{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/sj19k47x32/manifest","type":"Manifest","label":{"en":["Dr. Herbert Young"]},"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":["2006-07-04 (created)","2006-07-16 (other)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Lindsay Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["Herbert Young, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156795/file/286752","type":"Canvas","label":{"en":["Media File 1 of 3 - Young_Herbert_Pt_1.wav"]},"duration":3716.48464,"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/156795/file/286752/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156795/file/286752/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/286/752/original/Young_Herbert_Pt_1.wav?1755105729","type":"Audio","format":"audio/wav","duration":3716.48464,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156795/file/286752","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156795/file/286752/transcript/82492","type":"AnnotationPage","label":{"en":["Dr. Herbert Young Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156795/file/286752/transcript/82492/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This is an interview with Dr. Herbert Young on July 4, 2006. This is Tape 1, Side A recorded at his home in Leawood, Kansas by his daughter Lindsay Young. We’re going to start with some basic biographical and family data. Would you please give your name in full?\n\nHerbert Foreman Young. \n\nAnd when and where were you born?  \n\nI was born in Peoria, Illinois, December 6, 1946.   \n\nWhat were your parents’ names?\n\nMy father was the Reverend William Atkinson Young and my mother was originally Elizabeth Carrington Young. Grace was her middle name, so I guess it would be Elizabeth Grace Carrington.   \n\nAnd what is your wife’s name?\n\nI’m married to Lisa Marjorie Fassbender. So she’s Lisa Fassbender Young.  \n\nHow did you meet your future wife at the time that you met her?\n\nHer family was a member of my father’s church. My father was a Presbyterian minister. And her brother Mark and I were the same age, so we knew each other from high school and from the various youth group activities at the church. And so I guess in one sense I met her both through my father because of his being a minister and they being in our church and her brother because we went to school together.\n\nAnd this was an older brother, slightly, I believe?  \n\nThe same age for me but obviously her older brother by three years, I think. \n\nAnd when and where were you married?\n\nWe were married in Highland Park, Illinois. Actually in my father’s church and he performed the ceremony. Although he had moved on to another parish, however, Lisa and her family were still members of Highland Park Presbyterian Church, that was the church in which the ceremony was held.   \n\nDo you have any children?\n\nWell, yes. \n\nWhat is her name and when and where was she born?\n\nShe is Lindsay Mackenzie Young and she was born in Merriam, Kansas, on December 18, 1985.   \n\nNow we’ll move on to some educational background questions. Where did you grow up?\n\nI grew up in Highland Park, Illinois from about the age of eighteen months till almost graduation from college. I was born, as I said earlier, in Peoria, Illinois where my father was a Presbyterian minister at the Fourth Presbyterian Church there. And at about eighteen months of age we moved from Peoria north to Highland Park, Illinois.   \n\nDo you have any stories from your childhood that you might like to share with us?\n\nMany stories I guess of childhood. My mother was a first grade teacher. Actually, she was a teacher in Bannockburn, Illinois before she got married. And then after she got married she stopped teaching. There were three sons in the family, three children. My eldest brother was eight years older than I. My middle brother six years. And then World War II came along and immediately after World War II, I came along. In fact, I’m the leading edge of the Baby Boom generation. She had wanted to get back into teaching, so she waited until I got to be basically about first grade level, maybe Kindergarten, when she went back and did some part-time teaching, some substituting. She substituted for a teacher who kept saying that she would be back soon (I think she had some medical condition). She never came back. And so my mother ended up taking over the classroom for that teacher. And so throughout my years from definitely first grade through eighth grade, she was a teacher in the school in which I was attending which presented some interesting challenges, of course. Because not only being known as the minister’s son in a very large church, so well-known by most people, also the school teacher’s son. They say those kids either are really good, very well-behaved, or absolute monsters. And I guess I opted for the well-behaved.   \n\nDid you have any role models when you were young?\n\nI’m not sure that there is any one person particularly. Certainly my parents. My father being a minister and very interested in the spiritual side of people. He was also very intellectual and his sermons were always filled with many, many quotes. He did a lot of research on them. And my mother was very service-oriented also on the side of nurturing children. She loved first grade because first grade was when kids had not had any lack of positive experience in school. They came in really wide-eyed and eager. In fact, she had kids who knocked on the window of her classroom to come in before the building was unlocked because they were eager to start their work. And, of course, being on the first floor, that was easy for the kids to do. So in terms of role models, I think both of them pointed out two important things. One was learning and the other was service. And as I say, actually in my dad’s case adds sort of a positive aspect to spiritual growth. And those are things I think are very much a part of what family physicians do. So it doesn’t surprise me that as a specialty I was very much onto family medicine.  \n\nDid you have any special dreams or goals when you were young?\n\nI think I was always very attracted to scientific things. Some of it was on a fictional side. I really enjoyed reading science fiction, understanding new worlds. And it was before science fiction got into the fantasy sort of end. It was usually based on a lot of science. You have to remember, this was a time when we were in the Cold War. We were in an arms race and a space race against the Soviet Union. So I was growing up in a period when there was a lot more emphasis on science in school and people who were very much using science, like the astronauts were in the news. I walked around, as a lot of kids, with a transistor radio listening to the space flights from Mercury through the next ones. And had aspirations at one point, being science-oriented, to maybe going into some sort of biology that involved space. So growing up, had an interest in all sorts of science fiction through actually getting a part-time job through my father at a medical laboratory which I did from very late grade school, like about eighth grade, or earlier actually I guess, delivering the laboratory reports for a local medical laboratory to the doctors’ offices and cleaning the glassware on Saturdays. I also remember that I had a chemistry lab in my basement and friends couldn’t believe I asked for my birthday to have a gas line put in so I could have a Bunsen burner that actually worked. And I had gotten equipment through the medical laboratory I worked at. They sold me some stuff. And also when they moved from one building to another, I got some of their cabinetry. I can’t say I discovered any marvelous new cures or anything but it was certainly fun.   \n\nWe heard a little bit about your elementary school. Where did you go to high school and what were your early years in school like?\n\nI went to Highland Park High School which was a public high school. That’s another thing I think that’s notable about growing up at that point. Highland Park, Illinois, which was roughly a third Protestant, a third Catholic and a third Jewish was a very pro-education community. It was fairly Republican. So there were a lot of people involved in business who were neighbors and members of our church and a lot of my friends’ parents and all. Yet they valued very highly a public education and that I think gives you a lot more diversity, although not a huge amount of diversity. There were not too many people who weren’t Caucasian in our high school. But a commitment to education as an important function of society is something I think I took away. Highland Park High School had excellent teachers, excellent courses, excellent facilities. I took math and science all four years and was able to work as a laboratory assistant. Back then you didn’t take a course every hour. You had some study hall time. And you could apply to be an assistant in the laboratory, so I worked for chemistry one year doing that and I worked in biology another. The biology course I took was very exciting because it was an example of attempted innovation in science education. And while we had a very good teacher, we also had films. And we saw two films a week and they were by individuals who were notable scientists. I don’t remember if it was Watson or Crick or both of them. But when we learned about DNA, we learned about it in part from a lecture delivered on tape or seeing experiments demonstrated by the actual scientists. And it was a very wide-ranging biology course. Not so much traditional memorization of the order of species and so forth but a lot more on mechanisms and bio-chemistry. So a lot of science opportunity four years as, I say, science and math. In addition though we had to take government, history, four years of English was required. So I got involved a lot in the humanities as well. And I think that’s an important reason also probably why I was drawn to family medicine over the more procedural specialties. Continued active in our church youth group. And a lot of my social interaction was with kids who were in the church group. But the church group was very interdenominational and cross-religions. I know many of our retreats up to George Williams College Camp, a YMCA conference camp in Wisconsin on Lake Geneva, we had a lot of people who were Jewish and Catholic along. So I didn’t really understand anything about discrimination on the basis of religion when I was growing up because I never saw it. In terms of discrimination in race, that was on television. Because this period and then into college was a period of the Civil Rights Movement. And I remember in our church youth group, going down to hear Martin Luther King speak in Chicago. A very eloquent speaker. I can’t tell you what he said from that single speech but I can tell you how impressed I was and all of us were with his ability to lay out his concerns and about the social injustice that was occurring in the nation at that time.   \n\nSounds like a very influential childhood. Where did you complete your undergraduate work and what was your major in college?\n\nWell, that is a bit of an interesting story because I started out at Lawrence University in Appleton, Wisconsin which is a small liberal arts school. I think it was about 1200 students. And that was smaller than my high school. My high school had 2,000 students and when I graduated that high school I didn’t know the person on the left or right of me. Now I wasn’t a huge social extrovert, so when I mentioned that to my wife at one time, Lisa said oh, she knew everybody in her class, and she probably really did. But I tended to be in the group that was more studious. Certainly not the jock side. And when I got to Lawrence, being in a smaller school, it was much more community feel to it than the large high school. It was really a wonderful experience. And a little challenging the first semester because I was in a class that had more people yes, I will go to Lawrence than they had expected and so they didn’t have enough freshman dorm space. At that time the freshmen were all put together as freshmen on the same floors although spread out around campus. So I ended up with an upperclassman as a roommate. And it took me a little while to sort of connect socially as opposed to if you were obviously living on the same floor with a bunch of other freshmen. But I also at that point discovered the library and interlibrary loan. So I did a lot of research on dolphins at that point. Very interested in communications. And I suspect this was a little bit of science fiction on the one hand, fascination with another species in this case. And got lots of articles that had to do with communication or attempts of communi-cation. And that comes back again in a moment which I’ll get to. But in high school also I had worked briefly with a group that works with kids who want to learn about business, Junior Achievement is what it’s called. What I did is I got into working on a radio program on the local radio station, WEEF. By job however was to try and sell time on this commercial station for that program. And a fellow by the name of Brian Ross and another kid whose last name was Graham, they were the on-air people and I got to do the promotion and the sales. I never was very good at selling time. We had one really loyal sponsor, a photograph studio, and that was it. But it gave me exposure to the media. And I’d had a little bit of exposure before because for some reason or another I got convinced to try out for The King and I for Louis in summer stock. And that preceded the radio work. Patrice Munsel, a Metropolitan opera star, was playing the lead female role and Victor Jory who used to play a tough cop on Highway Patrol on television, played the king. And that was a stretch because I was a science sort of person. But somehow my brothers convinced me to do this. So that was an introduction to communication and performance. So when I got up to Lawrence, I tried out for the radio station and they were very happy to get me. It wasn’t that they didn’t have a lot of other people, but apparently I sounded like what they wished they had more of. And I didn’t know all the composers very well, so I had to get a little coaching. But basically had a radio shift for announcing. And this was a fairly powerful station and it got even more powerful after a gift to Lawrence University. So I found myself hooked on not only communications but organization and found myself as the Promotions Director as a student and then the Program Manager which involved selecting the program materials and arranging programming. And then moved up eventually to Station Director. By that point, I joined a fraternity and was one of those few students who had his own telephone extension at that point. Because in the old days when you lived in a dormitory there was a phone for about every ten rooms or more and you would get buzzed when it was time for…if somebody called you, somebody would buzz up and say you got a call and then you’d go to the extension on that floor. Well, as the Director, the Station Manager actually of the station, I had my own telephone. And by this point was living in the fraternity and while we all slept in a group sleeping porch, we shared space for our desks and clothes. So there were two of us and I had my desk with my own telephone which was really cool at that time up there. Now, of course, not only do they have phones in most rooms but most kids have cell phones. But that was science fiction at that point. You had to take liberal arts courses and they had a distributive education requirement. And I actually found my biology course to be ancient compared to what I had just taken at Highland Park High School. So I really got disillusioned by that traditional biology course. But found the humanities courses, particularly things like architecture or the music courses, not for music majors but for appreciation, to be very exciting because I hadn’t been exposed to that at all. Also, they had a non-credit Fortran computer programming course which was anyone who was interested could go and learn from the computer person, the person who ran the computer lab. They had an IBM 1620. And so I learned how to program, punch IBM cards where each command was put on a computer card that you punched out using a language that you had to learn. In this case Fortran. There was also COBOL and BASIC and some others. And I learned how to do basic computing. I also got involved in student government and my fraternity. So about the end of my sophomore year, I wondered if I really did want to go into science or pre-med and ended up transferring to Northwestern University in Evanston, Illinois. And when I arrived, I had completed basically all the liberal arts requirements for being in the School of Speech and only had to take a Western Civilization course which had 400 people in it in a large lecture hall and my first exposure to a teaching assistant. A graduate student who ran a very boring breakout session on Western Civilization. I don’t even remember anything I studied in Western Civilization. So I had to take the courses for the School of Speech and by that point had decided I would major in Radio, TV, Film. So I took the traditional courses in that, basic film, basic radio, basic television and then concentrated very heavily on the television side. But I also took courses in persuasion, in linguistics, in language and culture and those were fascinating to me. And I took a number of courses in sociology, sociology of the city, of education. A variety of things that helped me understand the society in which we live. And so at that point I was actually totally away from any basic science, bench science in particular. My activities there were less on campus because gee, when I arrived, I’m sorry Mr. Young but we have no dorm space for you. You’ll have to live off campus. And for a junior in college in an urban setting like Chicago and Evanston, Illinois having to find an apartment to live in was a real burden – not at all, it was really fun. So I lived off campus, commuted by bus, worked in my eldest brother’s commercial music company. His company wrote music for commercials and then recorded it. And commuted to downtown Chicago at all sorts of odd hours to just do odd jobs for him. And that was also the point where I really started dating Lisa who I had dated in high school a little bit and then when she went off to college, continued to see each other as we could on weekends and all. She was in Madison, Wisconsin by that point. \n\nWell, you covered a lot of stories from your undergraduate years. Do you have any other stories that you’d like to share or would you like to move on?\n\nI think we could move on. \n\nWhen did you decide to seek a career in medicine? I know you said you’d been kind of steering away from science.\n\nI was a few years away from college before I actually moved back to medicine. When I graduated from Northwestern University, I had to, of course, seek employment. And ended up hooking up with a friend who I had known at Lawrence University who is now at the University of Wisconsin but was behind me. He had an opportunity to convince one of the stations up there that their FM station was really not bringing them in any money and he could find someone who could do a progressive rock format. Progressive rock was a totally new concept then. Rock and roll had been basically very short songs, two/three minutes in length on 45 RPM records. But the long play record in stereo was beginning to really make a move. And this station, WIBA-FM in Madison, Wisconsin, essentially played taped music on a big tape reel system with a place for commercials to be inserted, except they were all public service announcements because nobody would really buy this time because nobody was listening to the FM at that point. So since Lisa Fassbender was an undergraduate at Madison, Wisconsin, I decided I’d look for work up there. And boy, this sounded appealing. So I had to learn about rock and roll music rather quickly because I was mostly into folk rock and I was into broadcasting and I was into announcing. But I thought about it and said gee, if you really respect the music, wouldn’t this be like a classical music station like WFMT in Chicago at that point. So I created a format that was basically a classical music format, very low-key announcing, and was able to get Radio Free Madison started on air and was able to build that over time because of the number of people who started listening to it from just 7:00 to midnight, then we started in the late afternoon and went after midnight to 3:00 in the morning on Friday and Saturday. And really was able to bring in some other announcers who really knew music a little bit better. Although back in that era people were playing everything. So it wasn’t like you could really make big mistakes, I think. Lisa and I got married and lived in an apartment building out in Middleton, Wisconsin and discovered that I was fascinated that one of our other tenants in the building was an anesthesiology resident. Got to talking to him and he was able to get me in to watch some surgery at the University of Wisconsin. And my eldest brother for some reason also said that I should be thinking about medicine. Maybe he didn’t think I did very well at radio. I gave it a lot of thought and when Lisa finally graduated at the end of her two years into our marriage, we switched off and she went to work and I went back to complete my pre-baccalaureate, pre-med courses which was essentially one year solid of physics and analytical chemistry, organic chemistry, the things that I needed to complete. I got that done but decided that it was unlikely that I was going to get into medical school right away because now I was older and had totally gotten out of it and depending upon the school and the admissions committee, anybody who’d strayed from the straight line path of bio-chem all the way or something was an unusual candidate. So I decided I’ll mix the two. So I went on for a graduate degree, a master’s in journalism in a specialized reporting program and there you selected your topic area and I selected biomedical. And then you selected a medium and I took broadcast. So I continued to take some science courses including one on history of medicine and another one on genetics and was able to maintain showing some grade point and work in science areas but building an alternative career, if necessary. Jane Brody of The New York Times is a graduate of this program and quite a science writer. But it was a fascinating group because many of the other people in it had totally different areas. One was science and he ended up working for the American Chemical Society. Another one was sort of in the sciences. He works on a publication that talks about the NIH all the time. Another one though was in education. There was an arts critic. It was a fascinating group and the seminar was outstanding.   \n\nI met during this period Dr. John Renner. I can’t remember the exact mechanism of it, but as I was completing my master’s work and it wasn’t looking like I was getting into medical school, at least not that year, I ended up taking a job as the medical editor of a publication called Standard magazine out of Janesville, Wisconsin. This never really lasted more than one issue. But I had to do some interviewing, so it was fascinating. I went to interview professors at the medical school. I guess that’s how I hooked into John Renner because I went to interview him, I don’t even remember the topic, but he was a fascinating interview. He had been a practicing family physician in Herndon, Virginia, after training at George Washington University. Had a very innovative practice and included a lot of concepts that we associate with the new model of care. After his rotating internship and going into private practice in Herndon, Virginia, which is, by the way, near Dulles Airport, he created in his practice many of the features that are a part of the current New Model of Care under the Future of Family Medicine. Was very patient-centric. It used a team approach. It was very innovative in the design. He stole some ideas I guess out of how to stock rooms in hospitals where you could have an area that was accessible from within the exam room and also in the hallway. So if you needed to put in a surgical tray or something for the room but you didn’t want to go in and disturb the patient who was in that room, the nurse could stock it from the outside and then when it came time, you simply opened the cabinet door on the other side of cabinet, which was on the exam room side, and there were the materials that you needed. From a patient-centered perspective, he understood that moms oft times, for example, solved problems in the management of everyday living for kids that doctors might not even think about. So he had support groups of patients with similar conditions and they would share among themselves appropriate ways of solving problems that a physician might never be asked about. If a child had an allergy to peanuts or something and you get two moms together, one who has a kid who’s had the allergy for awhile and has solved a number of problems like how do you handle it at parties or outings or whatever, get that mom together with a mom of a newly-diagnosed child with such an allergy and they could learn things from mom to mom that wouldn’t be normally learned in a traditional model of practice. And John had been recruited to the University of Wisconsin to head their newly-formed family medicine program. It had been formed actually by a partnership among the local family medicine practice community and some innovative faculty at the University of Wisconsin, one being Dr. Marc Hansen, a pediatrician, and a colleague of his, Karen Pridham, who was a nurse practitioner. Early in was Dr. Bill Scheckler who was an internist and later would drive his internal medicine colleagues wild by saying he was an incompletely-trained family physician because he only knew the internal medicine part of it. And then the local family medicine community, Dr. Dick Shropshire who later became an officer of the Academy nationally was one of those early local leaders. I don’t know how they learned about John Renner, although another thought about John is John was forever trying innovations. He did house calls. The only house call I was ever familiar with was when I was growing up. And we actually had a pediatrician for me when I was growing up and I remember I had put my knee on a tack and required a tetanus booster apparently, they thought. Or maybe that was a good excuse because it was the right timing. I remember that Dr. McNeil came by (he only lived really about a block from us), but he came by and administered the shot in the home. I did not appreciate home visits necessarily. Anyway, John as a family doc, in an area around Washington, DC that was still very rural, this was before some of the more innova-tive suburbs were created there, he would do home visits out of his station wagon to often farm families and all. And I don’t know if he really did this for very long, but he paired up with a local school science teacher who was also a homing pigeon fan and he actually had specimens delivered by carrier pigeon. He’d take the carrier pigeon out with him in his station wagon and would send it back with a sample. And this apparently made Medical Economics. So maybe that’s how they found John, but however they did. And the recruitment of John Renner was a bit interesting because this was a period now, we’re into the period where the beginning of the anti-war movement and Madison was a hotbed of that, was occurring. And so apparently on one of his recruitment visits or the recruitment visit, he was being driven into the campus which had National Guard troops apparently on it and the smell of pepper gas or tear gas was certainly evident in the air. And the police cars had cyclone-type fence but in a manner to protect their windshields from bottles being thrown at them. This was a period when John was being recruited successfully to come start this innovative program at St. Mary’s Hospital as its hospital base. But it was the University of Wisconsin’s Family Medicine program – predates it being a department. Meanwhile, I’m working over at Radio Free Madison and I would listen in the news room to where the riots were occurring for that evening, so I knew where at midnight, when I signed off, the best way to get over to the dormitory my wife was then living in to pick her up to go out for pizza. That was an interesting time. \n\nI got to know John when later I was doing an article for Standard magazine. And I don’t remember the topic offhand but I got to interview him and found him just absolutely fascinating. And so when the magazine folded (no pun intended), didn’t really make it at all, I was able to actually go back and was hired by John Renner on a sort of part-time, temporary position to help write a proposal for a federal grant or contract, I forget which, to come up with a coding system for primary care. And the reason that’s important is that way back then there really wasn’t a good understanding of what went on in primary care, in everyday family medicine, general internal medicine and so forth because the coding systems that they had at that point were really hospital-based. And here we are in 2006 and we’re still struggling to have a coding system that captures what goes on in family medicine where we’re often dealing with symptoms. They may not even ever reach a diagnosis and yet care is needing to be provided. And if you really want to study something, and this is something John Renner who was very committed to, if you’re going to study something you have to be able to code it. You have to be able to break it into pieces that you can then put back together, that you can take apart and analyze. And he saw very early the need for several things in family medicine. One of them was a better coding system that would allow us to capture the transactions that occur not only at the individual visit but at various times in the course of the life of a patient. And he understood how much what goes on in the commun-ity impacts health. So he would actually offer ten dollars to any resident who could come up with something that he hadn’t coded. And his system, he even had a way of pointing out, for instance, that a patient with limited mobility lived in a challenging position like up one flight of stairs. And he didn’t give away many ten dollars because he had really captured a lot of this. Unfortunately, we didn’t get the grant. I wrote the business section part of it. However, he liked my work, so I got hired and became his assistant. There were three types of people who worked for the university. There were the professors and then there were the academic support staff and then there were the civil servants. And I was in the academic support staff. So I got a lot of the benefits of a faculty member, like a month’s vacation, but some of the challenges like only getting paid once a month was a nice check all at once but you were running out of money sort of before you got to the end of the month. I quickly was embraced by not only him but by the faculty as somebody that could try and keep John organized. And John was just a constant flow of ideas but order, especially order on his desk, was not a strong point for him. And so he had a secretary but I was assigned the task of essentially trying to keep him doing the things he said he would do in other than the financial area. He had somebody else who did his finance work. So his desk looked far worse than mine ever did. And for anyone who has seen my desk from time to time, although right now it’s very neat as we recently moved our division, it’s quite a pile. I’m into, I guess, piling instead of filing. Well, John’s was far worse than mine has ever been. I remember trying to find a way to make sure we could get signatures on his documents. I also, because of my audiovisual training, did work as the audiovisual person for any of the academic presentations. So I would videotape them. And this was in part because we were in a growth stage as a program and then later a department and we shared our tapes with the new residency programs being started around the state. And John was a builder, so let me say that he had helped essentially start, I guess he started with the faculty at the Wausau program near (?), the Appleton program and the Eau Claire program. And also the University took on the St. Mary’s in Milwaukee program. And so trying to share materials with them out in the state was one of our functions. But my main job was to keep John on target and to get him to sign things. I finally was able to combine the knowledge that when we did our taping, that we had these huge cardboard dividers that separated the rows of tapes. You would get a two-tiered box of these larger three-quarter inch format tapes and between the two levels was a large cardboard. So I got that and some very large clamps, binder clips I think they call it. And anything he had to sign, when he got it, it was clamped to one of these large cardboards. And there was no way it could be lost because it stuck out. These cardboards were bigger than his desk essentially in width. And so if he laid it on his desk, part of it would be showing. That’s sort of a humorous example of trying to keep John on target. Another one was that his offices were in a former nursing dormitory, the program and department’s offices. And most of the rooms had one door just like a regular dorm room. But his office was designed in a manner where he essentially had one dorm room equivalent and his secretary had another one. And he would go out the door to the hallway directly and not tell her where he was going. And he was forever dashing off to do things. So no amount of trying to educate him as to the importance of letting his staff know where he was seemed to work. So I finally got one of those photoelectric cells that when you break the beam sets off whatever you’ve got plugged into it. And then I got a cheap buzzer system. And it was amazing, it didn’t take too long before every time he rushed out and heard the buzzer go off, that he turned around and told his secretary where he was off to, which saved a great deal of time. Those were humorous sort of minor ways in which I helped keep him on target. More impor-tantly were the things that he said in faculty meetings that he was going to do. And I was the only non-faculty member to sit in on the faculty meetings. And I think that showed a significant trust by John and by the other faculty because we were discussing significant personnel matters, concepts of recruitment. For example, one of the early struggles within the department was whether or not they should hire any faculty member who had not been in practice. When family medicine began, the only family physician faculty that you could hire were individuals really who had been in practice and like John would be recruited into the academic environment. Because there weren’t any departments when we started. John’s Department of Family Medicine and Practice was one of the early ones. Not the earliest but one of the early ones. And so you could hire faculty from internal medicine, psychiatry or OB/GYN who came out of academic departments but you couldn’t hire family physicians because there just weren’t any. Part of the faculty felt that you could not really be a true faculty member of a family medicine department as a family physician unless you had experienced practice. You had to know what the real world was like. And another part of the department said we acknowledge that importance but it’s also important for us to build our academic part of family medicine. And to do that you really need to get people in early and have them be able to build their career within academic family medicine. Actually, that is reflected in the name of the department. It is the Department of Family Medicine and Practice when it was formed to show that there was an academic discipline, family medicine, a science-based discipline. But that actually there was also family practice. There was the wisdom gained from practice. And eventually they did change their name just to family medicine as has the specialty. And it’s only within recent years that we have dropped family practice to say family physician, dropped family practitioner to say family physician. \n\nSo then you went on into medical school?\n\nRight. After working for the Department of Family Medicine and not getting into medical school after several attempts, I sort of figured that I might get in. I kept delaying my master’s degree, stringing that out as long as I could so that I could maintain with an academic record. But at the same time, realizing that unless I was sort of that unique match to what the medical school at that point was looking for, that my chances would get slimmer. But I was persistent. And obviously John wrote me very nice letters of recommendation. But I remember interviewing. And they were still doing interviews at that point. I’ve heard that the University of Wisconsin may have at some point dropped interviews. Interestingly, I got on a waiting list one year and said okay, I’m going to apply once more, because I got on the waiting list. I got down to tenth, as I remember, on the waiting list and then the period closed. Because some people get admitted there and drop out and there was usually an opportunity to get in for a few people. I had an interview with an anesthesiologist. And by this point, I had gotten to understand a lot of the issues of family medicine in a rural state like Wisconsin even though I was suburban-raised. John took me on a lot of trips out into rural Wisconsin and learning about the challenges in these rural communities. And family physicians were in short supply but so were general surgeons. And the idea that an anesthesiologist would even be able to practice in some of these areas was very unlikely, so they had nurse anesthetists and they were under the supervision of the surgeon. And it was usually a general surgeon as opposed to a family physician. Although family physicians were still doing more surgery then than they probably are now and certainly doing a lot of first assisting if they weren’t the surgeon him- or herself. \n\n  \n\nI remember an interview, getting into a bit of a debate with this anesthesiologist about the fact that for rural medicine to survive, you needed surgery to be able to be performed, general surgery in the hospital. And that required that you be able to have anesthesia and anesthesia wasn’t going to be provided by an anesthesiologist. The economics just weren’t there. Well, it turns out that she thought I had done an excellent job of presenting an argument that she didn’t happen to agree with. She really thought that anesthesiology should only be administered by an anesthesiologist. And she said we need people like you in medicine.   \n\nAnd I didn’t recognize it at the time, but I did later, reflecting on it, that the role that I’ve played in family medicine has been more in the organizational component of it as somebody who was very interested in relationships with patients and very interested in medicine. But also at the same time, very interested in the organizational aspects of medicine. So I guess it’s no surprise that I’m working for the Academy now and have done so for over twenty years, almost twenty-one, in fact, this month and that I was very active as a resident and student leader. So guess what – I finally got into medical school. And one of the first things I did was to get involved in the Family Medicine Club, as they were called then, and very early on was able to go to the national resident and student conference in NCFPR here in the Kansas City area. And usually the leadership of an interest group was the sophomores because in the University of Wisconsin system at least you had two years of pretty much classroom, laboratory and some contact with patients. But it was in the clinical years, the third and fourth year, that your hours got really ridiculous, that you actually were not in Madison, Wisconsin for many rotations. And so it would be very difficult to be a student leader during those years compared to the first two years. So the first year you sort of learned how to do it and the second year you became the leader or leaders as the case may be. So in my case, I was able to get off to the National Conference and was able to bring back a lot of enthusiasm. That was one of the greatest meetings I ever attended and the subsequent ones were as well. And I was hooked. I had never really been involved in a political process before and so one of the new experiences was to apply for service on an Academy commission and I was appointed to the Commission on Membership and Member Services. Interestingly, then also in a subsequent opportunity ran for an office and became a Student Delegate. And so I didn’t have much service time on the Commission on Membership and Member Services but learned quite a bit about the importance of an organization finding and keeping members. And the Academy has been very, very wise in investing in its future leadership. Initially that future leadership was nurturing students and residents. And more recently that is nurturing minorities and women and new physicians and a variety of other groups, foreign medical graduates and so forth. And that really has paid off, I think. Many of our officers and Board members and a fair number of the staff of physicians were individuals who were very active as students and residents. Our current Executive Vice President, Dr. Douglas Henley, was a resident chairperson when I was a Student Delegate, for example. Daniel Ostergaard was very active earlier in the resident movement. Bruce Bagley, the current Medical Director for Quality, was an early leader. And others who are more numerous than I can name at the moment.   \n\nSo I came back really energized and I signed up 100 new members to the Family Medicine Club at the University of Wisconsin by a simple administrative step of having the application available at our meetings which had great turnouts. But for some reason nobody had ever thought about having the application form there and since the Wisconsin chapter was exceedingly supportive of students, they paid the modest dues for students. So the threshold was like a catalyst somehow. The threshold was dropped and bingo, we signed up lots of people. That was also a time when I got to know Dr. John Beasley and he’s someone I’m sure we’ll have some more information about later. \n\nMedical school was interesting for me because I was married and the other people I hung around with, we hung as couples. One was another young and another one was yet another young, although she was not married. And then there was another person named Schepp (?). But the initial group included some people who were classmates in anatomy class. And one was from northern Wisconsin and was married and another, I don’t remember where he was from. But those were interesting times because most of the students were much younger, weren’t married at all, didn’t have much life experience and sort of viewed the world a little differently than those of us who were older.   \n\nDo you have any other interesting stories from your early med school years you’d like to share? Anything about how med school was?\n\nWell, it certain was, I’m sure, similar to the experience of a lot of medical students now, that family medicine was not held in high regard generally. And I think because I had worked for the department and was older that I never got the sort of messages that some of my fellow students about oh, who would want to go into family medicine, you can’t master all that information and you’re too smart to go into it. I never had that sort of discussion with professors because it was so clear that I was family medicine bound. The experiences that I had included, again, more on the organizational side. So, for example, I was appointed to the group that helped make decisions about the curriculum. And I learned a lot from a medical student perspective about how everybody’s fighting over student time. We were fighting in family medicine over access to students because as we still believe now, I think, early exposure to family medicine as a student especially in a hostile environment is very important to provide some true understanding of what it means to be in family medicine, the challenges and the rewards. And so we fought hard to get  a third year clinical experience. And while the faculty were doing their fighting, I was ready as one of those early ones to do a rotation of twelve weeks in my junior year. And I went with Dr. Denny Oeth (?) who was in practice in Madison, Wisconsin, a group practice. There were some interesting dilemmas in that, in that his practice did include, for example, some of the hospitals where medical students trained. And so I actually was involved in a couple of deliveries where normally the medical student who was on the OB/GYN rotation would have had that experience. But because this was a patient of Dr. Oeth’s, I ended up being the one most involved as a student in the delivery. That was also my first exposure as a medical student to medical practice. Now, I had worked in the Department of Family Medicine and Practice as a staffer, so actually had received my medical care, by my choice, at the St. Mary’s Model Clinic. And so I had the experience as a patient there. But, of course, I was viewing it as an employee also. And what I learned there was a different experience than what I learned clinically from being involved on a daily basis, seeing the patients with Dr. Oeth.   \n\nLet me go back to being a staff member before medical school at St. Mary’s. I can recall one of the most powerful experiences I had, an idea that I believe originated with Dr. Milton Seifert from Minnesota, I believe, in the Minneapolis area. And he had wanted to get patients together as a group and talk to him about how to improve their practice that he headed. I think eventually they may even have set his salary but we never did that in Madison. When I was still a staff member but also a patient at the St. Mary’s Family Medicine Clinic, the model clinic, and before medical school, I participated as a staff member in the patient advisory group. And we had quite a range of age from a young teenager, a woman, up to an older lady, I think she was in her 70s or 80s, and then people in between. And then other participants besides patients included at least one or two residents, a nurse who was the patient education nurse. And that was a position that was very important to John Renner. He felt that a practice of that size needed a nurse whose major function was to work with patients, to find good resources for them, to educate them about their health and disease, to do counseling as necessary. She worked in nutrition, she worked in diabetes. A full range of areas. And she was part of the group – Dorrie Blogner (?) I believe was her name. And I’m sure there was some office staff involved. But what I learned from that, which I didn’t see so much as a medical student where I saw more of the business side and the pure clinical, sort of traditional clinical side. But from a patient advisory group I saw the sorts of things that patients will bring to you in a group that they would never say to your face or which they’d only do when given permission and want to help the practice. So an example of what we had was, as I think I mentioned earlier, the clinical space as well as the department faculty and staff space was in a former nursing dorm at St. Mary’s Hospital, 777 South Mill Street, as I remember the address. And all the rooms looked alike. And patients would be put in a room like 1A or 3B. And sometimes they had to go to the laboratory, have some blood drawn or have a swab taken or whatever and then return to the room. And they would be sent back but they wouldn’t remember the 3A or that designation. And all the rooms looked alike, so they couldn’t do it on the basis of just looking in the door. They suggested that something be done in each room that made it distinct. And so that was done. Actually, I think they ended up painting the wall that you saw looking into the room a different color for each room. But the point was, they were expressing a very common, probably for every few patients this was an issue for them. But they never raised it. Nobody ever seemed to notice it before. But it was important to the efficient operation and to the customer service aspect of the clinical to have a way for those patients to get easily back to the room they needed to be in. And there were other suggestions that had to do with how the phones were answered or how parking was. There was a full range of things. And this is back in a time period, mid- to late-70s really basically when there wasn’t a lot of emphasis on patient satisfaction. There weren’t [    ] criteria or the other quality improvement things that we have now. This was being done by family physicians who wanted to find innovative ways to figure out how to improve care. And so I see a lot of the roots of the Future of Family Medicine and the New Model of Care are really things that have been in family medicine for a long time but haven’t been put together quite in the same way.   \n\nAs a medical student, back to that, on one of the first rotations of twelve weeks, that was substantial, that had its challenges as well because I was displacing some of my fellow medical students from some of their exposures like in OB. But the majority of my time wasn’t in the hospital and that’s where medical students usually are. It was in fact in the everyday operation of a clinic. And that’s when I got to see the teamwork between a physician and a nurse and the sorts of problems that patients bring in that are still in the symptom stage or relational issues, relation-ship issues or substance abuse or any number of things that a typical medical student is not going to see. And that early exposure was hard fought to gain. In my case, I elected not to do my surgery rotation till my senior year, which was great because I wasn’t planning to go into surgery. And, of course, by that point as a first-day senior, I was rotating with the first-day juniors who didn’t know very much about a clinical setting. And so it was sort of fun because I could show them the ropes having had a year of clinical experience. \n\nDo you have any other experiences from your medical school years you’d like to discuss before we move on?\n\nWell, certainly a lot of it has to revolve around the interrelationship with the family medicine faculty and residents and the Family Medicine Club. That was a time when clearly the commun-ity of family physicians were very eager to help out in any of our club activities. And the department was exceedingly supportive of those of us who wanted to get involved nationally as well as at the state level. I know I got asked to present a student perspective at a state meeting of the family medicine chapter up there and got to go to some of the other meetings. And that was a chance to continue to see the strong support by family physicians in building student interest. And that was a crucial time because a lot of resources were being made available because state legislatures had learned and then acted on the fact that there were insufficient numbers of family physicians being trained. And the medical school had not been very responsive and so the very clearly-instructed through a very powerful means, the power of the purse, that there would be family medicine training. And what they did was have a separate line item in the state budget. So you had this entire University of Wisconsin budget, one large number, and then there was the Department of Family Medicine and Practice as its own line. And that meant that the Dean and the Provost and Chancellors and all, they didn’t get to take any money out of that. That money went directly to Family Medicine. And that also though made, I believe, the hierarchy a little upset and nervous. And so as I was getting into my senior year, that was when Dr. Renner was not reappointed by the Dean as Chair of Family Medicine. And that was quite a shock. I have a lot of clippings. I had actually been doing a little work with the department again. A lot of clippings from around the state that just, not only the family medicines but the rural communities that had come to see John as representing their interests, the newspapers were just filled with criticism of this move. And the Wisconsin idea, the whole university’s idea is that the boundaries of the university are the boundaries of the state. That is the university is to be integral to all that happens in Wisconsin. But the joke was that the boundaries of the medical school were the boundaries of the medical school. They were very insular. So I ended up being appointed to the search committee for finding the new Chair. We did not really make much progress before I was done. And John eventually moved on to the Kansas City area and that was very fortuitous for me because I eventually ended up in his program. So with all the joy and success of the program in terms of the building that John did, there was also a great deal of sadness as I was finishing my medical school period and looking off to next training. \n\nYou were never involved in the military - is that correct?\n\nThat’s correct. \n\nWe’ll move on to your medical practice and employment.\n\nFrom graduation at medical school, and that was interesting because at that point when you graduated from the University of Wisconsin, you graduated with everybody else who was getting a degree. And so they gathered in the football stadium and the baccalaureates, as I remember, they simply announced the graduates of the engineering school, the Department of Chemical Engineering. And that section would stand up and everyone would applaud. But there was no individual reading of names. And the master’s candidates, I think maybe their names were read. But it was only the doctorates in medicine and the PhDs and JDs and all who actually walked across the infield, in this case, as opposed to a stage and their names were read and a diploma was handed to them – or at least a diploma case. And you were escorted and I was wanting so desperately to have John Renner involved that I asked him to be my escort even though he had left the university, as I remember, by this point. We’re going across and there’s some high official who shakes your hand. And this individual happened to be somebody who respected John very much. So he actually stopped the line to talk to John for a few moments. Not very many but enough that it was quite clear that he was bestowing on John particular recognition. And while it was my name being read out, it was glad in my heart to see John receive recognition from I  believe it was Dr. Kindig.   \n\nI headed off basically after interviewing in a lot of places to get out of Wisconsin and get a new experience. And when John Renner announced that he would be starting a residency program here in Kansas City at strangely enough another St. Mary’s, a different order I guess. Being Presbyterian I don’t quite understand all these things. But that he would be opening a very innovative program. I decided that I would interview among other places at the University of Missouri-Kansas City’s program. And I did my first year in fact there. The traditional first year in family medicine involved a lot of rotations and all. But then as no surprise, when John Renner opened his residency program at St. Mary’s in Kansas City, I transferred in to be one of the first four residents in that program and entered with second-year status. But they decided that they would include us in the practice which was built on Dr. Ken Sells’ private practice that was brought in. But they would involve us residents in a lot of time in the clinic at the very begin-ning. And we did hospital rotations. In my case, I ended up doing a fellowship year as well and so had the opportunity to really intensively build a clinical practice in a way that a second-year wouldn’t get the same volume. I was doing almost as many half-days as the faculty clinicians. And we rotated through a much more rapid call schedule because there weren’t very many of us when we started. Dr. Suzanne Sword was one of the others who I know was in this first class and she has been practicing here in the Kansas City area. She had done public health work for awhile and decided she wanted to go back and actually do a residency. I was able to continue very actively though as a resident. I’d been a Student Delegate then I became the Student Chairperson after that. Originally I was going to sort of sit out my first year in terms of residency and then got involved and became a delegate again and then became the Resident Chairperson. And ultimately despite the huge number of hours that a member of the Board of Directors has to put in, became the first resident on the Board of Directors not with vote. So I was technically called the Resident Observer as was the second resident who served on the Board. And then they gave a vote. So the third resident I guess technically became the first voting member as a resident on the Board. Our program grew. We had wonderful space at 2900 Baltimore. Even though it was a new building, I think the building has been torn down as has St. Mary’s Hospital for the new Federal Reserve center. This program was a John Renner program. It had the same sort of teaching corridor where the residents and faculty and nurses would work. And off either side of that teaching corridor were the exam rooms. It had the same nurse server, as he called it, where you could load supplies from the outside without disturbing anyone. It had a huge lending library and a patient education room which we also used for medical conferences as well and there were classes given. It had an exercise room. It had showers and all so that you could stay there if you needed to for any call purposes. It had a treadmill. Dr. Sells was very much into cardiovascular medicine issues. A strong emphasis on smoking cessation. And Dr. Sells had been a smoker himself and when he gave it up, he decided everybody else would in the world. He had a rather direct manner of doing it. But in terms of what we did, it was in a more traditional behavior modification approach. It continued to be a residency that did a national meeting on patient education. And John had actually started that in Wisconsin many years ago. I attended the first conference as a staff member working on it. Dorrie Blogner, the health ed. nurse, was also instrumental in the beginning. And interestingly, Jacque Admire, now Jacque Admire-Borgelt who’s on my staff as the Assistant Division Director, was involved from the National Heart, Lung and Blood Institute in that earliest Patient Ed. Conference in Madison. It was held there a couple of years and then it moved around the country for awhile. And then it settled down again in Kansas City where John Renner and Bruce Curry, a PhD in education, took over again. And STFM and the Academy became more involved in it. Don Bosshart, an STFM member, had been very instrumental also from the beginning. And that conference brought in national leaders. The head of the U.S. Preventive Services Task Force gave one of his early presentations at that meeting, for example. Jane Brody of The New York Times was an early presenter. So I had a different experience I think as a resident than many because of my organizational involvement, because of John’s support of that, the tolerance of my colleagues to allow me to do that. I had to give up vacation time for it. But there were some switches of call schedules and all that were required. And also the very strong emphasis on patients and patient-centricity in innovation. John, by the way, had computers for us while we were faculty members. Dr. Douglas McNeill was very much into coding systems and computers. And I remember sitting down with him one time and saying you know, I like this idea of a problem list that we use and I like our idea of flowsheets, but there’s a lot of paper here. Wouldn’t it be good, couldn’t we develop something where we individualized care to a patient by putting in the standard information in terms of their age and gender and risk factors and then any chronic conditions that they had – any diabetes or high blood pressure or whatever. And couldn’t we have the computer generate a flowsheet that is a single flowsheet for that patient? It would combine all of the parameters that you want to monitor including prevention. And he said a great idea but our computer capabilities at this point just really don’t allow that. I think we’re about there. I think we’re about to have the sort of medical record system and computer support that will allow us to do that. But not envisioned by us at that point is the fact that the patient will be so incredibly involved in the use of the computer inputting information from home, using emails – which, of course, the internet didn’t exist when we were doing this and emails obviously didn’t exist at all. It was really still generally you had your computer or you had your system computer for whatever health care system you were in. But they weren’t going to talk to each other at all. But I think if John Renner were alive today, he’d be looking at this and saying of course, of course. \n\nSo why did you leave that position?\n\nBasically I completed my residency and fellowship year and then was offered the opportunity to work at the Academy. And I was hired or recruited by Dr. Dan Ostergaard who was then heading up the area that had Scientific Activities. He was above the person who had that Division Director position, Ed Daleske. And Mike Miller was actually at that point the Acting Executive Vice President. I had, by the way, been on the Board of Directors during the transition when the prior Executive Vice President left and we were in the recruitment stage for Dr. Robert Graham. So I knew a lot about what was going on at the Academy from having been in the executive sessions of the Board of Directors; a lot of concerns about where we needed to go as an organi-zation. But interestingly, I think it was tobacco issues that was one of the draws for recruiting me aside from understanding the Academy quite well. So I did 20% time still at St. Mary’s seeing the panel of patients that I had had as a resident, then 80% time at the Academy. And one of the first tasks I had at the Academy was to develop a Stop Smoking Kit. Smokeless tobacco was another big issue at that point. So an early thing I did was to attend as an observer, including the closed sessions, of the National Institutes of Health Consensus Conference on Smokeless Tobacco and learned quite a bit about science policy development at that point. But as I say, the main initial sort of focus for me was to get involved in the public health and scientific affairs area. In fact, I was named Manager of Public Health and Scientific Affairs under the Division Director Ed Daleske who moved totally into other work then. He had been the staff executive. They used to call them the secretary to the commission. But that was about the time that you were born and so I didn’t go to the first summer meeting of the Commission on Public Health and Scientific Affairs. That is to say, I went to your birth. And went to the first meeting in January of the following year. But essentially took on the role of being the lead staff for that Public Health and Scientific Affairs group. But at the same time was going to be working on tobacco issues. So as my workload increased and travel in particular increased I actually found that it was very difficult to maintain a clinical practice with the panel of patients that I had. If they as a patient needed to go into the hospital then of course they’d go on the family medicine residency service. And when they were discharged, they would come back for the immediate care to the resident that had cared for them in the hospital. That’s the concept of building a resident practice. Which meant that I would increasingly lose patients and end up primarily doing walk-ins. And also at this point for reasons that I don’t really ever feel I understood, the volume of patients decreased at the residency program. So I would be seeing patients and a resident would be sitting there with nothing to do. And that just didn’t feel right either. So as my workload increased to a point where I really needed to be able to travel on fairly short notice, basically I left the family medicine program there and went full-time with the Academy. And one of the earliest things that happened also was they transferred the Committee on Health Education out of the Communications Division. Then Director Bill DeLay had been the chief staff. And that was moved into the division in which I was in, so I became the Director. Although eventually they changed all the director names that were not as a division director to Manager. Manager of not only Public Health and Scientific Affairs but also of Health Education. So I staffed a commission and a committee for quite a period of time. And the creation of a smoking cessation kit was one of the first tasks that I had been given.  \n\nThen as now a lot of activities of the Academy relied on external funding. And Lakeside Pharmaceuticals had come out with Nicorette gum, and this was the first nicotine replacement therapy for people trying to stop smoking. And they were willing to give the Academy some money for a project that we wanted to do which was to provide free services for our members to do smoking cessation. Then as now the principal, preventable cause of early death is tobacco use which leads to so many other diseases; not only emphysema, COPD but heart attack. And, of course, cardiovascular disease is still our principal cause of death. But also, of course, many cancers are tobacco-related. So we had funding and we wanted to do something that was patient-oriented but also practice-oriented. And so again I think a lot of the elements of what we see the Future of Family Medicine and the New Model of Care were foreshadowed by projects such as the Stop Smoking Kit. We put together a team eventually that included Dr. Leif Solberg from the University of Minnesota who is very involved now in quality improvement work. And he brought to us a model that he had used in his faculty clinic, a two-physician practice in Minnesota, that used a nurse in a very key role, used a physician as sort of an authoritative deliverer of the message you needed to stop and made sure that the practice was going to pursue smoking cessation. But a lot of the real work was really done by a nurse who would do a lot of the follow-up work, a lot of the counseling. We thought that was a good model. He also had a quality improvement component, a systems approach which allowed you to track your success. It used a card system, today we would use a computer system. It would help you track outside of the actual medical record your progress with patients and your follow-up. We did definitely a patient brochure. And we ended up doing quite an extensive one with permission, used other existing resources that were out there. We had humorous things. Door hangers that said “Beware, Somebody’s Attempting Smoking Cessation” because obviously you can get a little irritated. Also, one that says “I Quit.” Like a door hanger that you would have on a hotel room that says “Do Not Disturb.” It had other pamphlets and all. And most importantly, it had a manual which was a strategy for how to integrate smoking cessation within a practice. It defined the tasks that needed to be accomplished and then it’s up to the practice to make decisions about who’s going to do this, who’s going to do that. It used the medical record. We had stickers that indicated the smoking status of a patient because you needed a reminder. You could put this on the problem list or you would put it anywhere, but it told you this is a person who smoked. Because each and every time then that that patient would come in, if it was appropriate, like you wouldn’t do this two days in a row probably, but periodically you want to ask a patient who is currently smoking if they’re ready to stop and that you were willing to help. And it built on the work in general practice in England by a researcher named Russell who had shown that if you do nothing more than say to a patient as a physician, I know that you’re smoking; it’s impacting your health. You really should stop. We’re here to help you. This had shown that if all you did was offer brief advice after stating that somebody needed to stop, that 5% of patients would be smoke-free at one year. And all measurements in tobacco cessation really should be based on a one-year marker. And basically this is an amazingly cost-effective intervention. Five percent doesn’t sound like something…you wouldn’t want surgeries that only had a 5% success rate. But if you look at the harms and the benefits, there are no harms to saying to a patient the truth, that that tobacco is going to adversely impact their health and that they need to stop and you’re willing to help. There’s no downside to that and yet you have a 5% benefit each year. If you add nicotine replacement or other therapies, you can increase that rate much higher – 30%, 40% or better. And, of course, most people stop on their own. But the important thing is that this was an oppor-tunity for the Academy to work in a public health area, to be science-based and to be systematic in its approach.   \n\n [Interview continued July 16, 2006.]\n\nCould you summarize again what you started doing, your positions at the AAFP?\n\nMy first position at the Academy, which as I mentioned earlier, it was an 80%-time position, was as Director of the department of Public Health and Scientific Affairs which meant that it was supporting the commission of the same name. And then after I’d been there awhile, and frankly I don’t remember exactly when, the Committee on Health Education was transferred out of the Communications Division and into the Scientific Activities Division and I was given the addi-tional title of Director of Health Education. So I staffed both the Commission on Public Health and Scientific Affairs and the Committee on Health Education. And the Stop Smoking Kit was really developed by the Committee on Health Education. A number of individuals served on that committee who still are very prominent in family medicine. One in particular is Tom Houston who was one of the original founders of Doctors Ought to Care (DOC) which was an anti-tobacco group that countered advertising. And they also did things that were at times viewed by the law as not necessarily appropriate. Not necessarily the national organization itself but some of those who were so dedicated to the elimination of tobacco. If I remember correctly, there were some instances of cigarette vending machines having slugs put in them instead of a coin. It was something else that was round and would go through the slot but then wouldn’t function. To my knowledge none of the leadership was ever involved directly in that sort of activity. Then there was some reorganization over time and eventually I became the Assistant Division Director, a new position in the Scientific Activities Division. By that point we’d moved from our offices on 92nd Street to 8880 Ward Parkway. Interestingly, before we moved into that building, because of the growth of the Academy and staff including in our area, they ran out of space on the 92nd Street site and they moved our division, then headed by Ed Daleske and also having in it Rebecca Creek who is still at the Academy at this time, Joyce Haas who was working for me and is still with the Academy. We moved down to Ward Parkway in a building whose number I don’t remember but it must have been something on the order of 9200 Ward Parkway because it was at the corner of 92nd and Ward Parkway. And we occupied part of one of the higher floors. So we had to commute up the hill to the main building during that period. We moved then to 8880 and in that move the Academy made a significant change in housing. They moved from the style where every management person had an office to the use of cubes or cubicles – cubies as they were called. And that meant that a lot of people who had been in their own private office, could close the door, they were suddenly now in this open work environment. And that was quite an adjustment for many people. Some on the basis of the work environment just was much more noisy and others because it just felt like something had been taken away. The only people who had offices were Vice Presidents and above and Division Directors. I became an Assistant Division Director and in the new building moved from a regular cubicle into one that had wood. So they did set up sort of a visual hierarchy in that regard. In the 92nd Street building I only had one place that I was housed and we had this other down the hill location on 92nd and Ward Parkway and then in 8880 Ward Parkway. The division was on the top floor originally, on the west side and then we moved by the time I became Division Director over to the Ward Parkway side, sort of midway in the building, and then ended up moving out to the most northerly part of the division.   \n\nSo in summary I was Director of the departments of Public Health and Scientific Affairs from 1985 to 1986. And then ’86 to ’89 also held the title of Director of Health Education. Somewhere in there they actually changed those director titles to Manager and decided only Division Directors and Assistant Division Directors would have the title Director. Became the Assistant Division Director in 1989. And then in 1990 through the current time have been Director of Scientific Activities. The division went through quite a restructuring however about the time I was assuming the role of Division Director and what had been the people working on the scientific program for the annual meeting moved into the continuing medical education area. We also had the convention sales space at the Assembly move out of Scientific Activities and that ended up in the Meetings and Conventions area ultimately. And in addition, there were certain committees that were gotten rid of over time. So there had been a Committee on Mental Health and that was discontinued during some of this reorganization, although the exact date I don’t recall.   \n\nWhat were some of the duties of these positions and how did those change as you were promoted?\n\nI think I pretty well have gone over what committees and commissions I did originally which was Health Education and the Commission on Public Health and Scientific Affairs. Although I guess I should mention that prior to my joining the Academy, the Commission on Public Health and Scientific Affairs also dealt with environmental issues. And I think that was reflective of the nation’s interest in saving the environment, Earth Day and beyond, as we started realizing that the resources of the world were limited and our population was growing. And in particular there were a lot of issues of health relating to exposures. Pollutants having impact on respiratory disease, for example. But over time it became Public Health and Scientific Affairs. It had primarily interfaced with the government Centers for Disease Control, for example, the American Cancer Society. And we continue those relationships today with a number of other medical and voluntary health groups. And I supported either the members of our commission who went to represent the Academy or in some cases I was the representative. In the health education area another role that I assumed was when the Academy became involved again in the Conference on Health [Patient] Education, I served on the steering committee and so was involved in helping to select the offerings that would be at any meeting. It was a competitive review process and, of course, had the business management aspects of it. So in summary, I had representational duties, I had organizational duties, I had budget and other sorts of things you have to do in running an organization. As the Assistant Division Director, then I started assuming a role in support of the overall division activities. And then ultimately as a Division Director participated not only in the running of my division, hiring and firing, personnel issues and so forth but also became a member of what used to be called “Monday at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156795/file/286752#t=0.0,600.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/156795/file/286752/transcript/82492/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"” This was a senior management meeting that Robert Graham, Dr. Graham, as the Executive Vice President instituted before I got to be a division director where he wanted more communication across the divisions. There was a feeling that the various divisions worked I silos or what you might call     [    ] and this meeting was an attempt to bring together the leadership of the divisions to discuss issues that were important across divisions. And it was pretty informal at the beginning. In the new building we had a marvelous Board room and Monday mornings around 9:00 he’d come in and write on a piece of paper that was on a display board what the topics were that he wanted to bring to the meeting that day. I would go in early and take a look to see what it was and would start talking with my managers in advance of the meeting to get any input that I thought I could get from them, although we didn’t always know what the words meant, what the topic was going to really be about. Ultimately there was enough concern raised that we really needed to think about issues beforehand or to learn about them and so the meeting was moved to Tuesdays and became “Tuesdays at Ten” and the materials were passed out a day earlier. So we discussed everything about budget, about the internal organization of the operations, the publications. For example, there was a special group that I served on headed by Gordon Schmittling who was then and continues to be the head of the Research and Information Services Division. We had gotten a review by, I believe it was ASAE. And I don’t remember the exact words that go with those initials but it’s an association of associations basically. And there was essentially a feeling with the review that we were sending a lot of paper to our members and we weren’t sure they wanted it and we weren’t sure that they understood it was all from the Academy. Various parts of the Academy had their own newsletters, for example, for various programs and some of it, it wasn’t very prominent even that the Academy was the source of this. So this group did a very thorough review on inventory of all the publications and their frequency, their purpose and then made recommendations. And we got rid of some or we moved to have better identification. Bill DeLay, then head of Communications, also led another activity that looked at standardizing the look of the Academy. We have an official color blue, for example, that when the Academy letterhead is done or anything that we want that official look to be present, then we would use that particular blue. And it has an assigned number basically for printers. We also tried to use the seal more and in a consistent manner. That is an example of something that has periodically come and gone within the Academy because we set up these new standards for visual appearance and then they sort of disappeared over the years. And it’s just now with the arrival this past year of Donna Valponi who had been working at Hallmark and now is a Vice President in the Membership and Marketing area, that we began to look at this issue of being standard in appearance. And so much so now that our PowerPoint presentations for giving talks, we’re supposed to use a very specific template. And so every PowerPoint presentation coming from the Academy as an organization is supposed to have this same appearance. We also tried to do that with the website for awhile and part of my duties as a division director was to serve on the Online Committee, online meaning on the internet. And we worked to have standardization of not only appearance but also to have really one major website on the World Wide Web: aafp.org. But over time again we added new programs: familydoctor.org for example, our patient educa-tion site. So it got its own URL. In my division the Tar Wars program which is aimed at youth to try and keep them from starting smoking, it got its own website. Also in my division, the Americans In Motion program aimed to try and get more of our members initially, then their practices and then their patients doing exercise, at least 10,000 steps a day. It got its own web-site. Our Center for Health Information Technology that was created several years ago under Dr. David Kibbe got its own web address. TransforMED, our newest venture having to do with transforming family medicine, the design and function of family medicine practices, has its own website. The Robert Graham Center also has its own website. So at the moment the Academy has a web presence that is not just World Wide Web aafp.org. And then, of course, on that website we have a member-only access by putting in a code word and member ID. Other duties over time of a division director particularly in these last few years has included significantly more time spent in being a part of a senior management team. And Tuesday at Ten has been renamed Compass. And just in the last month we have finally redefined the current function of that group. So as a division director, once a week I attend a 60-90 minute meeting where we are trying to learn more about what’s going on in the environment of our members and of the Academy, to define value for our members, to get reports on progress to date, to challenge each other on what it is that we should be doing, to help in undertaking the strategic plan of the Academy that the Board of Directors in the last year has updated and so forth. The decision-making power is above, in general, the division director at this time and sits with what’s called the Vice Presidents Group. And that is the Vice Presidents, the Executive Vice President and the Deputy Executive Vice President. And they come to Compass and seek information, opinion and thoughts from us and ultimately those decisions are made at a higher level. So the role of a division director has evolved from when I first assumed it where there was just the beginning of organizational involvement through a period where Compass, Tuesday at Ten then, actually did make decisions – not all, but a number of them, brought by then EVP to now being more back to an information exchange but with the expectation that major decisions indeed will be vetted with Compass. And we’ve also recently eliminated something called Compass Expanded where the assistant division directors and some of the physician staff who are not assistant division directors also attended. That change has just occurred and in terms of its future development, you’d have to interview me later. \n\nWhat other duties did you do?\n\nIn addition to those that any division director would assume, by being the Director of Scientific Activities, I also continued to have representation responsibilities. So, for example, I’ve been the Staff Liaison for many years from the Academy to the United State Preventive Services Task Force. The Task Force is the gold standard organization for developing recommendations for clinical preventive services in the United States and we use their output as the science base for our recommendations and for clinical preventive services. Likewise, I’ve been a representative to groups of the American Heart Association, the American Cancer Society to a whole variety of Centers for Disease Control groups trained in various areas of smallpox response, immunization issues in general and so forth. Also have been lead staff to a number of groups. This past year influenza vaccine was in short supply and so I was the staff executive to the Task Force on Influenza Vaccine headed by Dr. Kellerman of Wichita, Kansas, our President-Elect. And the Assistant Staff Executive was John Swanson, Director of the Socioeconomics Division. That division, by the way I understand, may be changing its name shortly. And we had the recording secretary from my staff, Terri Vokins. So representative, lead staff in terms of various bodies. I’ve also had the Task Force on HIV/AIDS that I was staff executive to in the past. A variety of tasks that just come up and need to be done. I serve on a variety of panels right now: the Budget Management System Steering Committee which is looking at revising how we do our budget and is doing reviews account by account. Also, the Core Team for the Internal Management System, sometimes called a Balance Scorecard, which is helping us with our processes. And lots of meetings for all of these things. So the mix of a division director changes over time. And some of us who have significant professional duties and expertise are finding it a bit more stressful time as we sort of reorder how we use the number of hours that we do have.   \n\nWho were the people that you worked with most closely during different positions?\n\nThat falls out into a couple of categories. One are members. And those members are both the elected leadership and the appointed members of commissions, committees and task forces. I’ve been quite honored to work with some of the most brilliant scientific minds within family medicine through my work on the Commission on Clinical Policies and Research and now more recently, as it’s been renamed, the Commission on Science. So individuals like Lee Green, Dr. Green from the University of Michigan who has been quite involved in cardiovascular medicine but also in the development of clinical practice guidelines, using what’s called an evidence-based approach. Dr. Ted Ganiats of the University of California-San Diego. Likewise a researcher and also an individual with vast experience in the development and application of clinical practice guidelines particularly in the area of quality improvement. And currently he’s the acting chair of his department. Dr. Bill Phillips currently with the University of Washington in Seattle who was in private practice for many years but during that time was a notable researcher in the area that I would call practice-based research. And now he’s in a position at the University of Washington. I could go on and on with other individuals who were either chairs of the Commission or mem-bers on the prior Task Force on Clinical Policies for Patient Care which I also became lead staff for after Dr. Dan Ostergaard finished his work in that regard. The elected leadership involves people that our Congress of Delegates have elected to higher office. And the first of these that I knew was Dr. Stelmach here from Kansas City, Missouri. When I was a student, he was I believe at that point the President of the Academy. And so each President from then on I have had some level of dealing with. Some of them because they served as the chair of the commission that I have staffed. Because at one point the members of the Board of Directors served as the chair of commissions. Now they serve in a role of being the Board Liaison. More recently though task forces still are chaired by members of the Board and so I just finished working very closely with Rick Kellerman who at this date is our President-Elect and will assume the office of President at our annual meeting and then Board Chair a year after that. Then there have been I would call “notables” within the field. And again, they’re very far-ranging. And those include some who are notable in other fields. Dr. David Eddy, for example, who is well-known for his work in defining how to do evidence-based clinical practice guidelines. He was our consultant to the Academy when we started our work on clinical practice guidelines. And then staff. Many, many staff. Dr. Robert Graham actually arrived at about the time I did to become our new Executive Vice President and had been formerly the head of the Health Resources and Services Administration, came to be our head. He said he’d only be here a few years and he ended up being here fifteen years then he moved on. And Dr. Doug Henley, our current Executive Vice President, became our Executive Vice President, and he came out of practice. Doug was the Resident leader when I was a Student Delegate and so I’ve known him for years on and off. The same thing with Dr. Bruce Bagley, our current Medical Director for Quality, was an early leader. Other staff, Dr. Dan Ostergaard was the Vice President that my division director, Ed Daleske, reported to and to whom I reported when I became Division Director. And he likewise had been an early leader in the resident movement before assuming his position. Ross Black was the former [assistant] division director for Education. And he actually left, went into practice and came back as a member of the Board of Directors and is now back in practice. Tom Stern, Dr. Stern when I as a student was a senior member of the staff at the Academy and certainly well-known to anyone who studied the role of family medicine. Currently Dr. Norman Kahn, Jr. is my Vice President and he has been quite notable in his contributions to family medicine, particularly his leadership in the Future of Family Medicine project. Along with another very important name, Dr. Larry Green, who came to us from Colorado where he had been department chair and then served as the head of the Robert Graham Center, our policy center in Washington, DC. Dr. Wilson Pace, our current Network Director who I have hired on a part-time basis, 50% time, from the University of Colorado, has been an outstanding builder of our National Research Network and then working with other networks. A true visionary and a wonderful team leader. And before him, Dr. John Hickner was the first full-time Director of the National Research Network. Actu-ally, it had a different name at that point. It had a very long name that somehow the Board of Directors wanted attached to it. It was, I believe, the National Network for Family Medicine and Primary Care Research – which doesn’t shorten down easily. We’re now the NRN. And actually I was the first acting director of the National Research Network when we put together, along with Dr. Jim Gallagher, he’s a PhD sociologist who I’d hired. He was the first Research Director of the Network. I was the first Network Director. And the two of us and other staff, including Tom Stewart, put together our first federal application for funding from the Agency for Health Care Research and Quality to start that Network. I was very relieved when I could get a real researcher, John Hickner, to take the initial rein. And right now another notable family physician, Dr. Douglas Campos-Outcalt, who is from the University of Arizona, we have 40% of him as our Clinical Sciences Analyst. He has remarkable background in that he was an AMSA leader, the American Medical Student Association, at the time I was a student leader. And that group is certainly more progressive or liberal than many other physician groups of its time. And he’s moved through his career a very strong interest in public health at the University of Arizona. Prior to my being able to get some of his time, he was the Medical Director of Maricopa County, the Public Health Director. He currently serves on the National Advisory Committee for the Agency for Health Care Research and Quality, AHCRQ as it’s called. And also did a Robert Wood Johnson Foundation Congressional Fellowship and worked for the Health Committee of the U.S. Senate. These are just a few of an incredible number of individuals that I’ve been fortunate to work with and learn from and I’m sure there are going to be many more in the years ahead. One of the advantages of working at the Academy, unlike my role when I was an elected leader as a student and then a resident, is that the people who serve in those positions serve only for the term of their election and then they are done in a leadership role. \n\nYou were just making an interesting point about some of the benefits of not being an elected position.\n\nThere are certainly many benefits to being an elected official of an organization and I had that honor as a student and as a resident. But what I’ve really enjoyed about being on the staff is that there is really no term of office after which you know that you have to depart from your role as a member of the Board of Directors or a Chair of a committee or commission or whatever. As a staff member, you have the opportunity to make a continuing contribution over a significant length of time – in my case, 21 years. And that’s allowed me to do things that would have been very difficult as an elected leader to do. I’m particularly proud of having been able to move the role of science in the Academy. This has been a very slow, very steady process. In fact, I remember when we were at 8880 Ward Parkway and we used to meet once a year with our Executive Vice President as a division and I took the opportunity to talk with Bob Graham a little bit prior to the meeting with our whole division and expressed to him some concerns that I was hearing from my staff that the work of our division didn’t seem to be very highly-valued. And basically what he said was it has to do with where the discipline is at this point and a lot of the issues that our division was dealing with weren’t top-of-mind clearly. Science was important in family medicine but it wasn’t as urgent an issue as it later became. I’m pleased that I was able to be there at a time and hopefully facilitate the growth of the Academy’s role in science. And by that I mean both the creation of evidence-based clinical practice guidelines, our recommenda-tions for clinical preventive services, our influence at organizations like the Advisory Committee on Immunization Practice and so forth. And certainly the fact that an increasing number of our leadership had now been residency-trained and in many cases were members of faculties, had been able to be actual researchers, was a trend that made this process easier. But it was a difficult process. For example, a particular joy to me is that we now are bringing in large numbers of federal dollars through grants and contracts and cooperative agreements. To do that as an organi-zation, we had to value science sufficiently that we would make the changes in our accounting systems, in our legal offices in terms of review of federal requirements and our human relations or resources area to make sure that we were now an EEOC, Equal Opportunity Employer, and Affirmative Action Employer. That investment was a significant investment in terms of person hours and dollars. And we have made that a success because we’re bringing in a huge number of research dollars to generate new knowledge through our National Research Network, for exam-ple, in order to help our members provide better care. \n\nAre there any other kind of changes in the environment and culture that you’ve seen within this organization between when you first started and now?\n\nWell, very definitely we’ve moved from divisions that operated pretty much as their own entities unconnected to really the rest of what we’re doing to a stage now where we do have a strategic plan established by the Board, the highest priority being advocacy for our members and for their patients. The second priority being practice enhancement; that is how to change the practice of family medicine to best serve patients and to also make it possible for a family physician to make a living. And then the third priority is life-long learning. And then we have several other priori-ties. And the fourth one in fact is the one dealing with the health of the public. My division works very much on the educational component in the part that is the generation of a new know-ledge that we need in order to educate our members and also in the public health area in the major public health issues, which for the United States at this moment in time very clearly is the continued problem with tobacco use and also with increased weight and decreased exercise. Although also on the horizon for us in 2006 in the summer is the probability of some sort of pandemic influenza striking the world in the next years ahead. But to get back to your question, we have moved from working independently to working much closer together across divisions. So I work very closely with the Government Relations people, for example, on any advocacy that would better help our members with clinical preventive services or in tobacco control. And we’ve created a concept called resource centers. We’re still learning about how to make these work and I’m sure they will continue to go through some change. But where instead of having one person in every area who is sort of a marketing person, we’ve centralized the marketing process. And then they work with us as if we were a company and the marketing people were our advertising agency. Likewise, our clinicians are learning to work together. And again, there’s a lot of time and effort in trying to learn how to work with other groups. Ideally what we do in the Commission on Science should feed the work of the Commission on Education and the Commission on Continuing Professional Development and the Commission on Quality and so forth. One other thing I guess I would say is I’ve noticed that we have created a number of entities that do not have direct oversight by commissions or committees. This has allowed us to be more nimble. But it does mean also that we have to be very clear that we’re constantly figuring out what our members need, the directions that they need us to go in. And a professional association needs to be a mixture of both leadership, which sometimes means trying to help members do things they’re not ready to do, and also in being responsive to their very immediate needs. And in a sense it’s like a family physician seeing a patient. The patient comes in with something that that patient wants fixed, wants dealt with. But at the same time, as a family physician we need to be aware of the health issues of that patient that the patient may not be so aware of. In the clinical preventive services area, for example, there’s lots of screenings that patients frankly don’t show up on your doorstep asking to be screened for. Or they may present with a finding that you get from their history or from their physical exam that says ah, we have a problem here. But you’ve got to deal with that patient’s concerns first because that’s why he or she came to see you. But you’re failing to be truly a family physician if you aren’t also dealing with the things that you may have to sort of lead your patient to. It’s still their decision ultimate-ly. But if you aren’t serving them in that regard then you’re not providing the full scope of care that a family physician should. And the same thing with the Academy. We are perhaps a family physician to our members and so we both deal with the reason for a visit as well as the things we know they’re going to need to do and learn about. \n\nDo you recall when family medicine became a specialty and kind of what the feeling was in the air at that time?\n\nIt was a time when the nation was facing a fair number of challenges. And one of them that had been discovered was that the generalist role was still very much needed and yet there weren’t any new generalists being graduated in family medicine. It was also a time when some people felt technology was being used inappropriately in terms of medicine – and I’ll come back to that in a moment. It was a time when many state legislatures decided that there needed to be an assurance that there were going to be generalist physicians, family physicians trained, and in particular, be trained and remain in their state. So Wisconsin, for example, I’m most familiar with, had origin-nally allocated some money from the Legislature to the medical school to start a family medicine residency. But somehow that didn’t happen and so the legislative leaders got very upset and passed a separate line item in the budget for the University of Wisconsin that was just for the Family Medicine program. That money couldn’t be touched by the Chancellor or the Dean or anybody else. It had to be spent on that particular single task. And at Wisconsin in the family medicine community worked with some of the more forward-thinking members of the medical school: Marc Hansen, a pediatrician, being one of them. And Karen Pridham, a nurse, was also involved earlier. And they created the Family Medicine program, relying of course very heavily on the local practicing family physicians politically and for clinical purposes. And Dr. Richard Shropshire was indeed a major leader at the time. He later became an officer of our Academy. So in a sense the formation of the specialty came out of a public need. And it was a movement, it was a community needs-based change. And that was very refreshing because medicine had been going off on its own directions, quite frankly very enamored with technology and not so much with people. I think we’re still fighting that battle at this point. When I was a member of the academic support staff working for John Renner at Wisconsin, I was part of the interviewing process. And it was very clear that many of the residents who were drawn to family medicine and to John Renner’s program in particular did see themselves as change agents and as protectors of people. And this is a little different motivation than making money or being tops in your field in a research sense. And in fact we suffered a bit from the lack of that desire to conduct research for awhile as a specialty. And yet that was the only way that the specialty really could come about and meet the needs of people. And we are again facing that now and I think the Future of Family Medicine project, which in this case did a very thorough research approach to come to the conclusion of what we need to do to change the specialty, that is that movement being carried forward and now maybe you might say a more scientific manner. There were clearly early pioneers, like John Renner, who were builders and were confrontationalists as needed to be. And they are individuals that build tremendously. In Wisconsin, for example, it wasn’t just the University of Wisconsin, but that’s principally the building that occurred that started with Madison having three training centers, three model clinics and then adding Wausau and Eau Claire and the Appleton program and having taken on St. Mary’s in Milwaukee. Meanwhile, Mayo’s was doing something at LaCrosse and the Medical College of Wisconsin was building up programs in that part of the state. That showed a society that had figured out a need that needed to be met and made the resources available that needed to be there in order for this to occur.   \n\nOf the things that you’ve done, what do you feel have been some of the more important things or the things that have had the most impact?\n\nWell, since I’ve done such a variety of things, that’s a bit of challenge. I guess the common theme is using science to improve health. And whether that’s moving from a softer sense of science such as the Conference on Patient Education now transformed into the Conference on Practice Improvement. But that was something that I was very pleased to be a part of more so back in the early days than now because I don’t serve on the steering committee anymore. But that’s where I first learned about the concept of readiness to change which is now a basic part of health education, was through that sort of conference. The early work on getting evidence-based clinical policies for patient care, Dan Ostergaard carried the load initially but wasn’t as science-oriented. And so when we moved out of sort of the political process that it was at the beginning to a more science-based then I took over the staffing of that committee and he moved on to other important work. The Stop Smoking Kit, to my mind, is probably the single product, something you can hold in your hand, that I’m proud of because it allowed us at a very early stage, we’re talking in the late ‘80s, to do a lot of things that we’re now doing in a much more sophisticated way at a national level through our work with TransforMED and the quality improvement activities. But again, it was reflective of the people that we had involved in that process. We had Leif Solberg from the University of Minnesota who had a real systematic and quality improve-ment concept that he was able to bring to the table as a part of the group. We had Tom Houston with his clear commitment to tobacco control leading us as a committee chair. We had Art Ulene, not a family physician although he was perceived as a family physician by the public on the NBC Today Show, but brought his skillset to our work. So I guess it would be some long-term issues of giving us good science and then able to apply it. And right now I think probably at the top of that list would be my role in the formation of the National Research Network of the Academy. It may be that a year from now I’ll be talking more about how we’ve been able to prepare for pandemic influenza. Hopefully that won’t be what we’ll have to talk about. We’re hoping that our preparation is more an insurance policy for something that may never come as a worst-case scenario. But, of course, we’re getting prepared for that for some time in the years ahead.   \n\nLooking back over your years with the organization, what are your fondest memories and then why? And then what are your darkest days, most difficult times both personally and for the organization?\n\nI guess the fondest memories are all of the different people that I’ve been able to work with in a very team-oriented way. And there’s a sort of cadre in particular of people: Lee Green, Ted Ganiats, Barbara Hawn, Bill Phillips, Mike LeFevre. And I’m sure I’m missing a whole bunch of other people that I would put in there. So one type of fondest memory is working with these talented family physicians who have incredible expertise in their areas. In the research enhance-ment area would be people like Perry Dickinson and Frank DeGruy who were our leaders in other organizations like STFM and NAPCRG, the North American Primary Care Research Group. Kurt Stange would be another. A talented staff: Jim Gallagher, Wilson Pace, Doug Campos-Outcalt, Belinda Schoof. These are individuals who have been a great joy to work with. The whole National Research Network staff. And the senior leadership as well. And then the members themselves. But you don’t have as much contact really with them except as they get appointed to a committee. And by the members, I’m thinking primarily of the practicing docs, the main base of our organization and of this health care system. These people, whenever you can sit down and worth with them, listen to them, talk to them, are just outstanding human beings. They’re really committed to make a difference in the life of their patients. And if they aren’t being totally beaten down by the system, they also want to make a major difference in their communities, which is why programs like Tar Wars have been so successful. So I guess those would be the fondest memories. I would add that the Academy is a family and so being able to travel with my wife and daughter to many meetings where other members have brought their families. And the chance for them to interact is certainly another very family-oriented aspect of the Academy. \n\nDarkest hours – that I don’t really have anything that just absolutely stands out in my mind. I think things have been so much more on the positive than on the negative. Certainly the challenges have been there over and over again. We’ve had periods where the budget needed cutting and that’s never a pleasant situation to be in. We’ve had instances where there’s been some turmoil within the organization. But nothing like other organizations that have gone through major upheavals of any sort. So I really would have difficulty identifying so of a darkest hour. I do think that the specialty is again in a major period of challenge. And that challenge is a balancing act for us because on the one hand we have to really address the issues that are facing our members economically. If they can’t afford to be in practice, they aren’t going to be able to provide the care that they need to give to their community. Those challenges are for the most part not in my area. The fixing of the Medicare payment formula, for example, is not something that my area really deals with, though I take every chance I can and any audience I can to help the rest of the world understand why if we don’t fix that, that the issue that they may be asking me to address clinically such as increasing immunization rates among older people. If we can’t have our members afford to see patients who are Medicare beneficiaries, there’s no way to really help the immunization rates among these people. So maybe that’s the darkest aspect of the things. But I don’t think in the sense that probably the question was asked, that I can really identify a darkest hour in terms of the work of the Academy. \n\nWhat do you feel the organization is doing better nowadays than it was doing when you first started, and why? And what do you feel the organization might not be doing as well as it used to? What advice would you give for someone who would be coming into kind of a position like this?\n\nWell, I think that we’re doing better at being a national area. In the science area, for example, when I started we didn’t have even any relationship with the Advisory Committee on Immuni-zation Practices to the CDC, the group that sets the national recommendations for immuniza-tions. Early in my time with the Commission on Public Health and Scientific Affairs, we were successful in getting our first liaison to that organization. That was Dr. John Tudor, who I haven’t mentioned, I don’t believe, and who was another outstanding leader. He became our first and we built on that till now. We have two liaisons: Dr. Jon Temte of the University of Wisconsin and Dr. Douglas Campos-Outcalt of the University of Arizona. And when they go and they say something, people care at the Advisory Committee on Immunization Practices what our position is. And I find that same experience when I go to organizations as a representative. They care at the Health Professions Roundtable, at the Agency for Health Care Research and Quality. All sorts of venues, they care what we as an organization have to say. Our role in national health care reform again is not in my area but one that I think we can be very proud of. We haven’t gained what we need yet in terms of coverage for health care for all in this United States. But we’re doing it – we formed a political action committee, a PAC, this year past and we had access to the leadership of the Congress in a way that we never thought of before. We’re still fighting the battle of recognition in some other areas like disaster preparedness. People still think of emergency room physicians or surgeons for preparedness. And yet we know from Hurricane Katrina hitting New Orleans and that area, that we needed more family physicians to have been part of the preparation. As a staff we’re certainly working more closely together, focusing our resources on our highest priorities. And I think were you to interview me several years from now, I probably would have more success stories to tell because this has been at the beginning of that journey. We certainly have a political process that still brings forward many excellent leaders. For example, Dr. Kellerman, Dr. Van Durme, Dr. Rich Roberts. All sorts of great leaders. And I don’t want to offend anyone by not mentioning any, but the ones I’ve worked most closely with obviously are the ones that I know best. And we have done well as an organization investing in the younger members as students and residents in leadership development. And then after that we added on minority physicians, the physicians who are international medical graduates, women, etc. and this is the demographic change of the United States. We need to make sure that we’re turning out family physicians who represent that cross section of the United States because we’re the community level. And you need leadership. You need people who can go to government, who can go to industry and definitely deliver the messages that need to be delivered and to work cooperatively. And then most recently I’d say we’ve done a good job of beginning to transform the specialty through the use of technology like our Center for Health Information Technology where thirty percent of our members currently are in electronic health records. But now we have to enhance the value of those records, those systems. And then that will feed a whole bunch of other areas like quality improvement. We need to do a better job of conducting research. We’ve done a good job with practice-based research but we really need to keep that going because without the generation of new knowledge, we will not be as effective. And to generate that new knowledge, we have to do a better job of advocacy for funding for research. And we have lost some battles. The Title VII battle continues to have gotten worse and worse. That’s the funding for Health Professions Training through the Health Resources and Services Administration. So a mixed bag there. We’re doing a lot better in leadership and then advocacy and we’re certainly doing a better job in continuing professional development. But in some respects it’s just beginning and I’m looking forward to more years of work with the Academy in these areas. \n\nYou’ve touched on this several times throughout our interview. But what is your sense of where family medicine is going in the future?\n\nI think that it will be a very positive future as long as we keep our eye on why the specialty is so badly needed. We have a change in the expectations of younger physicians and the demands on them, so we’re going to have to continue to make it an appealing specialty to enter. We’re to some degree at the mercy of the admissions committees of medical schools because if they want to only take the board people who are procedurally-oriented, who want to make a lot of money, who don’t care about rural America – or may care in their minds, but the reality, when you look at what causes somebody to go rural, they’re unlikely to go rural or inner-city for that matter. If we don’t pay attention to that, we won’t draw the physicians that we need. But I think that the transformation of family medicine is going to do that and I’m very optimistic about our ability to garner new research funds. \n\nYou’ve mentioned a whole lot of people who have impacted you throughout your career. Who are some of the people who have touched you the most, who have affected you the most and why?\n\nSpeaking within the scope of family medicine?\n\nYes.  \n\nCertainly John Renner is probably the person who’s had the absolute most influence over me and I’m so sorry that he passed away these few years ago. John had the passion, the sense of respons-ibility towards patients but also towards the discipline, the motivation to get out there and do it. And in this sense, he’s a mixture of somebody who was very analytic but also as very forward-moving. In fact, you could almost think of him as a charging bull at times but one who has figured out where he wants to go. In that same department, I would have to say probably Dr. Marc Hansen, who is the pediatrician, certainly did…a very scholarly sort of guy, very much a clear thinker about where we needed to get to. And another product of that department, Dr. Rich Roberts who I worked with both as a resident and a student as a colleague, but also then later as he actually chaired our Commission on Clinical Policies and Research. He was the first Chair of it and I worked with him on the task force that preceded it. A man who really had a great deal of foresight. Politically very astute and continues to be very impressive as someone who can get things done.   \n\nThis is side B of tape 3 of the interview of Dr. Herbert Young by his daughter Lindsay Young at their home on July 16, 2006. You were talking about how Dr. Renner had been a very important person in your life.\n\nI was reflecting on the fact that I had worked for him first before going to medical school and then while in medical school had continued to learn from him. He was also my residency director from the program that I graduated from and I worked with him on so many different projects. My wife Lisa even ended up living with he and Diana Renner here in the Kansas City area when I came down after graduation from the University of Wisconsin Medical School. She needed to come down early to take a store management position or she wouldn’t get that position, so she came down and lived with them out in the Independence area on [    ] Road before I came down. John is the sort of individual that was going to get things done. And I tend sometimes to be a little too analytical and so learning from him how to move forward, how to keep up with him certainly was a major force not only in developing my beliefs or building on my values in terms of what family medicine is about but also in just how to deal with the world. Now I suspect I’m quite a bit more diplomatic than he would ever have been considered but he was quite caring and diplomatic in his own way. But he moved at such a fast rate of speed that it was tough for other people to even quite understand where he was headed. And I just have to say there are so many other family physicians who have mentioned earlier that for intense periods of time when they served on committees or commissions or were leaders of the organization as elected officers, that I also would have to say were major influences. And then, of course, Dr. Dan Ostergaard as my first Vice President and Dr. Norman Kahn as my current Vice President and many colleagues of course on the staff as well. \n\nAre there any last thoughts that you would like to add? Your opportunity to share your thoughts with future generations listening to this tape, to set the record straight on anything you feel might be important to address?\n\nWell, I think that you shouldn’t only listen to one voice. Family medicine is so complex in its development and its accomplishments, its challenges that if anyone is really wanting to learn about the specialty, they really need to listen to lots of different voices, read lots of different papers, study broadly because we are a specialty. We also, in my case, have just one of the organizations, the American Academy of Family Physicians that has interplay with the other members of the Family of Family Medicine. There are the members themselves, and I sure hope that we are trying to not only get oral histories of individuals who have visible roles, but that we’re out there gathering also from people who may never rise to any recognition in terms of a newspaper article nationally or a newsletter of the Academy but represent that core of what the Academy is all about. Because to really understand family medicine and what we’re accomplishing, you really have to hear from the real doc out in the community and his or her colleagues in practice – and ideally from their patients. I mentioned earlier in the interview about getting a patient advisory committee together. And it might be an interesting thing to have some practices, get some of their patients together and hear from those patients as a group, in a focus group, what it is that practice has meant to them. What that doctor or doctors have meant to them.   \n\nIt’s been a pleasure interviewing you. 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