{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/qf8jd4rm89/manifest","type":"Manifest","label":{"en":["Dr. Douglas Henley"]},"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":["2017-10-09 (created)","2017-12-20 (other)","2021-05-07 (other)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Dan Ostergaard (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians"]}},{"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/154894/file/284072","type":"Canvas","label":{"en":["Media File 1 of 3 - Henley__Douglas_Pt_2_17.wav"]},"duration":4371.11351,"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/154894/file/284072/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/072/original/Henley__Douglas_Pt_2_17.wav?1754511580","type":"Audio","format":"audio/wav","duration":4371.11351,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82311","type":"AnnotationPage","label":{"en":["Dr. Douglas Henley Interview Transcript (1) [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82311/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tape 1, side 1\n\nDr. Ostergaard: Today is Monday, October 9, 2017 and we are in the little studio at the Center for the History of Family Medicine in Leawood, Kansas. My name is Dr. Dan Ostergaard and I have the honor of interviewing for oral history Dr. Douglas Henley. And we’ve known each other a long time, so this will be an oral history but it will be laced with maybe some personal things as we go forward. \n\nFirst, I need you, Dr. Henley, to state your name in full and your current title, but also to say for the record that you agree to this taping and its use at the archives. \n\nDr. Henley: Thank you Dan. Douglas Eugene Henley, MD. My current title is executive vice president and CEO of the American Academy of Family Physicians. And, yes, I do agree to conducting this oral history, honored to do so.\n\nDr. Ostergaard: Let’s go way back to your nativity. When and where were you born? What were your parents names? Just a little bit about your family and your background from your birth on through your early years in grade school and stuff.\n\nDr. Henley: January 1, 1951 in Hope Mills, North Carolina, in a small, thirty bed hospital in rural southeastern North Carolina. My father was John T. Henley. He was a pharmacist by profession, a politician by avocation. My mother was Rebecca Henley and she was, I guess, technically a housewife and mother. Obviously wife, but she also was kind of the brains behind the Henley enterprise in terms of the work she did with my dad in terms of running their local pharmacy and paying all the bills and keeping up with all that organization while Dad was doing his political stuff. \n\nDr. Ostergaard: Knowing that your dad was a prominent state politician in North Carolina while you were growing up and, as you said a couple of times, very politically interested, how did that affect you in a) your thoughts about staying in Carolina and being a politician of some kind or b) when you got into your medical life later, thinking that you’d like to do medical politics in some form?  \n\nDr. Henley: A good point Dan. So I guess that I would answer that in two ways. First of all, growing up in a small town where the pharmacy was right across the street from not only the small, rural hospital but the doctor’s office as well and there were two family physicians that were in the clinic there. One lived like a block down from where the pharmacy was, the other was actually our next door neighbor in town. The pharmacy was always open when the doctor’s office was always open. Those were pharmacy hours. And back in those days the pharmacist was very much a caregiver as well as just someone who ran a complete drugstore but also ran a pharmacy. So people would come in and ask my dad for advice and he clearly would stay within his level of knowledge and try to get people to go see the physician. But nobody had health insurance back then. That was kind of an unknown quantity. That was before Medicare and before Medicaid, et cetera, so a lot of people came to the pharmacy looking for advice and counsel before they spent money going to see the doctor and so forth. But I observed early on with my dad that there were, and this was before credit cards and all this sort of stuff, when he would be in the pharmacy, generally on weekends, that certain people would only show up when he was there to get their prescriptions. Interesting. And so that intrigued me. People paid by cash. We did have credit. They were 5.5 x 8 cards that you just simply wrote on. If somebody couldn’t pay cash at the time of a visit or getting their prescription, they would have credit and they would receive … Mom would send them a bill at the end of the month and hopefully they would pay. But then there were a small group of people that, again, I observed that they would only come in when Dad was there. These were people that could afford neither. They didn’t have cash, they didn’t have insurance and they couldn’t afford credit. And my dad knew who they were and when they would come in he would make sure they had their prescriptions but he would go and talk to them privately, out of the pharmacy, somewhere else in the drugstore and make sure that they understood. Because I intentionally overheard some of these conversations. That’s called eavesdropping. Exactly. Kind of hide behind where the magazine rack was because I was just interested in what those conversations were about. And was telling people, you need to take your blood pressure medicine or you need to take whatever it was that they had, recognizing that they couldn’t afford to pay right then, but he knew they would make good on it, and eventually they did. That may have been a bushel of peas that they brought to the drugstore or a bushel of corn-on-the-cob or whatever, but they would eventually pay in some fashion even though they could not afford cash or anything like that. That’s wonderful. So with that example, I simply learned early on that it was kind of special to be in the healing profession and that influenced me greatly. So between observing that and then having a next door neighbor being a family doctor and the other physician down the street from the drugstore being a family doctor and the clinic across the street and seeing how Dad worked with the two of them. They kept saying we have two family doctors and a pharmacist, all you need is a general surgeon and an undertaker and you could cure the world or take care of the world. A lot of truth in that. \n\nSo that impressed upon me the desire, again, to go into a healing profession and to choose medicine and obviously to choose family medicine, given the mentors that I grew up with. Not just my dad, but the other two family physicians as well.\n\nDr. Ostergaard: Did it ever influence you to potentially be a politician?\n\nDr. Henley: Thanks for reminding me because that was the other part of the equation. So, again, l watching Dad in the legislature, in my opinion he did a lot of things for the state of North Carolina, not just healthcare stuff, although he did a lot of that, but other things as well. It impressed upon me the opportunity in politics to do something greater in good for people. And, again, Dad set the example that, in watching him, he was all about doing what was right for the people of North Carolina regardless of party affiliation, even though he obviously was a strong Democrat. Back in those days North Carolina was a strongly blue state, unlike being a red state today. But I would classify him as a conservative Democrat but he did work across the aisle. There weren’t that many Republicans in the state legislature, but there were some, and he was not hesitant to work across the aisle to try to achieve what was good for the people of North Carolina. So that was the example. So the ability … Once I went into medical school and got involved in the Academy, it seemed natural to kind of become involved in medical politics, as it were, in that regard. I didn’t want to be involved in civil politics because it would drive me nuts trying to raise money but … You didn’t want to do the baby kissing routine. Right. People have asked me from time to time if I wanted to run for public office and I said sure, if I don’t have to campaign. If I could just be in the office and do that, then that would be fine. \n\nDr. Ostergaard: Just a little bit more about growing up. Siblings and what was it like growing up in North Carolina? And any particular goals … You’ve been very good in talking about your goals that came from your relationship with your dad and what he did and all, but any more about growing up, siblings?\n\nDr. Henley: I have two brothers. My older brother John was four years older and he became an otolaryngologist, obviously also went into medicine. And then my middle brother Bobby was thirteen months older and he became a pharmacist and he took over Dad’s drugstore once Dad eventually retired from pharmacy and so forth. He still runs a small, independent pharmacy now. He’s pretty much divorced himself from all the drugstore stuff. He no longer has a fountain. He obviously had to compete against the larger chain stores now, so he’s decreased his inventory except for the pharmacy and he competes very well based on service and relationships, much like family doctors do. Hope Mills was a very small town. Growing up it probably was a town of maybe 2,000 people at the most, maybe 1800. No stoplights. I can remember when the first stoplight went in. That was a big day in Hope Mills when that happened on Main Street. We had a lake in front of our house that we could water-ski on and weekends were terrifically busy on the lake. And at that time you didn’t have other ice cream places like Dairy Queen and stuff like that. You didn’t have those. So the fountain the pharmacy was where everybody came to get their ice cream or a fountain drink or whatever. And from the time I was probably ten years old, I was a soda jerk. And weekends were busy with a full service fountain and things like that. We water-skied a lot, taught a lot of people to water-ski and just had a lot of fun growing up in a small town. \n\nDr. Ostergaard: When you grew up you married Mary. And I know you’ve been married for a very, very long time to Mary. Tell us, for a moment, how did you meet Mary and about the unusual sibling situation you have with Mary and you and your in-laws.\n\nDr. Henley: I’m happily married to Mary Stone Henley for forty-four years. Actually forty-five years now. But we met in high school. Her dad was a Methodist minister. He obviously retired, but he’s also dead now. All the parents are gone now. So when I was a sophomore in high school and she was a junior, her family moved to our church, Hope Mills United Methodist Church where he became the pastor. He was in the eastern conference of the Methodist church in North Carolina. And typically pastors would be every two to four years. That was just kind of the routine back then. So Amos was assigned to our church and they moved. So the way we met, that summer, which would have been probably the summer of ’66, that’s the summer I got my Eagle Scout award with a friend of mine, Evans Jackson. So in late June or that summer, or early July, which was probably like a month after they had moved there, we had the ceremony for that in our church with the scout troop. So her little brother Henry came to that service with his older sister Susan who is the oldest of the four siblings of the Stone clan. So after the ceremony was over, there was kind of a receiving line that my buddy and I were in, had gotten the Eagle award. So Susan brought Henry through the receiving line and he was most impressed with both Evans and I in terms of our medals and our merit badge sash and all this sort of stuff. So literally a week or two later when I was working in the drugstore Henry got a bad cold, so Susan came by the drugstore -  because Henry said he wanted a Coca-Cola and he wanted Doug Henley to deliver it bring it to him. So Susan came. I  had not met Mary at that point in time. So Susan came by and I said, sure. The parsonage was like two blocks from the drugstore, so when I got off that day, it must have been a Saturday or something like that. It was during the summer, so school was out. So I said, okay, I’ll bring Henry a Coca-Cola and I did. So Susan wasn’t there but Mary was. And, of course, she was starting her junior year at our high school and I was starting as a sophomore. So I brought Henry his Coca-Cola but I spent the next two hours with Mary. So from then on we started dating and dated for seven years before we finally got married. Dated through high school and college, then got married the summer before medical school.\n\nDr. Ostergaard: And was there some unusual … Did somebody else marry somebody else?\n\nDr. Henley: Yes. Just before Mary and I started dating, my older brother John, who was the same age as Susan, they started dating. And so brothers were dating sisters. And Johnny was already in UNC-Chapel Hill. Susan was at UNC-Greensboro, where she graduated from. And they dated for several years. Then they actually broke up for a period of time, for about eighteen months or so, then eventually got back together. And they got married two years before we did.\n\nDr. Ostergaard: So brothers married sisters. That’s really cool.\n\nDr. Henley: Right. That works well as long as the in-laws get along together, which they did. So that was not a problem. That’s a good thing. Still do, I hope? That’s right.                   \n\nDr. Ostergaard: Let’s switch to kind of your educational sequence. Where did you go to college? And anything you would like to share about college besides the fact that you were about to get married? And where did you go to med school and on to residency? \n\nDr. Henley:  So graduated from high school in 1969 and went to UNC-Chapel Hill for undergraduate school from ’69 through ’73, then medical school at UNC from ’73 through ’77 and then residency at Chapel Hill from ’77 to ’80. Undergraduate school was fun. I’d been very much involved in clubs and things like that in high school, Key Club and all that sort of stuff. So when I got into undergraduate school, frankly I didn’t want to do much of that at all. So I just kind of concentrated on studies, concentrated on Mary. The first couple of years she was actually at Western Carolina University way up in the mountains. So for the first two years we were separate from each other, so we had a long distance relationship which was difficult, but we managed it.\n\nAnd then she transferred eventually to Chapel Hill and finished her last two years at UNC so that we were able to be together then. But again, I didn’t really get involved in undergraduate school or clubs or things of that nature. I was inducted into Phi Beta Kappa and stuff like that, but mainly just concentrated on school and getting in eventually into medical school. We got married on May 26, 1973, right after I graduated from undergraduate school, just before entering medical school. Mary graduated the year before and she was working fulltime at a job in Chapel Hill. So started medical school that summer of ’73 and did that for the next four years with all the routine that involves. And then did residency for the next three years again at Chapel Hill.\n\nDr. Ostergaard: When you were in your residency in Chapel Hill, could you talk about, for a moment, any of your professors or teachers or mentors who were particularly meaningful? And I specifically would like you to comment on Ed Shehady (?) and also in terms of your then later transition into medical political, to Bob Shackelford. \n\nDr. Henley: In terms of Dr. Shackelford that you mentioned, that was in medical school. So let me go there first because I met Bob before I actually met Ed Shehady. So in between my first and second year of medical school, which would have been the summer of ’74, I had somehow worked it through some part of the medical school to do a family medicine preceptorship. It wasn’t required or anything like that and didn’t get any credit for it, it was just something, kind of a voluntary rotation that summer for six weeks. Interestingly, the faculty advisor then was a guy in anesthesia, of all places. And somehow, working through him and other contacts in the medical school, he had found out about Mt. Olive Family Medicine down in Mt. Olive, North Carolina. And Bob Shackelford and his partner, Herbie Cranegy (?), were the two people that ran that and they had always been accepting of family medicine residents from the Duke residency program – and they did medical students sporadically. But through this kind of summer preceptorship program, which they provided a stipend just for living, support and things like, I was able to spend six weeks down at Mt. Olive Family Medicine. Interestingly, Mary’s parents, her dad being a Methodist minister, they had been previously assigned to a new church in Warsaw, North Carolina, which is like fifteen miles from Mt. Olive. So I was actually able to stay with them during that six weeks that I went down there. I just fell in love with Dr. Shackelford and Dr. Cranegy. They were quintessential family doctors. They did ambulatory family medicine only because Mt. Olive was probably thirty miles from the nearest hospital which was in … It was too far away to do hospital work. But had a great network of – they supervised the local EMT emergency medical group, so they could transfer folks easily to the hospital thirty minutes away. So they had built not only their new office building, because previously they had been in solo practice, independent of each other, they came together as a new practice, built a new office, an office that I modeled my future office after years later. And they built a skilled nursing facility right next to it and they were obviously the supervising physicians for that. But it was just a great experience in between first and second year of medical school. And met Bob Shackelford and Herbie Cranegy at that point in time. And then a couple of years later, when I did my mandatory family medicine rotation as a fourth year student, then I arranged to go back there and do that rotation with him as well. And they were happy to have me back. And, of course, I knew a whole heck of a lot more then than I did as an infantile, between first and second year of medical school. I was able to do help do a whole lot more then than I was the first time around. When I was there that second time, towards the latter part of my fourth year of medical school, Dr. Shackelford was already involved and had been involved in the North Carolina Academy very strongly. Had been president of the North Carolina chapter. And at the time I was there the second time, he had been elected as vice-speaker of the Congress of Delegates of the AAFP. \n\nSo let me stop there with Bob Shackelford, then come back now to Ed Shehady. When I was there with Bob Shackelford the second time, that would have been the spring of ’77, which is when I graduated from medical school. The year before that, in 1976 when I was finishing my third year of medical school, my last rotation was on internal medicine and I was on a certain rotation. And I happened to be on call one night with a family medicine resident who happened to be on that rotation. Kurt Elscherman (?) was his name. And the new chair of family medicine, Ed Shehady, just shows up one night while Kurt and I were taking call. Now, what department chair shows up at 8:00 at night and hangs around for six or seven hours during the middle of the night? And Ed was the new chair of family medicine there, he took Robert Smith’s place. His goal was to see what it was like for one of his residents to take call on the internal medicine rotation. But here I was, the lowly third year medical student who just happened to be on call that night with Kurt. So Ed is the perfect example of the teachable moment. He’s just a great teacher. And he paid relatively little attention to Kurt but a whole lot of attention to me because he knew I was interested in family medicine, or at least we talked about that. So he was obviously beginning to recruit me for a future residency at Chapel Hill, which was fine with me because that’s where I wanted to stay. It was just a wonderful five or six hours spending time with Ed. One, getting to know him because he’s just such a fun guy, but a great teacher as well. And a few weeks later he called me up, which was the summer of ’76. So you were then between … Finishing third year, starting fourth year. Between third and fourth year? Exactly. He called me up and said Doug, I’d like to send you to this meeting in Kansas City for residents and students. So I said, okay, Dr. Shehady, I’d be happy to go but I don’t have any money to go to Kansas City. He said that’s okay, we’ll pay your way. So I came out to Kansas City. I guess that was probably the second time in my life I’d ever flown on a plane. Obviously the first time I’d come to Kansas City. I think that was the second student meeting and the third resident meeting because the residents had started, I think, a year before the student section did, as I understand it. And that’s where I met people like Bruce Bagley, a future president of the Academy, Joe Sugar, who was on the board but did not become president. Just a whole lot of other people. I’m not sure you and I met then. I think you and I met the following spring, which I’ll come to, when I came out to SOC and so forth. I obviously was turned onto the Academy. We had the students and residents that were there that gave their updates about their involvement with commissions and committees of the Academy. So when I got back home after that meeting, of course I let Dr. Shehady know what had happened and told him I was interested in serving on a commission as a student member. And obviously with my dad’s history that we’ve already talked about, I indicated that I would like to serve on the Commission on Legislation and Governmental Affairs. And so I talked to Dr. Shehady about it and I connected with the North Carolina Academy folks. And, of course, by that time not only was Dr. Shackelford on the board of the AAFP as vice-speaker, but Dr. George Wolfe (?) from North Carolina was a director on the Academy board. So I submitted my materials with the North Carolina Academy’s support. The new secretary of the North Carolina Academy was a lady by the name of Sue Makey (?), who would become the future CEO of the North Carolina Academy. So Sue and I started kind of at the same time with the North Carolina Academy. And sure enough, I was appointed by the board I’m sure because of Dr. Wolfe and Dr. Shackelford. I was appointed to the board as the student member of the Commission on Legislation and Governmental Affairs and attended my first commission meeting January of ’77. Let me finish the story, then I’ll shut up … So early that next spring, the spring of ’77, I was back doing my fourth year rotation with Dr. Shackelford and Herbie Cranegy in Mt. Olive and Bob Shackelford left to go to the board meeting prior to the SOC, the State Officers Conference. And they were going to have a panel discussion at that meeting about should every medical school have a department of family medicine. And so they had invited John Surso to be the student  …  John was the student chair and invited John to be on that along with Bill Coleman. Bill Coleman, a future president of the Academy, was then the resident chair. Bob Ragel (?) was the professor of family medicine. I guess Bob was still at Iowa then, I think. So he was kind of the elder statesman on the panel. And then they had Dean Elliott Richardson from Emery, who was the anti-department of family medicine speaker. Because Emery didn’t have a department of family medicine and according to Dr. Richardson, he would die before he would have a department of family medicine. Anyway, at the last minute, for some reason, John Surso could not come. That was actually during the board of directors meeting prior to SOC. So Dr. Shackelford raised his hand said I know where Doug Henley is. And, of course, I had been on the commission meeting and so forth, so some other people knew me by then as well. And so he called up and said, Doug, we need you out here in Kansas City. I said, well, Dr. Shackelford, I don’t have any money to come to Kansas City. And he said that’s okay, Herbie will write you a check and the Academy obviously will reimburse us. So off to Kansas City I went for the second time. That’s where I met you. Of course, I checked in about that with Dr. Shehady first and he said sure. So I met you at the Infectious Disease Symposium at the University of Kansas before SOC. I remember. Because you were going to kind of give me the lay of the land as to how this SOC thing worked and how this panel would work and so forth. And you immediately started grilling me about … Somebody was giving a presentation about meningococcal meningitis and you started grilling me about  meningococcemia and so forth. I think I got the answers right, but I can’t remember. So that’s how you and I first met.\n\nDr. Ostergaard: That’s not only a fun series of stories but it is an absolutely emblematic example of many things: No. 1, the value of a family medicine preceptor in encouraging a young student to go into family medicine. Absolutely. The value of somebody who has an interest in going beyond the norm; that is, getting involved, in this case, medical politics, encouraging a student to get involved in medical politics. And it’s an example of mentorship all the way around from Dr. Shackelford as a vice-speaker of the Academy and George Wolfe as a member of the board and Ed Shehady who wasn’t so much involved ever, really, in medical politics but an incredibly involved guy in working with residents and students in his role as president of the Society of Teachers of Family Medicine and other things like that. And, also, I must say the interest shown by a young Academy employee, me, in saying, well, let’s test and make sure this young kid from North Carolina is really on track. And passes the muster. And passes the muster. Obviously it was very clear that you did. And because I was in charge of resident, student, on the staff (?) side in those days, I remember that you did very well in that panel. And what I don’t remember though is – and if you remember, did you or any of the others on that panel really nail Dr. Elliot Richardson, the dean? How did that go on?\n\nDr. Henley: Well, I think we did. For some reason, I got to go first as a student. And I did have the audacity to say that, yes, every medical school should be required to have a department of family medicine and actually got a standing ovation from the audience. And then Bill Wendt (?), and then, of course, Bob Rankle (?). And the funny thing was Dr. Richardson, he was certainly intent on defending himself and he used the mantra or the advocacy point that he thought the curriculum of medical school should not be circumscribed to the point where one department would be required versus others because the LCME, at that time, technically did not require any particular department and so forth. But obviously during the Q\u0026A it was pointed out, would Emery get accredited if it didn’t have a department of surgery? Would Emery get accredited if it didn’t have a department of internal medicine? And he really didn’t know how to answer that, even though technically none of them were required per se. But the funny thing was (you may remember), in those days at SOC, if you talked too long … You had warned me about this and said If you talk          \n\ntoo long then they would have these crazy noises that would come across the intercom and shut you up. You know, kind of like the proverbial shepherd’s (?) hook, you know. So, bless his heart, Dr. Richardson went too long and this big lion’s roar came over. I’m sure he had been warned, but I don’t think he was expecting it. And so he had to kind of shut up in mid-stride because of that. Of course, that got a big laugh from the audience because nobody else had gone over, but he did.\n\nAnd that was a pretty big audience? Oh, yeah. How many people were there – a couple of hundred.\n\nAt least, yes.\n\nDr. Ostergaard: That’s a series of examples of a very, very bright med student and resident and the relationship between that student and a series of mentors and how important that is to our formation as a specialty and indeed going on forward to the next phases of our specialty.\n\nSo then after residency you went back to private practice. Yes. Or you started private practice. Let’s talk about private practice and how that formed you. And then how, with your role with the North Carolina Academy, that got you interested in going further.\n\nDr. Henley: Thanks to Ed, we had a strong practice management curriculum in residency. Again, this was 1979, 1980, in my last year. So I met a fellow resident in my class by the name of Chris Aull (?). And it’s interesting, Chris and I actually had met while we were both interviewing for a family medicine resident at the Medical University of South Carolina down in Charleston where Hyram Curry (?) and Lou Barnett were. A very reputable program back then. Everybody wanted to interview there. And it just so happened, and it was our wives that later remembered this, that both of us happened to be interviewing down there on the same day. So we actually met each other then, which would have been in the late fall of 1976. Then when we both showed up at the first day of residency, in the summer of ’77, at Chapel Hill, we thought we recognized each other, but it was our wives that put that together. So it was kind of, again, in my mind, pre-ordained by the Good Lord that Chris and I would get to know each other and become fast friends and ultimately decided to go into practice together. So during our last year of residency we began to plan for that and I was able to convince him that we ought to go back and practice in my hometown of Hope Mills, North Carolina because there were no other family physicians in the community at that point in time and so forth. So again, working with my dad and working with the local bank, we thought we were nuts but we borrowed $250,000, in 1980 dollars, and built a brand new office with some local contractors there and started our practice on July 28th, 1980. \n\nTape 1, side 2\n\nDr. Ostergaard: This is side 2 of the tape, the interview with Dr. Douglas Henley, on October 9, 2017, and we’re talking about private practice. So back to you Doug. You just set up your practice with a quarter of a million dollar loan with one partner and two very, very courageous young docs.\n\nDr. Henley:  It was and we kind of wondered what in the hell we were doing, but we did it – kind of the old-fashioned way, the E.F. Hutton way, I guess, whatever. Anyway, we started in July of ’80. And, again, the practice began to accept patients very rapidly. Back in those days electronic medical records were not yet available, but we decided to start from day one with an electronic practice management system which was unusual in those days. Most people had kind of a pegboard written system for how they billed people and collected and whatnot. But as part of that $250,000 we decided to invest in the computers and do it the right way and become electronic early on. So, again, we gradually built the practice. We added a third partner I think around 1985. Chris and I did obstetrics for the first ten years, routine obstetrics as well as full scope family medicine. Had hospital privileges at the hospital. Cape Fear Valley Medical Center was available, so from the office that was like a fifteen, twenty minute drive. And we actually lived in Fayetteville,     just practiced in Hope Mills. The practiced built very rapidly. I was there between 1980 and 2000 when this job became available. And at one point we were up to five physicians and almost from day one we always had at least one or two physicians assistants and/or nurse practitioners also working in the practice as allied health professionals also helping us see a large volume of patients.\n\nSo the practice was well received by the community. We made a decision early on that we would always make sure that based upon the population within the county that we were in, Cumberland County, whatever that population was as a percent Medicaid, that’s what our practice would be. So if the population in the county was 10% Medicaid say, then we would allow up to 10% Medicaid for our practice. Probably about 25% of the practice was Medicare. The rest was private insurance, although there was probably a 10% crowd that was uninsured and did not have Medicaid or Medicare or private insurance. So it was a diverse practice and served both the rural community in southeastern Cumberland County which did not have any other physicians or other providers at that time when we began, subsequently did - but also provided full scope. We were very proud of it.\n\nDr. Ostergaard: That is again a great example of not only the courageous two young doctors starting a practice with a lot of money borrowed, but full service practice and the use of computers.\n\nAs you brought the partners on, how did that work? Was that because your volume increased and you had to have them or you wanted the extra physicians and PAs that you mentioned to grow the practice?\n\nDr. Henley: A little bit of both. Fayetteville had a family medicine program that was affiliated with the AHEC system. And at that time, that particular AHEC was affiliated with Duke rather than Chapel Hill, because Chapel Hill didn’t it, as I understand it. And so John Blue had trained there and he had a scholarship payback requirement, so he actually worked for a while up in the northern part of Cumberland County at I guess it was kind of like a rural health clinic at that point in time. Probably would be called a federally qualified health clinic at this day in time. And John did that for two or three years and then he wanted to join a group for call purposes and we wanted to add physicians for call purposes as well as volume. So he joined us, brought some of his patient population down to the southeastern part of the county (not all of them). So he was our first partner. Then William Sanderson was the fourth partner that we added. William trained at the program there in Fayetteville as well. He was fresh out of residency when he joined us -  so, again, that allowed us to expand our patient volume and, again, add to the call schedule and things like that. Then our fifth partner who was Karen Barefoot, she also trained at the Fayetteville program and she joined us as well. She eventually left and went elsewhere, moved out of state. So adding partners and adding physicians assistants and PAs was, one, to handle the volume and the patient load, but also to handle the call schedule and so forth. Once John joined us, I guess it was probably later in the eighties, but he did not do O.B. Chris and I continued to do O.B. for a couple of years after that. And then we eventually decided to stop mainly because our annual volume was such that we began to feel somewhat uncertain with our skills in terms of maintaining our skills. And so that’s the main reason we stopped, not because of the burden. Or the medical legal wasn’t the issue? No, that was not an issue either. Interesting. And thankfully we had good support from the O.B. community in terms of backup and things like that, so that was not a problem either. \n\nDr. Ostergaard: Because you added some more folks to the practice, it made your ability to get more involved at the national level a little bit easier. So let’s get into some of the history, the trajectory that got you to where you are sitting right here today. In terms of both North Carolina Academy stuff and your taste, as a student, of American Academy stuff led you to do that pretty fast. Let’s go through some of that and tell us … You mentioned as a student you were on the Commission On Legislation and Governmental Affairs. What other ones did you do? Tell us how it all happened.\n\nDr. Henley: The first thing I’d like to say, Dan, is that from day one Chris knew that I wanted to be involved in the Academy. I was a co-chief resident with one of the other residents in our class, so he had observed me being involved in the Academy all during residency. And in my last year of residency I was chair of the resident section for the Academy and he knew about that. In fact, he had gotten some advice from faculty and others. When he was thinking about joining me in practice they said, Chris, you understand that Doug is going to be involved in the Academy come hell or high water and who knows how long he will be in practice because of that. But I had committed to him that I wanted to stay in practice but obviously wanted to do the Academy stuff as well and he was very supportive of that. So that was very important. And the other partners that we eventually brought on, they knew that as well and they were willing to do that. And my commitment to them was that I would be using my vacation time and stuff like that when I was involved in the Academy stuff and that I would, except for ultimately my presidential year, take equal with them during the year and things like that and that I would continue to be very productive in terms of … Because we were on a kind of productivity formula in terms of how we got paid and what our salaries were, so I wanted to continue my salary, obviously, but I wanted to obviously not try to increase a significant burden on them in terms of seeing patients while I was gone. During residency I went from student to the resident member of the commission. So my first year of residency, I was the resident member of CLGA. And I had intended to continue that, but Ed Shehady and Joe Schutar (?), Joe had just finished the term as the resident member of the RRC for Family Medicine, Ed and Joe approached me about taking over as the resident member of the RRC for one year. I agreed to do that and was appointed to that and that was an exciting and different year of involvement with the Academy. Ed let me use his secretary. There was a lot of paperwork involved with the RRC back in those days (I don’t know what it’s like today). But Ed allowed me to use his secretary at UNC to do all that paperwork stuff that you had to complete. And he later said that I used her about 90% of the time and he only had her for 10% of the time. And then obviously in my last year of residency, I ran for and was the resident chair during that last year of residency.\n\nOf course, I was involved in the North Carolina Academy all during this time and had served as a resident member of the board of directors of the North Carolina Academy. They were very welcoming and very supportive of my involvement as a resident and to some extent as a student, because it was just the latter part of that year, my fourth year of medical school. And early on, at the state level people reached out to get me involved. For example, I mentioned Herbie Cranegy from Mt. Olive. Herbie, at that time, was getting involved in the state chapter and in the early eighties was president of the North Carolina Academy, like ’81, ’82, something like that. He called me up one night and said, Doug, I want you to be chair of our Scientific Program the year that I’m president of the North Carolina Academy and plan our Scientific Program. I didn’t know how to do a Scientific Program at that time, but I learned with Sue Makey’s (?) help and so forth. So people like Herbie wanted to keep me involved in the leadership track, as it were, with the state chapter. And, of course, Bob Shackelford and George Wolfe were likewise inclined and other leaders. I met Jim Jones briefly during my fourth year of medical school. But certainly when I went into residency and went into practice, Jim was a very strong mentor in terms of encouraging me to stay involved both at the state level and at the national level and has always done that. More about that in a minute. \n\nAnd interestingly, from the time that I was involved with the AAFP on CLGA as a student, every single year thereafter I was always involved with the Academy at the national level. That may be a record. It may be – just by a set of circumstances. So when I finished my tenure as resident chair, then the Academy started this connection with … Do you remember the International Ladies Garment Workers Union? I do. Well, we had a task force on that. The taskforce on the ILGWU. And Sandy Panther was the secretary for that. And so Bill Coleman called me up, I can’t remember why, and asked me to be a representative to that ILGWU taskforce. I’m not exactly sure how that happened. So I did that for a couple of years. Now, what in the world did you know about ladies garment unions? I didn’t know anything about that or unions. But the union was interested primarily in educating their workforce about health and health care and they looked to the Academy to provide that type of education. So I guess they wanted a young physician in practice to be involved in helping them formulate that, so I got chosen. And that started kind of at the end of my residency period. And then the first couple of years in practice was involved in the North Carolina chapter. Then, probably mainly because of Jim Jones, I got appointed to the Committee on Scientific Program which was a three year appointment. But then I also served as chair, so it ended up being a four year appointment. And then following that I got appointed to the Commission on Health Care Services. You could serve for two 3 year terms back on those days. So I served my first term, got re-upped and served the first year as the second term. And by that time it was 1991 and that’s when I ran for the board and was elected to the board in 1991. Again, all through that time from 1980 to 1991 I was involved in the state chapter obviously and served as the … Interestingly, I was never an at-large member of the North Carolina board of directors. I was always on a committee or a chair of a committee. It was based on a regional system at that point in time and when the region that I was in, in Cumberland County, that southeastern part of the state because open. And for some reason they appointed another guy who had never been involved very much with the Academy at all and somehow he got it rather than me and I was royally ticked and so forth. But to the credit of some of my mentors, they said, Doug, just hold your horses, it will happen. And sure enough, like a year or two later all of a sudden the slate of nominees came out and I was nominated as vice-president – you know, just like that.  Well, somebody saw the value in this young man and his ability to go forward and they picked you. Yeah, I guess so. So I served as president of the North Carolina chapter at the ripe old age of thirty-six in 1987. Do you have any idea if you were the youngest president? I think I was – because, again, that was kind of unheard of back in those days. And I actually served an eighteen month term because they were switching from a winter to a spring meeting, or vice versa, I can’t remember which, so I served an eighteen month term. But, again, the chapter was very supportive. And in 1984 was when Jim Jones ran for the board of directors. And I’d been in practice only for four years and Jim chose me to be his campaign director. So I was happy to do that. In 1978 I had chosen to go to the Congress of Delegates at the Annual Scientific Assembly every year even though I didn’t have an official position. Again, some mentors told me I needed to go. Dr. Shehady made sure I had financial support to get there. And my first Congress of Delegates was in San Francisco. And I just showed up as a resident and just watched and fell in love with the Congress of Delegates and all the falderal of the Congress and the politics of the Congress and the elections and everything else and decided that, hey, I wanted to do that someday.\n\nDr. Ostergaard: You haven’t mentioned it yet, but I assume you became a delegate from North Carolina to the AAFP Congress of Delegates?\n\nDr. Henley: Yeah, later. But that was in like the late eighties. But that to have been way before you ran for the board? It was, but not too late. I think the first time I served as delegate was maybe around 1987 or 1988. And, again, that happened because one of the delegates at that time had been a delegate for a reasonably good time, Wally Brown … Again, Wally was always supportive of me eventually moving up in the Academy and he intentionally stepped down as delegate so I could fill that position. I mean it was obvious - he stated it. \n\nDr. Ostergaard: That’s wonderful. And indeed that defies a little bit sort of what the tradition had been in all of the Academy state chapters, that you go through all the steps and you pay your dues and the most senior guy gets the price. And you obviously defied that and people said, well, this young man ought to go far. \n\nDr. Henley: So I ran Jim’s campaign in ’84 and he ran for president-elect in ’87 and was elected, obviously, and served the next three years in an officer position. He came off the board in 1990, that was his last year I think, and then I ran for the board in 1991. \n\nDr. Ostergaard: Were you ever involved with the Commission on Health of the Public and the Commission on Science? \n\nDr. Henley: The first two years of my board tenure. That’s right, I remember that. The board members at that time shared commissions. Shared commissions, right. So I had never done that commission or knew much about it. And, obviously, as is true sometimes today, most of the board members wanted the legislation and health care services because they were kind of the more public commissions. But I really wanted to go for, then it was called Public Health and Scientific Affairs, because it wasn’t anything I’d really done before. So I thought it would be good just to get involved in that. So Herb Young was the staff executive. And I was his v.p.. So I remember that.        \n\nYou were the v.p. at that time. So I served as chair for two years in a row, my first two years on the board. And, actually, I thought this had happened, so I had Jodi look it up. But one of the proudest moments of my career in family medicine was in the summer of ’92, which was kind of getting towards the end of my first year on the board, the board was going through a revision of its strategic plan. And, remember, at that time we had two summer board meetings, one in June and one in August. And the one in June, I had talked to you and Herb about it … So they were going through the strategic plan and I made the motion to have them insert into general objective No. 1, it had previously been there about encouraging health promotion disease prevention in patient education – that was already there. But we inserted or had inserted “To assume a leadership role in improving the health of the American public.” Douglas, I remember that so distinctly. I was probably more proud of you for that than almost anything else in your entire career because it was new and we had to take care of the public health needs of people. And that continues to this day, in a major way, in our strategic plan. Where was that board meeting, because I remember that? Prince Edward Island, BVI, Canada. \n\nDr. Ostergaard: Well, lots of good things you did all these years. So tell us about the trajectory top the presidency. I assume that when you were a puppy, as a student, you decided you wanted to the president of the AAFP. And you can challenge me on that, if you wish. But tell us about your thought process and when was it clear you were heading that way?\n\nDr. Henley: My first commission meeting was in January of ’77. But November of ’76 I had gone to the North Carolina Annual Meeting for the first time as a fourth year student. And at that time the Academy president who came to the North Carolina chapter that fall was Les Huffman from Ohio. And, again, either George Wolfe or Jim Jones or Bob Shackelford or somebody introduced me to Les Huffman. You remember Les, he was a very gregarious guy and just loved to talk to everybody. And he encouraged me to get involved and stay involved and so forth. And that January when I went to the Legislation on Governmental Affairs meeting, the commission went out to dinner one night. And Mike Miller was the staff executive for the commission and Mike was general counsel for the Academy then. And he said, at the front of the hotel and people getting cars, we’ll go out to dinner. So I said okay, so I showed up. And the next thing I knew I was in the middle of the front seat of a car, people going to wherever the restaurant was – that’s when you had bench seats, back in those days. So a guy named Jack Stelmach was driving the car. Jack from Kansas City. Jack I think was board chair then. And on my right was Les Huffman again, who was the current president of the Academy. And so everybody was chatting. They were talking to me like I was the center of the universe because I was a student interested in family medicine. So I got to talking to each of them about what does the board chair do, what does the president do. And I was just thinking in my mind that, hey, I could do those jobs. So that became kind of the goal at that point in time, knowing that obviously that was some time in the distant future, but hopefully not too distant.\n\nDr. Ostergaard: So it did start when you were a med student?\n\nDr. Henley: Absolutely.\n\nDr. Ostergaard: So when did you put the plans in motion and when did they come really concrete? I assume when you were on the board - or was it all through the commission structure and everything?        \n\nDr. Henley: Well, probably both. But mainly in working with … That’s where it became important to be involved with your state chapter because obviously nominations come from state chapter for those positions and still do to this day. So if I had remained involved only at the national level and had not demonstrated leadership and involvement at the state level, then I would never have accepted the North Carolina chapter to be as supportive as they were. But I think, again, through hopefully hard work and demonstration of hard work, also with the support of a lot of mentors along the way – you know, people like Bob Townsend who lived not too far from Fayetteville, and Herbie Cranegy, as I mentioned before - George Wolfe, Bob Shackelford and Jim Jones, in particular. People like Lynn Church and others really supported that. So, again, by 1987 I was chapter president. Served in that role. Became a delegate around the same time in the Congress of Delegates. Obviously ran both of Jim’s successful campaigns for the board and president-elect. So I was getting known by the folks in the Congress of Delegates. Working hard with the ILGW taskforce as well as the Scientific Program committee as well as Health Care Services. And once Jim came off the board in 1990, then we were anticipating my running for the board at the ripe old age of forty for the board of directors, which we did in 1991 and was successful. Then obviously serving those three years, at the end of that three years you knew you had to run for something higher or you were off the board at that point in time. Fortunately I was chosen as chair. At that point in time, you may recall the chair was chosen from the third year class. And so I was selected chair that year, when we had the Annual Meeting in Orlando. And then ran the next year for president-elect in Boston and was elected president-elect at that time. And obviously served as president-elect, president and immediate past-president.\n\nDr. Ostergaard: When you became president were you the youngest president in the history of the Academy? We could look that up, but I certainly recall that.\n\nDr. Henley: I think so. When I became president I would have been forty-four. Forty-three when I was elected as president-elect. So I would think that’s probably true. I don’t know a way to verify that, but I suspect it’s probably true.\n\nDr. Ostergaard: I’m sure that Mr. Don Ivey, here in the Center for the History of Family Medicine, can figure out a way to corroborate or deny it.\n\nDr. Henley: Then, again, along with Pat Harr (?), I had the unique distinction of serving as board chair twice because during the year that I was president-elect that’s when we went through a big governance change. In subsequent decisions by the Congress of Delegates, we eliminated the position of treasurer, we eliminated the position of vice-president. The immediate past-president became the board chair. So with all the delay and the bylaws implementation and everything, even though that happened during my president-elect year, then the bylaws changes occurred during my president year, so when I became immediate past-president I became board chair the second time. And Pat did that as well. I think he and I were the only two that served as chair twice.\n\nDr. Ostergaard: Thinking back now to the sequence, just give us a little color. For example, I recall that the P.R. staff said that, well, we can send Dr. Henley anywhere. He can handle himself in any kind of a public speaking environment. Just talk a little bit about not just the sequence now but some of the more colorful things you did. And how did you view the differences that you faced being the outside guy as well as the inside guy? In the Academy structure the president is more the outside guy and the board chair is more of the inside leader. Talk about that.         \n\nDr. Henley: Of the two jobs, president and board chair, I must say I enjoyed board chair more. Not that I didn’t enjoy my presidential year, but I just enjoyed the organizational mechanics of the board chair year in terms of working closely with senior staff, then with Bob Graham as CEO, just in terms of the day-to-day organizational mechanics of the Academy and making kind of week-to-week board chair decisions about policy positions, letters to the federal government, things of that nature. But, again, enjoyed the presidential year very much and being the face of the Academy. I think all of the involvement that I did in high school and then the involvement with the state chapter of the AAFP over many years I think prepared me well for that. I felt very comfortable in the public arena and was able to testify before Congress a couple of times and so forth. But I think what Mary and I enjoyed the most was going to the state chapter meetings and meeting the troops. Because knowing that you represented the average family doc out there tolling through the important daily work of family medicine, it was just very rewarding to connect with family doctors all around the country and know that you were representing them. Being able to hear what their concerns were so you could more forcefully and more in an informed way represent their desires and their concerns. \n\nDr. Ostergaard: And despite the fact that you were in the rarified atmosphere of Congress and other organizations, they kept you grounded. \n\nDr. Henley: Exactly. And, also, the fact that I continued to be in practice at that time. So I think that grounded me as well, knowing what the everyday trials and tribulations were not only of being a family doctor but running a practice and trying to keep a practice open. \n\nDr. Ostergaard: We’ll come back to this in a little while. But the fact that you went back to practice successfully after all of the sequence and being president, was kind of a commentary on the fact that you kept that going. But back to the rarified atmosphere. So as the Academy leader both at the presidential face person and as the board chair, more a political leader person, you dealt with the AMA, you dealt with the other specialty societies. Talk about that and how that was a challenge or a pleasure or a difficult. Just how did you feel?\n\nDr. Henley: Well, I think the first challenge was actually a fun challenge because the year that I was chair the first time Bill Coleman was president. And you may recall, in November of that year, after I had become board chair, like September, October, whatever, that’s when the Clinton health plan … Was it 1994? ’93, 94. Yeah, that was a big year. Yeah. And so at that November board meeting was when the board took the risk of early on endorsing the Clinton health plan. We had a policy that said we endorse the Clinton health plan as a start in this debate. But a certain segment of our membership did not like that at all. But Bill Coleman and I had to kind of go on the road and defend that both at the state chapters as well as other kind of town hall meetings that we did during the course of the year, at clusters and things like that. And a lot of our members were not happy with this. But I think it was the right thing to do because back in 1989 we had adopted policy about health care coverage for all, which was like four years before that, and it was the right thing to do. It obviously did not pass. It failed for a lot of different reasons. But it was the right thing for the Academy to do. And I think, importantly, in my opinion it really put the Academy on the map as an organization to be dealt with from an advocacy standpoint at both the federal and the state level. And I think we benefited from that, even though some people thought we were on the wrong side of the equation. But I think we benefited from that in the long run in many important ways. So that was important.\n\nDr. Ostergaard: Did you take heat from … First of all, within the board was it tough to get that position passed? And, secondly, when it was passed and you and Bill Coleman went on the road, how bad was the heat from the chapters?\n\nDr. Henley: In terms of the board … Once the debate was over Mike Miller described it as probably the most important and most impressive discussion the board had ever had – and Mike had been around the board for a very long time. But you may recall … The board meeting lasted for two or three days back then. And on the first day it was a very heated debate. But at the end of that debate, I asked for a straw vote only. But said, look, we need to talk about this over dinner and have some time off before we take a final position, which we did the next day. The straw vote was very close but it was in favor. The next day, to his credit, Neil Brooks, who was then vice-speaker of the Academy … The initial motion was that we would support the Clinton plan, period. Neil made the suggestion the next day that we modify the motion that we support the Clinton plan as a starting point in the debate to achieve health care coverage for all. A great amendment. And at that point in time the subsequent vote by the board I believe was unanimous. We had a chance to talk more about it in a more social environment, which is very important sometimes for the board to do about controversial topics. And then when Neil added the additional amendment I think it was pretty well unanimous at that point in time. But the board, to their credit, fully supported that. And when Bill and I went on the road, again, just like it is today unfortunately, members were fairly evenly divided as to what was the role for the government to be involved in the delivery of health care and health care coverage versus the private sector and so forth. We had a lot of supporters but we had a lot of members that felt that that was not the right thing to do. But to their credit, once Bill and I could explain where we had come from and that this was about policy adopted in 1989 by the Congress of Delegates – it was not about politics, it was not about a political party, it was about policy the Academy based on the Congress of Delegates adopted policy adopted by in 1989. And I think members at that time were respectful of the decision. They may not have agreed with it, but they were respectful of the decision. And I still think it was the right place to be, even though ultimately it did not pass. \n\n(Recorded conversation ends.)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=0.0,4371.11351"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82312","type":"AnnotationPage","label":{"en":["Dr. Douglas Henley Interview Transcript (2) [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82312/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tape 1, side 1\n\nDr. Ostergaard: It is December 20, 2017 and we are in the Center for the History of Family Medicine. I am Dan Ostergaard interviewing Dr. Douglas Henley, part two of a three part series of interviews and I guess formal and informal oral history of the man who in this particular iteration of the conversation is in the highest elected leadership of the AAFP. Doug, last time we talked we finished up talking about the time when you were first board chair. And it was the time in 1994 when we, the Academy, were doing the Clinton Health Plan and that sort of thing. And we’re picking up from that point and hopefully through this conversation we’ll go through your second board chair year, which is your past president year. \n\nAnd I will give you the opportunity now to, first of all, tell us if you agree that we record this? Yes. \n\nTell us what else you might want to say about your first board chair year. And we’ll kind of go chronologically through this period of time and ask you to highlight lots of different things.\n\nDr. Henley: Again, as we’ve discussed before, the first board chair year was pretty much consumed by defending or advocating for health care coverage via the debate that was occurring in Washington around the Clinton Plan. And again, the Academy wasn’t fully convinced the Clinton Plan was the final solution of achieving health care coverage for all, but we offered our support of the Clinton Plan as a starting point in that debate both with the American people, with our membership and with the U.S. Congress and the Clinton administration. So, I think the Academy, just as we would years later with the Affordable Care Act, saw that legislation as a principle stance because of long held policies since 1989 about the need to achieve health care coverage for all. And this was the opportunity finally for the American people and our elected representatives to have that debate as to what the outcome would be - how do we achieve that goal within the context of the American experiment of a representative democracy?\n\nDr. Ostergaard: Remind us please as to how the Academy membership perceived all of those activities at that time both as they were coming down in D.C. and as the Academy took its position based on 1989 policy.  \n\nDr. Henley: Again, for some it was a very positive position for the Academy to have taken, so probably half of our membership was very supportive of the Academy. The other half expressed their concern and in some cases anger that we had taken that position. But those that were concerned about the Academy position, I think only read the first part of the policy statement, that ‘we support the Clinton Plan as a starting point’, but they ignored the latter part of that statement and thought we were just supporting the Clinton Plan because that was quote a Democratic plan. But, in my experience once either myself or Bill Coleman, who was president then, were either individually or collectively out talking to members and explaining the Academy’s position, most would be understanding as to why the Academy was taking the position – it was about policy not about politics. \n\nDr. Ostergaard: Were there specific resolutions to the AAFP Congress of Delegates at that time pro or con?\n\nDr. Henley: I don’t think there were. There certainly were none that were anti- Academy policy.  I’m sure, expressions of concern at reference committees and things of that nature did occur, but I don’t remember there being any resolutions that would have rescinded the Academy’s support, for example, of the Clinton Health Plan as a starting point. By that time … The board came out with that policy in November of ’93. By the time we got to the next fall, the fall of ’94, the Clinton Health Plan was kind of falling apart because of the national politics. So, by that time it was obvious that it probably was not going to be going anywhere despite all the activity that had occurred during that winter.\n\nDr. Ostergaard: So you were elected president-elect. Any comments on that, what happened then? You talked a little bit about this last time – against whom you ran, what were the issues involved, and then more substantively please into the contributions that you made and the Academy made in your president-elect year.\n\nDr. Henley: I ran against my good friend Ed Langston. The same year that I became board chair, Ed was elected vice president of the Academy, so he had an extra year to serve in that capacity. We ran against each other the following fall in Boston. Ed and I had been friends for many years             \n\nand we remain friends to this day. But as Ed would say, I beat him handedly, but that certainly didn’t negatively impact our friendship. Regardless of who won, that certainly would not have been the case. I think the issues there, at that Congress, were basically those about the need for the Academy to continue to push forward with health care coverage for all and Ed and I were pretty much in the same place on that. From a policy perspective and a philosophy perspective Ed and I had always been pretty much in agreement on those sorts of things. So, the choice of the Congress is what it is and I don’t think it represented a policy difference between the two of us in that regard. \n\nDuring my president-elect year the Clinton Health Plan had pretty much become a moot point, which was disappointing – the politics of the issue and the politics of the personalities became the focus rather than the need for the country to have a serious debate about why we should have health care coverage for all. That was disappointing, but it is what it is. During that president-elect year, when we got to the summer board meeting that year the board had become aware of the somewhat large and excessive governance structure of the Academy. Not so much about the Congress of Delegates but about the number of commissions and committees. And so, the board considered, that summer, the need to consolidate and condense our governance structure through the commission and committee process as well as some officer positions that were no longer pertinent. So, at the summer board meeting the board worked very hard to propose changes that were under its control, how to consolidate commissions and eliminate committees. And so as of January of ’95, I guess it would have been, all the committees went away and we consolidated a lot of positions into nine commissions which made all the sense in the world.  The board also decided that we no longer needed a treasurer position because the fiduciary responsibility of the organization resides with the whole board, not with one individual. And did we really need to have a vice president position. And given the internal board politics of the chair position, up to that point in time, coming from the third-year class, it was felt that the board chair position was so important, why shouldn’t that be your most senior board person which is your immediate past-president. And so, the board adopted all those changes, some of which required bylaws changes, such as the elimination of the officer positions and the switching how the board chair is determined.  This was put before the Congress of Delegates at the end of my president-elect year, debated and passed. But the bylaws issues would not be in place or be voted on until the following year which was at the end of my presidential year. And they were adopted in the fall of ’96. And so, because of that bylaws change, when I finished my presidential year in the fall of ’96, rather than becoming immediate past-president I became the first individual that served as board chair twice just because of that governance change at that point in time. \n\nDr. : Let’s back up just a little bit about some of the officer changes; for example, the elimination of the treasurer seems to make sense and seemed then to make sense partly because there was a finance committee. So what was the relative role of the chair of the finance committee to the now eliminated role of the treasurer?\n\nDr. Henley: At that time Joe Czarsty was the treasurer. The treasurer position was elected by the Board not by the Congress. And usually the treasurer served several single one year terms and Joe had been in that position, I think, for maybe two or three years at that point in time. But when the board made the commission and committee governance changes they also decided that board members would no longer serve as chair of the commissions as they had been doing and the commission chairs would come from the commissions themselves, chosen by the board. To his credit, Joe agreed with that change of eliminating the Treasurer position. Likewise, Glen Johnson was vice president then and agreed that the VP position was necessary.\n\nDr. Ostergaard: So who was the last elected vice president?\n\nDr. Henley: That would have been Susan Black. Oh, that was the next year? Yes, Susan was elected in ’95-’96. \n\nDr. Ostergaard: Back again to some of those really very, very significant governance changes. So the elimination of the elected vice president essentially also removed from consideration another of several of potential candidates for the president-elect job because you had three board members, a speaker, and a vice president who could be candidates. Did that have any effect on the organization (or correct me if I’m wrong)?\n\nDr. Henley: Well, that change created a situation where people in the third-year class on the board either had to run for president-elect or leave the board. In the past, if they didn’t get board chair those people would run for the VP position. One of them would get it and then that person would come back the next year to run for president-elect. So, it meant that the third-year class generally would run for president-elect, occasionally the speaker would run. So, you had the potential for three or sometimes four people running for president-elect. \n\nDr. Ostergaard: Well, what we’ve just been talking about may be more in-house political minutiae (Right) than most people are interested in. However, I would like to ask you what other major considerations for the good of the Academy occurred in your president-elect year and what did you consider to be your major accomplishment in your president-elect year?\n\nDr. Henley: Other than being very supportive of the governance changes in my president-elect year, that’s about all I remember in that year. But I was beginning to think in that year, for my president year, what would be my message to the membership because I was obviously very much looking forward to going out and meeting the troops, going to a bunch of state chapter meetings and things of that nature. So that’s where two areas became my focus: One, given my work as Chair of the Commission on Public Health \u0026 Scientific Affairs I thought it was important for the Academy to be thinking more strategically about a future research agenda to validate and support the role and value of family medicine and primary care in the U.S. health care system. We had a tendency at the Academy to make a lot of pronouncements about the comprehensiveness of primary care or the cost-efficiency of primary care but we didn’t really have a whole lot of data to support it and we needed to start thinking about that. So that was point one. Point two was kind of somewhat related, in the context of cost-effective care. I thought it was time for family physicians to step up to the plate and start taking some responsibility for the cost of health care as in the power of the pen. Today it may be the click of the mouse on the computer in terms of what prescriptions we write and to whom do we refer. Knowing that without a whole lot of evidence back in those days, but knowing, for example, if you needed to refer your patient for some gastroenterology type problems you generally knew in the community who were the GI guys, if they were present, who would also do a scope, no matter what, versus those that perhaps were more thoughtful in terms of whether a colonoscopy was necessary or not. So, it was time, I thought, for that conversation to begin. And so those two areas were a focus during my year as president.\n\nDr. Ostergaard: What did you consider to be the most important or the best one policy change?\n\nDr. Henley: At the Academy level? Yes. I’m not sure I follow what you’re … Well, what do you think was the most important? Of those two? Of those two, yes. I think probably, at that point in time, the needed investment in research to support more evidence to support the outcomes of family medicine in terms of quality and cost. \n\nDr. Ostergaard: And what was the nature of that investment?\n\nDr. Henley: In my presidential address to the Congress that year, I said it’s time for the Academy to make a multi-million-dollar investment and it was time for us to kind of put up or shut up – and those were the words I used. \n\nPut up or shut up. Put up or shut up. Wow. Exactly. How was that received? Well, a good member of the Congress of Delegates that time, who subsequently became a good friend of mine and later a president of this Academy, who was sitting in the Congress of Delegates that day, said he was really pissed off at me for saying that. How dare I question that! And that was Rick Kellerman. And he said what do you mean we must prove it? We know it’s true. But as he thought more about it, he agreed that, yes, it was time that we do prove it and we need to make an investment in that type of research. The need for evidence. Right, exactly. \n\nDr. Ostergaard: Let’s make sure we have the right calendar years. Your presidential year was ’95-’96? Right. So your past-president year, which you just described as then your second board chair year, was the year 1996-1997. Right. And much of what you just talked about … Shall I not use the same phrase that Dr. Kellerman used, but that made interesting conversation for where the Congress of Delegates came to fruition in your post-president board chair year, tell me more …\n\nDr. Henley: So, either during that last year as the board chair the second time or the following year, the board voted on an investment $7.7 million investment from reserves in this critical research. I think it was during my board chair year that we made that investment and we announced it at the Congress of Delegates that final year, when I finished my immediate past-president board/chair year for the second time. Also, at that second time as board chair is when Bob Graham, who was CEO then and Rosie Sweeney, who was Vice president for Socioeconomics and Governmental Affairs, they proposed the establishment of a policy research center in DC, consistent with this notion of the need to have more evidence about the value of primary care. We were becoming aware that in our advocacy agenda going forward with Congress and/or the administration was asking for more evidence to support whatever policy position we were advocating for. And so, I think in a very proactive way the Academy was very thoughtful about the need for that type of health care services research, not just clinical research, to support our advocacy positions. Thus, came the notion of a Policy Center for Family Medicine \u0026 Primary Care, which today we call the Robert Graham Center, named for Bob after he left the Academy as CEO. So again, that was, I think, an exciting part of my second board chair year in terms of kind of jumpstarting the notion about the budgetary commitment to the Graham Center.\n\nDr. Ostergaard: You’ve just described dollar amounts that are larger than dollar amounts that most of us had heard about in the organization previously, the $7 million, $7.-something million, for the research. How much for the Graham Center? \n\nDr. Henley: I think the initial estimate, Dan, was somewhere like $1 million a year. But that was built into the operational budget. That did not come from reserves.\n\nDr. Ostergaard: And, of course, we didn’t call it the Graham Center then. Right. Bob Graham would never have been so void of humility and presumptuous to do that. It was the Policy Center at that point. Right. But you make a very interesting distinction, both of which speak well of the Academy finances, that the $7 million for research came out of reserves and the $1 million per year came out of operational budget. We were in good financial shape at that time.\n\nDr. Henley: During the six years that I was on the board, the nineties were pretty good in terms of non-dues revenue. I can remember the first year that I was on the board, we had to make the ‘difficult decision’ about printing the American Family Physician twenty-four times a year versus twelve because we were getting so much advertising for AFP and the advertising was so much more than the clinical content. So, American Family Physician, each issue was becoming almost like three-fourths of an inch thick. So obviously with that level of non-dues revenue, that was good to have it because we could do a lot of creative things on behalf of the discipline as well as our members. It would be nice to have that problem today. Right, the world has changed.\n\nDr. Ostergaard: You’ve mentioned evidence-based and clinical policies – or you didn’t specifically     say clinical policies but … I’d like you to step out of the Academy internal sphere and out to the rest of the specialty societies. How did we relate as the AAFP to the other specialty societies who were doing clinical policies? Were we able to compete with them who had been doing it and who  originally were called the paragon of knowledge in a given specialty area? \n\nDr. Henley: To my mind, the major contribution of the Academy then, and this continues today, is that No. 1, clinical guidelines need to be based on evidence. And I’ll come back to another episode. And this did occur during my presidential year, so I’ll come back to that. That it needed to be based on evidence and that clinical guidelines needed to be multi-disciplinary in their development. And we were very vocal because at that point in time there were a lot of separate specialty societies that were coming out with their own clinical guideline. And many of them were based on a consensus approach rather than a true evidence approach. This was before the National Academy of Medicine came out with their pronouncement of how clinical guidelines should be done by everybody using a very rigorous evidence-based approach particularly in terms of making sure the guideline panel did not represent any biases by their affiliation with the industry or things of that nature. So, the Academy I think was very proactive in the sense of calling for a more evidence-based approach as well as multi-disciplinary in terms of how clinical guidelines were being developed. So, a perfect example of that was the year that I was president the Agency for Healthcare Research and Quality was early in the clinical guideline development process. They used a rigorous multi-disciplinary approach, evidence-based approach. And one of the first guidelines they came out with was the assessment of low back pain and it called for - guess what? A non-aggressive approach, absent the initial presentation with red flag symptoms of a given patient. It still called for the individual assessment of each patient but with the absence of these red flags it was okay to wait and not be aggressive in terms of surgery and/or diagnostic imaging. The need for physical therapy and a more rapid return to work, those sorts of things. And follow-up with the patient over a four to six-week period. And if certain neurologic red flag symptoms either were present or did develop, then that’s when you became aggressive – or lack of response to conservative management after six weeks. Well, the neurological surgeons went ballistic over that clinical guideline. I think we understand why they did, because it represented a threat to their livelihood. And some members of Congress went ballistic about that because, frankly, I think they were getting some PAC money from the back surgeons, one of whom was Congressman Sam Johnson from the great state of Texas, who’s still there. And I can remember AHRQ was getting bombarded. That was when the first efforts of Congressional attempts to eliminate ARCH began, was because of that clinical guideline. What is AHRQ again? Agency for Healthcare Research and Quality. I think it had a different name then, a different acronym then. No, I think that was right. Okay. So, I went on an NBC show one night. I was in one studio and Congressman Johnson was in another studio and somebody from the back surgeons was in another studio and we went at it. And the people at AHRQ have a videotape of that encounter. And every now and then I’ll encounter somebody from the old AHRQ days who always thanks me for challenging Congressman Johnson and the back surgeon by saying, hey, wait a minute, this guideline is not about cookbook medicine, which is what they interpreted it as. It’s still about the important interaction between doctor and patient in terms of what the patient wants and needs in the context of their symptoms. But absent these red flags, let’s have a conversation with the patient about, no, you don’t need an MRI, no, you don’t need a CAT (I don’t know that we had MRIs then but we had CAT scans). And you don’t need surgery. You don’t need to see a neurosurgeon right now. Let’s try these more conservative approaches. And guess what – nine times out of ten, if not ninety times out of 100, most people get better without aggressive treatment. Well, I think what you’ve just described also is often described as one of our fortay’s as family physicians and that is incorporating the art of medicine into the evidence and the absence of cookbook medicine which includes emphasis on the art of medicine and the patient. Right. Well, that’s a good anecdote. I certainly didn’t know about your NBC -- with the subspecialist.\n\nDr. Ostergaard: Going on to any other things in your second year of board chair that you’d like to comment on?\n\nDr. Henley: Other than, again, the initial conversations about the Policy Center, I’m not sure about other issues of focus other than the focus on how to obtain for evidence and research about family medicine and our advocacy issues. Again, all the issues about legislative action about Healthcare Coverage for All had pretty much died away by then and that remained off the political landscape for quite a while. \n\nDr. Ostergaard: Doug, kind of in that context, how have you seen the specialty change from the days when American Family Physician didn’t even have a bibliography because the people here at that point didn’t think that we needed to know what the evidence was from the literature, to where you just described? Talk about the change in the specialty over this time a little bit.\n\nDr. Henley: Again, I think there was, by evolving science, was the evolving notion of evidence-based medicine initially focused more on preventive clinical services and the evidence-base behind those. Immunizations and PAP smears and things of that nature, focused more on that than it did on chronic disease management, for want of a better comparison. And so, the Academy was very much involved in the what is the evidence behind clinical preventive services including having the audacity to suggest that what’s the evidence behind doing at the annual physical exam? And we dared ask that question. Which when you were in training, that was a given. Everybody should come in for a complete physical exam. And a chest x-ray and an EKG. Yeah, all those things. And certain labs. Well, what’s the evidence behind that? And, again, there was early evidence to suggest that could lead to harm because of over-diagnosis. Again, I think the Academy was very proactive in its thinking to be willing to question what is the evidence to support this work that we historically have taken for granted as valuable to improved quality of care and so forth? So, I’m proud of the fact that the Academy, during that time, that decade of the nineties, was very thoughtful and willing to kind of challenge the status quo with that type of thinking. That led in subsequent years the Academy being very involved in clinical guideline development in the other areas of medicine such as the evidence behind diabetic care and hypertensive care – and that continues to this day. Oh, yes, indeed, we were leaders at some point. We hired people like David Eddy to be consultants. We hired a guy on staff, a PhD named Tannin Bell (?) to help us with that at that point in time and got us going.\n\nDr. Ostergaard: A little while ago you mentioned that you were looking forward to your president year of doing a lot of state chapter visits – and I’m sure you enjoyed that. But much of what you just talked about is how we related to the outside world. Can you tell me your relative ratio of time and interest inside the organization with politics and all as well as state chapter visits and things versus working with the government and the other specialty societies and all?\n\nDr. Henley: Most of that would have occurred during the presidential year. It was probably 50/50. On the policy side, it was mainly through the AMA and with the AMA House of Delegates. It was, to some extent, through the Working Party, the Family of Family Medicine. I don’t recall, at that time, at least, that the Council of Medical Specialty Societies was all that active and all that much involved. It certainly is today but not back then. We’ve always had a strong government relations division in Washington, so there were opportunities to do some Congressional testifying    and interact with members of Congress. What we now call today the Family Medicine Advocacy Summit, back in that time an early model of that was just developing and was a very small affair. B but important in terms of bringing real family doctors to Washington to advocate on the Hill and/or with the administration on those topics and bring the family medicine perspective.\n\nDr. Ostergaard: As a little sideline, one of the things you did towards the end of your top level leadership was you went with Physicians With Heart to central Asia, you and Mary both. Comment on that.\n\nDr. Henley: The Academy had a relationship back in those days largely due to your leadership with Heart to Heart International. And through both the Academy, the Foundation and Heart to Heart, we had the Physicians with Heart program and working with the State Department. And we would go to the former Soviet Republics and bring in medications which were donated by the pharma industry. But with involvement with the State Department, we would engage the government in that country and help them understand the importance of value of primary care and family medicine to their health care system.  I remember when we went on our trip with you all, we went to both Kazakhstan and Kyrgyzstan. But the wakeup moment for me was when the physicians there described that under the Soviet system if you were doing a well child exam or a preschool exam for kids, you’d have to see the cardiologist for the chest exam, the pulmonologist for the lung exam and a GI guy for the abdominal exam. It just made no sense at all and no wonder their system collapsed under itself given the cost of all that much less the availability of all those specialists. And they, being the doctors and the leadership of those countries, just found it hard to believe that one physician could do all of that. But they were very interested in the concept of family medicine because they knew intuitively, based upon their experience with the opposite type of system, that would be far more cost-effective, far more accessible. And if you train people correctly, they probably can do that work because, guess what – most of the time that stuff is going to be normal particularly in kids and young people. So, my sense from those visits were that they were very interested in the model but they were trying to overcome their engrained mental model of having done it in an entirely different way. And perhaps a little bit threatened by the fact that one doctor could do what it took so many of them to do. Yes, exactly. Well, you were part of the only time that project ever went to two countries. And you got involved with that at a very interesting time, in the early days of the post-Soviet time. Right, exactly. Two beautiful countries, that’s for sure. Very beautiful countries. And Kazakhstan now being where the Russians still do their space launches and that sort of thing. Right.\n\nDr. Ostergaard: We’re pretty much done with your presidential and past-president year. Any other comments about that?\n\nDr. Henley: Not that I can think of. We’ve covered it very well. Appreciate it.\n\nDr. Ostergaard: Well, perfect timing. We will call it for this session. And at some point in the either near or not very distant future we hope to have another conversation because you’re by far the most lengthy senior contribution to the AAFP, as has been your time as our executive vice president, a very fruitful time, and at some point we hope to talk with you about that. \n\nDr. Henley: Look forward to it. \n\nDr. Ostergaard: Thank you so much.  \n\nDr. Henley: Thank you, Dan.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=0.0,4371.11351"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313","type":"AnnotationPage","label":{"en":["Dr. Douglas Henley Interview Transcript (3) [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Daniel Ostergaard: It is May 7, 2021. I'm Dr. Dan Ostergaard. I have the privilege and honor of interviewing my friend and boss, former boss, Dr. Doug Henley. Thank you, Dr. Henley.\n\nDouglas Henley: Thank you, Dan. Great to be here.\n\nDaniel Ostergaard: And with that, I dispense with formalities because I've known Doug since he was a puppy. And we will celebrate his successes and hear about some of his challenges while he was the CEO, EVP of the academy. Just for the record, we did in 2017, two interviews that were oral histories of Dr. Henley that covered his background, his youth, his family, and through his years as academy president. He's the only president of the academy who became CEO. And right now, we are in a pandemic, hopefully towards the end of the US part of the COVID-19 pandemic, although we are concerned about the rest of the world, especially India. But Dr. Henley and I are both fully immunized, so we dispense with this, even though we're in the boardroom of the American Academy of Family Physicians. Doug, tell us about the pandemic. When it started, you were the CEO.\n\nDouglas Henley: Right.\n\nDaniel Ostergaard: But you had made preps for this kind of an issue, this kind of a problem.\n\nDouglas Henley: Well, yeah. That's true, Dan. And so this is where I would have to give our IT department in particular a lot of credit, both with Gordon Schmittling when he was here in his latter couple of years, Gordon had started a process of making sure that the academy could continue to function should we have to leave this building for whatever reason. We weren't thinking about a pandemic back then. We were thinking more about a tornado or some major event like that. And then when we hired Michael Smith as CIO when Gordon retired, again about three years before the pandemic began, to their credit, Michael and Greg Belshe, who became division director of IT, began a process of kind of elevating that effort so that should we have to leave this building for a period of time, that staff would be able to work from home virtually.\n\nDouglas Henley: And so by, pandemic started in March of 2020 basically, by the middle of 2019, we were pretty much in a position where, from a technology standpoint, using in our case Webex versus Zoom, we would be able to do that. As it became somewhat possible, or probability that in late January, early February of last year that this pandemic might blow up. I didn't really know at that point and time. Again, Michael and Greg and their team began to kind of ramp up for that. When we came back from the board meeting at the end of February of last year, I called a series of meetings with staff very quickly around this board table to figure out. Okay, what are the steps we need to ... Are there any other steps that we need to take very quickly over the next seven to 10 days in order to prepare to shut down should that become necessary?\n\nDouglas Henley: We had about three of those meetings, which included folks from all around the organization, including in DC, in anticipation of that shutdown. And by I think it was March the 16th or something like that, is when we had the federal call for folks to start working from home. So kudos to again, the IT team, but kudos to the whole staff in terms of being prepared to do that. It wasn't an easy transition, but it was an important transition, obviously, same challenges for everybody else in the nation and around the world.\n\nDouglas Henley: What I'm thankful of is the fact that we had identified by that time, at the February board meeting, we had identified who my successor would be, and it turned out to be Shawn Martin, who was already on the staff as a senior vice president. But I'm thankful that if the pandemic had to happen, it happened on my watch the last six months or so, so we could kind of ease into the transition from working from home rather than dumping that on Shawn's lap, [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=0.0,281.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] as a new CEO.\n\nDaniel Ostergaard: Well, I was going to ask you about that. I mean, you left in the middle of the pandemic. So was that because you wanted Shawn to take over or because you'd done a good job getting him ready?\n\nDouglas Henley: Well, I think we did a very good job of preparing him.\n\nDaniel Ostergaard: I do too.\n\nDouglas Henley: I'd announced that August 1st of 2020 would be my last official day. We made it July the 22nd. But I think by then, we had made a good transition, and Shawn was part of that transition, obviously, because he was already here and had been here, obviously, for several years, so he knew the organization, so it was a smooth transition, a smooth handoff.\n\nDaniel Ostergaard: Well, I must say that probably about April of last year, I saw how well it was working remotely, that I complimented you, and you said to compliment Michael and Greg.\n\nDouglas Henley: Greg, right.\n\nDaniel Ostergaard: And I did so because it really was, from a member perspective out in the field, it really went well.\n\nDouglas Henley: Yeah. Well, thank you. And again, just think about some other people, just the whole staff had to obviously transition. But importantly, we had to transition all of our CME programs to be online, to be virtual. The meetings people, bless their hearts, they had to do a huge amount of negotiations with hotels and convention centers to get out of contracts that we had for in person meetings, and that was a difficult process because obviously, the hotels and convention centers early on did not want you to get out of those contracts. But again, our legal team and others had built into our contracts these force majeure sections that allowed us to, since it was declared a global pandemic, allowed us to get out of those contracts in a way that would not be financially harmful to the academy, and we could switch over to virtual meetings and still serve the needs of our members.\n\nDaniel Ostergaard: At what point did you make the decision to cancel the 2020 FMX, Family Medicine Experience, that we used to call the Annual Assembly, and the Congress of Delegates?\n\nDouglas Henley: I believe we did that at the April board meeting that year was obviously virtual.\n\nDaniel Ostergaard: So we had plenty of lead time.\n\nDouglas Henley: Plenty of lead time for that. It may have been a little bit later. I can't remember the exact date, but I think people saw that the handwriting was on the wall. But I believe it was late April, sometime in May that we went ahead and made that call. And the reason for that is if you're switching to a virtual meeting, you just had to make an entirely different set of plans. And it again, wasn't fair to the CME folks, to the meetings folks, and to others, to try to plan for two types of meetings – one virtual and one in person. Okay, if we have an in person meeting, we can do it this way. If we have a virtual meeting, we do it this way. Planning for both of those is very hard. Planning for one of them is hard enough, planning for both of them is doubly hard.\n\nDaniel Ostergaard: Well, again, having personally attended the virtual FMX, it worked well.\n\nDouglas Henley: As did the Congress of Delegates.\n\nDaniel Ostergaard: As did the Congress.\n\nDouglas Henley: Yeah, absolutely.\n\nDaniel Ostergaard: Okay. Still on the pandemic, and then we'll get to what we would've done had their not been a pandemic, I'll give you a couple of names. Dr. Fauci. Give me your reaction.\n\nDouglas Henley: Well, I've met Tony Fauci a couple of times over the years, and his boss, Francis Collins was a good friend of mine in medical school and residency. I have always respected Tony Fauci. I think he's one of the great assets of this country when it comes to medicine, science, and research and evidence. And I think the work that he and his team and all the folks at NIH over this period of time is just phenomenal in terms of the leadership they've provided to the nation and the leadership they took in working with the pharmaceutical industry to develop these vaccines in such a rapid fashion, so kudos to them.\n\nDaniel Ostergaard: Well, and the second name I was going to give you was Dr. Francis Collins. And for those who don't follow all of this, Dr. Collins is the director of the National Institutes of Health, classmate, or within the same class range as Doug at UNC, and somebody whom Doug helped us recruit to be the keynote speaker at the 2004 combined meeting of the World Organization of Family Doctors and the Academy in Orlando, and then again in Singapore in 2007. So I had the privilege of introducing him at both of those meetings. Okay, any more on the pandemic we should go over? Because this is ...\n\nDouglas Henley: I mean, again, hopefully we're soon at the point where, as more and more people get vaccinated, at least in this country, then we'll get back to a new degree of normalcy, whatever that may be, and hopefully can begin to divorce ourselves of masks and things like that. But we've still got several important weeks before us to make that happen.\n\nDaniel Ostergaard: Well, you closed the Academy to remote learning, remote working, as you stated. Is it going to reopen pretty soon? Because right now, the Academy's still essentially closed.\n\nDouglas Henley: Well, Shawn had mentioned to me a few weeks ago they were looking at perhaps having staff back in the building in June. But I just heard from Crystal just a moment ago that they moved that back to August, primarily because at least in this area, as you know, we're having kind of an upward trend in COVID cases right now, unfortunately, less severe cases, but still an uptick in cases. And the vaccination rate in the Kansas City area's not as great as it could be, so some work there still to be done. So as I understand it now, it'll be some time in August.\n\nDaniel Ostergaard: Well, just kind of as a sidebar, Crystal Bauer, whom you just mentioned, is the manager of The Center for the History of Family Medicine, which is the place that all of these oral histories are stored. And she did, is doing, a series of interviews of our members, our grassroots out in the field in the trenches members, about what it was like to be a doc out there during the pandemic. So it'll be really interesting to see those at some point. So going on, what have you been doing in the last nine months? How's Mary, and how's Maggie the dog? And how's life?\n\nDouglas Henley: Well, life is good. As I mentioned, I had anticipated my retirement in late July, early August of last year. I do think that being home from the middle of March, working from home, from the middle of March to July, was actually a nice transition in terms of being full-time at home.. So I think in a sort of strange way, the pandemic for Mary and I was beneficial in that way because we were able to get used to being together on a day by day basis, and yet, I was still working primarily in my study virtually during the day.\n\nDouglas Henley: But since July the 22nd, which was my last day here at the Academy, we've had a great time. We're basically introverts at heart, and so being at home and not doing any traveling was not a big deal for us. So we're planning, we were unable to go be with family last Thanksgiving, which was a bummer, back in North Carolina. But we had a virtual Thanksgiving session. We didn't get to go to our normal trip to Williamsburg, Virginia in December, first time in 43 years we've not been able to do that. But we are looking forward to doing that this year. And then so again, some of the travel that we had planned has not materialized, but we anticipate the fall of this year and into 2022 will allow for some of that. I intentionally decided early on not to get involved with any consulting or other type activities or even put my name out there for those activities for the first five or six months, just to kind of let the dust settle.\n\nDaniel Ostergaard: Good idea.\n\nDouglas Henley: And so I did that, but now I've been reaching out. I've started doing a little bit of consulting with a health IT startup company doing some AI work that I think can be very beneficial for primary care in particular, relative to electronic health records. Just accepted a position on a startup company board of directors out of Ireland that will be working with independent GP practices in Ireland and the UK about improving primary care delivery, so I'm looking forward to that. Been doing some  advisory work with the foundation here, not only about the Henley endowment  to support scholarships, student scholarships to the National Conference in trying to increase the funding for that endowment, which is now close to $300,000, which is amazing, in about a year and a half.\n\nDouglas Henley: But also, helping Heather Palmer and Mike Armstrong kind of rethink the Legacy Society, the estates that family physicians always have when they die, and perhaps contributing some of their wealth back to the foundation that way, so that's been fun. And just recently, I have to smile when I say this, but I say it with all sincerity fun, is Mary recently gave me a promotion. I am now vacuumer first class at home.\n\nDaniel Ostergaard: Really?\n\nDouglas Henley: Every Thursday morning, you ought to see me vacuuming the house.\n\nDaniel Ostergaard: Man, I'll come over and look at that. Good job.\n\nDouglas Henley: I've gotten very good at it.\n\nDaniel Ostergaard: Well, I'm proud of you for many things. But let me ask you, this is a pop question. So you're pretty proud of being a vacuumer. But in your 20 years here, of what are you most proud? What's your biggest success? What's your biggest achievement? And be very brief because I'll get into it after a second pop question.\n\nDouglas Henley: I think it would be creating a consistent and ever increasing loud drumbeat about the importance of family medicine and primary care to a better healthcare system.\n\nDaniel Ostergaard: It's an ongoing work.\n\nDouglas Henley: Ongoing body of work. Again, people have heard me say this before. My mantra is cheerful persistence.\n\nDaniel Ostergaard: I remember.\n\nDouglas Henley: And so over a period of 20 years that I served as CEO, I think we've been able to, year by year, using research and data and information, we've been able both in Washington at the state capital level and so forth, working with other primary care organizations and other external entities, I think we've been able to really create a situation where family medicine, primary care are seen as, or need to be seen as a common good for all people. And that's manifested I think in the report that came out from the National Academies just this week about the importance of primary care as being foundational and necessary to a better healthcare system.\n\nDaniel Ostergaard: A little bit of interpretation there, I agree, having seen parts of that report. The National Academy of Medicine is what those of us who are older used to call The Institute of Medicine. The IOM is now the NAM. But that's a powerful-\n\nDouglas Henley: It was actually the NASEM.\n\nDaniel Ostergaard: Well, if you add engineering-\n\nDouglas Henley: Science, engineering, and medicine.\n\nDaniel Ostergaard: Yeah. Science and engineering and medicine. But I think that is a huge report because that entity is not made up mostly of family docs. That entity is made up mostly of the sub specialists. So I know you've had an influence in there with all of the people that are ours, who are part of the IOM, I'll still call it. Okay, so maybe more on that in a moment. But I got another pop question. So what was your biggest challenge? Or what did you think just didn't go as you had hoped?\n\nDouglas Henley: I think it's the corporatization of medicine with many of members becoming employed for reasons that are obvious. So let me say,  the increasing consolidation of healthcare in this country, primarily driven by hospital mergers, a lot of horizontal mergers of hospital systems and so forth, but also vertical consolidation with employing more and more physician practices, not just primary care, but subspecialty practice as well. But the challenge of that I think with family medicine, primary care, and my concern is that it has the potential and is leading to a situation where family physicians either by their own decision, but I think more and more a decision by some upper management people to  narrow  the scope of family medicine.\n\nDouglas Henley: Our residents are still trained, as they should be to be, to be comprehensivists, to provide comprehensive medical care to a panel of patients of all ages and genders. But I worry that with increased physician employment, particularly by hospital and health systems and consolidation, that they are becoming adult ambulatory care physicians. And as Andrea Wendling, who's a faculty member at University of, at Michigan State once said, \"If we allow that to happen, we risk creating a pathway to our own extinction.\" And I worry deeply about that and how we can regain some momentum about delivering comprehensive care. Remember, all the research that's been done by Barbara Starfield and others, again, over the past two or three decades, if not longer, about the value of primary care, ie, improved quality, lower cost, greater patient experience of care, et cetera, that research clearly indicates that the value of primary care and family medicine comes from its comprehensiveness and its patient centeredness. It's a team sport and things of that nature, and I just worry about losing that comprehensiveness. I think that's a huge challenge to the profession and to the specialty in particular.\n\nDouglas Henley: And the second one, which I think is equally important as a challenge, is the high rates of physician burnout over the last five years in particular, probably 10 years, with the implementation of electronic health records and the burdensome nature of performance measurement and reporting by multiple health plans and multiple payers and things like that. It's just become extremely chaotic, to where physicians have become high paying scribes to the EHR, rather than paying attention to their patients.\n\nDaniel Ostergaard: Well, we at the Academy have been, from the beginning, encouraging EHRs, working to make them better, hiring staff who are experts in the area. Is the bottom line that the EHRs have been more of a detriment to our patient care or more of an assist?\n\nDouglas Henley: Well, I think it's a two edged sword. I think clearly, electronic health records have shown potential and have delivered on improving record keeping, the accessibility of record keeping, some elimination of errors, like patients who have allergies, and missing that within the old paper charts and things of that nature. But again, at the individual patient encounter day by day, they've become death by 1000 clicks because the software unfortunately, and this is where the House of Medicine, including the Academy, I think early on,, we missed an opportunity to influence the software development in a way that it became about team based care rather than bullets for billing. And basically, it transitioned into bullets for billing. And that led to all these clicks in terms of these reams of paper, if you ever print any of this stuff out. It just is a mishmash.\n\nDouglas Henley: However, I do think, and this is one reason why I'm consulting, excited about consulting with this AI company out of Israel, I do think that there are innovative solutions based in artificial intelligence and machine learning if the EHR vendors will allow them to plug and play with their software, where a lot of this unnecessary administrative and cognitive burden can be alleviated by using some of these evolving technologies of AI and machine learning embedded in the EHR.\n\nDaniel Ostergaard: Well, a few minutes ago, you said you were doing a couple of consulting and board things. And you said one was in Ireland. And I think I just heard you say just now that the AI, the artificial intelligence consulting is in Israel.\n\nDouglas Henley: Right. It's a company called Navina, based in Israel. The two co-founders used to be in Israeli intelligence.\n\nDaniel Ostergaard: Well, you better be careful. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=281.0,1391.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] is going to come and get you.\n\nDouglas Henley: I haven't asked them what they used to do, but I suspect that they know artificial intelligence pretty darn well, at least based upon what they've developed in terms of this AI platform is pretty impressive.\n\nDaniel Ostergaard: Well, we're going to come back to the challenges, and what do you see are the major issues facing our specialty in medicine in a little while. And I'm going to ask you just one more question, then let's get back to the good stuff, the successes. So one of the problems that I certainly observe is the seeming necessity of individual family docs to have to refer within the system in which they now are. And to me, that's potentially an ethical issue, as well as a business issue. Could you comment on that?\n\nDouglas Henley: Oh, I've got very strong feelings about this. I have a huge concern about that. When I was CEO, we clearly had indications from our members that as they became employed within a given healthcare system, like St. Luke's here in this area, or HCA, or whatever, that there is an incentive, including ultimately financial incentive, to refer patients within the system, both in terms of subspecialty referrals, as well as imaging studies and things of that nature. And while those referrals may very well be the best referral for a patient, and if that's the case, fine, but if it inhibits referrals to other places that are of equal quality, but at lower cost, that's bad if they get dinged because they do that.\n\nDouglas Henley: So an example, here in this area, let's talk about imaging. There's a group of radiologists that came together years ago that have created The Diagnostic Imaging Centers. They're independent, as I understand it. They're still independent from all the hospital systems. They do not charge a facility fee when you have an MRI, or chest X-ray, or whatever. And so going there for a diagnostic imaging procedures is far less costly, but if equal quality compared to getting your MRI at St. Luke's, or Research Hospital, or Menorah, or wherever. And any physician in this area is going to know that. And so if their patient has a condition that requires that type of imaging study, and it's less costly to the system and to the patient because there's a lot of out of pocket money here, even if they have insurance, that's bad ethics, especially if they are incentivized to refer them to the hospital for the same procedure where the cost to the system and to the patient is going to be much higher.\n\nDaniel Ostergaard: Well, I don't know about the incentive, but I do know that having had spine, cervical and lumbar problems, and therefore, a few MRIs, I have never been referred to The Diagnostic Imaging Center. I've always been referred to the hospital to which that practice refers.\n\nDouglas Henley: Right. Right.\n\nDaniel Ostergaard: Okay.\n\nDouglas Henley: And there's another ethical thing that I think the profession needs to also address, and that's the issue of where we train residents. And there's been great research done by the Robert Graham Center that shows, and these are all sorts of residents, not just family medicine residents, if you train residents in a high cost environment, think academic health centers, then when they go out into practice, even if they practice in a lower cost area like rural America, they will continue to practice higher cost medical care. If they train in a lower cost environment, think a community hospital compared to an academic health center, then when they go out into practice, even if they move into a high cost environment, they will practice lower cost medical care.\n\nDouglas Henley: And so I think again, the medical education system has to I think come to grips with this ethical dilemma about, we're training residents to practice high cost medicine when they practice and train in high cost environments. Now we can't ship everybody out to the hinterlands to be trained. So in these high cost environments, how do we educate and train residents to practice lower cost medical care?\n\nDaniel Ostergaard: Well, that's a tough one, and additionally a tough one because the residency, regardless of specialty, has to be funded to some degree by the hospital, so the hospital needs to get the revenue from teaching the residents to refer to within that system.\n\nDouglas Henley: Yep, yep.\n\nDaniel Ostergaard: That's another problem.\n\nDouglas Henley: Yes, it's a-\n\nDaniel Ostergaard: All right. Let's go to some more interesting stuff. You said one of the most important successes and achievements had to do with beating the drum in all environments about the need for and the acceptance of, and the greater value of family medicine as a component of primary care. Tell me a little bit about how that works. For example, you were part of the creation of TransforMed when it was here, and you work with the other entities, the group of six. But you have to tell us what the group of six is.\n\nDouglas Henley: Well, so first of all, I think this is where I would give our discipline credit for during my 20 years as EVP, we had two episodes, or two circumstances, where the discipline, all of the discipline, all the organizations of family medicine were willing to come together and critically reassess what is the future of family medicine. The first one of those, as you well know, started in 2001, a thing called The Future of Family Medicine Project. The Academy took lead in that, but took lead in both of them generally. But the other organizations of the family were intimately involved, the board, and residency program directors, department chairs, STFM, et cetera, osteopathic colleagues, and whatnot.\n\nDouglas Henley: And in that first Future of Family Medicine effort, we critically looked at: Is there a future? We asked the question. Is there a future for family medicine going forward? And that report, one of the outcomes of that report was rather startling that said, \"Unless there are significant changes to our healthcare system and to the discipline of family medicine, then its future may be tenuous over the next 10 years.\" So that was back in 2004 when that report came out, and so there were challenges to the discipline about reassessing the residency curriculum, reassessing how we can encourage more students to come into the discipline of family medicine, but also importantly, challenging our members in, relative to the Academy, members in practice, that their practices needed to improve. They needed to continue to provide comprehensive care, but it needed to be more of a team sport, and that we needed to pay attention to quality improvement and performance measurement.\n\nDouglas Henley: You can't improve unless you measure, to some extent, to assess where you are. And have we improved? And how do we improve the patient experience of care, not just the physician experience of care? Things of that nature. And the payment model needed to change for primary care. Fee for service was just creating a constant hamster wheel of volume based care, not quality based care, not value based care. And so one of the outcomes of that was to create an entity called TransforMed, that ultimately was a division, but kind of a separate division of the academy, but that would focus on helping practices transform into what was then called the New Model of Care from the FFM report, that then became the patients centered medical home.\n\nDouglas Henley: I can well remember in 2006, I connected with Paul Grundy and Martin Sepulveda from IBM. IBM had clear data, both domestically and internationally, that the more of their employees that were connected to primary care, their costs were lower and the quality of care was higher. And this was Big Blue. So it was profound that a large employer, both nationally and internationally, was willing to come work with us, connect with us, not just the academy, but with ACP, American College of Physicians, American Academy of Pediatrics, American Osteopathic Association, and together in 2006, we promulgated the principles of the patient centered medical home, which was the marker for our members to begin to transition their practices to the medical home model. The National Commission for Quality Assurance, NCQA, developed a certification program or a designation program for medical home.\n\nDouglas Henley: You couldn't just raise your hand as a family doctor. Jim King was one of our presidents then, and bless his heart, Jim said, \"You just simply can't raise your hand and say, 'I'm a medical home.' You've got to prove it. You've got to document it.\" And so it set the bar for our members and their practices to try to begin moving towards that model, knowing full well that it would be a journey that would never be complete because it would ... With the process of improvement, it's a journey that's never ending based upon evolving evidence and science of medicine.\n\nDaniel Ostergaard: And I recall that the other organizations, The American Board of Family Medicine and the academic entities, the STFM, Society of Teachers of Family Medicine, and others, bought into that.\n\nDouglas Henley: Absolutely.\n\nDaniel Ostergaard: And absolutely worked toward the improvement of PCMH, if you will. You mentioned IBM a moment ago. Tell me if this recollection is correct. I recall that IMB, at the time we were working with them, was so convinced about what you just said, that they actually didn't charge their patients, their employees, for patient care if they went to a family physician.\n\nDouglas Henley: You're right. They eliminated copays and deductibles for their employees who, if they went to a primary care physician's office.\n\nDaniel Ostergaard: Wasn't just us, it was other primary care as well.\n\nDouglas Henley: Yeah, general internal medicine and pediatrics as well, absolutely.\n\nDaniel Ostergaard: That should've been a signal to the whole rest of the industrial world.\n\nDouglas Henley: Well, and that's basically what the National Academy's report that just came out just said.\n\nDaniel Ostergaard: Just said.\n\nDouglas Henley: It's the notion of common good. It should be available and covered for everyone, and should be without copays and deductibles, yeah, absolutely.\n\nDaniel Ostergaard: Now you mentioned, or I did, we both mentioned collaboration with the other entities. People throw around the term the group of six, which works on this together. What's the group of six?\n\nDouglas Henley: So again, so fast forward now from between 2000, 2010, between 2010 and now, then in I guess around 2012, maybe 2013, again, as this constant drumbeat, if you will, about trying to make ...\n\nPART 1 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=1391.0,2104.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Douglas Henley: This constant drum beat, if you will, about trying to make primary care more visible. We had been successful as a result from '08 when President Obama got elected and his efforts to introduce health system reform, and the Affordable Care Act was first approved by Congress in 2010, didn't really go into effect until 2014, but the legislation was approved in 2010.\n\nDouglas Henley: And guess what? The Patient Centered Medical Home was all over that piece of legislation once implementation started in 2014. For the first two years, there was a 10% payment boost in Medicare for primary care physicians and so forth, so we were very successful in that endeavor. We'd been working very carefully, very closely as I mentioned earlier, with the AOA, the ACP and the American Academy of Pediatrics around the patients that are medical home effort.\n\nDouglas Henley: We had formed with IBM, the Patient Center Primary Care Collaborative, PCPCC now just called the Primary Care Collaborative, much simpler to say. And that brought together payers and employers and other parties interested, again, to be more vocal about the importance of primary care. So it wasn't just us. We obviously have a bias invested interest in primary care being paid differently and better, and things of that nature.\n\nDouglas Henley: Now we had other entities, other people external to the house of medicine saying the same thing. And then we decided in the early 2010s, the last decade, that we bring in the American Psychiatric Association and the American College of OBGYN into the group of six that became the group of four, became the group of six.\n\nDaniel Ostergaard: Right.\n\nDouglas Henley: So that we could collectively lobby Congress more forcefully on certain issues that effectively represented a total membership of about 550,000 physicians between all six organizations larger than the AMA in terms of membership. And I think speaking with a single voice on several issues, all related to the importance of foundational primary care was very important and very helpful.\n\nDouglas Henley: And also speaking out and beginning to speak out more candidly about issues of social justice and social determinants of health and things of that nature were also important to that.\n\nDaniel Ostergaard: Well, we didn't want to do this discussion totally chronologically, but we're kind of in that. And it's good because I think that a reader or an observer of this would like to know what kind of time and what is the situation around some of these things?\n\nDaniel Ostergaard: But if I jumped you ahead, go back a little bit to Starfield research, for example. You mentioned Barbara Starfield, not sure everybody outside of family medicine knows here, she was an academic pediatrician who...\n\nDouglas Henley: At Johns Hopkins.\n\nDaniel Ostergaard: At Johns Hopkins, who was absolutely wonderful, and the work she did. We couldn't have done it better than Dr. Starfield did. What was her influence?\n\nDouglas Henley: Oh, again, I think the influence of her research has been critical, again, to demonstrate the ongoing value of foundational primary care. And what Barbara... her research subsequently validated by Kathy Baicker and Shi, and the Graham Center and others, has clearly shown that simply by increasing the number of primary care physicians in a given geographic area per population, whether it's at the County level, the State level, or the national level, even worldwide, simply by increasing the number of primary care physicians, the quality of care goes up and the cost of care goes down. If you do the same thing for our subspecialty colleagues, quality goes down and costs go up.\n\nDaniel Ostergaard: Do they like hearing that?\n\nDouglas Henley: As long as I say the next statement, which is, that is not contrary to the work of our colleagues and sub-specialty medicine. We need them but they are not trained to deliver primary care. That is not their job. And it's just a demonstration to the American people and worldwide that you need a strong foundation of primary care in order to improve quality and lower costs.\n\nDouglas Henley: And we need our subspecialty colleagues when we need them. And most people, most of the time don't need a subspecialty referral. Most people, most of the time don't need a subspecialty referral. As long as primary care remains comprehensive. Back to our original comment about the concern, are we becoming less comprehensive?\n\nDaniel Ostergaard: You're right. And as I recall, Starfield's work, she also determined and then pled for the future that primary care retain care in acute care, not just chronic care.\n\nDouglas Henley: Acute care and chronic care are office-based procedures that are appropriate for the office setting, et cetera. Absolutely. And again, we are training our residents that way still with the curriculum. But again, if you look at data from the Graham Center and from the American Board of Family Medicine. For example, half the residents coming out today indicate a desire to perhaps do OB, but only about 10% of family physicians today are doing OB. Half want to do prenatal care. But again, only about 15% or so of family physicians are doing prenatal care, just as one example.\n\nDaniel Ostergaard: It's a huge decrease.\n\nDouglas Henley: I think there is an opportunity, a growing opportunity for family physicians, particularly with office-based ultrasound and things like that, for family physicians to do more office-based procedures. But that's an area, lumps and bumps type office-based surgery and things like that.\n\nDouglas Henley: Minor orthopedic injuries, a lot of that's being done less and less in the ambulatory space. And a big question now, again, getting back to the consolidation and employment issue, is that decision being made by the employer? I.e I'm hiring you, Dr. Ostergaard as a family physician, but I don't need you to see kids because we've got pediatricians to do that. I don't need you to do OB because we've got OBGYN doctors that we've hired to do that.\n\nDouglas Henley: So all I want you to do is take care of adults and preferably over the age of 65. And again, getting back to Andrew Wendling, if we're only going to be ambulatory adult medicine physicians, are we charting the course through our own extinction?\n\nDaniel Ostergaard: Well, early in the specialty, at least the training part of the specialty, we all trained to be the broad based family physician.\n\nDouglas Henley: Right.\n\nDaniel Ostergaard: And we loved it and wouldn't have gone into a practice that didn't do it. So the employer based system seems to be changing a great deal, but let me go back to something you've worked really hard on, and you've alluded to it a little bit already, but payment reform.\n\nDouglas Henley: Mm-hmm (affirmative).\n\nDaniel Ostergaard: We don't get paid enough. What did you do about that and why do you consider that an achievement, what we've done?\n\nDouglas Henley: So again, a little bit of history. The Future of Family Medicine Report clearly indicated that there was a need for the payment model to evolve. Historically, and still mostly today, fee for service is the coin of the realm in terms of how all physicians get paid. But it promotes a volume over value.\n\nDouglas Henley: And we're now spending in this country somewhere in the neighborhood of $3,7 trillion  a year on healthcare, most people would say, most experts would say that may be as much as 20%, maybe as much as 30% of that is unnecessary because of duplicative care, care that doesn't lead to better outcomes, et cetera. That's a big chunk of change. 20% of $3,7 trillion is a lot of money that could be redirected to foundational primary care if there was a different payment model.\n\nDouglas Henley: And we've seen... Just take the pandemic, take the first six months of the pandemic from March to the end of the summer last year, primary care suffered greatly because it was dependent. Our members and all primary care physicians were dependent upon patients showing up in the office, and they had to rapidly transition to virtual care. Fortunately, most payers, including the Federal government, have to give them credit for this, began to pay for video visits and even telephone visits, equally to an office visit, and credit to the insurance industry, public and private for doing that.\n\nDouglas Henley: But they need to continue doing that going forward, but that was still volume-based care. And so again, FFM one pointed to more of a capitated model of care, more of a population-based model of payment. The Family Medicine for America's Health, which was the second of the two re-evaluations of the specialty that happened between 2012 and 2017, was a second look at the future of the specialty.\n\nDouglas Henley: And again, pointed to a different payment model. And the Academy subsequently proposed to, as a result of Federal legislation, we were able to propose a payment model to HHS that would be a blended payment model, which I think makes sense. And again, the National Academies report points to this, a blended payment model that would be a mixture of a prospective monthly capitated payment per patient per month. But then fee for service for those things that were not part of the capitation.\n\nDouglas Henley: So I think that the typical things that all family physicians do in their offices every day, office visits, maybe a little bit limited laboratory, et cetera. That would be a capitated patient payment that you would get, whether you see the patient or not. You're a patient with diabetes. So in my practice, probably 50% of my patients with diabetes were well motivated and could really take very good care of their diabetes, but I saw them every three months. Why did I see them every three months? Because that's the only way I got paid.\n\nDaniel Ostergaard: Wow.\n\nDouglas Henley: Let's be honest about it.\n\nDaniel Ostergaard: That is honesty, yeah.\n\nDouglas Henley: Let's be honest about it. I saw every diabetic, every three months. Now, the ones that were well controlled, I probably could have seen every six months, rather than every three months. The ones that were not well controlled, probably needed to be seen about every six weeks...\n\nDaniel Ostergaard: Right.\n\nDouglas Henley: Not three months and so forth. So, if you change the payment model to this capitation in general, for this well-defined set of services, then if I need to see you every week, no big deal, come in every week. If I need to see you once a year, I'll see you once a year, and we'll do a lot of telephone visits or video visits in between. But if you have a lesion on your arm that we need to take care of, maybe I do that. Some other family docs may not do that. That still needs to be fee for service. [crosstalk","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=2104.0,2811.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]\n\nDaniel Ostergaard: For that procedure?\n\nDouglas Henley: For that procedure and fee for service would be an incentive for family physicians to do procedures in their office more and more. Again, enhancing the comprehensiveness of primary care [crosstalk","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=2811.0,2826.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nDaniel Ostergaard: Are we ever going to get there?\n\nDouglas Henley: Well, again, this report from the National Academies points in that direction, the Academy has presented a proposal to HHS for such a model. The commercial insurance companies are offering contracts. They're willing to offer capitated contracts to groups of family physicians, if they want to take a little bit of risk that would be a combination of capitation and fee for service.\n\nDouglas Henley: So there are models out there. I think the step that the country needs to take, and this will only happen through Federal and state legislation, will be, again, as the National Academies have indicated, is that primary care should become a common good, and it should be paid this way, and it should be available to everyone, whether you have insurance or not, you need to be covered. And that's the next step. Will we ever get there?\n\nDouglas Henley: The Academy in 2018, adopted a policy through our Congress of Delegates, that points in that direction in terms of legislation that would do that. It doesn't say how we get there to universal coverage. There are many ways of getting there, but the key should be the goal of coverage for everyone based in foundational primary care. And that's the goal that we have.\n\nDaniel Ostergaard: You just mentioned that positive Academy action of 2018, I would like to remind you that in one of the prior congresses of delegates, your speech as CEO to the Congress stated that, \"We, the Academy must view healthcare as a fundamental human right.\"\n\nDouglas Henley: Right.\n\nDaniel Ostergaard: To which you got a standing ovation.\n\nDouglas Henley: 2016.\n\nDaniel Ostergaard: 2016. [crosstalk","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=2826.0,2939.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]\n\nDouglas Henley: And we adopted policy the next year in 2017, that said exactly that.\n\nDaniel Ostergaard: And then we went to the other in 2018, but I must say, having been to every Congress of Delegates since whenever, except last year, virtual, I've never seen an officer much less the CEO, get a standing ovation. I don't think it's ever happened before, but that brings me to the issue of public health, the subject near and dear to my heart.\n\nDaniel Ostergaard: Because again, I've thanked you on prior occasions at the Congress and in your work here, promoting and talking about, and evangelizing for our need to work on the social determinants of health.\n\nDouglas Henley: Yes (affirmative).\n\nDaniel Ostergaard: And we're doing it now.\n\nDouglas Henley: Yeah.\n\nDaniel Ostergaard: We weren't doing it years ago. We were kind of a pure medical model if you will. And we didn't talk about how important education and poverty, and racial discrimination, and transportation, and all that is.\n\nDouglas Henley: Right.\n\nDaniel Ostergaard: Talk about that.\n\nDouglas Henley: Well, again, it's the notion of thinking about the health of a population, not just the healthcare. And it gets into the fact that either at the Federal or State level, or even at the County level, even at the level of local school board, when you think about high school graduation rates and recidivism, you're talking about the health of a population.\n\nDouglas Henley: We know from research that if you don't graduate from high school, if you compare a group of people that don't graduate from high school to a group that have, everything else being equal, between the age of 18 and 65, compare those two groups, the mortality rate in the group that didn't graduate from high school is twice as high as the group that did graduate from high school, just with high school graduation, everything else being equal.\n\nDouglas Henley: So again, when you talk about education, you have to think about health policy, not just education policy. When you talk about agricultural policy and the availability of fresh fruits and vegetables and things like that, you have to think about healthcare policy. When you talk about transportation or safe neighborhoods, or sidewalks in neighborhoods, you have to think about health, not just transportation, public availability of public transportation.\n\nDouglas Henley: And it gets to the notion of health equity, not just health equality, giving people an insurance card. Let's say we had healthcare coverage today, great coverage for everybody, just because you give them an insurance card doesn't mean that you've achieved equity. You've retrieved equality because everybody has a card and it's the same type of insurance, same deductibles, copays, whatever.\n\nDouglas Henley: But if that patient, that person has the insurance card and they can't get to the doctor's office because they don't have public transportation, then you don't have your health equity.\n\nDaniel Ostergaard: Or if they don't have access to healthy food.\n\nDouglas Henley: Healthy food, or if they live in an unsafe neighborhood where they can't get out and walk on the sidewalks, because they've got gun violence around them all the time. Or their kids go to school hungry and so forth. Or they don't have a bed at home and they have to sleep on the floor at night because they don't have the income to afford a bed.\n\nDouglas Henley: So that's the difference between thinking about equity, health equity versus health equality, and we need to achieve health equity. So you're right, by intent, around 2009, 2010, I started having my annual speech to the Congress include a little bit about those issues more and more each year. And the board of directors kept approving my speeches, which they  do, and I didn't get shot down by the Congress of Delegates. So I got a little bit more pithy and feisty to each year. And that led to the declaration in 2016, about health being a fundamental human right.\n\nDaniel Ostergaard: Well, that's from the Congress of Delegates point of view. And from the staff side here in the building, for which I was the VP for health of the public for many years, so the issue is near and dear to my heart, you created a staff entity...\n\nDouglas Henley: Right.\n\nDaniel Ostergaard: To deal with diversity and equity, as opposed to equality. Tell me about that?\n\nDouglas Henley: Well, again, after that Congress in 2016, I came back and had a conversation then with Julie Wood, who had become your successor. And I had charged Julie and her division director, Belinda Schoof at that time, to begin thinking in a budget neutral way and a staff neutral way, the creation of a center that would focus on diversity and health equity, which became the Center for Diversity and Health equity.\n\nDouglas Henley: So I charged them to do that. They came back in about six months with a wonderful proposal. It meant that we had to de-emphasize some things such as the Tar Wars program and some of our tobacco efforts and things like that. It meant that some of the staff that we had, that had been focused on those issues were not the staff that we needed to serve the needs of this new center.\n\nDouglas Henley: So unfortunately, we had to eliminate some staff positions to create the staff neutral position to hire subject matter expertise.\n\nDaniel Ostergaard: Those are tough.\n\nDouglas Henley: They're tough decisions but right decisions.\n\nDaniel Ostergaard: Yeah.\n\nDouglas Henley: And Julie and Belinda did a very good job of that. And so in 2017, we created and established the Center for Diversity and Health Equity, and they're doing a great job. They're doing a great job. And the Academy became well known as taking a leadership role in that area, which is what I wanted them to do, wanted the Academy to do, and the staff to do. The board certainly was very supportive of that.\n\nDouglas Henley: And two years later, everybody was mimicking what we had done. The AMA created a similar center in the AMA, and other organizations have done likewise.\n\nDaniel Ostergaard: Just for the record, on the issue of social determinants of health, which you've addressed and I think a great achievement, ongoing of course, for the record, our own family doctor member of the Academy, Dr. David Satcher, Surgeon General of the United States, and in my view, probably the most effective Surgeon General of the United States in the last 50 years, was the vice chair of the WHO global commission on the social determinants of health.\n\nDaniel Ostergaard: And that report circulated throughout the world and has been very instrumental as well. In fact, here at the Academy, I know that there have been a lot of people who focused on it too.\n\nDouglas Henley: Right.\n\nDaniel Ostergaard: We better move on.\n\nDouglas Henley: Let me just mention one more thing about payment because I think it's important.\n\nDaniel Ostergaard: Okay.\n\nDouglas Henley: A statistic to add to the record is, again, we know from both national and international research that other developed nations which generally have established their healthcare systems around foundational primary care, they spend roughly somewhere in the neighborhood of 12% to 17%, averaging about 14%, own primary care of their total healthcare spend. In this country, we spend only about 5.4% on primary care out of the total spend.\n\nDaniel Ostergaard: Do that again. Around the world, what?\n\nDouglas Henley: Average is about 14% to 15% of the total spend spent on primary care.\n\nDaniel Ostergaard: US?\n\nDouglas Henley: 5.4%.\n\nDaniel Ostergaard: We've got a lot of work to do.\n\nDouglas Henley: Got a lot of work to do. It needs an increased investment. So again, President Biden is putting a lot of emphasis, appropriately so I think, on infrastructure. Well, I think with this report from the National Academies, we're talking about infrastructure when we talk about primary care. And I would think that the Academy and our other colleagues that are focused on primary care are probably giving thought to, and having conversations with the administration that this infrastructure legislation that Mr. Biden's speaking about needs to include a focus on primary care, certainly be consistent with this common good notion from the National Academies.\n\nDaniel Ostergaard: Oh, that'd be wonderful.\n\nDouglas Henley: Absolutely.\n\nDaniel Ostergaard: That would be absolutely wonderful.\n\nDouglas Henley: They're talking about what? $1,9 trillion. Spend a $100 billion on primary care for goodness’ sake. Last year, with the previous COVID relief bills that Congress passed, Secretary of HHS had a lot of authority to parse out that money, hundreds of billions of dollars. And we were simply saying to the Secretary at that time that, \"Hey, allocate $20 billion just to primary care, you've got the authority to do it. Congress has already passed the money, approve the money. And therefore help those primary care practices stay in business, be they independent or whatever.\" And we couldn't get them to do it.\n\nDaniel Ostergaard: Maybe the new Secretary.\n\nDouglas Henley: $20,000,000,000, it would have been so easy and so effective, but they didn't do it.\n\nDaniel Ostergaard: Another future challenge.\n\nDouglas Henley: Maybe with this Infrastructure bill, there's some opportunity.\n\nDaniel Ostergaard: Let's talk a little bit about your promotion of academic family medicine, both in terms of the organizations and in terms of the annals of family medicine. Even though there were other family medicine organizations even here in this building, and we are one of seven family medicine organizations, talk about that, your approach to, and your success with the academic and the annals and those things?\n\nDouglas Henley: Yeah. Well, let me come back to the annals last, but in terms of academic family medicine, again, I am not one who's a teacher of family medicine from a clinical standpoint, but I certainly respect and have high regard for our academic colleagues, be they at the department level or residency level, medical student education level, whatever the case may be. And they're extremely important to the discipline.\n\nDouglas Henley: And again, I think the Academy, you've been intimately involved in this over the years, Dan, along with Norm Kahn and Perry Pugno , and Clif Knight and others, Karen Mitchell and many other folks in terms of working with the family of family medicine to promote the importance of departments of family medicine and residency programs around the country.\n\nDouglas Henley: And compared to the time when I was a medical student back in the late '70s, we're now in a situation where we have departments of family medicine in almost every medical school. We still have about six that are there still laggards, six or seven that are still laggards, but they're there. And I think in a generally positive way, the departments of family medicine and the residency programs have become intimately integrated into the academic infrastructure of this country, in terms of medical schools and so forth.\n\nDouglas Henley: And I think that's important because more and more, especially in these times of the pandemic and evolving payment models and so forth, a greater approach, a greater emphasis on population health and not just individual health that the medical schools are seeing the value that family medicine and the way family physicians can bring to these groups of people who get together and begin to address those within the academic institutions. That's very positive and so forth.\n\nDouglas Henley: What I worry about, and again, I'm reflecting on my early days of coming into the specialty. As you will know, and family medicine became a specialty in 1969, February the eighth, 1969. And I was just graduated from high school then, but going into college, looking towards medical school. So that was in the '70s, and the discipline by its very nature began as a counter-cultural movement.\n\nDouglas Henley: There was a lot of resistance to recognition of the specialty within the house of medicine and elsewhere within medical schools. In North Carolina, my dad had to introduce legislation to create the department of family medicine at Chapel Hill, UNC because the institution did not want to do it, but the legislature told them they would have to do it. So that's just a small example of that resistance.\n\nDouglas Henley: And so, we were kind of feisty and pithy, and kind of in your face. And I was not involved in it until the late 70s, but I was a strong observer of it. And I thought it was fun, and it was exciting. The first time I came and spoke at the Academy, when I first met you in April of what? 19... Whenever that was, 1979 [crosstalk","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=2939.0,3756.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] I was a medical student. Yeah. 1977.\n\nDaniel Ostergaard: And you were a skinny med student wearing a bow tie.\n\nDouglas Henley: But anyway, it was with a panel at SOC, me and Bill Coleman and Bob Rakel and Dean Elliot Richardson from Emory talking about should every medical school have a department of family medicine? That for some reason I went first as the student. And I said, \"Yes, they should.\" And that's when I got my first standing ovation, but the point is that every medical school didn't have a department of family medicine, and many were very resistant to it.\n\nDouglas Henley: And anyway, that was just kind of funny and I worry a little bit, and I've said this, I gave a speech at Chapel Hill last year, just before the pandemic hit, that I worry that we've lost some of that counter-cultural ethos, and that we need to get that back a bit in terms of being willing to challenge the status quo, particularly in the academic environment, in order to, again, maintain that culture from which we came.\n\nDouglas Henley: So I'll worry a little bit about that even though overall, I think it's very positive that family medicine is well-represented within the academic community. I think that's important. We've got the largest number of residency programs of any specialty around the country, whether they be an academic health centers or more often in community hospitals and so forth. There've been a huge growth there, which is obviously very positive.\n\nDouglas Henley: \\Now, getting back to the annals, when I came to the Academy  in August 2000, there had been a couple of resolutions at the Congress of Delegates in '98 and '99, maybe 2000, that spoke to the need of a greater capacity for the publication of research and family medicine. The only journals that we had at that time that were researched journals was just the journal of the American Board of Family Medicine, which was very small, but no other real research journals in the discipline. We've always had American Family Physician, but that's a clinical review journal, not a journal of original research.\n\nDouglas Henley: So given the action at the Congress of Delegates, when I first came in the fall of 2000, I began a conversation with Roger Sherwood, my counterpart at STFM, and Bob Avant, who was the CEO of the ABFM , the Academy could not... we were not in a financial position to start a research journal on our own. We would be today, but not now and not then, but could the family start a research journal?\n\nDouglas Henley: So I had the conversations with Roger and Bob, and they were very positive in moving in that direction. So we started conversations in that regard and we came up with the notion of the annals of family medicine, which in fact is the board of directors, is a cooperative effort of all the organizations in family medicine, including our osteopathic colleagues, and including our colleagues in Canada. They're on the board representing the board of Annals of Family Medicine as well.\n\nDouglas Henley: And we decided early on that it would be primarily an online journal, an electronic journal versus print journal. You get a print version if you subscribed to it and it's become highly successful.  I helped recruit Kurt Stange to be the first editor. Great guy, and did a superb job as editor of Annals of Family Medicine.\n\nDouglas Henley: And today, has a very high impact factor, I think equal to JAMA and others, if I'm not mistaken. And so it has served the discipline extremely well.\n\nDaniel Ostergaard: I reflect back on a couple of things. The progress made since I first came to the Academy. We had in the American Family Physician, there were no bibliographies.\n\nDouglas Henley: Right.\n\nDaniel Ostergaard: Because the leadership of the publications at that time said, \"Oh, those family docs don't care about the data. They just want to...\" to this. And to your contribution, which we talked about in our prior interviews in 2017, your personal commitment, and therefore the organizational commitment to research was exemplified by your initiation then of, I think it was $7.7 million.\n\nDouglas Henley: $7,700,000, yeah.\n\nDaniel Ostergaard: $7,7,000,000 allocation of Academy funds to the development in the specialty of research. And that was just huge.\n\nDouglas Henley: Well, that was another fun speech that the Congress Of Delegates I think...\n\nDaniel Ostergaard: Did you get a standing O?\n\nDouglas Henley: No, but I actually really ticked some people off.\n\nDaniel Ostergaard: Oh.\n\nDouglas Henley: Talked to Rick Kellerman about it.\n\nDaniel Ostergaard: Oh.\n\nDouglas Henley: Rick, that was his first time in the Congress of Delegates and he tells it in a positive way, obviously. But I basically said from the day, it's time for us to put up or shut up. And if family medicine does deliver value, let's prove it through research. And if not, let's fold up and go home. That was the challenge.\n\nDaniel Ostergaard: In other organizations, the CEO who said that might've just got fired.\n\nDouglas Henley: Well, I was President of the Academy.\n\nDaniel Ostergaard: Oh, you were President.\n\nDouglas Henley: Before CEO.\n\nDaniel Ostergaard: Well, let's talk about the Foundation. The AAFP Foundation has just grown tremendously and I'm very proud of the fact I've served on the board of curators now for six years. But you've made some major changes with the Foundation while you were in your CEO role. Tell me about them?\n\nDouglas Henley: Well, the Foundation is doing a great job and a lot of credit goes to Sandy Panther and Craig Doane and now Heather Palmer. But yeah, so around 2005, I began some conversations with Sandy because during my time on the board and then the first four or five years as CEO, I was... Well, first of all, prior to coming the CEO, I had served as a trustee on the Foundation, coming from a State chapter in North Carolina for a couple of years, and then as CEO ex-officio on the Foundation board.\n\nDouglas Henley: And it was always... the concern I had was it seemed that the Foundation often was... the strategic plan of the Foundation often was not in synergy with the Academy. And not that it has to be some tight fit in that things can't be a bit different, but it is the foundation of the Academy. And so it seems like there ought to be a greater collaboration and alignment of the strategic plan of the two organizations.\n\nDouglas Henley: And importantly, I thought that the staff of the Academy and the expertise that we had intentionally recruited for, whether it's marketing and other areas on the Academy side, could be of great benefit to the Foundation.\n\nPART 2 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=3756.0,4204.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Douglas Henley: Could be of great benefit to the foundation that the foundation because of the structure was not able to take advantage of. Because at that point in time, the foundation staff were separate from the Academy staff paid by the foundation, et cetera, just no integration at all. So in talking with Sandy, I said, look, let's think of a different structure and the different structure was to bring the foundation staff over and become staff of the Academy. Then the Academy would essentially rent them back to the foundation. So the foundation itself would not have staff. They would be Academy staff, but they would be devoted to the foundation now through an administrative services agreement. Then the executive director of the foundation would become a vice-president later called a senior vice president on the AAFP side and not only have foundation responsibilities but some Academy responsibility as well, primarily about fundraising and things of that nature. So we accomplished that, you were part of the senior management team at that time. We discussed it and thought that was a good idea. Both. We had conversations with both boards of directors and they ultimately came on board with that notion and I think we accomplished that in either '05 or '06. I can't remember which year. I think it's working extremely well since then.\n\nDaniel Ostergaard: Oh, I agree. I was still here at that time and marveled at the balancing act to bring this synergy, this collaboration closer together without getting in trouble with IRS codes of a 501C3, the foundation, and we-\n\nDouglas Henley: 501C6 for the Academy.\n\nDaniel Ostergaard: 501C6 for the Academy, but there's been no problem in that regard. So that balancing act went very well.\n\nDouglas Henley: Yeah, I think it's worked very well and it's, again, the result of that also has been, as I had hoped that the foundation had been able to take advantage of lots of expertise on the Academy staff side, that heretofore they had previously, they had not been able to do, which I think it's worked out well. A good manifestation of that was the recent complete redesign of their website in conjunction with the complete redesign of the Academy website in ways and things like that. The ability to completely refresh their donor system through their IT system and things of that nature. So I think it's worked out very well in that regard.\n\nDaniel Ostergaard: Well, one of the collaborations of which I'm certainly historically excited about was the collaboration between the Academy and the foundation on the Physicians With Heart humanitarian project in the republics of the former Soviet Union, which went on from 2003 to 2000, I mean, 1993 to 2011 and to which you accompanied us to Kyrgyzstan and Kazakhstan and I'm not sure you're going back to that part of the world for vacation, but it was an experience which I think we were of help with the Academy and the foundation and of course, Heart to Heart-\n\nDouglas Henley: And the state department.\n\nDaniel Ostergaard: Well, state department money for the most part. Let me throw out a couple of other terms and Fam MedPac, how did it start? Who started it? What's it done?\n\nDouglas Henley: Again, that's another part of this constant drumbeat about the value of family that's in primary care. The Academy, the political action committee Fam MedPac I think, was approved ultimately by the Congress of Delegates, in 2005, maybe 2006. Prior to that time, I remember my time on the board in the 90s that we had intermittent conversations about should the Academy have a political action committee that would, again, via votes in Congress but the contributions to various members of Congress on both sides of the aisle certainly improves access to members of Congress without buying votes. But it was not a ripe target in the 1990s and early 2000s, but with a bit more aggressive members of the board of directors, and certainly, I was open to the notion of a political action committee, our staff in DC early on had not been convinced that was a necessary-\n\nDaniel Ostergaard: Nor had Mike Miller.\n\nDouglas Henley: Nor had Mike Miller had been convinced that was a necessary step. Mike was essentially our COO and deputy executive vice-president until he, unfortunately, died in early 2000 or late 2000. But anyway, I think over time, it became evident based upon what was going on in the rest of the political world that having a political action committee probably was an important adjunct to our overall advocacy efforts and access to members of Congress. So again, the board of directors had conversations about it in '04 and '05, then ultimately presented that to the Congress of Delegates and it was approved. I think Fam MedPac has served us well over the past 15, 16 years.\n\nDaniel Ostergaard: Has it been tenaciously bi-partisan?\n\nDouglas Henley: Yes. In fact, back in 2017, I think it was, we engaged with a group called Ballast, which is an analytic group that looks at the impact of political action committees of all stripes on Congress and so they did a deep dive. They interview congressional staff, members of Congress, other notable, informed people in Washington, DC, inside the beltway asking detailed questions about the Academy or other organizations who have political action committees as to how they're reviewed within the beltway. We were pretty much dead center on being viewed as being bipartisan and we've maintained that over... We engaged with them for at least three years. So each year that the graphs and so forth that they produced indicated that we were perceived as bipartisan, maybe slightly, just a slight tilt to the left versus the right, but pretty much right in the middle. Most importantly, members of Congress and their staff I think the most important bit of information from that other than the bipartisan part was the fact that we were viewed as a source of credible evidence and information on a given healthcare topic and that's highly valuable today.\n\nDaniel Ostergaard: Excellent.\n\nDouglas Henley: Yeah. So that was good to see.\n\nDaniel Ostergaard: Well, it would seem to me, and I'm glad we are bipartisan as that study showed that given our advocacy for healthcare coverage for all, we would be more a little on the left. On the other hand, we could be providing PAC money to people on the right to get access to them, to convince them. But I do remember on two occasions speaking to the right that Newt Gingrich came to our Washington board meeting and sat around the table and he's not exactly a leftist.\n\nDouglas Henley: No, but a good thinker.\n\nDaniel Ostergaard: But a good thing to good thinker.\n\nDouglas Henley: But a good thinker.\n\nDaniel Ostergaard: Yeah.\n\nDouglas Henley: He certainly challenged us to think differently and about different issues and it's always good to hear both sides of the issue in terms of making an informed decision. Like I tell people today, if you read the New York Times, you better read the Wall Street Journal as well. If you watch Fox News, you better watch CNN as well-\n\nDaniel Ostergaard: Or MSNBC.\n\nDouglas Henley: Yeah. That'd be even better. So it's always important to understand and hear both sides of an issue, and then make up your mind.\n\nDaniel Ostergaard: Let's talk about some of the additional challenges. I gave you that pop quiz to which you responded, but that was a healthcare system. You came back with healthcare system consolidation, the rise of administrative burden. You talked a little bit about the eroding scope of family practice. What about venture capitalists? I mean not just the hospital employing family docs, but the big-time venture capitalists and their role.\n\nDouglas Henley: Well, so again, there's a lot of private money out there. Venture capital money out there in primary care today, we're talking hundreds of billions of dollars. You've got well, to me there's two types of capital like that. There's kind of institutional capital like the Walgreens of the world or the Walmarts of the world, come back to that. Then you've got the Silicon Valley venture capital people. So let me talk about the institutional capital. So, you've got Walgreens that last year, I think it was, did a deal with a large primary care group called VillageMD - huge group of primary care physicians, primarily family physicians. Well-known well thought of Walgreens gave them a billion dollars in this deal.\n\nDaniel Ostergaard: That's a national group, this village?\n\nDouglas Henley: Well, they were regional. Regional, but the deal is that they will create primary care offices attached to Walgreens. Now, this is not the retail clinic model. This theoretically is a full-service primary care clinic next attached to the pharmacy.\n\nDaniel Ostergaard: Not a minute clinic?\n\nDouglas Henley: Not a minute clinic. Staffed by primary care physicians, probably some non-physician providers as well, which is fine. Again, theoretically providing full-scope primary care. I view that as certainly a better and more realistic model of care compared to a retail clinic, like a minute clinic, which is a much more limited acute care-oriented type model. But the question becomes, at what point does the return on investment by, in this case, Walgreens become the driving force? Unknown, it may work out very well. I think it needs to be monitored very well. Does it become just an adult medicine type model versus again, comprehensive care for family medicine, et cetera? I think it's just an unknown, but I always have this concern in the back of my brain about when does the financial ROI become the major force.\n\nDouglas Henley: Then in the case of the Silicon Valley, you've got entities that are investing in large physician groups, some of it primary care. Some of it, there's a huge amount of venture capital, for example, in anesthesiology and emergency medicine, to the point where you've got these national ER groups now that are no longer controlled locally, but nationally, and you've heard of all this surprise billing stuff. Well, a lot of that surprise billing is in anesthesia in the ER, so that your hospital may be in-network. Whatever your network-\n\nDaniel Ostergaard: But not the group.\n\nDouglas Henley: But not the group, because the group is a national group now. A National ED group, Emergency Medicine Group and they refuse to be in networks. So you show up at your network hospital, but the physician seeing you is not in-network. So you get stuck with this huge physician bill or a huge anesthesia bill or something like that. Some of that's now occurring in primary care and so is that going to be good for primary care, or is it going to be bad for primary care? I think the answer is uncertain right now, perhaps a good example of that is there's a company called Aledade, which is started by a physician called Farzad Mostashari. He used to be in Federal Government Office of the National Coordinator. They have a model funded initially by venture capital where they provide kind of MSO services and support to primary care practices. They don't buy the practice. The practice pays them a fee to help manage their practice better, particularly in terms of quality improvement and performance reporting, and things of that nature. Some of the clinical and back-office stuff, and Aledade I think is so far, I've been impressed with their model and in terms of serving the needs of independent primary care practices to stay independent, including in rural areas and not just in urban areas. We've got a lot of family physicians-\n\nDaniel Ostergaard: We do. I can name a few.\n\nDouglas Henley: Yeah. That have been very involved in the Academy that are very involved in the leadership of Aledade. But again, Aledade that's a good example of where venture capital has been good for primary care and family medicine so far. So again, it's a mixed bag and I just have concerns about making sure that it doesn't become all about the almighty dollar and the return on financial investment.\n\nDaniel Ostergaard: Well, I've read quite a bit in the last many months in AMA publications, that AMA is working really hard on eliminating surprise billing. But let me ask you in the Academy too, but let me ask you this question. If I get hit by a truck somewhere in Kansas City, and they have to take me to the emergency room, will the ambulance driver know which one is staffed by actual docs of that hospital or by an outside group?\n\nDouglas Henley: They won't know.\n\nDaniel Ostergaard: They won't know.\n\nDouglas Henley: They won't know and you won't know either.\n\nDaniel Ostergaard: Well, I knew, I wouldn't know, but I thought maybe they would know.\n\nDouglas Henley: They're going to take based upon what your condition is. They're going to take you to the closest hospital that's trauma level one or whatever you need, and they're going to take it to the closest place for that. But the Surprise Billing Legislation did pass Congress in 2019. I think it was maybe it was in 20. I think, actually, it was early last year as part of some of the COVID relief legislation. It doesn't apply to your local ambulance service, which may or not be in-network, but it does apply to helicopter services and it does apply to all physicians and all hospitals. So now you cannot get that surprise bill from an... You may get the bill from an out-of-network physician, but ultimately they have to charge you in-network rates whether they're in-network or not. Then they have the opportunity to barter with the insurance company as to whether they can get paid higher than the in-network rate. But that's not the problem with the patient anymore.\n\nDaniel Ostergaard: Oh no, but you've answered my question because if I get hit by a truck in Kansas City, I'm going to say, I want a helicopter instead of a-\n\nDouglas Henley: An ambulance.\n\nDaniel Ostergaard: ...instead of an ambulance because they can't surprise bill.\n\nDouglas Henley: That's right. Kind of quirky that they let the ambulance drivers out of it, but still.\n\nDaniel Ostergaard: Doug, we've concentrated a lot in these questions about both the successes and the challenges on the external world, DC and the marketplace, and what's happening with all the business part. Tell me a little bit more about internal. I remember, well, internal to the staff and internal to this building, I remember, well, the budget crisis of whatever it was, '07, '08. You got us through that. How'd you get us through that? It was painful for some of us.\n\nDouglas Henley: Well, so our budget crisis actually preceded the economic crisis of the country. The economic crisis of the country was in 2008, early 2009, but our crisis occurred in '06 and '07. I think we were at the March board meeting and I think it was '06 or maybe in '07. We had a senior staff meeting because we were just beginning to get our... We approve our budget as you know in April or late April of each year. So we were getting our budget stuff altogether. All of a sudden we were informed by the publications people primarily that a big chunk of the advertising income for American Family Physician had tanked and that literally was creating a budget deficit, operational budget deficit of about eight or $9 million. Huge.\n\nDaniel Ostergaard: I remember.\n\nDouglas Henley: Huge amount of money and totally beyond our control. So over the course of the next several months in conjunction with the board, we set out a task of the board to approve the budget that April, which was a deficit budget. But obviously, we were looking towards the next year in terms of trying to get back to an operationally balanced budget. Now, what complicated that a bit more was me deciding that we really needed to get to an operational balanced budget because prior to that time, we, and this was true when I was on the board as well. We had always been using some of our investment money for operational purposes. So it wasn't a true operational budget, but my thought was at that point in time, given the crisis that we were in, why not take advantage of the crisis to some extent and see if we could get to a true operational budget that was balanced, not using any of the annual investment income and that we would then use if assuming the market was doing well if we could then use some of the investment gains year over year for special projects that would benefit our members.\n\nDouglas Henley: As you may recall, we had lots of conversations at the staff level about that. There wasn't total unanimity of thought on that, but that's the board bought into that notion. So that's the direction we went. That's why we had to close the gap of eight or 9 million versus maybe six or 7 million. We committed at the staff level to try to close that gap about two-thirds on the staff side, and about one-third on the board side in terms of governance things-\n\nDaniel Ostergaard: Oh, the board side, meaning board governance. Board travel and stuff like that.\n\nDouglas Henley: And where meetings would occur and things of that nature. Ultimately we were successful, but not even it meant on the staff side that we had to eliminate about 12% of our employee positions. Not an easy task by any stretch of the imagination, but we had to change a lot of other things as well. I mean, up until that point in time, we were producing AAFP News at least once a month, if not twice a month, that was printed and went out to all members by regular snail-mail. We made that electronic only. People thought I was nuts when I suggested that we eliminate that and move it to electronic only, but that's what we did and that's what we're doing today and members have adapted very well to it.\n\nDaniel Ostergaard: That was pretty early and electronic mail.\n\nDouglas Henley: But if we were doing a journal electronically, i.e. Annals of Family Medicine, why can't we do a member publication electronically. If we're doing a journal, my goodness, we could do this that way, just as one example. Again, we had to eliminate 12% of our staff, but we achieved that goal, not without a lot of anguish and so forth, but we got there and we got to a true balanced budget where we weren't depending on investment gains of the market. Guess what, 12 months later the whole country went through a big economic downturn and all of our colleague organizations at that time suffered the same thing for different reasons suffered the same thing that we did. They had to go through the exact same process that we had gone through 18 months earlier.\n\nDaniel Ostergaard: Are you telling me you're clairvoyant?\n\nDouglas Henley: No. I'm just saying we had a crisis sooner than they did, and we had to respond-\n\nDaniel Ostergaard: And we didn't have a crisis during the great recession.\n\nDouglas Henley: During that recession, we didn't. Absolutely. We had already had our crisis and so we didn't have to do it again. Most of those organizations likewise had to eliminate something like between 10 and 15% of their staff as well. So again, they had to go through the similar anguish and angst that we did, but it positioned us well. But at the same time, as we were finally coming out of that, you may recall, I suggested to the board and to executive staff that, how could we avoid this in the future? What can we do to better position us particularly at the staff level, administrative level to really analyze where we organized in the right way at a staff level. That's why I proposed to the board that we engage Accenture in using some of those investment dollars that we now had, not operational dollars, to take a complete re-evaluation of the staff structure and how we get our business done and so forth.\n\nDaniel Ostergaard: Accenture being a large management company that does this kind of consultative work in depth.\n\nDouglas Henley:  In-depth. They came in, we had a good team I think. We obviously looked at many different... Did an RFP and many companies responded, but we chose Accenture? I think overall, they did a very good job. I didn't agree with all of their recommendations nor did the board, nor did all the staff, but I think probably 80% of their recommendations were own target and created certainly challenged us to think differently about how we organize ourselves for the next 10 or 15 years, which is exactly what the exercise was meant to do. We made some, I think, important changes and addressed some opportunities for improvement. I think overall that exercise was quite good and today in the subsequent 12 years that I served as CEO, again, thanks for prudent investment strategy through our Commission on Finance and the board and our external consultants, we found ourselves having very large reserves that we could use for special projects that greatly benefited our members in the Academy, which we would not have had otherwise if we were using those investment dollars on an annual basis to balance the budget on the operational side. Up until the time of the pandemic, we had positive operational budgets for each of the next 12 years.\n\nDaniel Ostergaard: Well, I think that was a huge change. I mean, in terms of basically the survivability of the organization. Has there ever been a negative total budget except that one year that we had a deficit budget to prepare to go to the operational?\n\nDouglas Henley: You mean before that time, or since that time?\n\nDaniel Ostergaard: No. No. Anytime for that matter?\n\nDouglas Henley: Well, yes. I mean, when I was on the board we had a budget reduction exercise when I was on the board. We made a lot of... And that was primarily focused on a lot of governance changes-\n\nDaniel Ostergaard: Right. Eliminating some of the positions.\n\nDouglas Henley: That was when I was president-elect. We eliminated some board positions, we eliminated all those committees that we had, and ended up with just nine commissions and things like that.\n\nDaniel Ostergaard: I need to interject here for the viewer or the reader that Dr. Henley is the only one or I guess there were two people who served as president and then board chair before his presidency, and then board chair again, after his presidency. Am I right?\n\nDouglas Henley: Actually, there were three that-\n\nDaniel Ostergaard: So I can remember Pat Harr and you.\n\nDouglas Henley: So Pat And I were board chair twice because of that governance change that we made, those governance changes we made in 1995-1996, whenever that was, Way back when.\n\nDaniel Ostergaard: When Herb Huffington died?\n\nDouglas Henley: No, no way back before that. I think it was... Didn't we have a president named Lotterhos?\n\nDaniel Ostergaard: Yeah, Bill Lotterhos.\n\nDouglas Henley: For some reason, even in the old system, he served as board chair twice. He was elected board chair in his second year and his third year.\n\nDaniel Ostergaard: Well, this may be historical trivia, but for right now, where we have a CEO or somebody who finished being CEO nine months ago, who prior to the 20 years of CEO-dom had been board chair twice and president. So that's the context of what he keeps saying about, but that was really when I was in office but this is about the CEO. So another CEO internal thing I'd like to ask you about is I was never personally too excited about branding and changing things like that, but we initiated a bold champion act. A lot of that was you and Donna Valponi. Tell me about that and you told us as the seniors, at least the whole staff, remember the member, the member means everything. I forgot the mantra.\n\nDouglas Henley: Membership is everybody's business.\n\nDaniel Ostergaard: Membership is everybody's business. I had it pretty close. So talk to us.\n\nDouglas Henley: Well, I'm happy to say that in all the 20 years that I served as CEO, that the total membership of the Academy, including active membership, always went up. I don't think there's another medical association that probably can say that. The only time that we had a little bit of a dip in student membership, it wasn't a dip in total membership. There was one year where student membership was slightly lower in one year than the previous year. I think that was like 2002 or 2003. We had kind of a mix-up with the FMIG Groups and things like that. But after that. But the growth during the first five or six or seven years, that the annual growth was relatively small, they were incremental increases, which was good but not what we would hope in terms of both active membership growth and resident membership.\n\nDouglas Henley: So by that time, Donna Valponi had come on as senior vice president of marketing and membership and meetings. Donna had a strong background in that area and she believed very strongly in branding. I think appropriately convinced us at the staff level and then at the board level about the value of that. So, again, with board approval, ultimately, board approved what we called a bold champion initiative. I think the investment were in the neighborhood of about $7 million, which was interesting that the board approved that in the midst of that budget crisis that we just previously talked about, but it was an important expenditure of some of our reserve dollars then. So we recreated, redesigned the seal or the logo of the Academy and called it the bowl champion initiative. The tagline was strong medicine for America and we began to rebrand and remarket the Academy in a unique way. Membership took off subsequent to 2007 to the point where today we've got close to 137,000 members. I think back in 2006, seven, we had not yet exceeded a hundred thousand. So I think again, ultimately it proved to be very bold and very valuable.\n\nDaniel Ostergaard: Okay. I can see, thank you, Donna Valponi.\n\nDouglas Henley: The other part of that equation, I think that was important is our membership director at that point in time had left and gone to the AMA and Donna recruited Elaine Conrad to be our director of membership and she has done an extremely effective job in terms of membership, bringing membership value to all categories of membership. So Elaine gets all a lot of that credit.\n\nDaniel Ostergaard: Yeah. We stole her from ACEP, the American College of Emergency Physicians.\n\nDouglas Henley: Right. Right.\n\nDaniel Ostergaard: All right. Let's switch to your prognostications. Your thoughts about the challenges of the future, the prognostications for where we as family medicine will be 20 years out or whatever. To set that up, I'd like you to talk about a slide that you sent me from the OECD the Organization of Economic Cooperation and Development. The OECD is based in France. I've run into the OECD and works around the world and it is what the title says and that probably 40 nations are members, the Academy, Canada, Australia. Notably not members, the non-members include Russia and China, but you sent me a slide, which you said would make me mad and you use this slide in previous talks. You used it when you received an AMA award for lifetime achievement of a medical executive, which I think was it in a live? It was in a virtual AMA meeting. It was a virtual AMA meeting just last year and a similar, you stimulated and challenged a similar audience of this Society of Teachers of Family Medicine when they got their president's award. I think it was last August or something like that. So we're going to show the slide on the screen but you know it so well talk us through the slide and why it makes us mad.\n\nDouglas Henley: Right. Well, I first saw the slide that's on the video at a meeting of the Primary Care Collaborative in November of 2019, I had never seen it until then myself, either. We had a guest speaker that day, Eric Topol who previously spoken at the Academy's annual meeting. A well-known thought leader and provocateur in medicine, a cardiologist by training, but we won't hold that against him. He presented that slide and I don't think I heard the rest of his talk because I was so shocked by that slide. As the viewer can see on the slide, it shows that basically since the 1970s, until now, if you look at life expectancy in this country, compared to all the other OECD nations that you mentioned, the US has performed very poorly. Now, there's been a lot of attention over the past four or five years about the lower life expectancy in the United States, compared to other countries, primarily because of attention to the opioid situation and issues like that.\n\nDouglas Henley: Then the United States has the distinction, not a good distinction since the life expectancy data has been calculated on an annual basis since the middle part of the 20th century. We're the only developed nation where life expectancy went down three years in a row. Other nations that maybe have had a one-year blip where it may have gone down. But the United States, since 2015 has been on a decline. Obviously, we already know from the pandemic that just in the first six months of 2020, it went down a whole year. Now, as we look at the entire data for 2020, it's probably going to be worse than that. I'm sure we're going to see Italy and UK and others impacted as well but we've gone down. We had a slight, a very minute increase in 2019, but between 2015 and 2020, we've been on a downhill trajectory for life expectancy.\n\nDaniel Ostergaard: So that downhill slide predates the pandemic?\n\nDouglas Henley: Absolutely. Absolutely. And if you look at it from again, the 1970s, there's always been a delta between us and the rest of those countries. Nobody wants to talk about it. So this is a five-decade problem, not just a five-year problem and nobody is talking about this delta-\n\nDaniel Ostergaard: Except you and Eric Topol.\n\nDouglas Henley: Yeah. That's why I was so shocked by that slide-\n\nPART 3 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=4204.0,6304.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Douglas Henley: Yeah. That's why I was so shocked by that slide. And so again, when I was honored to get these two awards, I was thinking I'm just not going to do the regular thing and thank the whole world for it. I'm going to tell this story. Because I'm sure there are many reasons for that delta, but I think there are three big reasons why that delta is there. Number one is after World War II, all these other nations in some fashion charted a path where all of their people had healthcare coverage. The US did not. The US did not, and has not to this day. Now there are many different ways that they achieve coverage for everybody, but they basically did that.\n\nDouglas Henley: Also, all those other nations in various ways have invested more in the health of their population compared to healthcare. We've done the reverse. So for example, I'm talking about social determinants of health now. So those other nations spend roughly $2 on social support services compared to $1 on healthcare services. We do the reverse for every dollar we spend on healthcare services, we're only spending about 55 cents on social support services. Again, they spend $2 for social support compared to every dollar on healthcare services. For every dollar of healthcare services that we spend, we only spend 55 cents on social support services.\n\nDouglas Henley: So that goes back to social workers and food and public transportation-\n\nDaniel Ostergaard: All the things we talked about.\n\nDouglas Henley: And social policy and things like that.\n\nDaniel Ostergaard: Yeah. Dr. Satcher talked about it in the world stage on that WHO Commission on Social Determinants of Health.\n\nDouglas Henley: And the third thing, which I think matters is that again, as all those other nations began this process of universal coverage in some form or not, they based their healthcare systems in foundational primary care, and we have not. Since the advent of Medicare in 1965, and even before then, this country has gone hook line and sinker for subspecialty care, to the detriment of primary care.\n\nDaniel Ostergaard: So really, that started happening after the second world war when military injuries and things like that-\n\nDouglas Henley: Right. Subspecialization just took off.\n\nDaniel Ostergaard: It just took off, but we've just talked about, and you were proud of the fact that we're making progress in primary care.\n\nDouglas Henley: Well, I think we are in terms of recognition, but we haven't gotten there in terms of these three issues. We haven't gotten to universal coverage. The Affordable Care Act was a step forward to cover more people, but we still have, depending on time of year and what year you're talking about, we still have somewhere between 20 to 30 to 40 million people that don't have coverage or they lack adequate coverage. So we haven't achieved that goal yet.\n\nDouglas Henley: We certainly haven't invested in social, in social determinants of health like we need to, although there's a lot of attention to that this day in time. And for example, a lot of state Medicaid programs now are allowing various entities to use those dollars, for example, to make sure people do have transportation, to get to their doctors, not just paying the doctor for their care, but to allow for these other things to occur. But we still haven't recognized the important nature of foundational primary care.\n\nDaniel Ostergaard: And we didn't. So, okay. Tell me what is foundational primary care?\n\nDouglas Henley: Yeah. Well, to me, I think it has to mean at least three things. One is that you pay differently and better for it, and you invest more in it. We talked earlier about those other countries spend roughly 14 to 15% of their total healthcare dollar on primary care. We only do 5.4%. So we need to recognize that and begin a process of investing more in primary care in terms of that total spent. And I think, again, and I mentioned earlier that $3.7 trillion, most of it driven by fee for service, there's a lot of unnecessary and duplicative care going on there.\n\nDouglas Henley: And we don't necessarily need to spend more than 3.7 trillion, we just need to redistribute some of that in back into primary care. Not an easy task to accomplish, but it's getting a lot of attention now. National Academy's report that we talked about earlier, references that need in a budget neutral way, which means some folks will get paid less and primary care will get paid more in terms of investment. So that's one. I think foundational primary care gets to that notion of common good that we talked about before, where visits to your primary care physician should be without copay and deductibles. That's benefit design. We need to think about, coverage is good, but I'll use Medicare today. I'm happily a recipient of Medicare today. And as a recipient of Medicare, it is a great insurance [crosstalk","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=6304.0,6638.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]\n\nDaniel Ostergaard: I agree. Works perfect.\n\nDouglas Henley: I can go to pretty much any doctor I want to, anytime I want to, but that's the problem with Medicare. There's no benefit design that encourages me to go first to primary care, which is what I really need to do. Now I do that because I'm obviously a primary care doctor and I love my family doctor, and I will access the system through her. This allows primary care to be the gateway to the system, not the gatekeeper, but the gateway to the system.\n\nDouglas Henley: So if patients know that they can see their primary care physician without copay or deductible, but if I choose to go to the retail clinic, or if I choose to go to urgent care, if I choose to go to the ED, or if I choose to go to the subspecialist, like I can with Medicare, and it's going to cost me something, a co-pay and a deductible, I'll probably go to my primary care doctor first, most of the time. So that's making primary care at the gateway, and I think that needs to happen.\n\nDaniel Ostergaard: And not the gatekeeper, because in the early days of HMOs-\n\nDouglas Henley: Patients can still go, should be able to go wherever they want to go if they choose to go, but there should be some financial consequences beyond primary care, but not for primary care.\n\nDaniel Ostergaard: Tell me about the difference in GDP expended by the United States for health, relative of the other countries.\n\nDouglas Henley: It was about twice as much.\n\nDaniel Ostergaard: Or more.\n\nDouglas Henley: Per capita, yeah, per capita.\n\nDaniel Ostergaard: Okay. Now I'm going to ask you a couple of questions-\n\nDouglas Henley: With poor outcomes, such as life expectancy. By the way, I mentioned earlier of the Barbara Starfield research. As you increase the number of primary care physicians, quality goes up costs go down. There's a great article in JAMA, Internal Medicine by Basu and colleagues, I think January of '19 that showed again, increasing the number of primary care physicians increased life expectancy.\n\nDaniel Ostergaard: And you just said Bazemore and colleague-\n\nDouglas Henley: No, Basu, Basu.\n\nDaniel Ostergaard: Oh, Basu.\n\nDouglas Henley: But Andrew Bazemore, the folks at the Graham center reported that research by Phillips-\n\nDaniel Ostergaard: Right, that's where I was going.\n\nDouglas Henley: But again, simply increasing the number of primary care physicians improves life expectancy, compared to increase in the number of subspecialty physicians. Again, not an admonition against our subspecialty colleagues. We need them, they do great work, but we don't need patients [crosstalk","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=6638.0,6784.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]\n\nDaniel Ostergaard: You know, I love my family doc too, but I'm glad she didn't do my spine surgery.\n\nDouglas Henley: Exactly.\n\nDaniel Ostergaard: I needed somebody else to do that. Now that you're no longer CEO, I'm going to ask you a couple of questions that may or may not relate to current academy policy. So what do you think about Medicare for all?\n\nDouglas Henley: I'm in favor of healthcare coverage for all.\n\nDaniel Ostergaard: I didn't ask that.\n\nDouglas Henley: Well, I think if you simply covered everybody tomorrow with Medicare, I would be against that for the very reasons that just talked about. There's nothing about Medicare that incentivizes primary care. So it would be horrible for primary care. I talked about 5.4% of the total spend on primary care. For Medicare it's less than that. It's only about four and a half percent, and these are the sickest people, the country, over age 65. And it's only 4% going to primary care. So again there's no benefit design in Medicare that encourages primary care.\n\nDaniel Ostergaard: Nope, same thing. So, Medicare for all would be a bad thing, unless it was including some kind of benefit redesign.\n\nDouglas Henley: I don't think the country could afford it because unless there was significant benefit redesign, it would be terrible for family medicine and primary care without significant benefit redesign, et cetera. So I would not favor Medicare for all based upon the Medicare that I know of it as today.\n\nDaniel Ostergaard: Just as a side note, our academic colleague and one of our academic founders, John Guyman, has written several books. The last was a a small book he sent me, making the case for Medicare for all. And I don't remember now about those details, but let me ask you another off script, if you will, question because you're no longer CEO. What's your personal view of single payer?\n\nDouglas Henley: Again, I think single payer could be an option for this country to achieve coverage for all, but not without a lot of if ands and buts such as benefit design, that would make primary care foundational. The other component is a single payer like Medicare that would do a better job of supporting graduate medical education in terms of what's the physician workforce that this nation needs. As you well know, we're spending $15 billion a year roughly of Medicare dollars for graduate medical education, but with no research or planning as to what the national workforce needs of this nation are, in terms of family physicians or primary care physicians compared to our subspecialty colleagues. And so that's another component of foundational primary care. There needs to be the GME support, graduate medical education support for more primary care physicians, family docs in particular.\n\nDouglas Henley: So again, single payer could be a solution. The academy and the policy that we adopted in 2018, we list several solutions to possible solutions to achieving coverage for all based in foundational primary care. Single payer could be an option, Medicare for all could be an option. The so-called Bismarckian programs like you have in Germany, which are not-for-profit hospitals, and yet the physicians are still in private practice and things like that. You obviously have single payer in Canada, a different solution in the UK.\n\nDouglas Henley: So those are all solutions that I think should be subject to debate and dialogue with the American people and our elected representatives and whatever ultimately we decide, if it gets us to coverage for all basic and foundational primary care, I'm for it. But it needs to be, again, it needs to be a solution that is affordable, not only to individual patients, but affordable to the nation as well.\n\nDaniel Ostergaard: There are those who calculate future costs to suggest that if we did have universal coverage, that eventually it would in fact cost the country less than the current system.\n\nDouglas Henley: Perhaps, but not without significant benefit design.\n\nDaniel Ostergaard: You've said that before, and you're right.\n\nDouglas Henley: Yeah. And will the American people put up with that? They like unfettered choice. Like I have right now with Medicare. I can go to pretty much any hospital I want to, any doctor I want to, as long as they take Medicare and most of them do, but the American people would have to go along with this. And what restrictions, if primary care becomes the gateway, and now they have to pay more to go someplace else out of pocket, compared to primary care, are they going to be okay with that? Well, that's the debate.\n\nDaniel Ostergaard: The same question applies to the GME issue of if we really looked at workforce needs, demonstrated by everybody, including the National Academy of Medicine last month with the American people, at least 50% of whom don't want the government to tell her what to do or where to go. Allow us to say in this city, we need X number of family medicine residencies, and less of something else.\n\nDouglas Henley: Right. And usually less of something else means a procedural or procedural-oriented subspecialty of one sort or another, which usually means a lot of money for that hospital, and cheap labor, and a lot of jobs wrapped around it.\n\nDaniel Ostergaard: So that's very discouraging.\n\nDouglas Henley: So it is. And so you've got both Democratic and Republican senators in those selected states, think Massachusetts, Boston, Illinois, Chicago, New York, New York, New York, Florida, Miami, California, Los Angeles, and San Francisco, Texas, Dallas, and Houston. Whether you're a Republican or a democratic Senator that represents a lot of jobs and a lot of cheap labor. And you're going to fight to change that GME paradigm in funding. It's a very bipartisan issue.\n\nDaniel Ostergaard: I was alluding to that by my comment about 50%. Yeah. That's a more of a partisan issue, but the jobs is a bipartisan issue. Absolutely. Okay. Anything else you'd like to say about the future? I would like to bring up one more thing.\n\nDouglas Henley: Well, yeah. I'm very excited about the future of family medicine. I think that, especially with, and I said this before I got involved with this company in Israel that I mentioned about artificial intelligence. I think that that artificial intelligence done well, and let me pause there for a moment. So I mentioned earlier about our budget situation, the ability to use reserve dollars for special projects. Well, one of the special projects that the board funded two or three years ago to the tune of about $3.5 million  is a focus on engaging with and working with evolving AI companies so that their technologies will be advantageous to primary care in terms of reducing administrative and cognitive burden.\n\nDouglas Henley: So, for example, we were working, Steve Waldren is taking lead on that, Dr. Steven Waldren, one of our vice presidents. And so for example, they're working now with a company called Suki, which is a startup IT company. And they have a remarkable AI software platform that basically relieves the physician of documentation burden. So you walk in the exam room, you're having a conversation with the patient and the computer through voice recognition is automatically documenting the visit without having to use the keyboard.\n\nDaniel Ostergaard: That would be fantastic, of course, because I don't want my family doctor looking at the computer all the time.\n\nDouglas Henley: Right. So that's the reduction of administrative burden and documentation burden and so forth. Then the company that I'm working with, Navina, the academy's doing some early work with them as well. They've created a AI platform that once it's integrated with an EHR company, they've got two companies that we're working with now, it pulls clinical data from the EHR into a patient summary, they call it a patient portrait, which on one or two screens gives you the information you need for the patient you're getting ready to see.\n\nDouglas Henley: Whether it's a consultant note, laboratory data, previous diagnoses, whatever. So that the time that you spend on pre-visit work is dramatically improved. It's a lot safer because all that information comes together and you don't have to spend 15 minutes clicking through the EHR to get it because the software brings it together in that clinical summary, on a single or two screens.\n\nDouglas Henley: And again, they're testing that now. And the feedback they've gotten from doctors and patients has been very positive. So again, I think AI in that type of modalities can, again, greatly reduce both administrative and cognitive burden. And so family doctors can spend more time with their patients. Going forward, and this gets back to the notion of comprehensive care, I think that AI is going to be a challenge to family medicine, but also an opportunity.\n\nDouglas Henley: The challenge is that as AI evolves over the next 5, 10, 15 years, I don't know what the timeline will actually be, it should be able to bring to the point of care in a simplified version, the most recent evidence-based information that a physician needs to know about X diagnosis.\n\nDaniel Ostergaard: Right when the patient's sitting in the room?\n\nDouglas Henley: Right when the patient's there, including cost and quality data.\n\nDaniel Ostergaard: Okay. But I'm still going to have to read a whole bunch while the patient's there.\n\nDouglas Henley: Well, again, I said in a simplified summary version. So the challenge to family medicine is that some of the work that we do today will probably become a primary care commodity that lesser trained individuals can do just as well. But with that type of information, coming to the point of care, I think family physicians will be able to move upstream and we'll have less need for referral to some sub-specialists.\n\nDouglas Henley: Why do you need to refer to a rheumatologist if you've got the same information the rheumatologist has at the point of care, in terms of this is the diagnosis of rheumatoid arthritis or whatever it is, here's the current modalities of treatment? Why do you need a referral? So the challenge and the opportunity will be for family physicians to let go of the commodities and let a nurse practitioner take care of it, but be willing to move upstream and be more comprehensive.\n\nDaniel Ostergaard: Okay. Will that nurse practitioner be in my office or will that nurse practitioner be out there in her own practice?\n\nDouglas Henley: Well, I'm in favor of them being in the office of the primary care physician, but state legislatures will determine what degree of independence they may have.\n\nDaniel Ostergaard: Including in Kansas right now. Interesting.\n\nDouglas Henley: So again, I think that the future is bright. I think medical students coming through medical school today and so forth, that the opportunities are there to continue to practice comprehensive family medicine independently, or as an employed physician. But I think technologies such as AI and so forth will be there. What we used to call house calls of the past, video conferencing today is just the 21st century version of a house call. And who knows what a visit may be 15 years from now. It may be me being present with the patient through a holographic image.\n\nDaniel Ostergaard: And now you're really out of my sphere.\n\nDouglas Henley: And not just a video Zoom chat. Think of the Star Wars movies, where you had Princess Leia with her holographic image present. So again, I think family physicians will be able to ... Remember this mantra from it came from our friend, Bill Phillips.\n\nDaniel Ostergaard: Sure.\n\nDouglas Henley: A researcher from the University of Washington, great friend.\n\nDaniel Ostergaard: Family doc.\n\nDouglas Henley: Bill had this great line in 2001 that in family medicine, you can pretend to know, you can pretend to care, but you can't pretend to be there.\n\nDaniel Ostergaard: I remember.\n\nDouglas Henley: You're either there or you aren't. And so I think going forward with these advancing technologies of quantum computing and machine learning and artificial intelligence, I think there'll be ways that family physicians can be present with their patients in many different ways without necessarily being physically present and yet provide excellent care.\n\nDaniel Ostergaard: All right. That brings us back to our current reality and Barbara Starfield. The four Cs of primary care. First contact, continuing, comprehensive, and well-coordinated. Can we maintain those?\n\nDouglas Henley: I think we can. The care coordination I think is easily doable. The continuity is easily doable, particularly with benefit redesign and things like that. Comprehensive is, as we've talked about multiple times already, is going to be a challenge, but I think the opportunity's there to maintain the comprehensiveness. And the discipline right now is going through a rewrite of the residency curriculum, and they're still committed to that comprehensiveness. So I think that will continue. We'll continue to prepare residents that way. I think the question, the big question, as we've already alluded to, is once they get into practice, will someone else decide their scope for the [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=6784.0,7703.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"], or as we've always done, family physicians have always been what I've referred to as a pluripotential stem cell.\n\nDouglas Henley: They go out in your practice and they changed their practice based upon the needs of their patient panel in their community. And if they're making that decision, that's great. If they decide, no, I don't need to do OB in downtown Overland Park, but I need to do OB if I'm out in rural Kansas. but that's the family physician making that choice about scope rather than somebody else making that choice for them.\n\nDouglas Henley: First contact, it's interesting that you bring that up, Dan, because, and I mentioned this in one of my speeches to the Congress about five years ago, there was a research done by Bob Berenson and colleagues that said, and this is for all physicians, in the United States, only 29% physicians, again four or five years ago, only 29% of physicians had easy access afterhours for their patients. And so I think a challenge to the discipline, particularly for family medicine is not just extended hours, like early evening hours or hours on Saturday morning or whatever. And a lot of practices are doing that out of the medical home model, but family doctors need to pick up the phone after hours when their patients call.\n\nDaniel Ostergaard: We're as guilty of that as any other specialty.\n\nDouglas Henley: You know, I was in practice for 20 years. We had an answering service that would pick up the phone initially and say, Dr. Henley's on call, what's your problem. But we would always return the call. Now what you get, I hear this, you get an answering machine and if this is an emergency, dial 911, then there's a pause. And usually there's no message. And then if you wait five or ten seconds, then finally you say, okay, somebody is on call. You can call this number too. Well, most people hear that the first five seconds about the ER and they hang up and go to the ER. Well, we need to change that. So we need to be more accessible after hours, not just extended office hours, but family docs need to pick up the phone and they need to be available and take the model of direct primary care.\n\nDouglas Henley: Those physicians have a limited panel. They have a capitated model of payment, which is a membership fee. They don't call it a membership fee, but basically that's what it is per member per month. They are on call 24/7. They give their cell phone number to their patients. And if you talk to them, patients hardly ever bother. Hardly ever. In my experience in practice was that was always true. We had a practice eventually of four family docs and a lot of patients, probably 12,000 patients total, you didn't get that many calls after hours. And most of the time when you did pick up the phone, you could handle it over the phone and the patient didn't need to go to an urgent care or to an emergency room, because if you thought they needed to be seen, you saw them. But most of the time they could say, come into the office tomorrow morning at 8:30, and we'll see you then.\n\nDaniel Ostergaard: Well, then the answering machine that says, if this is an emergency call 911 involves a whole another discussion that I know who can get into, and that's the lawyers. If it doesn't say that, if they don't say that, and it's a medical emergency and somebody has a negative outcome, the lawyers will be on top of that one.\n\nDouglas Henley: Yeah. But what about having the old answering service? We didn't have an answering machine. We had an answering service, a live human being answering the phone, and they would ask the patient what's going on. And it was chest pain or something, they would immediately say, well, you really need to probably go straight to the emergency room. But at least you have some human contact, but also, Dr. Henley's on call or Dr. Aul’s on call. And if you want me to page them first, I'll be happy to do it. So, it ain't-\n\nDaniel Ostergaard: The legal thing is a bigger-\n\nDouglas Henley: It ain't rocket science. It ain't rocket science.\n\nDaniel Ostergaard: Okay. So you've been talking about AI and other things in the rarefied atmosphere of technology and the future. And I re-invoked Barbara Starfield and the four Cs. When I have plagiarized Dr. Starfield in talks all over the world, I've added two more Cs. And I want to know if your AI model can accommodate those two Cs. And those beyond the first four are caring and competent. Six Cs.\n\nDouglas Henley: Well, certainly the delivery of just-in-time information to the point of care can certainly address the competency issue and remaining current, another C, current competence.\n\nDaniel Ostergaard: But with competence, I get into the whole CME thing as we have the professional responsibility.\n\nDouglas Henley: Sure. Continuing medical education, et cetera. So I certainly think AI can be an adjunct to that. In terms of caring, absolutely not. That's a personal relationship between family, doctor and patients, or any physician and patient for that matter, and it's the expression of empathy and all those things. And it's that notion in family medicine of continuous healing relationships over time. I think that's a given in family medicine, given the continuity part, but that's the professionalism of being a physician.\n\nDaniel Ostergaard: So caring is going to be maintained in the new world. Has to be.\n\nDouglas Henley: It has to be, it has to be, I think if you're addressing the four Cs, Carrie has to be a part of it.\n\nDaniel Ostergaard: Yeah. Without stating it. Okay.\n\nDouglas Henley: Yeah, yeah. It's just like community. It's the new definition of primary care with the National Academy's report. Talked about maintaining relationships over time, I'm paraphrasing here, but maintaining your relationships over time. But it talks about in the context of the patient and the family and the community. Well, family medicine's been saying that forever.\n\nDaniel Ostergaard: Absolutely, right from the beginning.\n\nDouglas Henley: Yeah, absolutely. And that it needs to be more of a team sport and all those things. But we've been saying that ever since the specialty began, but also with the Future of Family Medicine report in the early 2000s.\n\nDaniel Ostergaard: Well, I'm so glad that the people of all specialties and stripes in the National Academy of Medicine have echoed what we've been saying since 1947 of AAGP, and 1969 of AAFP.\n\nDouglas Henley: Yeah. Well, the good thing about this new definition is that they describe it as a definition of what primary care should be. Not necessarily what it is today, but what it should be. And I think if that's the goal where the nation wants to go, relative to primary care, I don't think it should be, it eliminates urgent care and retail clinics.\n\nDaniel Ostergaard: Because we'll do it.\n\nDouglas Henley: Well, because there's nothing about retail clinic healthcare, or urgent care healthcare that's about relationships over time, or comprehensiveness and things of that nature. So I'm excited about that definition because it eliminates what some people think is primary care today, which is not primary care, which is not primary care.\n\nDaniel Ostergaard: All right. Let's switch to again, your future, not the academic and the Academy future, but the Doug and Mary future. Given that there's a huge horizon out there, I only know of one new thing that you've told me you've planned, and that's a cruise next June. What are you going to do?\n\nDouglas Henley: Well, we hope to do some travel, obviously, both domestically and internationally. Mary's not a great fan of international travel. So we'll probably do more domestic than we do international.\n\nDaniel Ostergaard: Well, the cruise is an easy way to do that.\n\nDouglas Henley: Right, but that'll be an international-\n\nDaniel Ostergaard: Right. But an easy way to do international travel. So she'll be happier with that than schlepping suitcases.\n\nDouglas Henley: Exactly. Yeah. Good point. So we'll do some travel. And as I've indicated already, I certainly am open to doing a bit of consulting work and or board work. So I've got feelers out there with the headhunters and things like that. And if something comes my way that tickles my fancy and somebody wants some of my time and they want to pay for it, and those sorts of things, I'll entertain that, but I can say yay or nay. Fortunately, we're in a financial position where I don't need a job. I don't need the income. So I'll either say yes or I'll say no.\n\nDaniel Ostergaard: Sounds good.\n\nDouglas Henley: I'm enjoying, again, doing a little bit of work with Heather Palmer and the staff at the foundation about the Henley endowment. That's very important to us. We've already made our $100,000 commitment. Thanks to the largess of the stock market, we've been able to bring in that $100,000 sooner than we had anticipated. And we've obviously gotten thanks to ... very gratified that others have contributed to honor us with that. So we're getting close to 300,000 and that supports something that's very near and dear to me. And that's a student scholarships to the national conference in the summer each year, which is how I began in the Academy back in the summer of 1976.\n\nDouglas Henley: So I look forward to continuing to work on the endowment and separate from that, I've always said relative to the foundation that family doctors don't necessarily have a lot of expendable money during the year, but they've always got an estate when they die. And so if they can direct some of that estate planning towards the Academy's foundation, then let's make that available to them. And hopefully many of them will consider doing that. You certainly have done that.\n\nDaniel Ostergaard: To put in a plug in that same regard, Ruth and I also individually have the foundation with our respective interests in our estate plans. I think this has been a good conversation. And I want to into the camera thank Douglas Henley, who is a now nine month CEO Emeritus of the American Academy of Family Physicians. And given the fact we're still in COVID, we are not going to shake hands, but we're going to do a fist bump. Thanks, Doug.\n\nDouglas Henley: Thanks, Dan, very much. Always a pleasure.\n\nPART 4 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=7703.0,8373.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072/transcript/82313/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284072#t=8373.0,4371.11351"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284071","type":"Canvas","label":{"en":["Media File 2 of 3 - Henley__Douglas_Pt_1_17.wav"]},"duration":2434.28339,"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/154894/file/284071/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284071/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/071/original/Henley__Douglas_Pt_1_17.wav?1754511536","type":"Audio","format":"audio/wav","duration":2434.28339,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284071","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284073","type":"Canvas","label":{"en":["Media File 3 of 3 - HENLEY_DOUGLAS_(5-7-21).wav"]},"duration":8373.672,"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/154894/file/284073/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284073/content/3/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/073/original/HENLEY_DOUGLAS_%285-7-21%29.wav?1754512453","type":"Audio","format":"audio/wav","duration":8373.672,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154894/file/284073","metadata":[]}]}],"annotations":[]}]}