{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/n58cf9m98r/manifest","type":"Manifest","label":{"en":["Dr. Joseph Scherger"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eThis interview focused on Dr. Scherger's travels through the medical care system. He entered family medicine in its early days, completing a residency then going into solo practice in a small community in California. He was recruited as a part-time residency faculty member at UC-Davis, then became part-time predoctoral director in the same program. He described his career plan as three 15-year segments: 1. Practicing family physician: 2. Leading and running programs; and 3. Major leadership positions. This interview covered the first two segments over 23 years. He became a full-time residency director in San Diego, and when his hospital began losing money and cutting the number of residents, he moved to become chair of the Department of Family Medicine at UC-Irvine. From there he was recruited as founding dean at a new medical school at Florida State University. There he endured a hostile provost who campaigned against him and his leadership and ultimately fired him. He returned to California to seek new challenges. Dr Scherger is highly introspective and reflects thoughtfully on his journey. His thoughts on how to deliver patient care and the future of family medicine are sprinkled throughout the interview.\u003c/p\u003e (summary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2007-10-18 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Cecilia Gutierrez (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Joseph E. Scherger, MD, MPH (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eThis interview focused on Dr. Scherger's travels through the medical care system. He entered family medicine in its early days, completing a residency then going into solo practice in a small community in California. He was recruited as a part-time residency faculty member at UC-Davis, then became part-time predoctoral director in the same program. He described his career plan as three 15-year segments: 1. Practicing family physician: 2. Leading and running programs; and 3. Major leadership positions. This interview covered the first two segments over 23 years. He became a full-time residency director in San Diego, and when his hospital began losing money and cutting the number of residents, he moved to become chair of the Department of Family Medicine at UC-Irvine. From there he was recruited as founding dean at a new medical school at Florida State University. There he endured a hostile provost who campaigned against him and his leadership and ultimately fired him. He returned to California to seek new challenges. Dr Scherger is highly introspective and reflects thoughtfully on his journey. His thoughts on how to deliver patient care and the future of family medicine are sprinkled throughout the interview.\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/2195/collection_resources/154130/file/283327","type":"Canvas","label":{"en":["Media File 1 of 2 - Scherger_Joseph_07_a.wav"]},"duration":2318.55702,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/283/327/original/Scherger_Joseph_07_a.wav?1753283903","type":"Audio","format":"audio/wav","duration":2318.55702,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327/transcript/81828","type":"AnnotationPage","label":{"en":["Dr. Joseph Scherger Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327/transcript/81828/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"DR. GUTIERREZ: GOOD MORNING.  I AM CECILIA GUTIERREZ, HERE AS A MEMBER OF THE BOARD OF CURATORS FOR THE CENTER FOR THE HISTORY OF FAMILY MEDICINE.  I AM IN SAN DIEGO, CALIFORNIA AT THE OFFICE OF DR. JOSEPH SCHERGER TO INTERVIEW HIM.  AND THE GOAL OF THE INTERVIEW IS TO COLLECT AND PRESERVE INFORMATION ABOUT YOUR VIEWS, YOUR EXPERIENCE, YOUR JOURNEY AS A FAMILY PHYSICIAN AND ALSO AS A MAJOR LEADER IN OUR SPECIALTY.  WE HOPE TO BRING THIS INFORMATION IN A MORE FORMAL WAY FOR EVERYONE TO SHARE IN THIS WAY TO CAPTURE AS MUCH AS WE CAN OF YOUR PERSONAL JOURNAL AS A GREAT LEADER IN OUR SPECIALTY.  I AM VERY HAPPY TO BE ABLE TO INTERVIEW YOU.  AND WE HAVE JUST TAKEN CARE OF THE ISSUE OF RELEASING THIS REPORT OR THIS INTERVIEW AS A GIFT TO THE BOARD AND TO THE CENTER.\n\nJUST TO START IN THE INTEREST OF YOUR BACKGROUND, PLEASE STATE YOUR FULL NAME, YOUR PLACE OF BIRTH AND TELL US WHAT ARE YOUR CURRENT PROFESSIONAL AFFILIATIONS.\n\nDR. SCHERGER: I’m Joseph Edward Scherger.  I was born in Delphos, Ohio, August 29, 1950, which makes me fifty-seven years old.  Currently I’m Clinical Professor at The University of California-San Diego in Family and Preventive Medicine.  But I’m doing two different medical director roles - one with the County of San Diego and.  I’m the Medical Director of the County Medical Services.  And then I’m also Medical Director for Informatics for Lumetra, which is the quality improvement organization for California.  \n\nTELL US A LITTLE BIT ABOUT WHO ARE YOUR PARENTS, WHERE ARE YOUR PARENTS.\n\n\nMy dad who just turned ninety, his name is Elmer Scherger.  He is ailing.  He is actually in hospice care right now for heart failure.  But he’s stable and doing relatively well at the moment.  I’ve been back to Ohio twice recently to be with him.  He was the president of a small town bank, as his father before him.  Growing up he was in a middle-management position at the bank as cashier but then eventually moved on to be president.  My dad is very much like the Jimmy Stewart character in the movie “It’s a Wonderful Life.”  He always dreamed of bigger and better things than the small town in Ohio.  But he stayed and helped out a lot of people and made a tremendous difference in the banking there.\n\nWHAT ABOUT YOUR MOM?\n\nMy mom’s name is Rita.  She is also from Delphos.  They met probably before high school and married.  Rita is a very, very strong woman.  My family is German Catholic.  A parish relocated from Germany in the 1840's and founded the town of Delphos, Ohio.  And it’s a very, very strong group of people.  My mom was a homemaker.  I’m the third of four children.  Most of my sort of simple rules of life and values and things were given to me - I’m always quoting the clichés my mother said.  I always thought they were her original wisdom.  And I grew up later with things like “Rome wasn’t built in a day” and all these various sayings that were really clichés but were all my mother’s.  She’s a wonderful woman.  She’s eighty-nine years old and doing okay.\n\nDO YOU HAVE ANY SIBLINGS?\n\nI have two brothers that are based in Lima, Ohio.  One nine years older who just retired as a clinical psychologist.  And my younger brother, Bill, is an OB/GYN physician.  My sister lives in the Boston area and is a homemaker with three children.\n\nHOW WAS IT GROWING UP IN OHIO?\n\nGrowing up in Ohio was really a gift.  My town was very much of a Norman Rockwell type of community.  Very stable.  It hasn’t changed much at all since then.  I grew up in the ‘50s and ‘60s and I was in high school to 1968.  And so a lot of the turbulence and the birth of rock and roll and all the various social revolutions of the ‘60s I kind of experienced from the innocence of a small rural town in Ohio.  I had a wonderful group of friends my mother called the gang.  But there were about seven or eight guys that we did almost everything together, that I’m still rather close to.  \n\nANY FUNNY STORIES OR ANY PARTICULAR THINGS FROM CHILDHOOD THAT STAND OUT AS YOU LOOK BACK?\n\nGosh, there are so many of them.  One of the things that was striking about my youth I should mention is I was a very, very religious young boy.  As a matter of fact, they had a nickname “holy boy” because I would never say a swear word.  I still remember one time this bully saddling me and tried to force me to cuss.  And I thought I was going to be a martyr at the time.  And that was kind of a dramatic part.  All of that changed when I went through puberty and I actually had this kind of fit of scrupulousness dealing with the hormones of puberty and my holiness.  My goal in life before puberty was to grow up and be a saint.  And I had actually figured out how I was going to convert Russia to Catholicism.  And this sort of crises of all of this came to a head probably when I was about thirteen or fourteen and I kind of shrugged all of that off and haven’t taken religion terribly seriously since the terms of the rigid rules of the Catholic church that I was totally, totally connected to.  I was able to let go of that and become a lot more pragmatic in my views of the world.\n\nGOING BACK TO ASK YOU A LITTLE BIT ABOUT YOUR BACKGROUND, YOU ARE MARRIED TO CAROL?\n\nYes.  We have two boys.  I was married in 1973, so I’ve been married thirty-four years.  A wonderful woman.  We met in Dayton, Ohio.  I went to college at the University of Dayton and I worked in the hospital through college as an orderly.  I started college in chemical engineering.  I didn’t even think of medicine because I couldn’t stand the sight of blood and hospital or doctor’s offices turned me off growing up.  But I didn’t like engineering.  I knew I needed to work with people.  So someone suggested or maybe I just thought maybe medicine.  So I went and got a job as an orderly to see if I liked it.  And working as an orderly, Carol was a respiratory therapist in the hospital and we met in an elevator one day and sort of cupid’s arrow.  I can remember vividly meeting her, it was March of 1971.  And it’s kind of a funny story.  I worked the graveyard shift from","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327#t=0.0,660.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327/transcript/81828/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"at night to 7:00 in the morning.  And Carol worked the evening shift.  But it was 4:00 to midnight, so we had an hour of overlap.  But we had never met until one day I came to work at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327#t=660.0,660.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327/transcript/81828/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and I was working on the third floor of the hospital.  And somehow I thought I may have left my lights on in my little Volkswagen.  And the one way I could find out was if I quietly went up to the fourth floor and looked out of a window.  So I kind of snuck away without telling anyone and got on the elevator and went up to the fourth floor.  The elevator door would not open and it zoomed down into the basement where Carol stepped in.  And I looked at her and I said how did you do that.  And she said oh, I always lean on the button - and she forced the elevator to go down.  But just as we went up a few floors, cupid’s arrow was swung - and the rest is history.   We had wonderful years together.  We met in ‘71, married in ‘73 and had our first child in ‘77.  So we had some time together before we started a family.\n\nWHEN YOU TALK A BIT ABOUT THE INFLUENCE OF RELIGION, CATHOLIC, AND GROWING UP VERY PIOUS, I SUPPOSE, WHO WERE YOUR ROLE MODELS AS YOU WERE GROWING UP AND GOING THROUGH THE TRANSITION OF ADOLESCENTS AND PUBERTY AND THINKING ABOUT WHAT WAS GOING ON IN YOUR MIND IN TERMS OF IDEALS AND GOALS AND PEOPLE YOU ADMIRED?\n\nDuring my religious phase my role models were all saints.  I loved having the name Joseph and St. Joseph was the father of Jesus.  And I chose the name, Andrew was my confirmation name because I thought Saint Andrew was really neat.  So I really modeled my role models as being various saints that are well-known in the Catholic church.  But after I moved away from that I really got very focused with the social movement of the ‘60s and my role models shifted to like Gandhi and Martin Luther King and the Kennedy’s, especially Bobby Kennedy.  I got very active against the Vietnam war and marched on Washington while in college as part of that protest.  So my mission-driven nature shifted from religion to social issues.  And the other thing that happened to me, I started college with chemical engineering but I quickly shifted to pre-med.  But my real love was philosophy and I graduated with a minor in philosophy.  And many of the 19th Century German philosophers, the whole sort of philosophical trend from Kant to Hegel right through to the existentials such as Nietzsche. I found that whole strain of Germany philosophical thinking very much focused my own sort of beliefs.  And Goethe, the great writer and poet, I thought was really sort of the complete man as far as I saw.  So I actually remember telling people that philosophy was going to be my life and medicine would be a hobby.  \n\nAND NOT THE OTHER WAY AROUND?  \n\nThat’s right.\n\nYOU STARTED WITH CHEMICAL ENGINEERING AT THE UNIVERSITY OF DAYTON?  \n\nYes.  It’s a Catholic Marianist college very similar to the University of San Diego here in town.  It’s a funny story why I went to that college.  Growing up in a small town in Ohio, the decision never seemed to be that important to me.  I was a very good student and was president of our student council and I could have taken the decision was seriously.  And my dad just looked at me said Joe, your sister is at Dayton.  Why don’t you just go to Dayton and make it easy on us and then after that you can go anywhere you want.  Now part of me thought of exciting places like Stanford or maybe Boston.  But be easy on us, we are paying for college.  After that you are on your own.  Why don’t you just go to Dayton - and I said okay, sounds fine to me.  And so that’s where I went.  It was not like any big decision.  There was no tour of different college campuses or anything like that.  But it turned out to be a wonderful place.  I was there just three years.  I actually graduated in three years because I did various things to get credits over the summers.\n\nHOW DID YOU TRANSITION FROM CHEMICAL ENGINEERING TO MEDICINE?  IT SOUNDS LIKE, FROM JUST KNOWING YOU AND TALKING TO YOU RIGHT NOW, THAT THERE WAS A LOT OF SOCIAL IMPACT AND THAT YOU ARE A VERY SOCIAL PERSON AND YET YOU HATED BLOOD.\n\nYes.  First of all, growing up Delphos only had general practitioners and they gave shots for everything and their offices smelled like alcohol pads.  And so there was nothing pleasant about the doctor and getting shots.  And I knew I was a people person but all of my scholastic ability was in math and science.  I never grew up with a broad liberal education.  I mean English was either taught by nuns or coaches.  My elementary and high school education had no teachers that you would find in a lot of great schools.  The nuns were fine but they were very strict.  They were very limited.  I still remember taking French from a nun who did not know one word of French.  All she knew was Latin.  And Latin was the big thing - I had Latin, Latin, Latin but it never made any sense to me.  But I remember her sitting there reading French quotes with a Latin accent, supposedly teaching us French.   But math and science came so easy that I figured that’s what my career would be.  Just before I applied and was accepted to Dayton in chemical engineering - before I went there, that summer I went to Ohio State to do a National Science Foundation preliminary study in engineering.  And I hated it, thermo-dynamics and stuff.  I still remember driving home with my mom in the car from Columbus saying I can’t do this.  This is totally boring and not of interest.  I’m a people person.  And I told her maybe I’ll go into psychology like my brother.  And then she said Joe, why don’t you think of medicine.  And I said I don’t know if I like medicine.  So when I got to Dayton I knew I had a dilemma.  And a friend in the dorm said I work as an orderly over at the hospital and it is a blast.  And he said I think they are hiring more; why don’t you go over.  So actually I went over and he and another buddy, we all became orderlies in this hospital.  We were nurse aides but we covered - like I was the only orderly in the hospital the nights I worked, so I was all over the place.  I was passing urinary catheters, I was doing enemas, I was taking dead bodies to the morgue.  I loved it.  First of all, any squeamishness quickly disappeared.  I just had a blast with the nurses.  The whole multi-disciplinary team nature of the hospital just seemed like a lot of fun.  So I immediately switched to pre-med and had a great time with it.  \n\nWHERE DID YOU GO TO MEDICAL SCHOOL?\n\nUCLA.  Now I took my dad up on his offer.  When I was done at Dayton I had actually decided that I was either going to go to medical school in Boston or California.  And, again, I didn’t really have that broad of a view.  The two schools in California I was interested in were Stanford because it was pass/fail and a very open, liberal education.  I really believed in student-driven education.  Only looked at pass/fail medical schools.  I was tired of playing the grades game.  And my uncle who delivered me, my dad’s brother, moved to L.A. in 1954 when I was only four years old.  And we had visited him and I thought it was a wonderful place.   He has passed away now.   So that was that attraction.  And then when I went to Boston where my sister was already living, Harvard was way too intimidating.  It had marble columns in front of the school.  And I said I don’t belong here.  But Tufts was a very liberal school - Jack Geiger, the kind of founder of community clinics and community health movement.  And I was a big social activist at the time, so Tufts had a special appeal to me. My first choice, Stanford, I actually did not get accepted.  My second choice, Tufts, accepted me but sent a letter saying that the tuition was going to double from $4,000 to $8,000 a year and they told people not to count on any financial aid.  So that sent a little panic to me.  And UCLA, I actually put it on hold.  And I quickly went out there, interviewed and was accepted.  And because my grades were good, they gave me an out-of-state tuition waiver which meant from the very beginning they gave me the same rate as a California resident.  So I thought this place really wants me.  So I became a Bruin there.  Very loyal to UCLA.  It was a wonderful experience.  \n\nIN TERMS OF LOOKING AT YOUR MEDICAL EDUCATION, WHAT WAS THE HARDEST THING?  YOU THINK ABOUT GOING THROUGH ALL THE PRE-MED, BUT ONCE YOU STARTED MEDICAL SCHOOL WHAT DO YOU THINK WAS THE HARDEST THING?\n\nCarol moved with me but we weren’t married.  In the beginning I moved into a private dorm and she lived a block away in an apartment.  She got a job as a respiratory therapist at Mount Sinai and Cedars of Lebanon.  Cedars Sinai had not been built yet.  So she went back and forth and actually gave breathing treatments to people like Elliott Gould and others.  For Carol and I the move to L.A. was like a wonderland.  We used to drive the Sunset Strip just for fun.  We went into Whiskey-A-Go-Go and sat next to Mama Cass in a booth.  To us it was just a great discovery.  Medical school was hard work but it was never hard for me.  My math and science and various abilities, I was doing real well right from the beginning.  I had 125 classmates.  I got very close to a group of them.  I fit in well.  I was the small town kid from Ohio.  I had never met a Jewish person in my life before, and 40% of my class was Jewish.  It was funny, Carol and I made friends with Jewish students and the Chinese students because they were totally new discoveries.  So I learned how to use chopsticks.  Mark Lieber and Jim Brenner were my best friends on the Jewish side.  I actually mentioned them once commenting about me as a Gentile and I didn’t even know what that was and I had to look it up.  We had a lot of fun.  But then Maurice Lem from Hong Kong and Wen Yap and others, we used to go to Chinese restaurants in Chinatown.  But I went to medical school planning to be a medical scientist.  Had the M.D./Ph.D. programs been developed, I would have been in an M.D./Ph.D. program.  I was going to unlock the secrets of auto-immune disease.  I was fascinated by the autoimmune collagen vascular diseases.  I was never a handyman with my hands.  I was strictly a cerebral guy.  I’d never fixed a bicycle in my life.  I’d never used many tools.  I was definitely sort of this city slicker.  It’s funny, back in Delphos, a little farm town, you were half farmers and half city slickers.  And I was clearly the city slicker.  Everything I did was with a paper and pencil and a slide rule or whatever.  So I assumed internal medicine and I assumed a medical science career.\n\nWHAT LED YOU TO FAMILY MEDICINE?\n\nIt’s a great story.  The first two years went along with me consistent.  I loved the stuff, bio-chemistry, physiology, thought they were wonderful.   And then in the third year I started doing the clerkships.  And I was the prototype of the student who fell in love with every clerkship.  And OB/GYN was wonderful.  Delivering babies was like a miracle.  But it was on an emergency room rotation, about the middle of the third year at Harbor General Hospital where they triaged the emergency room into the medicine side, the surgery side, the pediatric side and the gynecology side.  So there were actually four emergency rooms and people were triaged to whatever their problems were.  And as a student you were rotated among all four. So one night you did medicine, one night you did surgery, for example.  And what I found is that when I was assigned to the medicine side, I was not as excited about going in as when I was on the surgery side because I was learning to sew lacerations, put on casts, fix people up, get them better.  And I said this stuff is really fun and it’s not hard.  And I was doing stuff with my hands for the first time in my life.  And I said I don’t think I want to be an internist.  It’s tedious. You’re not making people better as quickly.  I need variety in what I do.  And I loved pediatrics.  So that - and the specialty of family medicine was in its infancy.  Tom Stern was the Residency Director at Santa Monica and it was one of the original programs.  And he was holding receptions for family medicine.  I looked up and found up about the Society of Teachers of Family Medicine that had just formed and the AAFP had just changed its name a couple of years ago.  And I basically found this counter-culture specialty.  I started reading Gayle Stephens.  And I was still this counter-culture person.  I had hair down to here.  \n\nAND YOU FOUND YOUR NICHE.  \n\nAnd I found my niche.  So I converted in the middle of my third year to family medicine and immediately got involved.  I joined AAFP as a medical student.  I got real involved in the specialty right away. \n\nYOU HAVE HAD AS MANY HATS AS I CAN EVER THINK OF IN LOOKING AT YOUR CV AND SO MANY THINGS YOU HAVE DONE OVER THE YEARS, FROM BEING A PHYSICIAN IN THE COMMUNITY, FROM BEING A GREAT TEACHER FOR STUDENTS RISING UP.  ROLE MODELS AND JUST SERVING AT SO MANY DIFFERENT LEVELS, THE BOARDS AND THE ACADEMY.  TELL US A LITTLE BIT.  THE SCHOOL OF MEDICINE, PROGRAM DIRECTOR FOR RESIDENCY.  YOU HAVE DONE IT ALL.\n\nNone of that was by design.  I never planned to do as many different things as I’ve done.  A big part of growing up in the ‘60s and ‘70s was the whole idea of planning your life.  John Gardner was a very important role model for me.  He wrote the book “Self Renewal” and wrote a book on excellence.  I knew that I didn’t want to do one thing my whole life.  First of all, in residency I decided that I also wanted a degree in public health.  That I wanted to not only work hard to be a good doctor but that I wanted to understand the health care field from a social and policy and population perspective.  Because I really wanted to have the ability to influence the health care system and I was very active as a resident in health care as a right, universal health care.  So I got a master’s in public health.  It was a very unusual thing, I actually completed my master’s in public health in the same month I completed my residency.  And even had to do a research project for a master’s thesis.  And I did all that.  I worked very, very hard, especially in my third year, to have those together.  But I was absolute about not going right into an academic career.  I was absolute.  My feeling was if I was training to become a family doctor I wanted to actualize that and go out and be a community family doctor.  And it would only make sense to me to go to a community that really needed me.  I thought the National Health Service Corps was a wonderful program.  As a matter of fact, at the University of Washington I was the advocate, the agent for the National Service Corps.  I helped boost it, things like that.  So Carol and I decided we were going to go back to California.  She did not like the Seattle weather.  It didn’t bother me but the Pacific Northwest was not for her.  She needed more sunshine.  We had driven all over the place discovering the west and we decided we liked northern California, more in the Sonoma County area where Davis, that whole area up there.  So that’s the region we wanted.  So I volunteered into the National Health Service Corps.  I never signed a scholarship because at that time they could never guarantee that you could finish your residency.  They kept saying if you sign a scholarship we can call you anytime.  I said that doesn’t make any sense.  I need to have my freedom to finish my residency.  So I volunteered into the National Health Service Corps and I found out that the volunteers were given a different list of places than the scholarship people.  And they had a really desirable site that was only eight miles from the college town of Davis that only the volunteers got to know about.  It was not a very fair system.  The scholarship people were sent to Barstow and all these godforsaken, isolated places where I was sent to a migrant health clinic at a place that was so nice that I stayed fourteen years.  So I started then as a migrant health doctor just eight miles away from Davis.  The hospitals were in Davis and Woodland.  There was no hospital in Dixon.  And I had a partner who I never met before who had just finished residency at Rochester, New York which was, of course, a mecca of early family medicine. So this guy, David Katz, and I shook hands.  I got there a month before he did.  And we converted an 8:00 to 5:00 community clinic into comprehensive family medicine.  We started doing obstetrics which they hadn’t done before.  When I arrived in Yolo County where Davis and Woodland are, there had not been a family doctor deliver a baby in four years.  And we quickly got our OB program with a little bit of a battle and started delivering babies.  We were really into natural childbirth, no anesthesia for women’s choice.  So we actually had women coming from all over to have us.  We were very much like midwives.  But we actually had three migrant clinics we were in charge of, the main one in Dixon and then there were two outlying clinics.  And we were co-medical directors with the community board and everything.  It was a great time.  But I saw a lot of inefficiency in how the clinic was being run and a lot of kind of waste of money.  And I thought to myself I can do this better than this community clinic.  So when my commitment was up, I actually opened up my own solo practice right there in Dixon.  And it grew over time to be a whole group of doctors.  We had so many people from Davis who loved our philosophy that were driving to Dixon for us to be their doctor that we actually opened a second office in Davis in 1986.  So I was doing that and was National Family Doctor of the Year while I was there.  But another thing happened while I was there.  UC-Davis was having declining interest in family medicine.  And the founders of the department, John Geyman, Hughs Anders, Gabriel Smilkstein, all these icons of early family medicine had all left.  And the interested in family medicine among Davis medical students had dropped 25% to 15% of the class.  And I was asked to help turn that around.  They had also lost their main clinical teacher of the residency because he couldn’t get the tenure.  And they took his job and chopped it up into part time positions.  And they wondered if I would work a day a week in the residency.  I started doing that.  Every Wednesday I was in the residency and so I practiced Monday, Tuesday, Thursday and Friday and recruited one partner to make that possible.  And then they lost their pre-doc director and asked if I would be the pre-doc director.  I said I will do that as long as I don’t have to leave my practice.  So I then went 40% university and 60% practice.  It was a wonderful schedule.  I saw patients all day Monday, Tuesday morning and then was pre-doc director Tuesday afternoon.  Wednesday I was in the residency.  Thursday morning I was pre-doc director.  Then I went back to the practice.  And we took the student interest in family medicine all the way back up to 25%.  We were one of the top in the country.  I actually started writing articles about career development.  Wrote a number of pieces.  Wrote a chapter in the book Teaching Family Medicine in Medical Schools at STFM.  So I began to live a double life.  I was the busy practicing family doctor in that location delivering lots of babies.  And I had started this teaching career.  Spinning back, as a resident I was very active in AAFP and became a delegate of AAFP.  While I was doing that STFM decided it wanted a board member who was a president.  And I became the first board member of STFM.  And Ted Phillips, on my own faculty, became president.  When I went into practice in Dixon I disconnected from STFM.  But when I got asked if I would want to start teaching at Davis, STFM gave me the chance to chair the communication development,  and I did that.  And then I chaired the education committee after that.  At Davis I even became chair of the curriculum committee.  So my academic career and my practice career were in parallel for a dozen years.  And I even was president of STFM in ‘86 while I was in practice in Dixon.  So I was busy but having a great time living this double professional life.  After about ten years of leading this double professional life I realized that the practice was so consuming that the amount of work that I could do and the academic work and leadership activities and others were limited.  So I realized that phase 2 of my career plan I should get ready for.  Let me back up - I still remember driving from Seattle to living in Davis.  I said I think my career is going to have three phases of about fifteen years each.  Phase 1 will be dominated by practice as a family doctor and then phase 2 will be maybe leading or running programs.  And then phase 3, if I’m lucky or able to do so, might be in some major leadership positions.  \n\nI actually thought of that, that I would divide my life into three segments.  Well, segment 1 lasted fourteen years, from 1978 to 1992.  And I began to realize that I had a choice, I was either going to stay with what I was doing my whole career and have a thirty, forty year as a practicing doctor who also did a bunch of other things or I was going to have to leave the practice so I could devote myself more full time to these other interests.  John Frey, who was very much of a role model for me - he had interviewed me back when I was a resident applicant at Worcester, Massachusetts.  But he told me about the Kellogg National Fellowship Program.  That it was devoted to training broad social leaders and that it’s wonderful and that I ought to look into it.  He had been in class five.  Well, I did look into it and said this is exactly what I need, this is broad social leadership training.  So I applied and was fortunate to become a Kellogg National Fellow.  And that was in 1988, the ninth class.\n\nThat was very much life-changing for me.  First of all, it gave me formal leadership training.  But it also had me working with people in other disciplines dealing with broad social problems like health care and poverty.  My learning plan was what are the determinants of health in a community.  And I quickly learned that medical care ranks about six in the determinants of health in a community.  Health in a community requires clean water, food, shelter.  But it also, more important, medical care requires employment and education and these other factors.  But what was happening in the 1980's is that the high costs of health care was syphoning so much money away from these other social problems which were actually more important to a given community.  And it was very sad where in much of middle-America schools were in decay and the communities were facing unemployment problems largely because of the rising cost of health insurance.  Yet the hospitals were building new buildings and competing with their CT scanners and things were very outbalanced.  And doing the Kellogg Fellowship gave me good grounding of that.  It has made me much more of a multi-disciplinary thinking person ever since.  When that fellowship program was over I knew that it was time for me to move on.  The most difficult thing I ever did professionally was leaving my practice.  I had delivered hundreds of babies and helped families through deaths and everything else.  And I still have a lot of mementos of that.  I had left patients before, but after fourteen years it’s really difficult.  But my wife and I moved to San Diego and that was a strategic choice.  Carol’s parents who lived in Dayton, Ohio actually moved to San Diego in 1977.  They lived in Solana Beach.  When we lived in Davis we had our two boys and we would come down to San Diego to be with Bill and Bianca many, many times.  And we looked around and said this is paradise.  And the summers in Davis were really hot and we thought if the right job ever opened up in San Diego, this is where we want to come.\n\n  \n\nAND WHAT WAS THE RIGHT JOB?\n\nIt’s amazing how things happen for just very fragile reasons.  I was done being a Kellogg Fellow and I ran into Terry Kane.  Terry Kane was in another way kind of a role model figure for me because when I was the resident on the board of STFM, he was president-elect.  He was in his thirties. He was actually a younger STFM president than I was.  We were the two presidents in our thirties. But he had gone into medical management stuff.  But I ran into him at an AAFP meeting.  We happened to be in Disneyland.  We were out doing Disneyland stuff and Terry came and looked at me and said Joe, there is a great opportunity in San Diego.  Sharp wants to start a residency program.  And I though oh my gosh, starting a new family medicine residency program in San Diego - I couldn’t think of a better thing to do.  I had already known about UCSD.  As a matter of fact, I actually came and interviewed to be Division Chief way back in 1988 right after being STFM president.  It just didn’t seem right.  It didn’t seem like a fit.  I remember (inaudible name) interviewing me and wondering who this young whipper-snapper was.  But it didn’t seem right at the time.  But that was the first thing I looked at.  I actually pursued Sharp.  I called up the person at Sharp that Terry Kane gave me his name and I said this is who I am and sent him my CV.  I said I would sure like to do this; I would like to look into helping.  And actually that kind of took it from a back-burner to a front-burner and things happened very quickly.  So I was actually hired by Sharp Health Care.  This is an interesting side story: The CEO of the UCSD Medical Center at the time hated Sharp.  Considered it an arch competitor.  And they tried to hire me instead, but what they were offering was nowhere near the opportunity.  It was maybe a residency program in Tri-City Hospital.  But when he described it and I said it just doesn’t quite sound the same and I am going to go to Sharp - and I still remember what he said to me on the phone, if you go to Sharp you will have nothing to do with (inaudible).  So don’t even ask for a faculty appointment.  Those were the words that were given to me in 1992.  So I went to Sharp anyway.  That wasn’t going to stop me.  And actually it was fun.  I knew Bill and Jimmy Fouts (?) over at Stanford real well and I told them I’m moving to Sharp in San Diego.  They said we would love to have a satellite of our P.A. training program in San Diego.  Let’s give you a faculty appointment.  My faculty appointment at Davis was phased out.  So I started the Sharp residency.  At the time Sharp hired me they were making money.  They had jumped both feet into managed care.  I thought managed care if done right was going to be the American model for health care.  I was very pro-managed care, managed competition.  If government regulated private partnership, you could make this thing work.  So I was a big advocate for managed care.  Sharp was a managed care-oriented organization.  We hired the faculty.  Sharp looked at me and said you look at our system, which was five hospitals, and you figure out how we can train the most family doctors.  So I actually got accredited a sixty resident program. (Inaudible name) was the natural place being the hub and Sharp Memorial and –- Vista being smaller programs.  And we were going to have three faculty officers which we actually started.  And it was fully accredited for sixty residents.  Unfortunately, after two years, by 1994, Sharp was losing money.  The insurance companies were squeezing for profit all the money.  And Sharp went from $20,000 in the black to $20,000 in the red.  All the people that hired me were gone.  It was devastating.  And they looked at the program and said we’ve got to downsize.  And so even after we got our original classes and accreditation I had to downsize from sixty to thirty residents.  And jobs got frozen and it was a difficult time.  As a matter of fact, Sharp was saying to me every week we may have to cut your program completely because it’s not our core business here to run a residency program.  \n\nIT DIDN’T MAKE MONEY.  \n\nWell, it cost money, in their mind.  And then that was the big problem.  Sharp is a non-profit organization and it wasn’t so much we needed to make money.  But we were interpreted as a cost center.  And quite frankly, they eliminated a lot of cost centers before they eliminated the residency.  But we were on the chopping block.  I had a decision for my career at that point.  I was being offered medical management jobs for organizations.  Like (inaudible name) became Medical Director of the Sharp Community Medical Group.  Or I could stay in medical education.  What I realized was leadership in medical education was a good fit for me.  \n\nTHAT’S WHY YOU WENT TO UCI?  \n\nYes, that’s it.  I looked at three chair positions: Tufts to be the founding chair.  Which I almost took but my family really didn’t want to leave San Diego.  And a head of primary care of Stanford or UC-Irving.  And I really chose UC-Irving because I could stay locally and not have to disrupt the family.  So I did that and the Sharp program ended shortly thereafter and was chair there for five years.\n\nI actually negotiated a new position at Irving which was Associate Dean for Primary Care.  I told them that I would really like to be part of the leadership circle at Irving.  If they were really committed to primary care, they needed to have a primary care presence.  So they actually created the position as part of my recruitment, which was wonderful.  And except for the two and one-half hours a day of commuting, it was a great job.  And I would actually still be there, I loved the job and I had a wonderful dean.  And Irving being the smaller, newer medical school, it was actually a great place to be.  It wasn’t pompous or arrogant.  It didn’t try to be UCLA or UC-San Diego which kind of considers itself kind of like an Oxford University.  UC-Irving was much different.  It did have standards.  It had Nobel prize winners and things like that.  But it was committed to primary care.  \n\nI’ll tell you how the Florida State thing happened.  I was really very happy at Irving and not at all looking at a different job or looking to leave.  I never planned to leave the Sharp job.  Had Sharp not started losing money, I probably would have spent fifteen years there.  And had Norman Kahn not come and talked to me about Florida State, I would have stayed at Irving for fifteen years.  But I believe it was at a fall meeting, an AAMC meeting, Norm Kahn said to me Florida State wants to start a new medical school and family medicine is going to be a cornerstone initiative and an opportunity to have a family physician founding dean.  And we thought of a handful of people who we think are qualified to do the job.  You are one of them.  Could we submit your name?  And my answer was no because I said the last place I’m going to move is Tallahassee, Florida.  My family is happy. \n\n \n\nBut then I realized the magnitude of that opportunity and talked to Carol.  She was not terribly excited about it but realized that it was a tremendous opportunity.  And so I came back to Norman and said okay.  That was in the fall of 2000 and I went to Irving in ‘96.  A search committee, we did a preliminary interview which I actually did by video from the west coast.  And then the formal interview, I ended up being the selected candidate by the search committee.  There were some interesting politics going on.  The president, he and I were a wonderful fit.  And I still remember our four and one-half hour dinner when I came and visited and it was just very exciting.  I was a bit naive and didn’t really understand higher education or the role of a provost.  I never even knew what a provost was because the University of California didn’t have a provost.  But I quickly learned that the provost is the chief operating officer of the university and the deans all serve at the pleasure of the provost.  He’s the equivalent of an assistant vice chancellor here.  A president kind of does the external world and the provost runs the university.  I learned that the provost really did not want me to be the chosen dean.  As a matter of fact, he made an effort to get the search committee to reconsider because he didn’t feel I had the experience.  The biggest critical need was getting accredited and they had actually already been turned down once - the first new medical school in over twenty years.  And he wanted someone who was a retired dean from Michigan State to just come in and get them started.  And the search committee said no, this person doesn’t have the charismatic skills that you want for a dean.  So they kind of rebuffed the provost.  And I had an awkward meeting with the provost even when I was interviewing for the job.  But I thought I had gotten along with almost everybody else so that was fine.  So I arrive and it was a great experience.  I wouldn’t trade it even though it had a very negative ending.  It was incredibly valuable and positive.  And I’m very proud that in the last issue of Family Medicine Florida State is the No. 2 medical school in the country for family physicians.  So the mission did work.  But the provost and I never really got along.  He micromanaged me, controlled my budget, told me what I could and could not have.  I divvied the money up quarterly.  It was lied to the LCME that I really did have the control that I didn’t.  It was a difficult cross that I bore.  What happened is the president who hired me retired after I had been there a year and one-half.  And the new president came in, he interviewed me about things.  And he actually asked me about the provost.  The question was should I keep the provost or get a new provost?  And I said I think you ought to get a new provost.  And I went into great detail of why.  And he thanked me for the information.  A couple of weeks later he announced that he was keeping the provost and I knew I was in real trouble.  And the provost called me into the office.  He used a specific incident.  He actually called me and said Joe, you have hired a new faculty member that I don’t think is working out, I want you to fire him.  And I said I can’t do that.  I just relocated his family.  I’m aware of the situation and I’m managing it.  I can’t just fire him.  He said I want him gone in a week and I want you to take care of this.  So a week later I made an appointment with him with a whole plan of how to address this faculty issue.  And I never got to open the plan.  He brought in a witness and handed me a letter (inaudible).  And that was what I called Black Tuesday back there.  It was January 26, 2003.  I was flabbergasted.  I should have seen that coming.  But I really thought I could work with anybody.  All of a sudden I was the dean.  I had a tenured faculty position there and could have stayed.  They put me off in a corner in an office and gave me an assignment. But Carol and I looked at each other and said we’re moving back to San Diego.  Coming back home.  So I actually had to hire an attorney, negotiated a five month severance package and we moved back to San Diego.  So in my three phases of my career, the practicing and teaching, the middle-management phase was divided between Sharp and UC-Irving and that was nine years.  \n\nI really thought the dean job at Florida State was the beginning of phase three, a major leadership position.  But it lasted just twenty-one months and I came back here.  And now my role model is Al Gore.  I have read a lot of books.  I had a mentor at USC by the name of Pat Lattory.  He ran the leader in Masters in Medical Education program.  I got to teach in that.  I took Pat on as an executive coach when I went to Florida State because he had been a college president and everything.  And Pat actually ran three retreats at Florida State.  I brought him out.  And he knew all about my provost situation and tried to help me through it. But Pat had me read a book called Leadership Without Easy Answers by Ronald Heifetz.  And in that book it talks about leadership with authority and leadership without authority.  And he said leadership with authority is when you are a president or a dean and you can do great leadership things.  But you also are confined by the job.  And then leadership without authority, like Gandhi or Martin Luther King and now Al Gore.  And look what Al Gore has done without being vice president and the president is doing things without authority.  So in many ways my role since 2003 is to do leadership without authority. Although I do have authority in these positions, I don’t really think of them that way.  What I had to put on hold when I went to Florida State was this passion for re-design of primary care.  My career passion is to be part of the transformation of family medicine into a whole new process of care.  \n\nI WANT TO ASK YOU A LITTLE BIT TO LOOK AT THE SPECIALTY.  YOU PROBABLY ARE LIKELY TO HAVE SEEN SO MANY CHANGES IN FAMILY MEDICINE FROM BEING AN ACTIVE SOCIALIST IN THE ‘70s AND SO AND THE BIRTH OF THE SPECIALTY AND STRUGGLES AND ALL THAT.  WHAT DO YOU THINK IS THE BIGGEST ACCOMPLISHMENTS OF THE SPECIALTY?\n\nThe big accomplishment was that the whole historic tradition of general practice was transformed into a specialist of family medicine.  That the time honored role of the general community physician, the one who took care of the children, cradle to grave, could have been lost.  And it was nearly lost in a multi-specialty age of specialization of the ‘60s.  And it was saved and was given a new life.  And I got to witness that early history and sort of the whole thirty years from the early mid-‘70s to now.  And the integration of bio-psycho-social model, embracing that bio-psycho-social model, community orientation.  All the right values and philosophy of care.  And so family medicine conceptually and from a value structure is absolutely vital to be the foundation of health care.  And if you have a rich foundation of family medicine everything else would take care of itself in many ways in terms of health care costs and access, etc.\n\nWHAT DO YOU THINK IS THE BIGGEST CHALLENGE THIS SPECIALTY IS FACING RIGHT NOW AND HOW IS THIS GOING TO LEAD TO THE PASSION YOU HAVE BEEN TALKING ABOUT?\n\nThe biggest challenge is that we need to reinvent ourselves again.  That the care model that we have does not work.  And we are facing as grave a danger today as general practice faced in the late ‘60s when only 5% of students were going into general practice and it was essentially done.  Family medicine faces that same challenge today.  And not because of external forces like more money in other careers or medical students have different value systems or all the things that we can point fingers at.  The problem is looking in the mirror and coming to grips with the fact that what we do has become fundamentally different. And it’s become so different that we have to change the form in which we do it.  And let me explain ... \n\nTELL US A LITTLE BIT MORE ABOUT WHAT ... \n\nPrior to the 1970's people only went to the doctor when they were sick.  The general practitioner opened his office not knowing who he was going to see that day.  And people started arriving and they started signing in and waiting their turn.  And they had respiratory infections and other problems, headaches, you name it.  Maybe they were depressed or had a chronic problem, so they would keep coming in frequently.  But the reason they went in was because they were sick.  General physicals were very rare.  They were only done for certain reasons and they were a very minor part of the work.  And chronic illness management really didn’t exist for all practical purposes.  It sort of was so simple.  I mean a type 2 diabetic would be given a diet sheet and a refill of Diavenase (?) or something and very little else.  Well, now our work, preventive medicine has been discovered, we now know comprehensive prevention, the U.S. Preventive Services Task Force in Health Promotion - comprehensive care used to be taking care of the whole person but it was acute illness care. \n\nWe now have preventive medicine and we have chronic disease management and those two things fill our schedules.  When someone gets sick they can’t even get in to see us.  We don’t even have room for the people who are sick that day.  And retail clinics and urgent care centers and diversion systems, because it’s hard to even fit in.  We now are dominated by a whole different work.\n\nBut we have hung onto an historic –- schedule of doing the work.  It’s been known way back even to general practice that if you look at a doctor who is seeing multiple people an hour, the quality of what is being done is poor.  –- Peterson in 1950 at the University of North Carolina, he was a professor in the medical school.  And he sent teams out with permission to sit in the general practitioner offices and watch them work and evaluated the quality of what they were doing.  And it turned into a scathing report about general practice.  It missed all the interpersonal and relationship stuff and how that’s true.  But it looked at the nuts and bolts of quality medicine and it wasn’t there.  And family medicine modified, I mean we went from forty to sixty patients a day to twenty to twenty-five patients a day. But the nature of the work is such that no matter what bells and whistles or tools you might have, if you are still trying to see someone who is sixty-two years old with hypertension, diabetes, arthritis, heartburn, preventive care and they’re in for their periodic visit and you are given fifteen minutes to care for them, I think the Ram Study is right - you’re only going to be able to do the right thing about half the time.  The care model doesn’t work.\n\nHOW DID YOU ENVISION BEING A FAMILY PHYSICIAN?  OBVIOUSLY, I HAVE HEARD YOU TALK ABOUT IT.  BUT I WOULD LOVE TO HAVE YOU DESCRIBE IT.\n\nThe birth of the vision came from my practice in Dixon.  I was very productive.  I was the most productive partner, I saw twenty-seven patients a day.  And I often reflected, I said there are four or five people a day that you really need to see.  And I wish I had more time for them.  But I was so busy servicing the needs of the rest, the common things.  And the Marcus Welby model often stayed with me.  Marcus Welby, which was the great family doctor TV show, every week there was a therapeutic triumph or a family that was in trouble, in crisis.  And he and his team had a tremendous, realistic triumph every week.  And the rub on Marcus Welby was that we could all be Marcus Welby if we only had one patient a week to focus on.  And, of course, one patient a week is not realistic.  But what I always liked about Marcus Welby is he could step back from his practice and who do we really need to concentrate on this week.  When I was in full time practice I always had people who were dying or babies going to be born.  Every week had its major event.  It could have been a TV show.  And I always felt like that’s the real drama of my practice.  That’s the really important stuff.  That’s the stuff that is really different.  Birth and death people get real.  In between they play roles.  And we go through a lot of routine stuff.  But I thought somehow the family doctor should step back from the treadmill of the busy office schedule to strategically think about how he can help the patients that really need help, he or she.  So then in the late ‘90s things happened to me.  I show up at UC-Irving and I’m a department chair.  And this is where my role models come in.  Two of my role models, Lynn Carmichael and Lewis Barnett, both as department chairs kept 300 patients and they took world class care of those 300 patients.  Lewis Barnett, I knew his model the best.  His administrative secretary had the list of his patients.  And while he had a clinic once or twice a week, he would see his patients whenever they needed him.  They would be fit into his administrative schedule.  They would show up in his chair’s office.  And his secretary would make their appointments.  They wouldn’t call the clinic.  They would call his secretary.  And he delivered personalized medicine to them.  Tom Wiekert did the same thing too (inaudible).  So when I arrived at Irving I thought I get to be a personal physician.  I’m going to have 300 patients just like Lewis Barnett. But what happened was our phone system at Irving was so terrible that patients were saying I really like you but I can’t stand this place.  So I started giving them all my e-mail.  By that time I had been on my e-mail just like the rest of us had.  At the Kellogg Fellowship we were all on e-mail, back a decade earlier.  So I started giving all my patients my e-mail and said e-mail me before you ever make an appointment.  I did it just to get around our phone system.  I didn’t do it to revolutionize care.  And I thought I only have 300 patients, I can do that.  What I realized after a year was this was revolutionary.  It was a new platform of communication.  It made access continuous, not at the side.  Those 300 patients I took care of with an average of twenty e-mails a week and ten visits.  So I was doing two-thirds of my communication of care by e-mail and one-third in face-to-face visits.\n\n  \n\nAnd they thought I was the greatest doctor they ever had.  And I was being a great doctor because nothing fell through the cracks.  My HMO cost, because these patients all had managed care plans, my cost dropped off the charts compared to the rest of the people in my group.  And I said this is a new platform of care.  Now at the same time I was put on the ION Quality Committee with Don Erwick and all these people.  My modern career began with the work on that committee, that refocused movement.  \n\n(Taped conversation ends.)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283327#t=660.0,2318.55702"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283326","type":"Canvas","label":{"en":["Media File 2 of 2 - Scherger_Joseph_07_b.wav"]},"duration":2278.8248,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283326/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283326/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/283/326/original/Scherger_Joseph_07_b.wav?1753283902","type":"Audio","format":"audio/wav","duration":2278.8248,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154130/file/283326","metadata":[]}]}],"annotations":[]}]}