to San Diego to do something, but I don't know what this something is.\n\nA.  Well, he's to become vice president of a health care system there, the Sharp Hospital System, which is--and his role in that is to build family practice education into that system.  But you know, it's--I think it's really the first step in his movement along a Terry Kane, Woody Warburton direction, as I see it.\n\nQ.  I'm not sure what Terry's doing as far as the family medicine and what he's active in now, but Woody's had a hard time.  I mean he certainly is, it's been very difficult in that particular organization is--\n\n[interview ends]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262305#t=0.0,1890.16475"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262304","type":"Canvas","label":{"en":["Media File 2 of 2 - Colwill_Jack_1992.04.28_-_Side_2.mp3"]},"duration":1538.79013,"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/3629/collection_resources/141776/file/262304/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262304/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/262/304/original/Colwill_Jack_1992.04.28_-_Side_2.mp3?1739222047","type":"Audio","format":"audio/mpeg","duration":1538.79013,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141776/file/262304","metadata":[]}]}],"annotations":[]}]}