{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/tq5r787v1k/manifest","type":"Manifest","label":{"en":["Dr. Steve Collier"]},"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":["2016-07-28 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Sam Taggart (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["Steve Collier, 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/collection_resource_files/thumbnails/000/290/302/small/SteveCollierM.D.DVD.mp4_1756914765.jpg?1756914768","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302","type":"Canvas","label":{"en":["Media File 1 of 1 - Steve_Collier_M.D._DVD.mp4"]},"duration":4106.35225,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/290/302/small/SteveCollierM.D.DVD.mp4_1756914765.jpg?1756914768","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/290/302/original/Steve_Collier_M.D._DVD.mp4?1756914723","type":"Video","format":"video/mp4","duration":4106.35225,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302/transcript/83662","type":"AnnotationPage","label":{"en":["Dr. Steve Collier Interview Transcript 1 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302/transcript/83662/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview with Dr. Steve Collier\n\nGood morning; it is 7/28/16 and my name is Sam Taggart.  We are in the office of Dr. Steve Collier who is actually the Steven Collier Institute for Wellness.  We are here this morning as a secondary interview with Dr. Collier because I have already interviewed him previously.  We are going to focus most of our attention on his life and when he decided to come back to Augusta as well as what went through that process. \n\nSteve, talk a little bit about your training and where you went to medical school as well as where you did your internship and residency; that kind of thing.       \n\n “I went to the University of Arkansas in Little Rock for medical school and graduated in ‘80.  I couldn’t make up my mind of what I wanted to do; still don’t know for sure, but I remember being torn between doing a flexible internship in pediatrics and a regular family practice.  At that time, AHEC residencies were fairly new.  I elected to go to Pine Bluff and do a family practice residency there.  I left there in almost the beginning of ’82 after being recruited heavily down here to Augusta.  The training was good just for what I wanted to do; the set up is very similar to what we do now at ARcare as far as having a continuity clinic, seeing patients in the hospital, doing deliveries, and being involved in all aspects of care.”\n\nTalk a bit about how you got recruited back to Augusta; I’ve heard this story, but I think that is a story that people need to hear.\n\n“Yeah that was very interesting.  As I said, I was down at Pine Bluff and Augusta knew that they were going to get a new clinic.  Prior to that, they had a clinic in a house trailer that had two Vietnamese doctors here holding things down.  The Vietnamese doctors had come over from Vietnam, but they had severed their time in the rural practice program that they were in.  The town knew that they were about to lose their doctors and they were going to go back and specialize in gastroenterology, or something.  So, Augusta was pretty desperate and I had known the County judge, or knew of the County judge; we were really good friends and also Jack Ingram, who happened to be a cousin of mine also.  John Davis and Jack Ingram were on the recruiting committee.  I came home every other weekend or so, as I was working emergencies rooms in Woodruff County at that time. We had a hospital there and I worked the ER there or over at Searcy.  Every time I would come to town, John Davis would want to meet with me about coming to practice here.”\n\nAs I remember it, John Davis; it was hard to tell John Davis no.\n\n“Oh yes; whatever obstacle that I would throw up, he would just shoot that down.  I would say, “You know, I don’t want to take call” and he’d say, “Well, I’ll work on the call” or “I might not be able to make enough money here” and he’d say, “Well, I’ll take care of that.”  You know, he was \n\n\nvery instrumental in recruiting and wouldn’t take “no” for an answer.  I remember I had tried to put him off for a little bit, because I was in training plus the residency was pretty hard and sure enough he would send somebody from Augusta to Pine Bluff with a contract.  I never will forget that day; it was in the summer time and the people from the hospital operator paged me to come down.  Sure enough, John Davis had sent somebody down there with a contract for me to sign and I said, “Well, I need to read that contact” and they said, “The judge said to wait here until you sign it.”\n\nI think everybody in the county was kin to John; one way or another.  He was a butcher before he became the County Judge.\n\n“That’s right.”                    \n\nI had to get that in here because he is such a great character.  So, John and Jack Ingram were able to convince you to come back here.\n\n“They sure did.  I’d say on John Davis; from what he sold me in the very beginning, it was all exactly right.  He stood by me for as long as he lived; even at his last days, we were very, very close.  As his doctor, I went by after the funeral with his widow and she told me that John always thought that the best thing he ever did as County Judge was to recruit doctors back to Augusta.  I already knew that, but she confirmed that.”\n\nYou were from Augusta originally; where did you grow up, in town?\n\n“Oh yes, just right here in town; down the street here.”\n\nLet’s make a note here in case we don’t get to this later; ARcare has a brand new facility, not brand new now but it was built over in Quarry, a large sister living care facility called “John Davis Facility.” That is an interesting point.\n\n“john Davis being the county judge; we would work on the whole county, so that was our plan to have a long term care facility at McCrory and all three towns; Cotton Plant, McCrory, and Augusta to get a clinic, which we accomplished that.”\n\nSo when you put your boot on the ground, what did you find?\n\n“House trailers here and at Cotton Plant.  You know, the Vietnamese doctors were leaving, but they did have a fair amount of patients.  We had a hospital that was very small.”\n\nWhat was the name of the hospital?\n\n“Woodruff County Hospital at McCrory.  We had Dr. Frank who was an older doctor here in town who I had gone to Dr. Frank during my tenor and had two doctors over at McCrory.  So, everybody kind of found their nitch almost immediately.  The thing that kind of made mine a \n\n\nlittle different was that I went to multiple towns.  At that time, Dr. Frank was only here at Augusta and McCrory doctors, Dr. Own Wilson, were only there at McCrory.  Cotton Plant was only there by itself.  So my thing that was I’d say stressful at times was that I made the rounds on those three towns and DesArc too.  Dr. Robert Williamson came back to practice with me probably after about three or four years, so we were just like a Methodist preacher; you know, running a circuit.  On certain days, I’d be at certain clinics; but primarily, I was at Augusta.  That system evolved sort of the seed to why ARcare would go to the next little town and it was just amazing the culture of each town.  The system that we would set up was still really based on what we did in Augusta the first year; you know when I found that.  The beauty of being with the cooperation was not the profit; they kept building the buildings if you were successful.  So, we got rid of the trailers in DesArc, Cotton Plant, and Augusta; its nice buildings and that attracted other doctors.  When I think back, I just think that we had probably 100 doctors total through these 35 years I have been practicing that have gone; a lot of them have passed away or moved on.  I had a lot of help, a whole lot of help.  I think about those doctors.  We lost some in plane crashes; some passed away, some we lost because of age.  I’ve always tried to recruit those doctors and I think back over the 35 years as a long-time medical practice; we had some great doctors.  Then we had good doctors back in the good ole days that would be doing a residency or internship and they’d work for us over the weekends as much as they could, so I was able to meet some unbelievable doctors who wanted to come and do rural practice; just amazing stories.  I think of a doctor in Conway, Don Steely; Dr. Steely is double boarded in internal medicine/pediatrics and is a cardiologist now.  He worked for us for two or three years; he was just an amazing guy.  He would see as many patients as we could load him up with and we tried desperately to recruit him; but, you know, he was going to be a cardiologist.  We’ve had some residents who actually did like a rural practice rotation, which was easier than working in an emergency room.  I think they had a great experience; you can call those people back up and it was the real thing through the years.”\n\nI want to talk about how long it would take for you to realize that this system was going to work.                                    \n\n“Now, that’s a good question.  I remember; a lot of Augusta people and you probably too would go to Florida at Destin to think.  I remember one summer, I still had young children and it was probably ’84 or “85ish and that was the question of that vacation; thinking”Is this thing going to work or should I go back and do a specialty in neurology?”  You know, I really did put the pencil to it and even called some friends; Dr. Lucy was still the head of the department.  You know, I had always been interested in neurology.  I did a little research and found how you can get into the program; but then when it came down to doing it, I just couldn’t pull the string.  I would have been about 32-33ish and then it was one of those things I thought, “I’m going to have to stay with this thing and not go back or end up specializing.”  So around ’85-’86, I made a commitment that “Hey, I’m going to go down this road.”\n\n\nSo, it’s 3-4 years into?\n\n“Yes, it sure wasn’t at the beginning; I just really didn’t know.” \n\nYou told me one other time about the public health clinic here and your involvement with the public health clinic when you first set up here.  Can you talk about that a little?\n\n“I think you might be referring to the mental health piece because there were so many as you said, “evolutions”.  When I really started here, we were run by an outfit that was really a community mental health center.  So what that basically meant; John Davis said to me, “Doc, here’s the deal, you’re going to have a regular family practice practice and then we have a lot of mental health issues here and this corporation; Wilber Dean Mills Treatment Center.”  We were very involved in that, so yes; I was involved with that.  Basically, that was just doing medication checks; really that is what it was actually for schizophrenics.  I had worked at the state hospital for one full year just doing med checks back when I was in medical school; that didn’t scare me, I was ok seeing those mental health patients as they didn’t have a doctor.  It was much later that they were able to recruit a psychiatrist.  We were able to recruit a psychiatrist to put me out of my misery in doing that.  We have always had a relationship with the health department; so back in those days, I staffed those clinics back at the health department.  I put in a full day of work in these clinic and our regular clinics.  You know, John Davis as the county judge wanted all his clinics to continue to run; the TB clinics and the pap smear clinics.  So, I’d put in a full day at work and then schedule all the pap smears and coposcopies for afterhours at the court house with the health unit there.  I’d see 20 patients or so after work.  It was quite a challenge when I look back now and see all the different things we were doing.  The thing was at that time was that we just wanted to keep the public health serviced going in Woodruff County; it was a matter of survival.  It would ensure you to survive if you had a doctor that was agreeable to staff those clinics.”\n\nNow you talked earlier when we started about the fact that you had 100s of doctors, but one of the routine things that is so hard in rural health, and that is part of our project: the ever changing face of rural health, is people saying we can’t recruit.  How did you go about recruiting people to come to Augusta, McCrory, Cotton Plant, and DesArc?\n\n“Well, it started off in the very beginning with me working the emergency room circuit.  You know, I always just loved being a doctor; I mean I would staff the clinics here and work the ERs, especially at Searcy, here, and other places.  In the emergency room system, there was a doctor in Dardanelle a radiologist, Dr. Skip Berry, and Dr. Berry and I were good friends.  I would call him and we talked a lot.  We would exchange doctors and ideas.  So, they way that he had set up his emergency room were that he had on the side an ER staffing service.  He had offered me a job to working there; so, I had kind of got in with the Berry’s and some of their teaching.  I had a big guy who was an ex-state trooper and he would come here; he was the business man.  He \n\n\nwould come here and we would try to figure out how we could get these doctors back.  He was basically doing sort of the same thing; staffing the ERs in rural Arkansas.  Then also later, Les _______; so, I visited with Les quite a bit because he was working some of the same ERs.  Back years ago, we had the Medi-quicks; there was Dr. Schrader from over at West Memphis.  He was a race car kind of guy; he loved the race cars.  So, I really had those three doctors and I had worked from them some.  I used to staff the Medi-quicks on weekends too instead of the ERs because I found that that was not as hard to staff compared to an emergency room.  I always felt like I needed to get as much experience as I could.  So, that was probably the first 7-8 years.  But through those connections, really that is how we recruited the first doctors.  Some had been in the emergency room and burned out; when you work in an emergency room, boy that’s tough.  It’s a tough deal and I think, “Hey, we can craft something here from you that are not as hard as working in the emergency room where you can sleep at night.”\n\nTake yourself out of the physician role; if you were just John Davis, or somebody like John Davis, who represent a rural community and trying to recruit young doctors to come into the community, would you be able to do it without that networking?\n\n“I don’t really think so; I think you need to network to recruit.  We have not used headhunters; it’s always been a word of mouth from another doctor or just by our name.”\n\nSo you started out and the name of that corporation first was “Whit River Rural Cooperatives”?\n\n“Now, we started out when I first came back in the early ‘80s as “North Arkansas Human Health Services” and then in ’86, we split and Jettison all the mental health services just became “White River Rural Health Incorporated.”  Later when we got bigger than just the White River area, we went to “ARCare.”\n\nLet’s talk about the White River Rural Health; when that was created as a separate entity, where all were you covering at that point?  What communities were you covering at that time? \n\n“At that point, it was just basically along the White River.  It would be DesArc, Hazen, Augusta, McCrory, New Port, Bald Nob, and Cotton Plant; we were probably right around 12.”\n\nHow did you make a decision to go into a community?\n\n“Well, we had a saying there for a long time: “When the people ask us to.”  We had like a little program that we would present to the City Fathers, which was an adaptation of what the City Father’s of Augusta presented to me.”\n\nUsually they would call you first?\n\n\n“Yes; I think of the Carlisle clinic, which I think is a great town.  We keep up with Carlisle even though they were a ways way and even had some doctor’s exchange.  They couldn’t decide what to do and they had the same drill; they had a recruiting committee of citizens.  They met one night at their civics center and I bet they had 100 people there.  They had people give their presentation, they had me give a presentation, and Ray Cockrill at that time was our CEO and then somebody from the State Office.  We told them what we had to say and they asked us to step out.  They had three candidates; they voted, and then called us back in.  They said, “You are the winner” and they gave us a check for $50,000 to start the remodeling on the Inman clinic.  Dr. Fred Inman had been a physician at McCrory, so I always knew Dr. Inman.  Anyway, I think he got Hotchkins and they didn’t think he was going to make it, but he did.  He had treatment back in the ‘60s and he came back to work for us.  We remodeled his clinic with the support of the community and he worked with us until his death.”\n\nYou had mentioned to me earlier about the three year process that you go through when you go into a community.  Talk about that.\n\n“I sure can and it works like a charm for community support.  The first year, we have town meetings and we invite 10-15 townspeople.  Then, we have 9 meetings and invite those 10-15 people and you invite those 10 people the next month and 10 more; you go on and on until the end of the thing and you might have 100 people there.  The one thing they have to do during that first year is give you ideas that you can covet.  The next year, we study that.”\n\nWhat do you mean ideas that you covet?\n\n“Like at McCrory, it was the nursing home; the first year that we did McCrory, they said, “We’d like to get a new nursing home.”  Well the next year, we had to study that.  It ended up being a $9,000,000.00 project and that was a big deal for the county; so we had to study that.  The third year; well, we built it.  So, that’s why; when we see that’s the big need and over there that is what it was.  Bald Nob, it happened to be a dental clinic, which is still going and we did that initiative probably 6-7 years ago.  We still have a dental clinic there.  We have private dentists who staff it, but that’s what they wanted.”\n\nWhere does the money come from for all this?\n\n “We have to find it.  Like on each one of those things; the nursing home at McCrory, we had that reserve at the nursing home.  At Augusta, their big need as getting involved in the arts and plus Augusta wanted some new clinics too. Bald Nob was a dental facility...”\n\nWhat do you mean Augusta wanted to “get involved in the arts”?\n\n“Plays, we have one tonight actually at the camp.  We have an affiliation, I guess you would call it, with the University of Arkansas; Dr. Jiloph has been on our board for just the promotion of the arts.  One of the things that we found out that people had wanted was like “whatever happened \n\n\nto the place we used to have back in the ’50-60s?” and somebody said, “I don’t know.”  So, we brought those back and they are still going.”\n\nTalk about literacy; that’s a really important subject.  But before we leave this subject, is ARCare funded by any state organizations or any state funds?\n\n“Not through state funding.  We get Medicaid and we have a foundation that helps run our education system; so, indirectly through like a school.  It’s like we’re running a school.  We got on that and that is kinda like what we’re talking about with the literacy; the initiative.  During our initial initiative here in Augusta, we found out that literacy was a really big problem.  We just found that out through the Arkansas Literacy Counsel that we really had a low rate here. So, that stimulated “Where are we going to start with this problem?”  So, it was easier to start with the children.  At night we are doing a program and it’s been more than a success.  We just; it’s amazing the things that have been accomplished since the Augusta initiative 11 years ago.”\n\nSo this was all started by your organization of ARCare?\n\n“Yes.”\n\nIt’s not a state function?\n\n“No.” \n\nIt’s all private non-profit enterprise.\n\n“Yes; that’s right.”\n\nHow many people are on your board?\n\n“1 5 or 16 on the operating ARCare board and then like 6 on the foundation board; a total of over 20 on our boards.”\n\nTell me about your literacy program and your other programs provided.\n\n“Well, it’s really just exploded since Sam was involved in one of the initial ones.  We did a play on his book over at the Ken over in McCrory.”\n\nIs that on old movie house; the Ken Theatre?\n\n“Yes; sure is.  They are having a production tonight at 7:00pm and if you went over there today, it’s decorated and ready to go.  So, where do I start on that; we just started by knowing there was a problem.  Some of the reviews of the school systems are not the greatest in this part, or the whole Delta area.  So, we started to work on that issue with the assistance of the University of Arkansas and Dr. Jiloph.  We were able to identify where we could make some changes and monitored the ACT scores.  Jolin Bowen, who has since then retired; we just started at the basics \n\n\nwith the students.  What I was able to see; I was seeing unbelievable results.  The literacy, as I said, for the adults has been much slower because of the funding; it does depend on state funding.  For adults, it has been much slower.  The children; we were able to get into the department of education and that system has just exploded as far as our opportunities.”\n\nWhat all communities are you working on with the literacy program?\n\n“Well, Augusta was our flagship.  We took a big gamble and just built this Augusta facility that is a $3,000,000.00 facility.  We have over 100 students there, after school programs, summer programs, a ______ program, infinite toddlers, and a director who is actually going to obtain space for us, which we already have, in McCrory and that is like a miracle to actually work together in these towns. We are going to have two big classrooms and a cafeteria in McCrory.”\n\nAugusta and McCrory are rivals; that has just always been a rivalry.\n\n“That’s right and now, we have Augusta-McCrory.  It started out as just Augusta and now, it’s McCrory.  McCrory is very supportive.  We have a transportation system and then in Cross County, Cherry Valley; it’s more rural than what we are here.  It’s just out in a bean field and has this consolidated school system.  The school; we did get that through the Department of Education.  We have a clinic that is attached to the Cross County School system and then we have what we call a “job fair” or a job section of that; a job advancement area for the older children.  It is very well in partnership with that school district.  South Side up by Batesville, we have a $1,000,000.00 clinic up there on their campus.  We were going to participate and was working with the superintendant of the school to do the same thing that we do here offering all these programs, which I don’t even have all the time to tell you about all the different programs and places we’ve been, but we came up $200,000 short.  We were building this real nice building similar to this and we were short by $200,000; ARCare was going to sign on the note to guarantee it and to go ahead and do the other $200,000 when just miraculously somebody from Little Rock gave a $200,000 gift; but they didn’t want any recognition.  So now if you go up to South Side, they have just an amazing facility right on their campus.  We have a pediatrician, which this has helped us recruit pediatricians.  Remember my story was about family Practice.  Now, we are building an infrastructure within ARCare of pediatricians. I don’t know why it’s taken me almost 30 years to think about; but we recruited like 6 pediatricians that are either coming out of Children’s or coming out of their private practice.  They’ll go to Cabot South and we’re going to have a pediatrician there in Conway.  We would’ve never thought about this if we hadn’t done that simple little project that you were involved in.  I don’t know why it took me so long to understand about pediatrics.  Traditionally, ARCare and White River Rural Health in North Arkansas; all those things have always been about adult medicine.  We’d always say, “Yeah, Family Practice has doctors who will see pediatrics,” but we didn’t really specialize it or really look at the challenges that children face, which I learned later in life.  I went and taught in some medical school the disabilities children have.  I remember when I was, as I’m not an \n\n\narchitect, and they said, “Hey, do you want to have some rooms for speech therapy/occupational therapy?”  I said, “Why would we need that?” I remember telling the architect, “What are you talking about?”   Well now, we’ve had to remodel just to get those services.  We had to make those services available as I had no clue of that as a doctor practicing in this town; I didn’t even know.  Now, it’s all we want; so we’re bringing in the pediatricians and it’s a whole other program that is so much more sophisticated than how we started based on literacy.  It was based on literacy because literacy evolved into well living by children.  It’s just something that you overlook.”\n\nLooking now at the scope of what this organization is and at some point you decided, or the board decided, to change it from White River Health to ARCare; how many counties is ARCare in now in the state of Arkansas and in Kentucky? \n\n“Right now in Arkansas, we touch 25 counties.”\n\nHow many clinics are there and how many physicians?\n\n“37 clinics and we do it by providers; but we are right at 60.  Out of those physicians, we’re between 25-30; some of our doctors are part time.  Some are older doctors; we have some that are looking at 80 years old and they still have a lot to give.  They are excellent clinicians, but they are part time.  They come to me and say “Steve, I love practicing medicine; but I got some grandchildren and I need to……”\n\nSo they draw a pay check from ARCare?\n\n“Right.”\n\nAre there APNs or PAs?\n\n“Yes; both.  We have more APNs, but we do have Pas.”\n\nAbout what is the total on that?\n\n“Right at 60.  In Kentucky, we have almost better staffing in Kentucky that we’re seeing in Paducah. We took the exact same systems, models; although we haven’t got the education there; we just barely got our foundation formed.  We actually have four clinics and three doctors; it’s just amazing.” \n\nIs it called ARCare there?\n\n“Kentucky Care; we have four clinics there with three docs and then nurse practitioners who are excellent. The Medical Director is Dr. Brazil who had worked in the same kind of drill as us; he worked in ERs and urgent care centers and then he wanted to slow down so that’s how we were able to get him to come to us.”\n\n\nWhat motivated you to become so involved in ARCare?  What moved you to do this?  This is a great program.\n\n“You know, it’s the way it happened; the way it was laid out. I had to make that decision in ‘85, “Hey, am I going to stay here or am I going to specialize?” and I labored with that decision.  So, I was basically just a working doctor until the ‘90s.  I just took my own call, a 7-day a week mass, and I guess the last baby I delivered was in ’86 or ’87.  I came out of obstetrics in ’87 after six years.  I figured, “Hey, I can be respected if I put in 6-7 years of obstetrics, which I did; and I came out of that.  At that time, I did recruit another family practice doctor to continue our OB services.  Then when it got into the ‘90s, I started thinking more about the systems and getting involved with state issues.  I was on the medical board from ’92-’98; it was an 8 year term and I spent a lot of time in Little Rock at those board meetings, which I learned a lot about practice all over the state.  I made a lot of good friends, doctor friends; there were a lot I already knew from med school.  We had worked; at that time, Bill Clinton was Governor and he appointed me the Medical Board and I used that because he helped us to plant clinics out like at Hazen.  We had a Mayor there, Mayor Hordichek, and she had seen what we had done at these other places, but she didn’t know who to call.  So, she just called Bill Clinton and told him, “We need one of these clinics here in Hazen” and he called me.  He called and said “Hey, you need a clinic in Hazen.”  I said, “Ok, but we don’t have any money to do that.”  I remember telling him that.  We do get federal assistance if there is a case for it and sure enough he started the proceedings and that clinic is doing great.  We have an open house tomorrow and a new doctor.  We are finally moving out of that building that Mayor Hordichek had wanted us to be in.  We are having a school give-away with school supplies, bouncy houses, and stuff like that tomorrow.  The ‘90s was a transformative time for me; it was just, I don’t know, more of that systems thinking and “Hey, what are we really doing to make a difference?”  Plus going to Little Rock, seeing what other doctors were doing, and reacquainting with people I had gone to med school with; by the end of that, I thought that maybe I do want to look at medical management.  So, I started taking courses at Southern Cal in positions in management.  Eventually, I got a certificate; like an MBA, but it’s not.”\n\nLet’s talk a little bit about your relationship with the health department.  I think you do a lot of the AIDS work; talk about that a little bit. \n\n“Oh yeah, we sure do.  We do it for the whole state on Part-B, Ryan White.  We had a meeting yesterday with Dr. May Smith and we reviewed the whole state.  Really the thinker for that HIV program is Dr. Moore.  He is from Augusta and his dad was the police chief.  He does our protocols and set this whole system up, which is sort of like I said about pediatrics, it’s a system within a system.  His HIV system actually is larger than the ARCare footprint.  Like when you asked how many counties are in here; we really are in like 60 something counties because of where we have HIV contact places.  So, he really runs that whole program and we run that through the health department.”\n\n\nThat’s interesting.\n\n“But, he is the doctor who runs it.”\n\nAre there still mental health services in these towns; like in Augusta?\n\n“Yes; we just are starting a new one.  We, you know, sometimes let a certain system melt down because what we are finding is in rural areas, it really is melting down and there is maybe not enough people to have licensed social workers and psychiatric APNs.  So, we are rearranging that right now and are going to Little Rock and to Cabot South; that’s what we call that clinic.  We are going to be doing substance abuse and behavior health.”\n\nSubstance abuse, especially Meth and prescription narcotics, are they a big problem over here?\n\n“Oh, it’s just terrible. It’s the skirt; it’s just terrible.  We did write a grant for that and I know they looked at the statistics and they were just horrible.”\n\nAny different from what you would say in the central footprint or northwest footprint of Arkansas?\n\n“It was pretty much equal.  We got it all the way from Little Rock to Paducah.  We decided to have epi-centers for substance abuse and for behavioral health.  So, we have an epi-center at Paducah, one at Cabot South, and one in Little Rock.  Now, it’s going to be as you know urban, so that’s our first forte into urban type practice.  So, we are kind of letting others do some of the rural mental health and we’re trying to get into transportation.”\n\nTalk about a couple of subjects that are just kind of off the wall; one is tele-medicine and your involvement in tele-medicine.\n\n“Yeah in tele-medicine, ARCare is ready to go.  We have the talent and hardware, but we have not been able to have the business case for it.  I’ve heard that the next legislative session, they are going to equalize the billing.  We’ve been involved in two or three trials and would be fine with it; but we’ll see if we can get some finalization.”\n\nHow would you use it primarily?  What would be your primary use of tele-medicine?\n\n“Well, we’re looking at models for HIV; because with HIV, it’s pretty simple.   You know what the CD4 counts are and you’re going to change the medicine.  There’s not many doctors really that want to do that, so you can either have his doctor and Dr. Moore at one end of it and the patient or have a nurse practitioner, RN, or whoever our case manager is, somewhere and you can make those adjustments to their medication.  Behavioral health is the same way; we’re not having, it’s really been difficult to find a psychiatrist to work with us.  I was reading an article last night and psychiatry is the oldest, in terms of the average age of doctors, the oldest\n\n\n specialty there is in modern healthcare.  It’s amazing; 60% of them are over 55.  Well, they’re not looking to go out and work with a profit that is trying to treat people on Opioids; I mean that later in their careers.”\n\nNow you are not the only cooperative in the state.\n\n“The Community Health Center; right.”\n\nThere are about 6 or 7?\n\n“There are 11 total.”\n\nDo you work with them at all?\n\n“Oh yes, we sure do.”\n\nTalk about them a little bit or what you know about them.\n\n“Well, they are all over the state, but we still don’t cover the entire state.”\n\nReally?\n\n“Oh yes.”\n\nWhat part of the state is not covered?\n\n“Kind of that Western Central area; around Booneville and Mt Ida around that hole where those mountains are.  But the strategy with the community health centers is that we needed to be evenly spread over the state, which we’re not.  So when it started back with Linda Johnson, it was an Eastern Arkansas phenomenon.  It was ground breaking to go west; just ground breaking to go west of the interstate here as everything had been east of that.  So, the newer systems are in the northwest half of the state.  You know, Magnolia has a new one; a new clinic there.  It’s not a new system, but it is a new clinic.  There’s one up in Northwest Arkansas that really administers to the Marshalles up there.  There is one at Clinton and in that area; Clinton and Marshall.  There’s one in West Memphis and one that is extreme Northwest Piget and Corning as well as Clarendon.  In east Arkansas, there is one at Forrest City.”\n\nIs there one down around Eudora?\n\n“Yes, there is one down there and one around Hope.  Each one of them sort of have a little bit different focus.  There is also one at Jefferson; matter of fact, there is one at Pine Bluff and that’s how I was even introduced to them.  I did my residency there.  At the time I was at Pine Bluff, I just knew their Executive Director, Larnel Davis.  I think his brother had been the chancellor there at UA……”\n\nHe was from McCrory?\n\n\n\n“Yes, he was from McCrory.  Now, Larnel was there CEO at Jefferson Comp.”\n\nHis father had been the Head of UAPD?\n\n“No, it was his brother; I think it was his brother.  So, I got to know him; you know how you’re in the hospital and everybody’s talking, but I really got to know Larnel just right out of medical school.  So, I understood what a community health center was and it was attached to the hospital.”\n\nIs he still active?\n\n“No he retired 2-3 years ago; I went to his retirement party that he had at the Pine Bluff Country Club.  But, he introduced us to a lot of the things that we still use and he was a pioneer; he and John Eason. John Eason and Larnel Davis were really activists in starting the program in the places where they were working in East Arkansas and the Pine Bluff area.  That is how I even first knew about it.  When I started talking about Augusta, there were a lot of variations between the systems.  I didn’t, even me as a kid getting out of school and residency, realized the difference.  I learned later when I saw what was going on that we are similar to Jefferson; down there, it’s a very similar situation and I was already working at it at Pine Bluff.”\n\nGenerally what kind of relationship do you have with the private health care communities?\n\n“Generally, it’s excellent.  It’s excellent and I’ll tell you what, it has changed so much.  That piece of it has changed because years ago it was more fractionated than what it is now.  But with the hospital systems purchasing so many of the doctors, the doctors don’t see their practice as a private practice that they are controlling anymore because it’s controlled by the hospital.  Our strategy on that is; we are still autonomous from the hospital system, but we are still to be as friendly as we can be and as accommodating as we can be to the hospitals and their doctors.”\n\nI saw on your sign it says, “Something-Baptist” what is the relationship there? \n\n“Yes; well years ago, that relationship was probably in ’92 when I said I started going to Little Rock in the ’90s. I knew Russ Harrington and the previous CEO knew Russ Harrington; that’s basically how we started.  We knew we were having challenges in recruiting and knew we were having challenges in expanding, so we affiliated with Baptist in ’92.  They basically offered us support of the targeted areas and plus back then before the private option, they would see our patients regardless of their ability to pay and never said a word about any patient that we would send.  For them, it was an outreach out into the state; so with Russ retiring, we’ve continued to work with them.  We work with them now more specifically in central Arkansas and we cling onto our hospital partners; the unity with St. Barnard’s, Memphis Baptist, and the smaller hospitals.  It is key, because we have to complete a circle now.  Plus the way things are changing, if they are going to have to bundle payments and the way the hospitals; you know if they have hip surgery, there is going to be one bundled amount of payment that the primary \n\n\ncare doctor will get X amount of money and the hospital will get XX amount, so we want to be thought of because our patient revenue is still what keeps us going.  You know what I mean, It’s still very, very important.”\n\nHow did the private option change what you do?\n\n“It’s been good for us.  You know, we were running an uninsured rate of 30 something percent.  Now, we’ve widdled that down to about 8%.  We still have some people uninsured, but it’s not near like it was.”\n\nIs that because they don’t want to take government assistance or do you know?\n\n“There is some of that in there, but that 8% would be other things too.  It’s complicated; they don’t really qualify or just sort of in no man’s land.  They might be the working poor; saying they have a job, but they are right there in that it depends on the number of dependents.  ARCare has gone out and really beefed up our case management.  We feel like that’s what the case managements are working on; that 8% to see what the deal is.”\n\nHow many other physicians are there in Augusta bedsides the physicians here?\n\n“Oh, we are it here.  Most of the towns, it’s just us.”\n\nHow many doctors are here again?\n\n“Well total, we are looking at 25-30.”\n\nTo round in a hospital?\n\n“No; 25-30 staff our clinics.  There are about that many more nurse practitioners also.”\n\nHow many doctors round in the hospital?\n\n“Well, we only make deals with the hospital.  They have hospitalists.”\n\nSo Woodruff County has hospitalists?\n\n“No, we had to close the hospital.  That’s a whole other story, but we had to close that hospital.  We were very involved in that and John Davis was too.  When we make a health care decision, it’s a community effort and John Davis was in that and I was working with them.  The conclusion was and this was during the DRGs when they first rolled out; I never will forget the night that President Regan rolled those out, we got a copy and studied them the next day.  It did shut down small rural hospitals.  We knew that was going to happen.” \n\nSo when did Woodruff close?\n\n\n\n“It was in the late ‘80s; ’88-‘89.  What we did; we had to come up with a plan and so, that plan was to convert that whole hospital into a nursing home; long-term care.  That was the best thing we ever did because we could run a nursing home a lot better than we could run a hospital.  So we ended up years later after the judge had passed away, they left me with a large reserve that I could take to build a new nursing home, which is the Premiere Structure here in Woodruff County.  I think we ended up at $9,000,000.00 that we took as part of their legacy and said, “We’ve got to do something with this money” but we really didn’t know what.  Well, the old building was just getting old, so we built a new state of the art long-term care facility that has a residential care facility and has dialysis unit, which is kind of premiere to have a long term care facility with a dialysis unit.  Then we partnered with another “not for profit” dialysis group out of Tennessee; DCI, and we got them to come in there, so there was a lot of Medicaid along dialysis.  Each thing I do, I learn a lot.  I took nephrology my senior year, but I never realized how sick those patients were.  So now, ARCare is providing transportation for our dialysis patients all the way to DesArc and bringing them back in.  We have a dialysis unit and they’ve gone through, I know, one lease period and they’ve kept it up, which is just amazing. We didn’t know if we could keep a dialysis unit up, so we are probably going to be doing a VA contract.  We haven’t even had a VA contract, because we didn’t need it until here recently. So, we are going to do a VA contract, which will probably bring in more dialysis patients.”\n\nLet’s talk a little bit about critical access hospitals, transportation in rural areas, and its impact on critical care and your involvement in that.\n\n“Yeah, it’s been the same.  Really the one we worked with real closely with was Calico Rock in Hazard County.  We met probably 10 years ago at Calico Rock and had a good group of doctors who was sort of doing similar to what we were doing in these rural counties.  Woodruff and Izard; you think, “What is the similarities?”  Well, they both have the White River, but their culture is totally different.  It’s beautiful up there; it is just beautiful.  It’s not even like you’re in the Delta.”\n\nYou’re in the mountains.\n\n“Yeah, it’s just beautiful; but they are in poverty.  So, we had visited with the community leaders and I will never forget that; we drove up there one night 10 years ago and met with them for what seemed like forever.  They told us the threat to their critical access hospital and thinking that they were going to have to close that hospital, which this was 10 years ago.  They said, “Well, what we have is a three clinic system.”  I guess that they had heard that we had a clinic system that we had actually kept afloat.  They had one at Calico Rock and that’s where their main docs were, they had one at Melbourne, which they had some other docs there, and one at Horseshoe Bend.  I’m not going to bore you with the details; but over that 7 year period, we were able to help them.  We purchased the clinics; two clinics from them: Horseshoe Bend and Melbourne, and that gave them a shot in the arm with the funds that they received for the sale \n\n\nof those clinics.  That got them over the hump and as far as I know, they’ve gone under some different arrangements with affiliations with hospitals, but they are still open and going.  We acted as sort of a bridge; now we are running the clinics in Melbourne and Horseshoe Bend and doing fine.  Like at Horseshoe Bend, I think we are the only providers there.  It’s a beautiful town; a real neat town.  I only wish I could go up there where it could be neat.  It really has beautiful lakes and rivers up there, but it is still hard to recruit doctors right now.  We have a really excellent nurse practitioner and a PA and they are just doing gang busters.  So, that’s kind of illustrative of what we’re doing in Wynn.  We had a similar situation in Wynn.  They had a critical access hospital there at Cross Ridge and they were just right before having to shut it down.  Memphis Baptist was saying, “Hey, we’re going to have to leave town” and St. Barnard’s was saying, “Well, if you would pass a mileage, we’ll help keep it open.”  The County Judge at that time had been talking to our County Judge and said, “Well if you get a community health center, it will just make it look better; it’s that your trying.” So, that’s why we are in Wynn, to shore up. So, we received a grant in Wynn to shore up the critical access hospital.”\n\nWho did you receive the grant from?\n\n“HRSA; Health Resources Services Administration.”\n\nWho are they?                                                                \n\n“A federal agency; but that was part of our pleadings when we pleaded; community health centers and critical access hospitals are closely associated in some places.  It happens nationwide; when a small hospital is closing, they say, “Hey, let’s have them work together or run them as the same.”  We’ve been a part of that.”\n\nLet’s talk a little bit about the transportation component of all this; ambulance services and getting people with acute illness to the hospital with your role in that.\n\n“Well, our role is that we run a van service.  It gets patients back to our clinics, Little Rock, Memphis, or Jonesboro just depending on where they are.  The services on the EMS side, I have always pushed and made appearances before City Counsels for a paramedic service; so that has been hard for them to make it.  Like here, we have Pafford now and in Brinkley, they have Southern; that has helped us because some of these hospitals are closed and they were able to get transportation.  Now, we are having a recent push here of the helicopter assistance; it’s amazing they are really pushing and I have several patients who have signed up for helicopter assistance.”\n\nWhich one is it that they signed up for?\n\n“I don’t even know.”     \n\nIs it Airovac out of West Springs?\n\n\n“That sounds familiar, but I don’t know.  I think I’m going to sign up for it myself, so I haven’t really read it.  I have some patients that have signed up for the helicopter system.  So, we have the paramedic system here and the one at Brinkley.  The one at Brinkley is strong and the Pafford here is really strong out of Hope.  So, they are kind of the last man standing, because you know we came through the evolution of having just the City run it.  I think they still do at DesArc.  They went from that to a county run ambulance, then it went from being a volunteer EMS or somebody.  I remember when I was practicing full time in the beginning, “Hey, you might have somebody be teaching English and she might just run out” I loved those days; she’d just run out of the classroom, take her car, and met an ambulance to go on a run.  That’s a true story.  I had a few scenes where I was there and I said, “What are you doing here?” and they’d say, “I had to make the ambulance run” and I’d say, “Who is teaching your class?” \n\nWe are talking about the corporatization of medicine and I think clearly in rural settings you can see, or in any setting not just rural settings, the positives of it.  Is there a down side to all of this?\n\n“A down side, well yes.  I think the down side is you know you are definitely going to lose the quaintness; there is no question that you’re going to lose the quaintness.  You’re going to lose the ability to pen the responsibility, or somebody accepting the responsibility.  It is so easy when you are in a corporate setting to add, “Well, it’s not my problem.”   You can deskirt those responsibilities by corporatization.  The personal touch is definitely going to be in jeopardy; there is no question about that.”\n\nWhere do you see ARCare or what else ARCare becomes going from here?\n\n“Well, I think as I look and I’m sure that’s been said; “I know I have probably almost for sure put in the lion share of my career and the short stick is in front of me”, so I see continued change that I wouldn’t necessarily think “Oh, that’s a great thing.”  Because I see continued less personal care, there is no question that I see it going in that direction.  I think I see a tremendous number of doctors that are looking forward to their retirement because of this continuous, and not just the ERM systems, it is the corporate changes.  So, you know, it is much more difficult to hang on the way the old classical family practice and GP did.  You know, keep your shingle out; you’re 85-90 and still see a few of your pets; treating them the way you want them being treated.  It’s almost like there are forces to make sure that that goes away.  It’s a challenge to keep our older doctors credentialed for whatever reason and that’s definitely going to continue to change.  There doesn’t seem to be any mercy for that.  I see ARCare and we step in there with our credentialing and make sure they keep their CMEs up and prompted them up in every way we can to keep them practicing for another year.  But then, that is us trying to defend them and that’s not defending them against a law suit, that’s just defending them against insurance companies and government.  There is definitely that change being pushed and when those docs \n\n\nare gone, which will happen in 10 years, I don’t know; it’s just going to be a lot more non-personal contact and I think the younger people like that in a way.”\n\nDo you mean younger physicians?\n\n“Younger patients.”\n\nTell me where you send patients from this clinic if they need to be hospitalized.  Do you go to Little Rock?\n\n“We go to Searcy.”\n\nHow far away is that?\n\n“21 miles.”            \n\nDo any of the doctors here round at Searcy?\n\n“Well, Dr. Moore still does and I was until January 1st.”\n\nSo you still see patients in the clinic?\n\n“Yes, in the clinic but not in the hospital.”\n\nEvery day?\n\n“No, at least once a week.  I still go to the nursing homes and round there and I see patients here; that’s kind of the extent of my clinical experience now.  I just have changed more to geriatric practice and chronic disease practice.  We are really big into the chronic diseases. I do a lot of the setting up of new programs.  We are swinging a new diabetic program in Kentucky.  We got a diabetic program here and then that’s what I do; I set them up.  As far as my patients, I see them, right here and in the nursing home.”\n\nWhat do you do besides medicine; anything else?\n\n“Well, I exercise as much as I can and travel; those two things.  That’s what I do.  We have a river here and I got a boat.  I got a boat here and one at Heber.  I enjoy boating; I just like to be out on the water.”\n\nI want you just pretend we’re not here; you’re talking to your great, great, grandchildren.  What would you have to say to them about your life and what you’ve done with your life?\n\n“Well my life, the practice of medicine was a great experience and whatever it is like in the future, I would encourage you and prodigies to continue to on.  I was fortunate enough to come up with some ideas that could help people and I think that that can still be done in medicine.  It will be very different, but it can still be done.”\n\nThank you very much. I appreciate you spending the time with us; this is very good.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302#t=0.0,4106.35225"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302/transcript/83663","type":"AnnotationPage","label":{"en":["Dr. Steve Collier Interview Transcript 2 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302/transcript/83663/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview with Dr. Steve Collier\n\nHow are you dealing with changes in Medicaid episodes of care?\n\n“Well, it’s a challenge for us, because right now we have...”\n\nEverybody in the system.\n\n“Yes; but, there’s basically a waiver that the Medicaid Director is filing with Health and Human Services to take away our PPS rate, which means…” \n\nAnd that’s the one that covers things that are not covered right?\n\n“Exactly right; so, the Governor is on our side, but he appointed the Medicaid Director.  But, the Medicaid Director is listening now.”\n\nHe wants to give her attention; aren’t you talking about Janie or the other?\n\n“Yeah, well Anthony Allison; that’s an inside deal because he used to work for ____________in Kansas. Every state has a sed different; you know in Kansas, he had the same program there.  But that’s ok, that’s just the politics; he’s wanting to go to Washington and work there with his old boss.”\n\nOK, I’m going to turn negative on you for a minute; the counties that you work in, in the east not necessarily Faulkner County, have lost 10% of their population in the last 10 years and some places more than that.  Unemployment greater than 20%, poverty greater than 25%, school enrollment is way, way, down; almost the same as population.  How much of what you are doing right now in these small communities is a stock kept measure until there are just not any people left?\n\n“Well, that’s a good question that we ask ourselves; because we spit it up and do a lot of studies, like that Grant Rider.  I can name the counties that no matter what we do, there is going to be a decline.  Part of our strategy is to slow the decline down.  Those counties would be Jackson, which is on top of Woodruff, and then Woodruff, Prairie, and Monroe.  There is no question that every time they do a census, it’s down in those counties 20% and there is not any good news at all.  Brinkley even lost its Wal-Mart when we did the initiative there.”\n\nThat’s a tell-tell indicator isn’t it?\n\n“Yes, yes; they lost a Wal-Mart.  In Prairie County, when they had that flood, people moved out and they don’t go back.  They did not go back.”\n\nHow big of an area did that cover for population?\n\n“The town proper, 2,500 people.\n\nYeah, DesArc.\n\n“I’m telling you.”\n\nIt was something.  I talked to people from there and it was truly unbelievable.\n\n“It was terrible.  It was truly a flood, like a New Orleans’ deal.  A lot of people just moved out and it’s not like they moved back in.  Like New Orleans, a lot of those people stayed in Baton Rouge just so they don’t have to go back to a flooded city.  So, the schools are going to suffer with that. In Woodruff, I’ve seen before just a very small workforce and the whole county is down to 7,000 population.  Jackson County, a very similar situation; but they have a little bit better industrial base.  The hospitals; well one hospital went completely under, Dr. Frankum’s Hospital is no longer; it shut down years ago and there is a private company, Community Health Systems, that owns the other hospital there.”\n\nWho is Community Heath Systems?\n\n“It’s just a private hospital system out of Tennessee, which is an oxymoron to me; I don’t know how they can make it.  Our thing is that we have to allocate our resources on a regional basis and we have to look at both sides of that Delta, like Craighead and Cross.  Wynn is doing pretty well and Jonesboro is booming.  On the other side, which is still rural, Izard County is very poor and that’s why we got the grant.   Then we have Cleburne County, which is very rural, but they have such a good community spirit; they built a wellness center and got a branch of ASU up there.  Then, we have White County, which is one of our rural counties, that is doing very well; we have two really big clinics there.  Lonoke is the same thing, a rural county, and it’s helping to carry those other counties I mentioned, I think was 5.  We will continue to downsize, but that’s where the board is pushing me, because they don’t want those to close.  They don’t want the ones in those counties to close or limit services at all.  Like at Cotton Plant, I’ve had to pledge to the board that we were not going to close.  You know, Cotton Plant, there is only 500-600 people, we have a board member from there, and a mayor; that’s what’s different, they stay on me.  Me personally; because they don’t want it to close.  I’ll have to show them some really…”\n\nGrimm\n\n“Yes, I will have to really prove that that needs to close.” \n\nSo, it may come to a point where you now use one indicator, “Well, they lost their Wal-Mart” and it could come to a point where they lost their clinic.  It’s just maybe even broader implications that you lost that; if your commitment to being there…what a sad message.\n\n“That’s right because when you get fewer people, like say Cotton Plant’s 500-600 people, they are totally dependent on us.  They don’t have cars.  They are dependent on us for their doctoring and medicine.  We have a van that brings their medicine up to Cotton Plant.  It would make those people even worse off.”\n\n\nIs there any, I know they lost  their elementary school around six years ago and they don’t even have an elementary school, is there any real community infrastructure left there, besides y’all?\n\n“Minimal, just minimal.”\n\nA lot of boarded up store fronts.\n\n“Then you really get into that kind of like an apocalypse movie; who is left at the end divided amongst themselves.  Sure enough, there was one guy who retired and moved back thinking he’ll really make a difference and got this thing to impeach the mayor.  They went round and round and it was kind of like one of those things that didn’t get him impeached by two votes.  Well, I don’t know how that is going to affect this guy’s enthusiasm.  I don’t know if he is going to say, “Yeah well, you can’t do any different; you know” so.”\n\nWhat are they fighting over?\n\n“Being Mayor.  He wanted to be Mayor.”\n\nOh, they’ll fight over anything; like Helena and West Helena.\n\nWhat is your relationship with the other community health centers in the state?  How many of them and how big a part of the population do they cover as far as you know?\n\n“Oh, you know, it varies.  They cover, well our goal as a CHC group, the whole group, our goal which we are not there and it’s probably one of our weaknesses, we don’t cover the whole state.  There will be some empty pockets, so we all are working together on a strategic plan; ARCAR is a piece in that, we just happen to have 12 counties.  But the thing is, you know, there is 12 CHCs statewide and there’s places that needs CHCs and with this change, I don’t know how.  Like at Texarkana, I know that they want one and have been talking about it for years, studying and this, and that, and demographics; they applied for a grant, but didn’t get it.  So, AHEC is trying to help them.  It is a struggle in rural health.   Texarkana is their city, but then they look back to southwest Arkansas and some of Texas.  I mean there is almost, this is negative; but, there is almost an over-whelmingness to try to get things done.  You are truly pushing against a bolder that is as big as this room.  You might get some headway and that’s what we call playing the whole field.  I don’t know why Texarkana didn’t get the grant, but then if you don’t get something; if you don’t get a new clinic, they put you back like two or three years.”\n\nOh, I bet.\n\n“It’s like you just started, then you kind of forget about it for six months, and then you start back again.  So, if there aren’t any players in this town, they wouldn’t be here.  AHEC has wanted to do that, but I don’t know where they are now; I don’t know.  I even lose track of what they’re trying to do.  I’m sure there are other sections; I mean, I got all that I can keep up with. There \n\n\nare other counties with pretty big pockets of poverty and I know that is something to think about; like down at Crossett.  I don’t think there is a CHC at Crossett.  I don’t even know the area; I’ve only been there once in my whole life.  As far as me wanting to run down there and starting a CHC, I mean…… you would have to do the community deal, to meet with them, talk about it for two years, then you have to get some politician by the throat.”\n\nThat’s what I was going to ask you.\n\nDo you run into this notion with maybe a lot of politicians or leaders, “Now, that is something that is going to die anyway.” We just have to accept the inevitability in some areas and maybe towns; I’m just saying that they may just have to.  It’s almost Darwinian.\n\n“No, we haven’t to be honest.  We haven’t, because we have what we call a crack grass roots advocacy and that’s the patients.  We take care of whoever would say that in their area and I don’t know if I’ve ever known of a… now you have some of your state reps who maybe have a two, three, or four county district and never has seen a CHC and don’t know what you’re talking about; I see that in Kentucky.” \n\nYou say you do see that in Kentucky?\n\n“Yeah, that’s how we got into Kentucky.  I know this isn’t about Kentucky, but there are eight counties in Kentucky with that river that’s just beautiful, I think it’s the Tennessee River, and it cuts off those eight counties from the whole eastern part of Kentucky.  Well, over in Appalachia, every county has a CHC and they are big all the way through Kentucky.  Through the politics or just all the attention of being on that eastern side of the Appalachia and the Coal Miner’s Daughter, and all the mines and how poor everybody is.  Hazard County has the biggest CHC, I mean, they are big.  As a matter of fact, they had to vote to have us to come into Kentucky and their only thing is that they knew the political thing; there was nothing in western Kentucky.  So, we finally had a judge, the same thing as Woodruff County, say, “This is crazy, y’all are getting all these benefits and showing up your infrastructure, and we’ve got the PADD (purchased air development) and it has no representation.”\n\nIt’s like they let it wither.\n\n“That’s right and I don’t know if they made a conscious decision to do that; but, Purducka is not a bad town.  It was great.  We did start new towns just like Augusta, or very similar to Augusta, probably 1500 people and they had no clinic.  I had a judge that was just pissed off, they had nothing.  They had the Baptists try, and the Catholics try, and every time, they would shut it up.  His only thing was, and as a matter of fact we got an innovation reward just last week; he said, “I want a clinic that’s not going to close.”\n\nWell yeah.\n\n\n“That’s all he wanted.  He filled in the questions with the health department, because he went first to the health department in Kentucky, and said, “Oh well, what if they take all our business?” and he said, “Well, they’re not.”  He understood that the health department was different than the CHC.  He went to the governor and they gave us the money to start it.  He told him the whole story and we’re doing great.”\n\nTwo things along the very line right there that you’re talking about; you’re legislative support in the state of Arkansas and Health Department support, official governmental support in the State of Arkansas and pushback, various areas of pushback where you’ve said, “We’re not competing with you” but I guarantee there are people over there, outside of Augusta, that might perceive this as pushy or competing.  What do you say to those?\n\n“Well, it’s in our Charter that we’re not supposed to duplicate a service,” that’s what we always say.   If there’s not a need, we don’t go in there.”\n\nWhat about legislative support in the State of Arkansas?\n\n“Oh, it’s been excellent. I’ve been very pleased.”\n\nMainly in east Arkansas or all over the state?\n\n“Well, it wouldn’t be kind of strong.  Yeah, I mean, we definitely had to go with the northwest part of the state.  I mean, yes it is; I don’t know how to say it, but yeah.  It’s been an east Arkansas deal, as far as our silent supporters; like Keith Ingram, he’s a senator or something now; but, he was so strong for us.  You get to West Memphis; they think CHCs ought to run the whole thing.  You get to Bentonville; they don’t think we should run nothing.  So, the equal part is kind of in Little Rock.”\n\nI don’t know how you deal with those folks.\n\n“It’s a different story; but yeah, yeah it’s tough on that.  It’s a balancing act.”\n\nI can imagine.  Well, they come from an etiological standpoint, it’s not every things spaced.  \n\n“Yes”\n\nI can see how that would be such a hard sell.\n\n“Oh, it is; it’s different.  If we weren’t so strong in the east, we couldn’t do it.  The governor’s involvement is good for us.  Bill Clinton and all of them all the way back; David Pryor, Dale Bumpers, Frank White was kind of….., Huckabee was good for us, and Beebe has been excellent. Really the bigger thing with the trauma System, I just hope that they don’t do away with that whole thing; the trauma system for UAMS.”\n\n\n\nInterestingly, Paul Halverson had the same comments about getting extremely good support from both Huckabee and from both ends of the state.    \n\n“That’s right, but there is a new league in there; a new league of legislatures.  Governor Huckabee was for this two; he was.  We did very well under George Bush; he was great.  We had presidential support; the only little blip which he reversed his field, everybody has been for CHCs.  Reagan did have probably six months where he was against it, but he came around and changed his mind; you know what I mean.  But now there is and I hate to call it radicalism; but yeah, I would think they would be; like at Oklahoma, they have a senator over there who thinks the whole thing is a bad deal.  They catch it much worse…”\n\nIt’s purely etiological; there is nothing that’s incurable.\n\n“Oh josh yes; the thing is the benefit that those people get; they don’t deserve.”\n\nThat’s the heart of it. \n\nThat same sentence that was said “They shouldn’t get any support towards…,when the tornado came through; that’s the same guy?\n\n“Yeah; same deal, same guy.  He said that it shouldn’t be the government to help, when the tornado came though, that is should just be private people and they would think like this; the same way.”\n\nThat’s their own fall back physician, but when you say “Ok, how do you organize that to have that ready?”  It’s still rooted into the notion of giving some turkeys at Thanksgiving and Christmas.  \n\n“Yeah, now that is the negative piece that we really are sensitive to.”\n\nSo Steve, you know, you have provided greatly; I’m sure your board is excellent, good, and provides leadership, but what happens to this organization when you one day retire?  15, 20, or 25 years from now; what happens to this?\n\n“Well, I think, we are trying to develop leaders and we already have them going to school and getting their Masters, NPAs, and the business side of it.  So, I think we have a roster of good leaders; like the lady that you were talking about, the COO; she’s our grant rider.  She’s done excellent with that.  We have one guy who keeps us afloat financially and has revolutionized our understanding of finance.  Then, we have Dr. Allen, on the clinical side, and I should qualify that all these guys are under age 45; they are all young.  So really, it’s getting to be where I am the oldest in the deal, you know what I mean?  What we call leadership, I am the oldest.  It will have to fall to somebody younger, by 10 years.  I’m 58, and we need somebody under 48 to take over.”\n\n\nIf you, at one point or some point, on looking back on this and say “What is the one thing that I/we have accomplished that I feel the proudest of?” What would it be?\n\n“Spreading the model; it has been truly amazing.  We took everything that we were doing in Arkansas, in our 12 counties, and you could take that gospel anywhere and sell it as a solution to healthcare, which we done in Kentucky.  You can take that anywhere.”\n\nNow you said healthcare; solution to rural healthcare or healthcare period?\n\n“It would be rural, not urban; I would have to exclude urban and hospitals.  That’s not our cup of tea.  Because we are so different; there is like a center in Chicago that is right downtown from one of the hospitals; that is totally a different animal than us.  Denver is the same way; Denver health has everything just built together.  They are overrun and can’t see all those people.  Rural medicine, it’s different.  So, I would say it would be a successful model in a rural setting.”\n\nOf all the things that you have done or trying to do, what has been your biggest disappointment?\n\n“Well, getting physicians to buy into the whole deal. Finding other doctors who wanted to be dedicated to rural medicine; that’s been a disappointment.  I would say when there is one younger doctor who wanted to work, say in his 30s, wouldn’t want to work and say, “Man, that looks like a good career path to go down” that has been real disappointing.  I really thought somebody would show up; but they hadn’t.”\n\nHadn’t yet.\n\n“No, I have no had one guy or girl to show up and say, “Man, that looks like a great thing you’ve done; I’d like to do that same thing.”  The thing is, we’d say, “Well here, you go for it.”\n\nHere’s the package; go for it.\n\n“Yeah and we presented that to many young doctors.  Say, “Hey man, can live in Searcy; it’s not that you even have to live in Augusta.”  We have a lot of people who live in Searcy.  You could live in that area, you wouldn’t have to live close to be a player.  You have to live in that area, but I don’t think that it’s that bad.  You could live at Heber.  You probably couldn’t live in Little Rock and do what I’m doing, but you know you could do that.”\n\nIn the process of doing all things, the many different prongs that y’all have gone out and done, have you done any scientific studies of your results?\n\n“Uh huh, sure have.”\n\nHave you published any of them?\n\n\n\n“In the Kuizi publisher, not really in a scientific journal; but we’ve done studies that we reported back to Herzon and those are pretty elaborate.”\n\nWhat are some of the areas where you looked at say: childhood obesity, chronic disease, those kinds of things?\n\n“We do what we call collaborative.  We’ve done diabetes, monitoring the hemoglobin A1-C and document the improvement by going to our wellness center and we have diabetic education trainers   We have done prevention patient safety and pharmaceutical collaborative medication errors and we do have a childhood obesity collaborative that is ongoing now.  So yes, we have done a lot of that.”\n\nWho are you collaborative with on the childhood obesity?  Or is that just something within your organization?\n\n“Well, it would be other CHCs or hospitals just around the nation.”\n\nWhat about infant mortality rates?  Have y’all done anything on looking at that?\n\n“Well, I will say what we do is monitor infant mortality rates basically.  Our focus is being 0-3.  But, we are getting out of OB; this is our last year.  We’ve had an OB program since ’81, but we are getting out of that next year.”\n\nIs there a reason why?\n\n“We are losing our doctor.  We have always had a family practice based OB, plus he’s just tired of it; he’s been doing it for 10-15 years.  It’s by referral system now.”\n\nDo you have any mantras sayings that anybody within the organization has heard at least once?\n\n“Oh, gosh yeah; we had a lot of them.”\n\nNo, you personally.\n\n“Oh yeah, me personally; one of them I always say is “I’m not worried about what’s going to happen in the morning.  I’m worried about what’s going to happen a year from in the morning.”  You know, you get these immediate issues that probably won’t even make a difference.  What makes a difference is what you’re going to be doing a year from in the morning.  Where are we going to be in a year from now?  As I have evolved in my role as leader and CEO of this group, I’m not going to panic about anything that is going to happen in the morning.  I’m going to be concerned and plan; and that strategy is just amazing.  We have employees who have caught on to that because so many things are so short sided; so short sided.  So, we are having a plan that if the Director of Medicaid was able to cut, like he is saying he is able to cut us, would we survive \n\n\nor not?  We’re going to have to go back finance-wise to figure it out.  I have them figuring that out on the weekends.”\n\nThat’s pretty determined.\n\n“Heck, I know it is, yeah.”\n\nCertainly is in mental health.\n\n“Yes, it sure is; it’s a mess.”\n\nGut it.\n\n“What’s it going to do to the health department?”\n\nThat’s a good question.  What’s it going to do to the Med Center?  At some point, the governor may have to say, “You know, he may be creating my legacy and it’s not one I want to leave.”\n\n“That’s right.  Well it was interesting the way they ended up in the legislative session not knowing if we were going to get fully funded on the tobacco funding, talking about the Med Center and us as we are the partners on where that money goes; you know, they led us to believe that all of it might not meet our budget.  Then, it was in the paper that we had a surplus.  The only criticism that I had on the governor was that he said he sent his accountants back because he thought that that was a fluke; he should know that it’s not a fluke.”\n\nThey were trying to explain to him various….\n\n“If they did have that money, it needs to go where it was already voted and approved; so.” \n\nI don’t know, as I look at it, it could be just such a dramatic change that a whole lot of people again, the ones that suffer most would be that 50%.\n\n“Yeah, because what he’s picking on is that lowest group.”\n\nYeah, you know, it all sounds as they present it and the Governor has done too much mouth work for them, I think; “ We’re being watched by the nation”, and they may watch him.  It’s kind of like you watching an old ship sink.\n\n“Uh huh.”\n\nI obviously had some feelings about it.  But look at mental health; I’m retired again for the third time and I’m not involved in it, but I just think that it’s sad to watch that kind of callous view of it and they’ve got that kind of tea party kind of folks with an etiologically obsound to do things, because there is no evidence.\n\n\nWe didn’t tell you when we started out and you may not know, have you ever heard of Birch Tree Communities?  He started Birch Tree Communities.  \n\n“Yeah, ok yeah, yes.”\n\nHe is the founder and he’s the one that kind of did for Birch Tree Communities what you’ve done for rural health.\n\nScale….you know, it’s where my heart is and I did my internship years ago in community mental health.  But I’ve watched, you know, what’s happening in the community mental health is that they need a few more funerals; seriously.  They have guys that have got in early and saw those and their entitlement and they would cling to the physicians, but they’ve had tremendous, you know, failing what they’ve done over the number of years.  I used to feel that they could get the mental health counsel and say, “You guys keep giving up and refusing to do things that you really charter to do,” “Well, we don’t get paid for it.”  You better find a way, someway.\n\nYeah, it’s like pediatrics; same thing.\n\nSomeday, some other people will come in and say, “Well, we can do what they do, because they don’t want to do this.” \n\nIt identical to optometrists and ophthalmologists; the same situation; if you don’t provide the service, somebody will come in and take over your place.\n\nSomebody will do it and it’s really sad, because if you are looking for ways to fight and save what they’re getting, but not to fight to say, “Hey, here’s what we….”  I understand there was a lot of reaction to the Executive of the Mental Health Council to her asking them to send her some bullet points on what you bring to the community that you need; they got unsettled and said, “What is she asking that for?”  I said, “I would think that she wants to know what’s unique about a mental health center.” “Why, she don’t need that; don’t answer that.”  That’s kind of the position that they’ve taken.\n\nThat’s the last position you took before you retired.\n\nYeah, that was a disaster; I just said, “You know, you can’t; you’re boats going to sink.”  So, that’s why I was interested in those things.  I just want to tell you personally, that I just really enjoyed your story.\n\nI have too.\n\nI like what you’ve done and admire it.  I was just sitting here thinking “What would, if somebody came in among the mental health people and said, “Ok, here’s what you’re going to have to do, the linkage that you’re going to have to form, and the things that you’re going \n\n\nto have to do to be viable and vital to your communities.”  You just spawned a lot of thought that I don’t do anymore; so, thank you.  This was just fascinating.  I just admire what you’ve done.\n\nIs there anything else what we haven’t asked or covered here about what you do?\n\n“The general part on rural health care, now y’all know on the statistics that every time that they go back a do census, they based that funding on the number of population.  They do that by townships; I mean, they know and analyze that.  So, there is going to continue to be even more of a challenge for rural health care because there’s defiantly in our area going lose population.  If we didn’t have those towns that are holding their own; like Jonesboro, Searcy,  Clyburn, and all of White county, if we haven’t been fortunate enough to pick up Faulkner, because even though they say “it’s not fee for service anymore and volume based,” it still is;  even under all the new plans and even more so.  They say, “If you don’t serve a pretty big population, it’s still going to be based on numbers.”  For rural medicine, there is definitely an exodus everywhere.  It won’t affect me because we’re looking at when we do another census in seven years, it will be down a little bit so they will cut us, but the next one I will be out by then.  You know, long term if they continue that, because the big funding, big services, big access, to the larger cities; it’s just the way it is.  That’s going to be the new commodity, population; there is no way that you can replenish the population.  You can’t just move people in.”\n\nDo you foresee potential of places like Cotton Plant, your principal involvement being one of transportation?\n\n“Yes.”\n\nTransportation out to services?\n\n“Yes, yes.  Parking is the same way; we had to relook at parking.  Parking in Cotton Plant was really losing; they had no schools and they are at the very bottom now.  We had to move our clinic from the downtown historical area out to 64, to try to move it out toward Earl where you could at least pick up the population out there at Earl.  So, it’s really beginning to be much more population based medicine; even for rural.  That’s going to force you in to this regional kind of wrapping arms round up a large area.  You know, medicine is not equipped for that.  Even here in Little Rock, the Med Center’s mission is Pulaski County based with maybe their surrounding counties.  But, it’s going to force us in rural medicine to have a much broader regional view.”\n\nYeah, we met with Tom Bruce and that was one of his comments that he made and made a couple of times in different ways that he felt like part of the end of rural medicine was regionalization.\n\n“Yes, yes.”\n\n\nClearly, that was what you had to get away from in small towns.  Just like you have to get away from multiple small school districts.  You have to start consolidated and go regionally.\n\n“Hey, we’ve learned that in the economic piece of this.  We got into economics in community development that you have to have, according to the gurus even though it’s that teacher at UCA about economic development, you have to have a critical mass of 10,000 people in order to have, you know, a successful development program.  Well, really the truth is when we assessed to have that, you really don’t.  You can have about 8,900; they really don’t have who has the full 10000.  Well, you just need to do a poll of Arkansas.  In our 12 counties, we’re looking at maybe 3 or 4 cities that would keep us open.  We don’t have any 10,000.”\n\nThere are about 15 counties in the state who have less than 10,000 people.\n\nWell look at Monticello, they have just under 10,000, but that includes a college; a university branch, a weak one, that has 3,000 students.  So, they are under that number. What are they going to do; they have lost all theirs and they are kind of hold on.\n\n“I know what the government is going to say, or Medicaid or whoever.  They are going to have to spend more money on those few people who live at Cotton Plant.  My theory is being, “OK, you be the one to tell them that, instead of me.”\n\nThey’re not going to be able to.  You say, “I want to introduce…” and they’re gone; “Sorry, we have another commitment” and leave.   You know, you’re heart can go out to those people.  Like in school consolidation, you have these bitter, bitter, battles because you had people sympathetic.  School has more meaning than just the classes; time has rolled over and the schools couldn’t keep up.\n\n“Hey, but it’s a bonanza; on the on the flip side when your invading a population, you’re going to be adding these services.  One area, it’s stealing from Peter to pay Paul.  Like in the northwest part, they have really a lot more say and a lot more… the cities are growing up there.  I know that that is going to happen because I saw it in the whole state of Kentucky.  It’s going to continue to be like that; mild distribution of resource based on the population.  So, rural health is still going to continue to be behind the eight ball; it still won’t matter.  It wouldn’t matter if I did all this and blah, blah, blah….it won’t matter, because it’s not just health care.”\n\nNo, it’s not.\n\n“Like if you have a doctor in a clinic, it’s kind of beside the point.”\n\nYou can envision in the future some huge class action suits that are similar to the education field, it favors the need to enhance funding to this, there is, and strictly basing it on population and they may not win.\n\n\n“Right, yes.”\n\nThat’s why I was asking about that a while ago, I think we will see more people who are leaders and politicians who will say “No, it’s going to die anyway, go ahead and let it, and we will offer those services here. They can kind of use a little base.”  It will come to this.\n\nI really thank you and this is the end of the interview…","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159356/file/290302#t=0.0,4106.35225"}]}]}]}