{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/nz80k28f92/manifest","type":"Manifest","label":{"en":["Dr. David L. Massanari"]},"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":["2009-04-02 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}},{"label":{"en":["Agent"]},"value":{"en":["Sandy Panther (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","American Academy of Family Physicians","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["David L. Massanari, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153750/file/282859","type":"Canvas","label":{"en":["Media File 1 of 1 - Massanariz_David_09_a.wav"]},"duration":3223.79922,"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/153750/file/282859/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153750/file/282859/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/282/859/original/Massanariz_David_09_a.wav?1752675918","type":"Audio","format":"audio/wav","duration":3223.79922,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153750/file/282859","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153750/file/282859/transcript/81711","type":"AnnotationPage","label":{"en":["Dr. David Massanari interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153750/file/282859/transcript/81711/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I would like to start at the very beginning of your life and have you provide information on when and where you were born, some general information on your parents, what they did, what your childhood was like, where you went to school and get through your early years through high school. And then we’ll go on to college and medical school and so forth. \n\nI was born in Illinois. My parents lived in a small town called Fisher. And when I was born my fraternal grandparents were still living in the house that we were living in. I was the first-born and was born in Champaign, Illinois which was about 20 miles away. The larger town in the area where the University of Illinois is located. My father’s name was Russell Massanari. He was one of a family of five boys and a daughter. My mother was Fern Reeser and she came from a larger family of three brothers and I believe five sisters altogether. I was born January 1, 1949. In those days the first baby born in the county, and I understand my parents received a number of items such as a baby carriage and other things. They always kidded me that they got that rather than the tax deduction that year. My grandparents moved about a block or two away. That must have been when I was about two or at the most three. I have very few memories of those years, although I do remember a couple of things. One is sitting on my grandad’s lap while he talked in German to his friends. The other was the old phone systems then were not the crank phones but there was a central and you would pick up the line and talk to the operator. I apparently used to pick up the line and say I want to talk to Grandma and the local small town operator was kind enough to make the connection for me. My father and his two brothers continued in the Joe Massanari \u0026 Sons interior decorating business which my grandfather had started. Primarily in Champaign/Urbana, and the area around there. So I started working with them some when I was in late grade school and early high school and did some wallpapering of homes in the Cham- paign/Urbana area. My mother was an at-home mom during the time that I was at home, although both she and my father were very active in the local community, particularly at the local stage and also in the national organization of their church. So they were very physically involved with a lot of organizations and meetings as I grew up.  \n\nI went to the local grade school which was about a mile away and usually walked to school. Then went to the high school in the local town. I think my graduating class had 44 in it, as I remember. It was not a huge school. I did a number of sports in high school and involved in the activities there. Our family had the first international student live with us for a year that our high school had. This was a young man by the name of Roshi Yamaguchi who lived with us for a year. Fortunately, we’ve kept in touch over the years and it’s been a really fun relationship. He’s currently the Consul General for the consulate in Miami, Florida for –. So it’s been fun keeping track of him and visiting various places with each other throughout the world over the years. It was interesting in the ‘60s to have a Japanese foreign student in the school. There were some folks in town who were fairly adamantly opposed to that happening. But it actually ended up being a very good year and I think people learned on all sides.\n\nAt what point in time, I would assume it would be somewhere in your early years, did you decide that you wanted to become a doctor? \n\n\nIt’s difficult to know for sure. A real good friend of mine’s parents lived across the street from us, was Dr. Ernest Smugger, who was a general practitioner there in town. And then in my early childhood, he left and went up to Evanston and did a surgical residency. And his son Mark and I were about the same age and good friends. I remember a number of things in terms of Dr. Smugger. One of the things was Mark and I, one day in our very young childhood, decided that the trees that fell down after a storm needed to be cut up with an axe. And so we went after it with the axe. And at one point I thought it was my turn and he didn’t think so. And as he came back with the axe, hit me in the head and gave me a fairly good laceration above the eye. And Dr. Smugger put that back together along with fairly strict instructions to both Mark and I about our inappropriate behavior. My Uncle Walter was a general practitioner in northern Indiana, in the Goshen and Middlebury area. So I knew him and saw what he was doing very peripherally as a physician. And I think some of those early experiences, along with my interest in science throughout school, let me think that perhaps medicine was something I would want to do.  \n\nI know by your CV that you did go to Goshen College and did a Bachelor of Arts in Natural Sciences. So that started the ball rolling.\n\nI did, yes.  \n\nAt that point, was it during those years that you decided to then apply for medical school? \n\nI did. I had some other thoughts for a while about perhaps going more into an academic biology career but basically ended up back in medicine, which is what I always thought I would want to do.  \n\nWould you help us out by telling us the medical school and then how you did internships and residencies? \n\nI went to the University of Illinois School of Medicine. Started out at the Chicago campus for the first year. And then learned throughout that year that the University of Illinois was opening several new campuses the following year, one of which was in Rockford, Illinois and was very interested to hear what they were talking about in terms of their goals for the school at Rockford as it was going to be a small class, was going to be very clinically-oriented and very much focused on primary care medicine to try to meet the needs of health care of at that time, parti- cularly the rural areas of Illinois but also cities as well. It sounded like an exciting program. And I decided to apply there and it was one of the first classes at Rockford. I believe we were about 20 students. We arrived in town, they had never had medical students before. It was a time in the early ‘70s, would have been about ‘72, I believe, when there were a lot of newly-trained special- ists and subspecialists coming to Rockford, were kind of excited about being able to teach at the medical school. And as such we were very involved early on in clinical responsibility. One of the things the school did was in our sophomore year we already had assignments, I think it was about two days a week, in clinics where we saw our own patients which we followed for three years. So that was a somewhat unique and innovative approach that was quite enjoyable.  \n\n\nWhen you graduated from there, what took you to Boston? \n\nAs I said, I thought I wanted to do family medicine and went to Rockford because it was clinically-oriented. It was a really good experience there. As a senior medical student I would be on a medicine service where I would have what I guess these days is called junior intern responsibility, or at one point was called that, for a medical service of maybe 10-15 patients. I would be able to see them, make rounds with the attending and usually be in the library reading by midday which, as I talked with my colleagues later on who went to medical schools, was unique for a senior year medical school experience. I had thought I wanted to do family medicine and was pretty much headed that direction. But like many medical students was told by people that I was around that I really was doing too well and was right up near the top of the class and should really think about something other than family medicine because that was really a waste of talent, and the usual stories that many of us have heard over the years in family medicine. And had one professor, Bob Reese, who had been there at the medical school and was just in the process of going to Boston University Department of Pediatrics. And through discussions with him I decided maybe I would do pediatrics. And Boston City was just starting a program that was a combined pediatric and internal medicine program and I said let me try what’s happening in the big city and see whether that’s something I might want to do. Got to Boston, started my pediatric medicine joint program and became a first-year intern at Boston City Hospital which,  needless to say, was a rude awakening from my experience as a senior medical student in Rockford, Illinois. And after a couple of months of running blood samples through the corridors at 3:00 in the morning only to find the nurses who had gone home the night before arriving bright-eyed at 7:00 in the morning after 16 hours off, I began to wonder whether this is really the best way to get my education. I also discovered that pediatrics was just as general as family medicine and not nearly as much fun. So at that point in time, I looked around at what might be available for family medicine for the following year. And I was fortunate enough that a good friend of mine, Rick Tachman(?), who I had met in medical school, was in the York Hospital family medicine program in York, Pennsylvania. And interestingly enough, Robert Evans who was then the dean at Rockford previously had been at York Hospital as, I believe, the educational director there. And they also just happened to have a second-year family medicine slot come open that year. So that allowed me to actually move from Boston City Hospital pediatric medicine program to the York Hospital family medicine program which was a move that was fortunate for me and I think was the right move for me at the time.  \n\nObviously you are married and I would like to learn a little bit more about Nancy and your children. At what point did you meet Nancy? \n\nI’m not sure that either of us can recall when we first met because we both were from Fisher. We both went to the same church, we both went to the same school and we started dating in high school while I was a sophomore and she was a junior. We continued to see each other. Went to separate colleges for a couple of years but seemed to always end up coming back together again. And we were married in 1970 after she graduated from college and I actually had one year of college left. So we’ve known each other a while. Derrek is our oldest child. He was born in 1975 when we were in Boston. Then Jessica was born just before we left York, Pennsylvania. And Rebecca, our youngest, was born in Maine after we set a practice there.  \n\nAnd that leads me into the next question: when you finished your residency you went to Maine? \n\nYes. In York I mentioned that our good friends Rick and Jan Tachman were there and Rick was a family medicine resident there. We continued our friendship with the Tachmans while in York. And then Tom McDermott and his wife Kippy – Tom was also a resident the same year with us in York, Pennsylvania. And after getting to know each other, the three of us decided we would like to kind of set up a practice together. So for the three of us coming out in 1978 wanting to set up a new practice together, we weren’t quite sure where we would go and whether we would be able to find a place that had room for three new family docs at once. So we split up the basically northeast United States area and each of us made trips to different places. We had chosen the northeast because several of us in the group were from that area and some of the rest of us, like Nancy and myself, felt that if we weren’t going to be within a couple hours’ drive of our parents and families that it probably didn’t make a whole lot of difference where we were because we weren’t going to be able to drive there. And we did find Sanford, Maine was looking for physi- cians. Someone who had been very busy there had a couple of associates who had left and was just in the process of leaving. And it seemed to be a good opportunity for us at the time. So we set up practice in Sanford.\n\nYou had a very diverse career because you were in private practice and then you went on to become medical director. So if you could just sort of run me through what your practice, and you can take it up to today – we’ll do the practice part of it first and then the political part with the Academy and the Foundation after. \n\nAs I said, we set up practice together in ‘78 in Sanford and continued to practice there. As time went along, Dr. McDermott ended up going into addiction medicine as his primary interest and left our group and went on, on his own and subsequently up to the Augusta area. We had other folks that did join us throughout that time. I continued to practice there with Rick and the others until I believe it was 1998. At that time, after having been involved with the Academy for a while and being through with my time on the Academy Board of Directors I was kind of looking to see if there was some way I could continue to be involved in medical policy professionally through my work as well as through my organizational involvement. And there came the oppor- tunity then to work as the medical director for Harvard Pilgrim Health Care. Actually, associate medical director in Maine. And I decided to give that a try and did that for a couple of years in Maine. And then moved from there to the medical director for medical management for the organization, working out of Boston. I was particularly attracted to Harvard Pilgrim at the time because they seemed to be very interested in working with physicians and seeing physicians as a very valuable part of quality and quality improvement. And worked with them until I believe it was 2003 when I decided it was time for me to kind of move on, at that point in time, to some- thing else. That decision to move on was in part driven by my feeling that as the years went by, Harvard Pilgrim was looking more and more for central management of quality issues and patient care rather than relying as heavily on the physician community to partner fully in those areas. From then I took a job as medical director for a community health center here in Arizona, United Community Health Center in Green Valley and was the medical director there for about three years. The last year of which I was also the acting executive director which the Board asked me to do after the long-term and founding executive director left the organization. As that went along, I was, I guess one might say, missing the clinical side of medicine after having spent about eight or more years doing almost exclusively administrative work. And now working as the geriatrician with some long-term care, taking care of patients here in Green Valley in sub- acute, post-hospital settings as well as long-term care, assisted living and dementia units. And enjoying getting back to kind of what brought me to family medicine in the first place, and that’s caring for people over time and kind of sharing their joys and sorrows with them as they work through their health issues.  \n\nAt that same time, was Nancy teaching all along? \n\nShe taught initially when we were married. Had a few other jobs when we first were married but primarily was a teacher until our children were born. And then she took a few years off to be pretty much at home caring for the kids. Went back to teaching then when our youngest went into school and taught throughout our time in Maine. When we moved here to Arizona she decided it was time for her to take a bit of a break. But being a teacher at heart, found it very difficult to stay home and is back teaching again now.  \n\nWhich I find fascinating because she is very good at working with kids. You can see that when we travel. \n\nLet us now get into the political side. At what point did you start becoming involved? I would assume you started by becoming involved with the state chapter before you became involved nationally? \n\nI was practicing in Maine and got to know a number of family physicians in Maine. And I believe Harold Burnham was the physician who was on the Board of the Maine Academy at the time and first suggested I might want to become more involved with the Maine Academy and did so at that time. A lot of our concerns at that time were about the health care delivery system in Maine. Also, early on in some of the discussions with Washington around Medicare and the Medicare fee structure and the Resource-Based Relative Value Scale. The Maine Academy had really good working relationships with Senator Mitchell’s office at the time and we worked very closely with him trying to see whether we could do anything to help re-look at how services were valued. So I was involved in that as well as some of the educational things in Maine. Actually, early on in Maine I was talking with other physicians there and thought it would be helpful for Maine to have a Foundation. And worked I believe in 1988 and a little bit before there actually pulling things together and setting up the Maine Foundation. About the same time on our Board in Maine we had a resident member by the name of Rick Donahue who came from a trip that he had had, I believe, with Physicians With Social Responsibility in Europe. And he had had the fortuitous event of actually meeting Yevgeniy Chazov who was then the Minister of Health in the Soviet Union. And they apparently did a hike together and were talking a bit. Dr. Chazov was talking about, thinking family medicine needed to be something that then the Soviet Union thought about and brought back towards their system. And when Rick came back and came to the Board, he had this wild idea that we, as the Maine Academy, ought to try to work with Dr. Chazov. And so at the time, which was the late ‘80s, being a rather naïve guy who had no idea how to work internationally when there was no access to internet or anything else at that time, Rick and I worked together and through I believe it was primarily Telex Communications, if I can remember what that was like 20 years ago, actually received an invitation from the Soviet Ministry of Health. And a group of about ten of us in the spring of 1990 or thereabouts, actually traveled over to the Soviet Union. And spent most of our time in Moscow on that trip kind of learning about the health care system there and talking about family medicine and the joys of being a family doc in Maine. That was really kind of an interesting thing. As I look back it now, I can’t believe that we were actually able to coordinate things and make that happen at that time. Subsequently, about a year later five of us were invited back in the spring of ‘91, which was just 6-8 months before the Soviet Union dissolved. Five of us were invited back and we actually did like a five-city tour talking about family medicine to some of the academic and political institu- tions of the then-Soviet Union. It was really an amazing trip. We were guests of the Ministry of Health and actually had the private plane of the Transportation Ministry to fly us around to all these events. It’s hard to believe, at this point in time, that this country doctor from Maine who I really hadn’t had much experience with these things before was part of that whole experience.  \n\nAnd you’ve still kept in contact with them, have you not?   \n\nYes. One of the physicians that we met there, we still communicate with periodically. And actually we were in Russia a couple of years ago and saw – while we were there, which was fun. Then with my involvement with the Maine Academy then was on the American Academy Congress of Delegates through that experience and participated in a number of committees and commissions. And eventually was elected to the Board of Directors of the Academy.  \n\nAnd you went through the chain, did you not, and became President?   \n\nYes. I went through things and was President of the Maine Academy. That was about the same time we were doing the exchange with the Soviet Union. So I think it was ‘89 to ‘91 that I was President.  \n\nAt what point did you run for the Board of the Academy? \n\nWe had talked in Maine about whether Maine should run somebody for the national office. And as we looked at that, we tried to see whether that would make sense. And if so, who should run for the position. The Board of Maine decided that they wanted me to run for the Board of Directors of the Academy. And then in 1994 the annual meeting was in Boston. And Maine being a small state decided that would be a good year for that to happen because we could all drive there. So I was elected to the Academy Board in ‘94. Was on that Board for three years, as is the usual term. As it came toward the end, there had been a number of changes that happened over that period of time, one of which was that the national Academy decided to drop the office of Vice President. And as I came to the end of my three years on the Board, I had always thought that perhaps I would consider running for Vice President but that position was no longer avail- able. And as I looked at the following three years, if I would have decided to run for President and would have been elected, it would have fallen over my youngest daughter’s senior year in high school. And I decided at that point in time that I really had enjoyed working with the Board of Directors but that I wasn’t willing to commit the necessary time to do the presidential duties if, in fact, my youngest was a senior in high school. So decided at that point in time not to run for the presidential office and continued to be involved in the Foundation, which I had started doing as a Board member of the Academy.  \n\nOn the Academy’s Board what were some of the issues that you dealt with that you, number one, were most proud of; and number two, were there burning issues that occurred while you were on that Board for the three years?   \n\nWell, it’s difficult to think back at this point in time to what was really 15 years ago. Clearly we continued to be very involved with Washington and what was happening with health care delivery at the national level. During my time on the Board, I was the Chair of the Commission on Legislation and Government Affairs so was very involved with testimony and lobbying through Washington at the time. We did see some small successes in terms of access to care for patients as well as benefits and some reimbursement issues that we worked with Washington on. But part of the reason that I really was interested in becoming involved nationally with the Board was to try to see what we could do to continue to move forward health care for everyone and was disappointed that really things moved as slowly as they did. We had during those times discus- sions in terms of how closely we should be involved with what was happening in Washington, particularly some of the changes that the Clinton administration was looking at. And those always ended up being heated discussion, trying to decide when we should join with the folks that were interested in similar things as us but weren’t completely aligned where we were trying to go and when it was best to step back and not be particularly closely aligned to folks. That even though they were doing some things we agreed with, were doing others that we were less inter- ested in. I remember one discussion at the Board meeting, we were trying to decide what position to take on a proposed regulation that would insist that mothers and their babies could stay in the hospital for a longer period of time. The Board had always been very opposed and the Academy had always been very opposed to any kind of mandates in terms of how health care was deliv- ered. But this was one that people felt really was trying to in fact emphasize the patient as the focus and the physician as an important part in the decision-making and the true decision maker rather than having insurance companies or regulations make decisions. So that was an interesting discussion and one example of where we ended up trying to work carefully between the decision about where to align ourselves when some things we strongly believed in were supported whereas others we strongly believed in seemed to be undercut. I don’t recall right now any other specifics that I can talk with you about.\n\nThen you came onto the Board of Trustees. So you held those one-year terms from the Academy’s Board to the Board of Trustees of the Foundation? \n\nThat’s correct.  \n\nAnd if I’m looking correctly, it looks like you held those in ’96 and ’97 or was it earlier than that?\n\nThe Academy Board elected in the fall of ‘94. Then I believe the following year, the first opportunity I had I was in fact chosen to have the one-year term that began that January of ‘96. I think that sounds right.  \n\nBecause you actually, by your CV, were on our Board for nine years.\n\nI think it’s actually ten years. It was ‘96 through ‘05. \n\nObviously, you were integral in a lot of the decisions on the Foundation Board. Would you like to just reflect where you were in ‘96 and some of the accomplishments, some of the problems that occurred in those ten years and the most memorable moments? \n\nClearly a big change happened over the ten years that I was on the Board of the Foundation. When I came on in ‘96, as I recall, we were still very small and just in the early stages of recov- ering from some very difficult years at the Foundation. If my memory serves me correctly Sandy, I believe you were with the Foundation at the time. But I think you actually didn’t come on as the Executive Director till, was it ‘97?  \n\n‘97, yes.  \n\nI was trying to remember back. So you and I actually spent the ten years together. You were there probably 12 years in that position?  \n\nIn the position as EVP?\n\nYes.  \n\nYes, it would have been ’97 to 2007. \n\nThat’s what I thought. So you actually took up the position as EVP the year after I started on the Board and you stayed as EVP one year after I was off the Board. So our time together on the Foundation pretty much overlapped and was fairly much the same period of time. So you, I’m sure, know more about those years than I do and were clearly the key leader in bringing us from where we were back in ‘96 up through where the Foundation is now. Included were the years of growth. I don’t remember the exact numbers in terms of our annual budget and our philosophy budgets in ‘96 but I know that we did grow significantly over those years. And trying to build an endowment and develop a foundation that was able to be sustained in and of itself was a major goal that we had. And I think that through the help of an excellent staff and good support across our constituencies, we were able to do that. Towards the end of my time on the Foundation there were some changes in the structure of the Foundation vis-à-vis the Academy that happened. I think many of us were seeing the Foundation as it was growing, as it being a very important part of education in family medicine and support of family medicine activities. And some folks were even thinking that perhaps it would go the point that we should consider trying to reach out more to the patients to get them more involved rather than just being a foundation primarily supported by Academy members and industry. I think for a number of reasons things moved on and the Foundation now is, in my opinion at least, a bit more tightly linked to the Academy. And I think that has some real positive aspects but may also have some limiting aspects in terms of the Foundation’s ability to reach outside of its traditional base for support.  \n\nAre you still active at all with the Foundation? \n\nI’m a contributor, a donor to the Foundation. But, really, I’m not active in a leadership role in any way at this point in time.  \n\nAny particular issues other than the obvious, the financial issue? Any memorable times you spent with the Foundation? \n\nIt was always enjoyable getting together with the folks. I think some of the most memorable ones have to do with the several international Physicians With Heart activities that I participated in. The first was, if I recall, Moldova. And I’m trying to remember exactly what the situation was. I think at the time I was Vice President of the Foundation and for some reason, which I don’t recall, the President of the Foundation had another engagement, I believe, and was unable to participate in that trip. So I had the opportunity to visit Moldova and work with the folks there around issues of family medicine. And then subsequently traveled to the Republic of Georgia and to Tajikistan. Those were all very interesting and educational, enjoyable experiences. And hopefully in the process of bringing medical supplies to those countries as well as discussions regarding family medicine with policy leaders and educational experiences with the physicians, we hopefully helped to move family medicine forward in those areas.  \n\nI will insert one comment here. The Foundation was integral in the Children’s Project and funding that. Are you aware that that project has gone by the wayside? \n\nIt’s my understanding the decision has been made, the Academy is not participating any further and that the Foundation, last I knew, was still looking if it had other ways that it could continue mission in some of these areas without the ongoing physicians with our program.\n\nTell me a little bit about some of the professional activities outside of family medicine that you have been involved in. I noticed from your CV that there were a lot of professional activities that were not really connected with family medicine. For example, the U.S. Department of Health and Human Services, Medical Mutual Insurance Company of Maine. Those types of activities. \n\nIt’s hard for me to know where to start and what you might be interested in. But while in Maine I was involved not just with the Academy but was very interested in what was happening with public health and health care delivery in Maine and as part of that did participate in some Medicaid committees throughout the state and what was happening. Was involved with the Maine Medical Assessment Foundation as we were looking at ways of improving quality across the health care delivery system in the state of Maine. And also was a board member of the Medical Mutual Insurance Company of Maine for about five or six years. Part of the Risk Management Committee of that in terms of trying to help the liability insurance needs of the physicians of Maine. As many liability insurance companies, the Medical Mutual name grew up partly because of some of the insurance crises and also because physicians wanted to feel that they were in fact helping to be responsible for liability insurance and not having insurance companies make the decisions which did not always feel like they were in the best interest of either the patients or the physicians. So I was involved with that. As part of my work with the Maine Academy and beginning involvement with the national Academy and close work that we did with particularly Senator Mitchell’s office as well as Senator Cohen’s at the time, was interested in the Practicing Physicians Advisory Council that was set up in the early ‘90s and was appointed to that council which dealt primarily with giving frontline practicing physician input to the Medicare program as they were looking at various policies and decisions throughout the ‘90s. Also, around a similar time I was the Academy representative to the National Institutes of Health, a panel on gallstones and laparoscopic cholecystectomy. Also did some other kind of short-term consulting work with the University of Iowa on some of the resource-based relative value scale work that they were doing. Throughout the early practice days in Maine, I was a preceptor at the Maine Medical Center of Family Medicine residency program as well as being involved with some other organizations through Maine primarily around care delivery and primary care public health issues.  \n\nNow I would like to move a little bit into the philosophical part of it and ask you what was your biggest satisfaction in being a physician or a couple of areas that really provided you with a great satisfaction in the choice that you made to be a physician. \n\nI actually was talking with Nancy a little bit about that the last day or so as I was thinking about our conversation today. And as I continue to work and look back over my years in medicine so far, Nancy and I discussed the fact that really I’ve kind of come full circle back to really doing clinical medicine right now on a one-on-one basis with patients. And since my time with the Foundation, have really been very much apart from or not directly involved with organized medicine and medical policy and so forth. And actually I’m finding on a day-to-day basis my interactions and caring for patients seems to be one of the things that’s the most rewarding, most personally satisfying and enjoyable parts of what I do. As I think back on things, I’ve enjoyed all of the parts of medicine I’ve done. But probably the most personally satisfying and fulfilling is the day-to-day care of patients.  \n\nThat’s wonderful. That’s not what I would have expected but that’s great. Because I see you with more involvement obviously with the political side of decision-making.   \n\nAre there any disappointments? \n\nI’m not sure I have any major disappointments that I would say at this point in time. At times I might think back and ask myself whether I might have enjoyed perhaps being more involved in the academic and educational world than what I have been. Throughout what I do, I’ve often had students and physicians, nurse practitioners, PAs working alongside me, with me, and have enjoyed the educational parts of that. But really at this point in my time in medicine, I’m not sure I’m ready to start off in a new direction. So I think right now I’m pretty much satisfied with what I’m doing and will just continue to see what other opportunities may come along throughout the rest of my career.  \n\nIf you started all over again would you have gone a different direction, done something differently? \n\nI’m not sure I would have. As I say, at this point, as I look back and reflect, you sometimes can identify times in which decisions were made that went one direction rather than another direc- tion. But it’s always hard to say what one would have done differently or if one really would have done anything differently. As I said, the one area that I sometimes wonder about is whether I may have enjoyed being more involved in the academic world than what I really have been.\n\nAny other areas that you would specifically like to cover? Is there anything you would like to add or questions that I did not ask? \n\nI guess I can’t think of any specific things right now, Sandy. As I mentioned to you when we first talked about this, I’m not really sure that I had much to add for you in this or whether I’m really an appropriate person to be interviewed in terms of the history of family medicine. I’m not sure I’ve played a very big role in it. But I hope my discussion with you today has been helpful to you. I can’t think of anything else I need to add right now.\n\nOne thing I would like to do, and we’ve done on all of the interviews and most Past Presidents particularly of the Foundation, we always allow time for you to reflect and the possibility of coming back again if there are areas that you missed or specific items that you didn’t cover today and you have this ah-ha moment, that we can always come back and do an addendum. And I’ve done that actually with Dr. Evans and one other.   \n\nI would like to thank you for today.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153750/file/282859#t=0.0,3223.79922"}]}]}]}