{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/n872v2fg5g/manifest","type":"Manifest","label":{"en":["Rosemarie Sweeney"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2012-03-01 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Michael Devitt (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","Family Medicine","Practice Advancement and Advocacy"]}},{"label":{"en":["Subject"]},"value":{"en":["Rosemarie Sweeney (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156793/file/286749","type":"Canvas","label":{"en":["Media File 1 of 2 - Sweeney_Rosemarie_Pt_1_12.wav"]},"duration":6546.53558,"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/156793/file/286749/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156793/file/286749/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/286/749/original/Sweeney_Rosemarie_Pt_1_12.wav?1755102697","type":"Audio","format":"audio/wav","duration":6546.53558,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156793/file/286749","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156793/file/286749/transcript/82485","type":"AnnotationPage","label":{"en":["Rosemarie Sweeney interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156793/file/286749/transcript/82485/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This is Michael Devitt. I am an intern with the Center for the History of Family Medicine. Today is March 2, 2012 and I am interviewing Rosemarie Sweeney, the Vice President of Practice Advancement and Advocacy with the American Academy of Family Physicians as part of an oral history project for the Center. Do you prefer Ms. Sweeney or Rosemarie?\n\nActually I go by Rosie.   \n\nBefore we begin our interview, I would just like to confirm that I have your permission to record this conversation and that at its conclusion we will send you a tape of the interview for your personal files. So do I have your permission to record this conversation?\n\nYou do. And you should also have my written authorization as well. \n\nYes, I’ve got a copy of that on file already. Have you looked at the list of questions that I had e-mailed earlier?\n\nI do. I have them right here.   \n\nWe’re just going to start at the beginning with the early life and family and then go from there. To begin, would you please give us your name in full?\n\nMy full name Rosemarie Sweeney. No middle name. \n\nAnd your present title at the Academy?\n\nMy present title is Vice President of Practice Advancement and Advocacy.   \n\nTo talk about your early life here, when and where were you born and where did you grow up?\n\nI was born September 2, 1950 in Fall River, Massachusetts. I grew up in Swansea, Massachusetts where my mom still lives. \n\nWhere is Swansea, Massachusetts?\n\nSwansea is actually about twenty-five minutes from Providence and not quite an hour south of Boston. It’s about twenty minutes from the ocean and southern New England. \n\nAnd what did your parents do for a living?\n\nMy mom was a nurse who worked the night shift at a local hospital and my dad was a quality control engineer for various plants. He ended up retiring from a chocolate factory. \n\nCan you tell us a little bit about the chocolate factory (that sounds interesting).\n\nHe worked for Merckens Chocolate in Mansfield, Massachusetts. And he was the one who, when the machines broke down in the middle of the night, they would call him and he would make sure things worked okay. He would check on the quality control. And if you’ve ever had a chocolate-covered cherry, he would bring home the ones that when they made a mistake on the line and ran them through double, he would bring those home because they were seconds. And once a year at Christmastime, he would take us up to the plant and we would get to go to the refrigerated floor, which was the fifth floor, and go through and see all their refrigerated chocolate before it was packaged and shipped. So even though he worked in a chocolate factory, we still liked chocolate.  \n\nWhat about your mom? You said that she was a nurse who worked the night shift at a hospital. What hospital was that and how long was she there?\n\nShe worked at St. Ann’s Hospital. She went back to work when we were probably in junior high. And she worked the","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156793/file/286749#t=0.0,660.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156793/file/286749/transcript/82485/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"-7:00 shift until she retired, I’m not sure which year.   \n\nYou said “we.” Do you have brothers and sisters?\n\nI have one sister who is eleven months younger than I am. And she is the principal of a public school for early childhood special ed. kids in Taunton, Massachusetts.   \n\nSo she stayed sort of local and you ended up in D.C.?\n\nYes.\n\nSince we’re talking about families here, tell us a little bit about your own family. Are you married? Do you have any children?\n\nI’m married to Ed Rice. We’ve been married for 34 years and we have one son Jonathon who will be 21 and who is at Pitzer College in California studying global political studies. \n\nSounds pretty interesting. How did you and your husband meet?\n\nVery quintessentially Washington. We met when I was an intern on The Hill and when he was a staff member on The Hill. And we got to know each other and were friends and dated for six years and got married in 1978.   \n\nI may come back to that question or we may go into that a little bit further down when we start talking about your career and working in Washington, DC. But just to kind of stay on the early life and family section for now. What was it like growing up in Massachusetts? Do you have any stories or memories from your childhood that stand out to you?\n\nThe town we grew up in was probably 10,000 people. And my interests were music. And in high school sort of a social change and my decision was do I go to the New England Conservatory and play the violin, which I wasn’t very good at but I liked, or do I go to a liberal arts college and pursue public policy. And strong memories from being a senior in high school, that was the year Robert Kennedy was shot. And my sister and I were in charge of Youth for Kennedy, so we were pretty active in that. And Martin Luther King was shot. And that sort of galvanized my decision to pursue public policy. \n\nWhat was that like? Do you remember where you were or what the situation was like when you heard about those assassinations of Senator Kennedy and Martin Luther King?\n\nOh, very vividly because I had an interview with a scholarship committee when Robert Kennedy was shot and we were following news reports, whether or not he was still alive. So it wasn’t a very good interview. I was totally distracted. And when Martin Luther King was shot, I went to the principal of the school and suggested that the flag be put at half-mast, and he suggested I might want to leave for the day. So I have pretty vivid memories of that spring. \n\nThat was 1968, right?\n\nYes.\n\nThat was a pretty turbulent period.\n\nA pretty intense time. \n\nMy mother is right around the same age as you. So she tells me about those every once in a while. Whenever she hears anything about Kennedy or Martin Luther King, the same sort of memories come back to her.\n\nTo go back a little bit before high school, when you were a child in elementary school or junior high, did you have any special dreams or goals? Anything that you wanted to achieve?\n\nI wanted to live in different parts of the country. I wanted to see more of the country. That was one of my things I wanted to do. \n\nDid you get to travel much?\n\nNot as a child. \n\nTo kind of go off for a second, have you had the chance to travel much now, since your childhood?\n\nYes. And I intentionally went to school for awhile out of New England. I went to school in Michigan for my first year and a half and then came down to DC. And then certainly working for the Academy, I think I’ve traveled to every state including Alaska and Hawaii.   \n\nSo you’ve been able to achieve that goal?\n\nI’ve seen a lot of the country, which was important to me. \n\nSince we’re already starting to talk about high school and college a little bit, let’s transition into that for a second. Where did you go to high school and what was that like?\n\nI went to [Joseph] Case High School in Swansea. I was sort of a nerdy, geek kid. I was not particularly popular. I was into music and sort of social activism and couldn’t wait to go to college.   \n\nDo you want to expand on that a little bit, that you were sort of the nerdy, geek kid with the music and the social activism? What type of atmosphere was that like in the mid to late ‘60s?  \n\nMost of the kids in our school could have cared less, and so there wasn’t a lot of engagement. I had a few friends and my sister. I played in the band, sang in some choirs, played the violin, played the clarinet. We had a little group that we played guitar and flute and sang. We sang at some local TV shows. We tap danced, we did ballet. So we did a lot of performance kind of stuff. And then, like I said, we were involved with Youth for Robert Kennedy and really following the presidential campaign and all that pretty actively in high school and most of the kids in our town really didn’t have any interest in that.   \n\nSo there wasn’t a whole lot of political activism?\n\nNo, not really.   \n\nThat seems kind of interesting because at least my perspective of the ‘60s is that there were all these issues about civil rights and women’s rights.\n\nOh, there were tons of issues going on and in social studies we learned all about the Civil Rights Movement and all the different groups and all that. But the town and the school that I went to just, people just weren’t very interested.   \n\nYou mentioned social studies. Did you have a favorite class or was there a favorite teacher maybe in high school?\n\nNot really. I mean I enjoyed social studies, I enjoyed music, I enjoyed English, reading. But I didn’t have any particular teacher that was remarkable.  \n\nCan you tell us a little bit about the music, playing the violin? How did you get interested in that?\n\nI was interested in that from the time I was little. And then I took music lessons at school. There was no sort of local youth orchestra or anything, so I just ended up playing with my teacher. And then I had various teachers through high school that I would play with. \n\nYour childhood sounds a lot actually like mine. I grew up in a small town just outside of New York City, about 7,000. And the same thing. You played the violin, I played trumpet in grade school and junior high and all that. So very interesting.\n\nAfter high school, when you graduated, what were you thinking about doing? Did you have sort of a career in mind or a particular direction you wanted to go in?\n\nI knew I wanted to be a political science major. I knew I wanted to do something in public policy. And I wanted to work for a social change.   \n\nAnd you had mentioned that you went to a school in Michigan first?\n\nTo Hillsdale College in Michigan which was a little school in Hillsdale, Michigan. I only ended up there because I wanted to leave New England. I really wanted to go to Carleton or Reed but my father said that was too far and we couldn’t afford to get me there. And Hillsdale, I met the people there, they were recruiting at a college there. And so I applied and got in and decided I would go to Hillsdale College in Michigan, having never seen the school or never set foot in the state. So I went there for my freshman year and transferred in the middle of my sophomore year because I had had a lovely time, I met nice people, I had ripped through every class in the Political Science Department. And sort of a family lore: when my father dropped me off at college he said “You damn well better be able to support yourself when you graduate.” And those words stuck in my head. And I had the feeling that if I stayed at this very fun liberal arts school in Michigan, I would not be employable when I graduated. So I transferred to American University in DC where I had been accepted initially anyway. Having never been to American University or see Washington, DC, transferred in the middle of my sophomore year.   \n\nJust to make sure I have this correct… both of the schools that you attended, you hadn’t set foot on either campus before you actually started classes?\n\nNo, I just had the catalogs. That’s what people did then. You read the catalogs. You applied. They accepted you. You packed up your stuff and your parents dropped you off. That was a whole different process than it is now.   \n\nYeah, no Internet or websites or anything to look all that up.\n\nRight. \n\nWhat was that experience like, just traveling to a brand new campus where I take it you didn’t really know anyone other than maybe…\n\nI didn’t know anybody. But that’s what you did. You went to college and you met people and you kind of created your own path and it was great. \n\nI take it you must have some pretty interesting stories from those times at either Hillsdale or at American?\n\nThey were completely different environments. Hillsdale was completely politically apathetic. And that was the time when the moratoriums were going on. And basically the faculty said if you don’t go to class on the day of the moratoriums, you’ll fail for the semester. So there wasn’t a lot of encouragement of student activism. But it was also a time when there were bomb threats. Even in this little town in the middle of nowhere, there would be the occasional bomb threats and they would have to evacuate the buildings and the fraternities would all have big parties. So that was kind of a schizophrenic time with all this stuff going on around the country with the Administration, against the Vietnam War, and being aware of all that, but being in an environment that really discouraged student activism.   \n\nWhat are the moratoriums that you’re talking about?\n\nDuring the Vietnam War there would be days of moratorium where students across the country would stay away from class and have anti-war rallies and that sort of thing. \n\nSo this wasn’t just particular to Hillsdale but this was something that was happening…\n\nThroughout the country.   \n\nDid you participate in the moratoriums?\n\nNo, we didn’t have anything going on. You were just aware of things going on around the country. Which was also one of the reasons why I decided to transfer.   \n\nSo you said that the two atmospheres were completely different. So compare what it was like at American University to Hillsdale. \n\nAmerican University was very, very activist and there would be demonstrations in the morning before classes when Melvin Laird, the Secretary of Defense, would be driving to work. And he would go around Ward Circle, which was right by the school. There were some clashes with police that I was not personally involved in. But the School of Government was tear-gassed, finals had to be postponed till the following fall. There were a lot of protests. There were anti-war events down by The Ellipse, by the White House. And I went to one of those and got to meet then-Senator Edward Brooke from Massachusetts who was there. There was a lot of activism going on around the city. The students were very, very involved in the anti-war protests. It was a completely different environment in Hillsdale.   \n\nI take it you either lived on campus or you lived close enough that you could participate.\n\nI lived on campus. \n\nSo you were able to just experience all this firsthand?\n\nAbsolutely, yes. \n\nWhat kind of effects do you think that had? And then consider the time that this was going on, you mentioned the Vietnam War and the protests and all of the advocating for social change. How did you feel in this environment?\n\nMy goal was that you need to work from within the system. So I did internships on The Hill doing menial things. But you still felt like you were a part of learning about the real system. So I wasn’t an anarchist. My public policy goals were how do you make systematic change to make the world better for people? And that was what my goal was from the time I was a senior in high school. And so I felt like as a student I got to participate in part of that.   \n\nHow did you end up doing in college? Your major was political science?\n\nMy major was political science. And like I said, at American they really encouraged you to do internships. And at that point it was pretty easy. If you were willing to volunteer, people were willing to have you. And through a friend I was able to intern for Senator Ted Kennedy, just one of many interns. And we would do everything from using the autopen to sign postcards to doing menial tasks. But we would work in the intern office down at the Senate a couple of afternoons a week. And that was a really fun experience, to kind of get to know your way around the Capitol. That was also the time when the Senator had his driver’s license revoked and his intern director, Tommy, would drive him around. And then if you were lucky, you got to go driving around with the Senator, which my friends and I got to do on occasion. So that was very exciting. \n\nYou’re just leading into the whole next set of questions, kind of off the script, but mentioning Ted Kennedy. So this was also late ‘60s, early ‘70s. What was that like, meeting Ted Kennedy? What was he like as a Senator at that time?\n\nHe was very engaging. He was very passionate. Despite the personal issues that the Kennedys always have, he really wanted to make things right for people and make sure that the least in society were taken care of. And that meant a lot to me.   \n\nDid you work with Senator Kennedy on any campaigns or particular issues or projects that interested you?\n\nNo, as an intern you would show up and just do whatever little task they would ask you to do. So no, we weren’t involved in legislation or anything substantive. Just you did whatever, whether or not it was clipping newspapers or sorting mail or delivering things. Just intern menial tasks. \n\nWhat kind of effect did that experience have on you, just being in the Capitol, being involved with this legislative body and these people who can make those types of social and political changes? How did that feel knowing that you were connected to that?\n\nIt made me want to work on The Hill when I graduated. I knew that’s what I wanted to do. \n\nSince we’re talking about that, let’s start talking about after you graduated. I’m going to ask sort of a different question here real quickly. You had mentioned Senator Edward Brooke. Did you work with him as well as an intern?  \n\nNo. I knew who he was and I just happened to have met him at an event at The Ellipse.   \n\nI didn’t know if you had ended up working with him.\n\nNo, I didn’t. \n\nOkay, I just wanted to clarify that. I believe the first Representative that you started working for, at least after Senator Kennedy, was Representative Margaret Heckler.\n\nI worked for her as an intern my senior year in college. I probably worked about half-time for her as a senior, getting credit for an internship. And then she had said to me that if I would work in the office in Massachusetts, in her district office, for six months after I graduated, then she would have a job for me in DC after Thanksgiving. So I worked with her my whole senior year. \n\nSo you did the internship up in Massachusetts first?\n\nNo, I did an internship in DC. My senior year in college. \n\nWhat was that like, working for her? What was she like as a Representative?\n\nShe was very dynamic. She was a liberal Republican interested in helping Vietnam vets. And that was the kind of work I ended up doing. It was a very dynamic staff. Very fun, very interested, very committed people that really gave me the opportunity to do all kinds of things. Whether or not was sorting newspaper articles or feeding radio tapes or writing letters, I got to do a lot of work as an intern. They were very trusting of interns and very inclusive of interns. \n\nJust checking your resume and your CV, you mentioned a little bit that there was some legislation that you, I don’t know if worked on are necessarily the right words, but it was legislation related to Medicare and Social Security and helping veterans. Could you tell us about some of those programs?\n\nOne of the pieces of legislation that I got to work on with one of the other staff had to do with setting up centers for Vietnam veterans to make sure they got the services that they needed. We would do a lot of work with people trying to get their Social Security checks or Medicare or problems getting their Medicare benefits or problems getting disability stuff processed. So representatives do a lot of that sort of work on behalf of their constituents. So we worked on various legislative things, some of which went somewhere, some didn’t. And also a lot of sort of hands-on work with constituents. \n\nSo you got to interact with a lot of you could say everyday people who were affected by these different issues?\n\nYes.\n\nHow did that tie into your sort of view of social change and helping people? How did you feel being able to work with people like that on such a personal level?\n\nI thought it was really important. And this is getting ahead, but when I came back in November one of my jobs was to do constituent casework. And you would work directly with the federal agencies to sort out what issues people had to see if you could make sure their paperwork didn’t get lost and didn’t get shuffled around. The agencies have congressional liaison people and you work closely with them on various issues and individual cases. So there’s a lot of that. In terms of putting a face to things, there was a Vietnam vet named Rusty who would visit the office regularly and he would sit and tell me about the issues that he and his peers were experiencing and what they needed. He was lobbying for the Vietnam vets, but he was a vet. And it was very powerful to sort of talk to him about the issues these kids were facing coming home with different injuries or trying to get jobs and trying to get in school and all that kind of thing.   \n\nWe’ve talked back and forth, you have mentioned and I have mentioned a little bit, talking about Vietnam. I know I hadn’t really mentioned any of that in my list of questions. But just generally speaking, what was your perspective on the Vietnam War, living during that time? And what kind of social effect did that have personally and then nationally, do you think? How do you think that ended up changing the view of the country on certain issues?\n\nWell, at the time they had the draft and you were lucky to be a girl. The boys in our class, the nights when they would have the lotteries and pull up the numbers and you had friends that you knew were going to be leaving school. So that was very personal to see that happen. And working for Mrs. Heckler, getting calls from her district, which is where I had grown up, and actually getting calls from some kids that I had gone to high school with who had been to Vietnam and now needed help with benefits and all that, it made it very personal. I think the student activism in the ‘60s and the student activism that really did bring the War to a conclusion was very powerful. It said if you galvanize, you can make a difference. So it was a very powerful time but very disturbing. I think we all remember the images on TV. It was constant. And listening to President Johnson. It was a very powerful time.   \n\nIt was the first televised war.\n\nIt was and it was graphic. \n\nSo you knew people who had served in Vietnam. You probably went to high school with dozens, maybe hundreds of them. What was that like? You said being a girl during that time, you weren’t necessarily called to serve but you definitely knew people who were called to serve or…\n\nWere drafted to serve. \n\nOr were drafted to serve. What was that like during one of those drafts, those lotteries? How did that affect things on campus?\n\nThat’s what people were fixated on, was their number going to get called? It was very scary. \n\nAnd if someone’s number did get called, how did that work? Did they then have to report to go serve?\n\nYes.\n\nAnd that was it? There was no real way out of it, I take it, back then?\n\nNot really. I think if you were a conscientious objector or something like that. But by and large people had to serve. \n\nTo go back a little bit, you had this transition in the late ‘60s from President Johnson to President Nixon. And you’ve mentioned that you worked as an intern for Senator Kennedy, a Democrat, and then you worked for Representative Heckler, a Republican. Can you compare working for members of the different parties?\n\nAt that point it really didn’t matter. She was a liberal Republican. And that point Congress was not this polarized place and it didn’t really matter that much. People worked together. And I was an Independent, so it really didn’t matter to me. But it wasn’t that polarizing force that we have right now.   \n\nYeah, things are a little bit different now than back in the ‘60s and ‘70s, at least in that regard.  \n\nVery different. \n\nAre there any other interesting stories or memories you have about working with Representative Heckler? Any other maybe pieces of legislation or fond memories that you have from that time?\n\nI think the main thing was that working for her both in Massachusetts, which I did for six months, and then coming down and working for her in DC, I had the opportunity to learn a lot about how committees work just by observing committees here. I had a chance to see how she worked with the press. I had a chance to watch different members of Congress sort of work together from different parties on issues that they cared about. So it was a great way to just get a lot of experience writing statements, writing letters, working with the different federal agencies, kind of learning what agencies had which programs, learning about the appropriations process, learning about governmental budgeting. It was just a great opportunity to learn a whole lot about how DC stuff works and have a firsthand experience in a lot of that.   \n\nAnd you’ve been able to use a lot of that experience not in your personal life but in your career working with the AAFP and the other organizations that you’ve been involved in?\n\nYes. \n\nIf it’s alright, we could start to talk about that here. After you worked for Representative Heckler, you joined the American Osteopathic Association in 1974.\n\nYe.\n\nWhat made you decide to work for the AOA? How did you get involved with them?\n\nI wanted to work for an association because I’d had a lot of contact with people with various associations. And having sort of seen how Congress worked, I thought this would be fun to try to be with an entity that influences Congress and the agencies. So I was looking for jobs in the Washington Post and I actually applied for the AOA job through a blind ad in the Washington Post and they called me up and inter-viewed me. And I was interested in health issues, so it worked. I didn’t have any connection to them. I don’t think anybody gets a job through blind ads in the Washington Post anymore, but I did. \n\nWell, congratulations. Now the AOA were headquartered in Washington, DC? Or where were they located?\n\nTheir headquarters was in Chicago and they had a Washington office that was across the river in Rosslyn, Virginia.   \n\nSo that’s where you ended up working?\n\nRight. \n\nIt’s interesting, you mentioned Chicago. The American Osteopathic Association and the AMA are both headquartered in Chicago. And you said you ended up joining the AOA in the mid-70s, 1974. And I mentioned on my list of questions that it was sort of an interesting time for those two organizations to be working together. Osteopathic physicians had just gained full practice rights in all fifty states in 1973 and chiropractors had also just gained full practice rights in 1973. What was it like working with the AOA? Did you get any sort of competition or anything like that from the AMA? Was there competition between the two associations?\n\nNo, there really wasn’t competition. In fact, I got to know some of the AMA staff well and we would work together on issues. A big focus of the AOA at that time was to make sure that osteopathic hospitals were part of the then Health Planning Process. They wanted to make sure that osteopathic treatments and the perspective of osteopathic physicians were taken into account in the Professional Standards Review Organizations. So there wasn’t a lot of competition. We worked with the AMA staff on sort of the major issues and then we would lobby on specific and osteopathic bend on particular issues. But they also were very interested in, at that time the AOA had about 17,000 members and I think about 90% of them were I primary care. So they were very interested in workforce and making sure that education programs for primary care were supported. So there were a lot of mainstream issues that we worked on with other physician organizations.   \n\nJust for our listeners and for the future, could you maybe describe some of the differences and similarities between osteopathy and medicine?\n\nAllopathic and osteopathic medicine are very similar in terms of studying the basic sciences. Some schools, I think Michigan (don’t quote me on that), the medical students and the osteopathic students take courses together. The osteopathic physicians also would do osteopathic manipulation therapies that they would use in some adjunct to other medical treatments. And they were very holistic in their approach to people. And I said, very primary care-oriented. And I think these days if you go to an MD or a DO and if you don’t really pay attention, I think people are treated pretty much, you get the medical treatment you need. Osteopathic physicians do have the additional osteopathic therapy that they will use when appropriate.   \n\nTell me about some of these mainstream issues that the AOA and medicine was facing at that time. You talked about primary care a little bit and you talked about education. What types of issues were the medical and osteopathic professions facing? And what types of changes were they advocating for?\n\nWell, that was at a time when the sort of quality issue began to emerge. And Congress created entities called Professional Standards Review Organizations that were actually coming up with the beginning quality standards. There was a national advisory council, the Professional Standards Review Organization. And one of our goals was to make sure that there was an osteopathic physician on that commission, which there was, a doctor named Ray Salume (?). We got to be appointed on that. And it was a very important commission to the medical world. They used to meet in the auditorium of the HHS building. And they would come out with manuals, so for particular conditions what things should be done, what things shouldn’t be done. It really was the beginning of the quality agenda. And that was a big deal for all of the medical specialties in the AOA at the time. There were also health planning agencies. And when there were going to be hospitals built in a particular area, they had to go through the health planning agencies. There was a national advisory council dealing with that. We wanted to make sure that osteopathic issues were taken into consideration and health planning in different areas. There was legislation that had been passed to provide funding for education programs in primary care. That was something that Senator Kennedy was very involved in. That money had to be appropriated, so we would work with the appropriations committees to lobby for funding for primary care education. The access issues really didn’t emerge until later, so that was really not part of the portfolio.   \n\nSo there are a number of issues then that the AOA and the AMA were working on.  You’re talking about standards, quality, education.\n\nI really didn’t get into the payment issues until I came to the Academy. But those were emerging issues as well. You know, Medicare payment issues for physicians. \n\nIf you could, maybe just walk us through one of these issues. You could pick one.\n\nI’ll pick the one that’s sort of how I ended up with the Academy and that was the whole issue of workforce grants to education programs, funding for education programs. So we work with the…first you had the committees that had to authorize funding for education and then they had to be appropriated and then it had to be administered by the Department of HHS. And so you worked on those issues in those three different phases: lobbying so the program was reauthorized, making sure that there was funding, and then working with the HHS people on how were they going to organize the grants program so that residency programs could apply for grants for their education. And that was sort of a cross issue between Congress and the federal agencies and one that I worked on at AOA. But also the person working for the AAFP was working on that. So it was a primary care issue and that’s one that we spent a lot of time on and I spent time working with the AAFP person on.   \n\nHow long would it take say from the introduction of a policy or a rules change or something like that to go through the whole legislative process? Would this take months or years? And how many people would be involved in something like that?\n\nCongress used to reauthorize programs fairly deliberately. So if you had a program for health professions that was expiring, the staff for the then Senate Labor Committee and the Energy and Commerce Committee, the staffs all worked together, both the Republican and the Democrat staffs. They would work on a version of the legislation and it would go through a committee. And there would be hearings and it would pass the House or the Senate and then it would go over to the other one. And it was a fairly efficient policy-oriented, not partisan-oriented process. And there was a lot of interaction between the congressional staff and the staff of associations and a lot of interest in what’s the data that we need, what do we really need to make this work. And there was a lot of collaborative work. So it wasn’t a torturous process. It wasn’t a partisan process. It was how do we train more primary care doctors and what’s the best way to do it? So it wasn’t a multi-year process. It would be probably over a year, but not torturous. And then the regulatory process also was a little bit more straightforward at that point. The programs were less complicated. And viewed comments on the proposal and they would finalize them. And then you worked with the agency people to make sure you had the information you needed to get to your field so that they would apply for the grants or whatever. So at that point it was actually easier to get policy done than it is today. \n\nWere there any particular policies or agenda items or anything along those lines that you could say you’re most proud of or that you can look back on and say yes, that’s something that has really helped in terms of primary care or we’ve really made a difference?\n\nI think one of the things that we were able to do at that time was to talk about the whole process of graduate medical education and how that relates to training of primary care doctors. And primary care doctors, whether or not they were in osteopathic programs or in allopathic family medicine programs, were typically trained in community hospitals, in outpatient settings. Not the typical academic medical center model, which is how Medicare GME policies, graduate medical education policies, were really built. And we were able to do a lot of education to begin the changes in policy, which we’re still working on, to encourage training in outpatient settings and in primary care. And so part of that was bringing in educators, talking to people on The Hill, going out to Baltimore, talking with staff who were doing the programs for Medicare. We brought in a hospital finance officer from a hospital in Missouri to really talk through the details of how Medicare GME funding came into an entity and how it was allocated and how it wasn’t really tied to the training and outpatient settings and all that. So that was the beginnings of getting some of the policies changed over time with those regulations that we were able to do with congressionally and with the agencies. So I think that was important. I think the issue of making a case for why primary care is important to the health of the country and what role primary care and primary care physicians can play in keeping people healthy, that was sort of the foundational to all the things that we were working on. And I think that’s made a difference even today as policies are changing. \n\nAnd talking here about primary care and the importance of getting primary care physicians and getting access to that… Another type of care, I guess if you want to call it, managed care was introduced in the early 1970s. What were your thoughts about managed care at the time? Your thoughts or the AOA’s position on it? And how have your thoughts changed about managed care since then?  \n\nIt wasn’t at AOA, it was really when I had come to the Academy that we engaged in managed care. That is when the whole thing was emerging and primary care was hot. Everybody in the world wanted to be primary care. We had members who did very well under a different type of patient arrangement. But the forces that tried to get people into gatekeeper models and make primary care the bad guys that were perceived as preventing people from getting care really tainted the whole thing. One of the concerns about managed care was that people felt that doctors were getting paid to do as little as possible. So everyone wanted to be primary care quickly faded. As public policy moved away from managed care, the public didn’t tolerate it. \n\nAre your thoughts about managed care the same now as they were when you started at the Academy then?\n\nIt kind of depends. If you’re talking about that you put primary care physicians in a position where people are mandated and can’t go anywhere in the system without getting permission from their primary care doctor and if you have payment tied to that and peoples’ benefits tied to that, this country doesn’t tolerate that very well. So we really don’t use the term “managed care” much anymore. But skipping ahead to today, we’re very much pushing the Patient-Centered Medical Home model of transformed primary care which is relationship-based. And if a person and their family have a good relationship with a practice that knows them, what we are experiencing is that people don’t require to get permission to go anywhere in the healthcare system. But they’ve got this trusted entity that knows them and they seek out advice from their patient-centered medical home. So the practical effect is that they’re care-centered managed. They’re not self-referring for things they don’t need or that are inappropriate. But if you don’t have that financial requirement that people are penalized if they move around the system. You don’t need a financial requirement because they have a relationship with a trusted entity and that’s where they’ll go for advice. So to me that’s the promise of the patient-centered medical home which is different from managed care where you put primary care doctors in a least type role. I think there’s a balance. \n\nWith the patient-centered care then you’re seeing improvements in patient quality, improvements in communication and probably reductions in drug errors, medical errors, that sort of thing as well.\n\nOf everything, yes, because people are paying attention. \n\nIt’s my understanding that in the mid ‘70s, the Nixon Administration had considered introducing national health insurance, but it was derailed for a number of reasons. What were your recollections of those proposals for national health insurance? And if it had been enacted, how do you think the practice of medicine would be different today?\n\nAt the time AOA was not involved in that legislation. So I didn’t have firsthand knowledge other than as a person in the country who was aware. But I don’t know the details of that. It wasn’t something that we worked on.   \n\nMaybe from personal opinion then, if we had had a national health care law passed in the 1970s, what effect do you think that would have on medicine today? And if you don’t want to answer that, that’s fine as well. It’s just a question I wanted to throw out there for you.\n\nI’m really not sure what effect it would have on medicine. You wouldn’t have the large number of uninsured. You wouldn’t have the cost shifting that’s going on. We may have had a more consistent value of primary care, which has waxed and waned over the years. But I always thought of it more in terms of people – we would probably have a healthier population.   \n\nIf it’s okay, I can start asking you questions about the AAFP and when you started with them.  \n\nSure.\n\nIt’s my understanding that you joined the Academy in 1979.  \n\nYes.\n\nHow did you first hear about them and what was it that interested you in joining them?\n\nThe Academy had a staff person in DC who I knew because we worked on issues together such as funding of education. And I had respect for the organization. The issues that they worked on were similar to ones that I was working on with AOA. So she actually said I’m leaving to go work for a federal agency, you should apply for the job, you know the issues – and I did. \n\nWho was that staff person?\n\nHer name was Carol Cowgill and she left to go work for the Energy Department. She was an attorney. \n\nSo you ended up essentially taking her position?\n\nYes.\n\nWhat was your title when you started at the AAFP?\n\nIt was Director, Washington Office. Which was funny because the Washington Office was me and my assistant [    ] who was half-time, working part-time for the Academy and part-time for another organization with whom we shared space. So that was the Washington Office. \n\nSo basically two people?\n\nYes.\n\nSo you basically built the Washington office from the ground up?\n\nWell, I took it over from Carol. And the person who I reported to was Mike Miller who was a Director of the Academy in Kansas [City]. \n\nThat sort of answered one of the questions I was going to ask:  Who were some of the people that you first worked with at the Academy.  So it was Mike Miller and…?\n\nRoger Tusken was the EVP and Mike Miller was my boss in Kansas City. \n\nWhat were your responsibilities as the Director, early on?\n\nInteracting with primarily the committees in the House that dealt with public health issues like the Energy and Commerce Committee, the Ways and Means Committee, and the Appropriations Committee. And then the Senate, it would be the Appropriations Committee, the Senate Labor Committee, and the Finance Committee. And they were the committees that had jurisdiction over Medicare, over public health funding, and over the appropriations. And then I worked with the various federal agencies including, they didn’t call it CMS then, but the people that dealt with Medicare payment, with medical education and a lot of work with the Division of Medicine that administered grants for family medicine education programs, both departments and federal for residency programs. So it was working with both The Hill and with the agencies and making sure that we had the opportunity for family physicians to testify at various hearings. We commented on proposed rules. Just normal government relations things and making sure the Academy’s perspective was heard.   \n\nWhat was a typical day like for you in Washington in those early days? Or was there such thing as a typical day for you?\n\nThey were all different. But I think it was my second day on the job, we had a member of the Academy coming in and I took him up to Rockville for a meeting with the Food and Drug Administration. We used to do a lot of work with the FDA. But I go to congressional hearings. When I heard about hearings, I’d meet with its congressional staff. I’d seek opportunities for Academy members to testify. I’d draft testimony and they would come in, we would review the testimony, I’d take them up to The Hill, they’d do their hearings. We did a lot of that kind of thing. Meeting with people at the Division of Medicine talking about the grants program, any issues that came up. So things were different. But it was all interesting. We would focus on the federal agencies and doing reports for the Academy. The Academy had its Commission on Legislation that Mike Miller staffed. And I would attend and worked with him on putting agenda materials and that sort of thing for them. But it was tracking what was going on in DC. Making sure the Academy knew what was happening and that we had an opportunity to have input where appropriate. \n\nCan you tell us a little bit about the grants program? You mentioned that a couple of times.\n\nLegislation was passed, and I want to say in 1974 but I could have the date wrong, and it was health professions and it was federal funding to provide grants for health professions education. And they provided money that residency programs in family medicine could apply for and departments of family medicine and medical schools could apply for. And it’s a program that’s been in effect since that time. It’s congressional, it has to be reauthorized, money has to be appropriated and then the grants are administered by the Division of Medicine. So programs have to apply for them and there are grant reviewers and that sort of thing. And that was just one of the programs that has been around, that remains important for family medicine and for other primary care education programs.   \n\nAre there other grant programs like that out there that also play a pretty significant role in family medicine and primary care?\n\nThat’s the biggie.   \n\nIs there an actual name for the program per se?\n\nHealth Professions Education. It’s a section in the Public Health Service Act, Section 747 of the Public Health Service Act. \n\nI just wanted to make sure that we had that down. You never know, somebody may want to look that up at some point in time.  \n\nNow you were a registered lobbyist as well. How did that tie in to your activities with the AAFP? Or did you have to be a registered lobbyist to participate in some of these activities? How did that help you in terms of maybe gaining access to or being able to attend meetings?\n\nIf you’re working for an organization and part of your responsibility is meeting with congressional staff or members of Congress to advocate on behalf of your entity, you should register. And so it’s just part of what you do. So I have been registered as a lobbyist and I still am, even though that’s a smaller part of my day-to-day responsibilities now. It’s just a legal requirement that if you’re going to be an advocate on The Hill on behalf of your organization and you’re paid to do that, you need to register and file reports. It doesn’t give you anything, it’s just a legal requirement. It doesn’t get you access, it doesn’t not get you access. It’s just a fact of life. \n\nLike you said, it’s a requirement? It’s something you have to be in order to participate?\n\nBe in compliance with the law, yes. \n\nIs there anything about working in Washington, DC or working with those particular people – Mike Miller, you mentioned, that stands out? What can you tell us about some of those people who also worked in the Washington office?\n\nThey didn’t work in Washington. They worked in Kansas. \n\nOr who you reported to, I guess?\n\nI reported to Mike Miller and Mike reported to Roger. And they were colorful, smart, fun people. The Academy was much more of a social entity at the time. Just as an example, when I was interviewed for the position, the second step in the process, they flew me out to Kansas [City] and they took me out to lunch with the then-Socioeconomics Division because they wanted to see if I would get along with people.   \n\nI don’t know if they would do that nowadays in terms of flying someone out. But that sounds pretty interesting.\n\nYes. So I got to know the people at headquarters. Some of them were my peers and we shared a boss in Mike. So it’s one of the ways I got to know the organization. \n\nWas that your first time in Kansas City?\n\nYes.\n\nWhat were your impressions of the city back then?\n\nI really didn’t see all that much of it. I came into the office and the office was very nice. We went to some restaurant and the people were nice. It was an interesting organization. There were issues that were of interest to me. I had been to Kansas City once before. When I was working for AOA, the Drug Enforcement Administration had a meeting and we were doing something with controlled substances. So I had been to Kansas City once before then. But it was more a chance to get to see some of the people. I liked them – they were nice, they were smart. \n\nI was going to ask you maybe to expand on that a little bit, since you didn’t get to see the city as much. But the organization, I take it, it made an impression on you?\n\nYes.\n\nSo you worked in the Washington office starting in 1979. And then in 1992 you were promoted to Vice President for Public Policy and Practice Support?\n\nI think the title at the time was Socioeconomic Affairs. It was a weird title, it didn’t mean anything. I had the chance to kind of grow the Government Relations Division. I don’t remember how many staff we had at the time, but we had grown the lobbying staff. So we had several people working on issues. And I did have the opportunity to apply for the position and got it. So that was a good career change for me. \n\nDid it change your role at the Academy in any way? What kind of responsibilities did the new position bring?\n\nI had been the Director of Government Relations and this position was the Vice President that oversaw the Government Relations Division, what was then called the Socioeconomics Division, and also what was then called Research and Information Technology Division. So it was overseeing three divisions, two of which were at headquarters and one of which was here in DC. So I spent a lot of time traveling back and forth, being part of the VP team, attending Board meetings, which I previously hadn’t done. So it really was a completely new job.   \n\nIt sounds like it was a pretty significant change for you.\n\nYes.\n\nWhat was it like being in charge of those divisions and being involved with all the travel and the extra responsibilities and the different decisions you had to make? What was that like?\n\nIt was fun and interesting. I’ve always been interested in sort of organizational development issues. So being able to be part of the VP team that dealt with sort of educational things, not just issues, was interesting to me. I knew there would be a lot of travel in the job. That was a given and that was fine. There are certain things that you need to do in person. And one of the first things I did was scheduled meetings with each of the divisions just to get to know the people and talk to everybody individually and hear what they did and what they thought and what their ideas were. And initially my role was to learn and then provide whatever guidance I could, whatever leadership I could. Making sure that we were doing things that were in line with what was important organizationally. So it was a fun job. Bob Graham was the EVP at the time. It was Bob that promoted me. Mike at that point then was promoted to be Bob’s Deputy [EVP]. I thoroughly enjoyed working with Bob Graham. And I had known him a little bit in DC when he was the HRSA Administrator. He had been on The Hill before then. And it was professionally very challenging. It was fun, it was interesting. So it was a good move for me. \n\nThat kind of leads into my next question. You talked about organizational development and you talked about Bob Graham. My understanding is that you played a pretty significant role in developing and creating the Robert Graham Center. Could you tell us a little bit about the Center and also maybe a little bit about Dr. Graham – how the Center came into being and your experiences working with Dr. Graham?\n\nThe idea of having a policy center in DC really was Bob’s and it was something he talked to me about on several occasions, over a period of a couple of years. And we had some conceptual discussions with the Board about it and then put together not what we would now call a business plan but a fairly detailed description of if we were going to have a policy center in DC, what would be the purpose, how would it help the organization, how would it have credibility. We spent a lot of time in putting together that proposal, in talking with people on The Hill, people with other agencies, people with foundations, people in university sort of research centers. And one of our questions was, if the AAFP, as an advocacy organization, creates an entity which is of the Academy that does policy research, that has conclusions that are positive to family medicine and its agenda, how will that information be believable? And we were told that if you allow this entity to have editorial independence and to publish its research findings based on data that it studied and even if those don’t comport with your policy, if you allow them to publish without hindrance and if you don’t have them controlled by a member entity then over time even the positive things that they say will be viewed with credibility. So we intentionally set the Policy Center up as a division of the Academy and we said your work should be roughly divided into half of it be research done to help in advocacy efforts. For example, Government Relations has good evidence-based data to assist with their advocacy. And half of the portfolio of work should be investigator-initiated. And you study what you think is important to primary care, family medicine, the healthcare system. And you can publish without organizational review of your work. So we put together a proposal for the Board and they agreed to it. Larry Green was the first Director. And part of my job, I felt at the time, was creating a new entity, was to have them not located in Governmental Relations but be physically separate. So we rented space next door. And to allow them the freedom to make it up as they went along and to let the Center evolve. And that’s what happened over time. When Bob left the EVP of the Academy, he was the first Scholar in the Center. And then the Board determined, and I don’t remember the year, to call it the Robert Graham Center in honor of Bob because it was really Bob’s brainchild that created this Center.   \n\nSo what was it called then before it was called The Robert Graham Center?\n\nThe Center for Policy Studies in Family Practice and Primary Care. And now it’s the Robert Graham Center for Studies in Primary Care and Family Medicine. \n\nWhat are some good memories or recollections you have about working on that Center or some of the policies that you’re most proud of?\n\nOne of the first things we wanted them to do was to do work to actually get published in some of the major journals. And they did that. They were one of the first groups doing studies on sort of safety and errors in primary care. They did do work that got published in the New England Journal and major journals. And that was one of the initial things we wanted them to do. They created sort of one-pagers on issues that are now published in American Family Physician. If Government Relations was working on something and needed to know what’s the impact of X policy on people or geographic areas or what’s the economic impact of having a family physician in a community, they would do work to help government-related agencies to advocate. So that’s grown a bit over time. We’ve had several scholars and different people visiting. And it’s grown to be an entity that’s recognized and respected. It’s done well. We’ve been pleased. \n\nAnd you played a pretty big role in that?\n\nAnd part of my role was to get out of the way and let it develop and protect it from too much interference. Now they do get a significant amount of money in different grants from foundations, some subcontracts for federal money. So they’re doing quite well. \n\nThat’s something to be pretty proud of then.  \n\nYes.\n\nYou also played a role in, it’s called the Center for Health Information Technology?\n\nYes.\n\nCan you tell us about that as well?\n\nWe were watching sort of the healthcare system and the environment and realizing that healthcare is behind the rest of the economy in terms of systemization. And one of the things that we felt was important for family physicians was that family physicians begin to use health information technology, electronic health records. And we decided the best way to do this was to hire some expert staff, invest in resources, and really try to make a commitment to have family physicians get involved in using EHRs and have the Academy try to influence the industry so that the EHRs and the other information technology being developed would make sense for primary care. So we again decided to create a Center as a division of the Academy, to be located at headquarters, and hired family physician David Kibbe who was an expert in that field. And David hired Steven Waldren who was a young family physician, who’s an informaticist. And we basically said to David, we want to influence the industry and we want to influence family physicians. And again, David worked out of North Carolina, would go to Kansas City occasion-ally. And basically giving him the space and resources to try to galvanize family doctors around EHRs. And so the staff worked very closely with chapters. They did regional meetings. David did a motorcycle trip around the South, visiting different family physicians that were starting to use EHRs and that had been featured. So part of it was the strategy of showing family physicians, here’s a family physician like you with a practice like yours who found an EHR that works. At the same time, the staff worked with the major HER developers and companies to try to make sure that they influenced what those technologies looked like. We had a program called Partners for Patients where HER companies would work with us. They would come up with ways of making sure that family physicians could afford EHRs. They didn’t have a lot of capital up front, so they could get different financing mechanisms. We explored at one point, should we get an open source HER working with other physician organizations and not doing it alone. And there wasn’t interest by our colleagues, so we didn’t do that. But we did what we called a West Coast Swing. We spent time with GE, we spent time with Hewlett-Packard, with different companies that were getting into the HER space. So it really was investing time and energy by creating a Center, by hiring some really smart staff and encouraging family physicians to engage in EHRs. And right now over half of Academy members are using EHRs, which is the highest percentage of any medical specialty. And we managed to do that before the Congress passed legislation that provided any financial incentives for HIT. So we’re pretty proud of that. \n\nThat actually answers a question I was going to ask: What effect do you think the Center and the development of the EHRs has had on the practice of family medicine and primary care?\n\nI think it’s had a significant influence. Also, the Center staff have been really able to influence what’s going on with the Department of HHS, working with the Office of the National Coordinator, working on meaningful use requirements. They’ve had a great deal of input into that.  \n\nSo you could say that the Center was really sort of ahead of the curve?\n\nDefinitely. And now the Center is located within the Practice Advancement Division. It’s still a Center and the Director is Steven Waldren. And his second in command is Jason Mitchell, also a family physician, who still does practice part-time and is also an informaticist. And working with David as our consultant, the three of them really comprise the brains of the Center. \n\nFor the tape, could you restate the three of them?\n\nSteven Waldren, Jason Mitchell, and David Kibbe. All family physicians. \n\nAside from all of these activities that you’ve had working with the Academy, you also are a member of a number of professional associations: the American Association of Medical Society Executives, Women in Government Relations, and the Westmoreland Children’s Center, just to name a few. Do you have any stories from your experiences with those organizations that you’d want to share?\n\nWell, Women in Government Relations is an organization that I was pretty active in earlyish in my career. We started a Health Task Force. At that time there really wasn’t that much opportunity for women in the field of government relations. But our organization has grown and I belong to it, it’s a great resource, but I’m not all that active in it anymore. With ASAE and some of the others, they are professional organizations that are good when you need a resource for something. I have not done the path of trying to run for the board and all that. I occasionally serve on a committee or a task force. But they are mostly good organizations when you need resources. So, for example, when we’re exploring a political action committee, ASAE had good information that we got and used. So I view them more as professional resources. My experience with Westmoreland Children’s Center and then subsequently with the West End Episcopal School was serving on their boards of directors and as an involved parent serving on the board of my child’s school.  \n\nASAE is the American Society of?\n\nof Association Executives. \n\nThat’s not one that I had listed on the questionnaire. So I just wanted to clarify.\n\nIt’s a resource for association executives. \n\nWe are the final questions section, if that’s okay. You’ve been involved with the AAFP for more than three decades now. How has family medicine changed in that time and where do you think it’s going? Where do you think it will be in another thirty years?\n\nFamily medicine came into being as a specialty to meet the needs of the people at a time when we had proliferation of subspecialization after World War II. And it really was designed to train doctors to meet people where they are and provide the kind of care they need. Now as the country has changed and its people’s needs, wants and desires have changed and as the health care system has changed, family medicine has needed to change. And I think it was very thoughtful of the organization to do the Future of Family Medicine study about ten years ago and really ask some hard questions and then try to transform family medicine to meet those needs, wants of the public. For example, to provide convenient patient-centered, team-based care, comprehensive care, relationship-based and really trying to take family medicine to the next level. And that’s what we’re doing right now with the whole effort toward the Patient-Centered Medical Home. That’s why we created TransforMED, to help make that change. So that is evolving even as we speak. So I think as long as family medicine really remains focused on taking care of people, providing what they need in a way that they will access it, I think family medicine will be important and relevant. But it’s having to change. And if it doesn’t, I think family medicine can margin-alize itself. But I’m pretty optimistic, the way things are going, that family medicine will become even more relevant to people over time. And I think that’s starting to be recognized. Primary care is all over the place. People are talking about primary care. It’s written about in the news. It’s on TV. Primary care is in a great place. So I think that while some family physicians are feeling overworked and the payment system doesn’t reward them and all that, I really think we’re at the precipice of positive changes. \n\nYou mentioned relationship-based medicine and the patient-centered medical home, those models. Would you maybe just want to expand on that a little bit? Maybe what you see as the strengths and weaknesses of those?\n\nI think the strength of the Patient-Centered Medical Home is that we came up with a set of joint principles in 2007, working collaboratively with ACP, with American Academy of Pediatrics and with American Osteopathic Association, to come up with a set of joint principles which we all agree to organizationally, which have really been foundational to all of this medical home stuff that’s going on. So rather than have the ACP talking about advanced (I forget their term). But they had a term, pediatrics had medical home, we had personal medical home. And we decided on a joint set of principles to sort of say this is a description of a practice which is physician-led, comprehensive, coordinates care, systematized, quality-oriented, knows people, involves people. All that was really foundational to this stuff. And it emanated for the Academy from the work we did on the Future of Family Medicine and the work that the other organizations did. And that really was based on what people need and what the health care system needs. So I think that’s a real strength. The weakness of the Patient-Centered Medical Home is that people don’t know what the word “medical home” means. And we’ve done some research and we know a negative connotation is that people think of it as a nursing home. But the idea of a patient-centered practice is we think the way things ought to go right now and people seem to be responding to that. \n\nYou mean in terms of changing that language?\n\nWe haven’t changed the language because that’s the language that’s sort of out there in the policy world. But a practice that’s recognized as a Patient-Centered Medical Home doesn’t really name itself a medical home. They will say they’re recognized as a patient-centered medical home but then they’ll be known as whatever their practice is called. So I think that’s one way to get over the word barrier. \n\nSince I asked about how family medicine has changed, how has the Academy itself changed or evolved over the years since you joined it? And where do you see the Academy going as well?\n\nI think the Academy has become a much more professional organization. I think the caliber of the staff has increased. I think the organization is much more focused. Because the needs of our members are changing, the Academy, one of its strengths is listening to its membership. The leadership of the Academy in terms of the members is really important. The policies are driven by members and I think that’s a strength of the organization. I think we’ve become more focused, more professional. Certainly the organizational review that we just went through the last year where we looked at what we do, how we’re organized to do, what’s the value to our members and coming up with metrics to sort of consciously pay attention to how do we know we’re getting done what we say we’re going to do – I think those are all important, positive changes for the organization. \n\nDo you see any possible negative aspects or negative signs for the Academy in the future? I guess there’s always the potential for something but…\n\nLike any organization, we’ve had challenges. We’ve been affected by the economy as have other organizations. We’ve had to make some staffing cuts over the years. We’ve had to make some tough organizational decisions. But I think that the organization is healthy financially. I think we have good staff leadership and a smart staff as a whole. So we’ve had challenges, as have had other organizations. One of the differences in the Academy is that like everywhere else in the world, you can’t guarantee anybody’s job for life. There’s not a safety in the workplace as much as there used to be. But I think it’s a good, strong organization that’s a great place to work and I think it’s going to remain that way. \n\nI agree. I’ve only been here three months myself. But I really seem to have enjoyed my time here. So if I can have the same length of career that you did, I think I’d be pretty happy with that.\n\nLooking back over your career, what are some of your fondest memories of working with the Academy?\n\nOne of the most fun times working with the Academy was back during the Clinton Administration when there was great interest in healthcare coverage for everybody. And the Academy was absolutely in the thick of that. I will never again have the opportunity to go to the White House so often as I did then. There were opportunities for physicians to meet the President so frequently. The Academy Board had the opportunity to sit down and have an afternoon meeting with Hillary Clinton. And she sat there with her notepad and fired questions and wrote answers. We had a meeting in the Roosevelt Room with President Clinton. I had the opportunity to be in the Oval Office while the President was recording one of his radio addresses talking about Medicare and Medicaid. We had the opportunity to review parts of the Health Security Act, to write parts of the Health Security Act. There was just a ton of interaction with the White House. And we know that all fizzled, but the Academy was in the thick of it. When the Obama Admini-stration came in and were interested in doing things in healthcare, we had the opportunity to meet with the transition team and encourage them, as they were doing the stimulus package, to do something with health information technology. We encouraged them to do something with the workforce. They did that. When the President was going around talking about his plan for healthcare coverage, we arranged for family physicians to be at all kinds of events. So it was a lot of working closely with the White House. Having Lori Heim be able to come in when the bill was signed, to be at an event, sitting in like the eighth row from the President. So just a lot of things like that where I think the Academy really had an oppor-tunity to have substantive input, to have face-to-face opportunity to meet with people. And those have been very exciting times and very fun times. And then most recently, being able to be one of the people who helped draft the principles for the Patient-Centered Medical Home. To be an organization that was one of the three founders of the Patient-Centered Primary Care Collaborative which now has over 900 organizations. And their mission is to promote primary care in the patient-centered medical home. To be in the thick of that and to be part of the creation of that sort of thing and the development of it has been great.   \n\nI just have to ask, what were your personal impressions of President Clinton and Mrs. Clinton and President Obama (I don’t know if you got to meet him or not as well)?  \n\nI found the Clintons to be engaging, smart, interested. I really found both of them to be, they really knew their stuff. They weren’t propped up by advisors. When the President met with our Boards and talked about healthcare, he knew what he was talking about. And when we met with Mrs. Clinton to talk about healthcare issues, she knew what she was talking about. Very smart people but also very engaging. I have only met the President [Obama] once. I haven’t had a chance to talk with him. I’ve seen him at events but we haven’t had the opportunity for our Boards to sit down and talk with President Obama, so I didn’t have that same experience. \n\nDid you have any opportunities to meet President Bush as well?\n\nI did not. I had the opportunity to meet with Dan Quayle, but that was just at a smallish meeting. \n\nAnd what about the George W. Bush Administration? Did you get to meet any members of that administration as well?\n\nSome, but they were less interested in the stuff that we were doing. I got to go to his inauguration. But it wasn’t like the interaction that we had frankly on a day-to-day basis with the White House, which we had with the Clinton Administration. \n\nLooking back, what did you enjoy most about working at the Academy?  \n\nI’ve really enjoyed working with the people. I’ve had some really fabulous colleagues that I’ve had a chance to work with, not just in DC but at headquarters. I’ve had the opportunity to work with members that have been on various commissions and on the Board of Directors whom I’ve enjoyed as people and really admired professionally. So I think it’s working with some really smart, passionate, nice people. \n\nWhat did you enjoy least about the Academy or about working at the Academy?\n\nThe last couple of years have been tough because there are really no boundaries anymore to your work life. So you have travel and you lose weekends and there are evening conference calls and there are meetings at 6:30 in the morning. I think the hardest thing is that there are no boundaries, that you could work 24/7. You’re almost a victim of our technology. We’re on email all the time. And trying to create space for life and still do everything that I think is required for this job, it’s hard to maintain a life balance which is personally important to me.   \n\nIt’s not as easy to get away from work as it used to be.\n\nRight. And I travel about one-third of the time. And trying to have a life, it’s hard. \n\nAt least with retirement you’ll more time to enjoy those things.\n\nYes. And that was one of the main decisions that my husband and I made, that I’d like to be in the same time zone as he is.   \n\nWhat do you think was your greatest accomplishment with the Academy or the thing that maybe you’re most proud of accomplishing?\n\nI think the fact that the Academy stayed engaged and firm on the issue of supporting healthcare coverage for everybody from the ‘80s on, even when nobody wanted to talk about the issue. And took a risk and played a role in the creation of the Health Security Act. And played a role in the creation and support of healthcare reform. And the fact that we were able to keep a constant policy on what do the American people need. I’m really pleased that we were able to do that and I think I played some role in that.   \n\nAre there any things that you wish you could have accomplished while you were with the AAFP but were unable to do so?\n\nWell, there is so much more to be done in terms of changing Medicare payment policies. We thought we had a winner back in ’89 with the passage of the Resource-Based Relative Value System. That hasn’t played out as well. So payment issues need a lot of work. We made some progress in Medicare [    ] medical education, but still needs a lot of work. Healthcare coverage for all needs to be implemented in a way that really does get people coverage. Recognition of the value of primary care by the public in the private health system. It’s beginning but it’s not where I’d like it to be. So there’s a lot of things that aren’t in an optimal place. But as I think about what has been accomplished and what needs to be done, you have to play for the long haul in policy and system change and it doesn’t happen overnight. But a lot has happened that’s been good. More people are covered. Primary care is starting to be recognized. So you never get everything that you want and you always wish you could have done more.   \n\nBut it sounds like you’ve done a lot in your time here.\n\nWorking with the Academy has really given me a chance to do what I wanted to do when I was a kid, and that was how do I get involved in a way that can make some changes in the system, that will make things better for people. And working at the Academy has given me the opportunity to do that. \n\n  \n\nWhat do you think about the current state of health care in the United States? What do you think can and should be done to fix the healthcare system?\n\nWell, the healthcare system is a mess. I think the healthcare system is completely driven by money. I think it ought to be driven by what people need. If I knew how to fix it, I would be a czar, which I’m not. So I really don’t know. But if policy makers could step back and stay what is the result we want to achieve and pay for that, that would be great. But it’s such an industry that it’s going to be hard to change. I notice every time I come to Kansas City and go out to the office, there’s a new building that’s some medical thing. And I think do people need all that stuff? What do we need to do to keep people healthy? And until we figure out a way to focus on keeping people healthy, paying attention to them earlier on and not just worrying about every high tech cure…I think we’ve got it backwards, but I don’t have the solution. \n\nWhat do you plan on doing now that you’re going to retire? Do you have any plans in mind?\n\nAs I tell people, anything I want to. I would like to have time to go to my book club and walk my dog and hang out with friends and do more of the volunteer work that I like to do. My husband and I are planning a trip to Paris in October. But I don’t plan on spending all my time traveling all around. I’ve been traveling all around and I’d like to stay home. I really enjoy doing things with friends. I’d like to spend some more time with my husband. I’d like to go visit my son at school in California, visit my mom in Massachusetts. But I would just like to get a little more balance in my life and see what’s on the other side. See what doors open up. \n\nYou know, eventually they’re going to hire a successor for you. Do you have any advice or suggestions for that person? Or do you have any advice for people who may succeed you in the future?\n\nI think whoever succeeds me will be completely different from what I am. And I would just say make sure that you understand and believe in the values at AAFP and understand what our members value. And understand the place of primary care and just be passionate about trying to make those changes that will help family physicians practice in a way that they want to. And make sure that people have access to the care from family physicians that they need. But I think that every person who comes into a job brings a different set of skills and different personalities and can take it to the next level. And I’d say go for it and have fun with it. \n\nDo you have any suggestions for the Academy as to who they might want to hire?\n\nActually, they’re already interviewing a bunch of people. The Academy at this point is a really well-regarded organization. We’ve had great candidates for all the jobs that we’ve had open lately. So I think the challenge for Doug is going to be you’re going to have a choice of many really qualified people and you just need to decide which is the right fit for the Academy. \n\nAny final thoughts or comments or opinions you’d like to share?\n\nNo, I think I’ve had a chance to share more than what I thought I would. So thank you. \n\nThank you for the time you gave me this morning and allowing us to tape this, to put your thoughts down for posterity for the Center. 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