{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/v11vd6r10c/manifest","type":"Manifest","label":{"en":["Dr. Lori Heim"]},"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":["2015-01-07 (created)"]}},{"label":{"en":["Agent"]},"value":{"en":["Sandy Panther (Interviewer)","Don Ivey (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":["Lori J. Heim, 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/153034/file/281669","type":"Canvas","label":{"en":["Media File 1 of 2 - Heim_Lori_15_a.wav"]},"duration":3265.71373,"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/153034/file/281669/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153034/file/281669/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/669/original/Heim_Lori_15_a.wav?1752086215","type":"Audio","format":"audio/wav","duration":3265.71373,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153034/file/281669","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153034/file/281669/transcript/81613","type":"AnnotationPage","label":{"en":["Dr. Lori Heim interview transcript  [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153034/file/281669/transcript/81613/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Sandy Panther: Good afternoon Dr. Heim.\n\nDr. Heim: Good afternoon.\n\nSandy Panther: This is Sandy Panther and I want to verify and have you confirm please that you realize this is an audiotape and give us permission to so tape you.\n\nDr. Heim: Yes.\n\nSandy Panther: Dr. Heim, I would like to start at the beginning of your life, if you could, please. Tell me when and where you were born. Tell me about your parents, what they did for a living. Siblings, their names and ages and what they do. And then if you would please, just continue through your early years.\n\nDr. Heim: Okay. I was born Lori Joan Heim, June 28, 1955, in Livermore, California at an Air Force base that no longer exists. And about two weeks after I was born, my parents took me on a cross-country car trip because my father was in the Air Force. He was Frederick Nelson Staltz (?) and my mother, Ruth Marie Staltz. Dad was being transferred to the Pentagon, so we left California and that was my early traveling history, to go back to Virginia. Dad, at that time, I think was Lieutenant Colonel in the Air Force. He had been in several of the wars and he was a bomber pilot. And my mother was a teacher. She had wanted to be an attorney but her health prevented that. And I’m the youngest of four kids. My oldest brother Fred was in the car. My next was my sister Ann and then my middle brother Ken and myself. And I understand that at age two weeks I was a very good traveler. So we ended up in Virginia where we spent several years before we were transferred to Germany where I went to a Germany kindergarten and learned how to speak a little bit of German. And we traveled around Europe, then we returned to Virginia for three or four more years before my dad was transferred once again – this time to Panama which was a fabulous place to grow up as a kid. \n\nDuring that time was my first real encounter with the medical system because I was in a parade and a motorcycle gunned right behind me and my horse I think reared or did something and landed on my leg which crushed his fib. And I was taken to a Panamanian clinic first and then to the military hospital. And the difference between the two encounters was I think my first indication of the disparities of medical care and what incredible implications that could have. The civilian hospital down there that was run by the military was top-notch care. But recovered from that after a long period and then moved back to the states. This time to Washington State and there went to high school and eventually started college there. So after that, I did not have a direct route into medical school. I started out at Washington State University and I was going to be a journalism major. I was really not that good at writing. I think I went bent toward the idea of a reporter only because I think I do better in front of a camera and speaking. But then gave that up and I took some time off from college, went back into university, this time at a community college down in Portland, Oregon. And at that point, I was going to be an education major and that then did not really spark my interest. My mother was a fabulous teacher but I didn’t have it in me, at least not for grade school or high school. So dropped out of college again. Then I ended up, just by happenstance of a relationship, living outside of Hood River, Oregon. I don’t know how I got into it, but I ended up being a nurse’s aide in a psychiatric unit, a locked psychiatric unit, which lots of funny stories from that. Some tragic, some funny and some scary. But that’s when I started thinking about medicine. Because as a child, I actually had wanted to be a vet, not a human doctor. But I didn’t want to be a vet when I got older because I didn’t like how veterinarians, when I interned with them, did so much of the senseless things that I thought like docking tails and things that I couldn’t get behind that philosophy. So here I am now in a locked psychiatric unit as a nurse’s aide and then decided to move up to Hood River where I was a nurse’s aide with my boyfriend. He was the nurse in the CCU ICU and I was his nurse’s aide. And that’s when I started thinking I want to be a nurse. And I want to be a CCU nurse because I love cardiology. However, when that relationship split up, I moved back to Portland, Oregon and I still continued into nursing school where I made lifelong friends and had a fabulous experience. But as my girlfriends always used to joke with me, I spent way too much time trying to go too far in depth when we were studying into the well, why are we doing this and what’s behind this. I loved the nursing aspect of taking care of the patients, getting to know the families, really getting to be an advocate for the patients. And I think that’s one of the reasons why family medicine and I were a fit because it’s the same sort of holistic approach to the patient; it’s just you’re within the hospital setting. But I also had some physician attending. I don’t remember if they were interns or not, but I thought they were awfully bossy. And I kept thinking, you know, I can do this. I’m as smart as these guys. So that’s what I did – I dropped out of nursing school and decided to go pre-med and went back to Portland Community College and switched over to pre-med. And I thought that was my nursing experience and nursing school would give me a better feel for what medicine was about. Medical school and pre-med, of course, were a whole different ballgame and I had to shift gears quite a bit because I did not have much of a science background other than what little I got in nursing school. Was a journalism major before that and then an education major and was not strong on math and science. \n\nBut then during my I guess junior year of pre-med, I became engaged to my current husband Jim and we married in December of 1979. And he was very, very supportive of my going into medicine. Was not at all threatened by a woman who was going to have a career in medicine. So then we started the application process and I applied to I think about eight different medical schools. Was accepted at I think five, which was such an incredible relief, as anybody knows who’s gone through that. One of the schools that accepted me was the military medical school, the Uniformed University of the Health Sciences in Bethesda, Maryland. And initially my parents had had mixed reactions. For one thing, my mother, even though she wanted to be a career woman herself and did have a career in education, she however said two things: The one about medicine, it was not a good choice for me because she thought it would be too demanding. And that was the only time that I ever heard her say anything sexist. But she was definitely concerned that medicine would be a barrier to having a family and a stable marriage. Then when I wanted to go to the Uniform Services University, it was my father who looked at me, and he had retired by this time as a Colonel in the Air Force, and he said, Lori, are you really sure about this? Because I was not known as someone who took orders very well. I had always been of an independent streak, as they used to nicely put it, and was very much the tomboy growing up. I had been involved in anti-Vietnam war activities when I was in high school even though my father was in charge of the ROTC. So it’s not like I came from a military family but was unquestioning of the military. But I convinced them that I thought the difference was that in the military, I may not agree with their philosophies just like we may not agree with what Congress does sometimes. But we still support the institution, and more important I thought was, the truth always needed to be supported in whatever happened. And we learned that from Vietnam and I had learned that lesson very well, that the families and the service members still deserve the best possible care – and I thought I would be in a good position to do that. Plus, the school had two other great advantages. One, you got paid while you were going to school. So, coming from my family, I did not have any financial support and Jim made just enough money at the time as a radio engineer that I really wasn’t going to qualify for any scholarships. So part of the decision was, quite frankly, financial. The other aspect was that the school was fairly new. It wasn’t brand new, but it was fairly new and it was very well-resourced and was determined to be a leader in academic medicine and the first of the kind to have all services represented. So they want to make it flagship and I thought that was also quite advantageous for me. So that’s where I went. This was in 1982. And when you go into the military school, you have the option of being able to choose which service you go into. Unfortunately, my year they did not accept any public health applicants and that was really due to financial and political reasons. But my second choice had been the Air Force, for obviously family reasons. Dad used to joke, the Air Force was always known for going into an area and first they would look around and see where to put the officer’s club and then they’d look where they should put the pool and then they would look, oh, where do we put the runway. And I liked that philosophy of taking care of the comforts and looking out for the troops and then the mission. But anyway, that was sort of the joke about the Air Force and I thought it bodes well for me. So, I joined the Air Force at the time I joined the medical school. You had to be on active duty at the time. \n\nSo, I was in for over twenty-five years starting with that initial commitment to serve. During that time, the medical school was exactly what I expected. It was top-notch. I still have friends that I know from there that were good friends and in fact still see on a regular basis. And I think that’s true of many medical schools. But the difference was that because of the mission of the military, it was really important that the school try to instill a sense of teamwork and camaraderie. That they wanted graduates who knew how to be part of a greater mission, be part of a team. And so they did a lot of things, I think, to try to decrease both inter-service and just interpersonal rivalry. Although most of my friends did still remain from the Air Force, but quite a few from the Army and Navy. And we were taught at that time how to be prepared to practice in an austere environment. So we were being trained to be deployed. And that means that you don’t have a lot of equipment. You have to rely on a lot of interpersonal skills – being able to work with other people, being able to organize and not simply rely on technology. And I think that that also points to the need for a strong primary care base. So, our school had a strong family medicine, had a strong primary care component and it was fairly well-respected. It was like every other medical school that I think you find in the country still today, unfortunately, that many of the other specialties still look down on family medicine. I think we have all heard the story of being asked well, you’re smart, how come you’re going into family medicine? And that routinely happened to me as well throughout my rotations. But I think it may have been less at the time as some of the universities. They had an opportunity for rotations, some were mandatory. \n\nFamily medicine was actually a mandatory third year rotation. And I went down to Ft. Gordon, Georgia, where I met my first important mentor. And that Jeanette -- (?) who has been the recipient of awards from the AAFP. And she was faculty there in the Army and she was the first female family physician who was polished, compassionate, smart and a wonderful teacher who was impressive but not overwhelming, not daunting, and who was very encouraging. So I had been undecided up until that rotation. I still thought that I would go into cardiology, I think until that rotation, because I liked everything that I did. And after her encouragement and seeing her as a role model, I pretty well settled on family medicine, then spent the fourth year trying to look at was that the best choice. One of the things that I found as I really started honing in, it was not necessarily the patients because I think I would have loved the patients in any of the fields. Wasn’t interested in radiology. Did not have the 3D brain for it. Wasn’t interested in anesthesiology. But I loved surgery and you still get to see your patients. So I loved so many of the different aspects of medicine. When I started looking at colleagues, I said, you know, I’m actually going to spend more time with my colleagues than I will with certainly patient and probably more time than with my husband, if you look at it. So, I then started, on every rotation, looking at who were the types of people involved in that specialty. How did they get along? What was their life balance like and their professional satisfaction and support of each other? And I kept coming back to family medicine having --. Those two seemed to have the other attendings that I kept thinking, you know, I would be happy with them as my friends. I would be happy working with them and feeling fulfilled, feeling supported. And that became sort of the final straw. Everything seemed to fit the best with family medicine. So, I was accepted. I graduated in 1986 and was accepted into Andrews Air Force base in their family medicine. And it was a three year residency commitment. The first year was pretty rough. We were supposed to be a class of nine and we started out too short. Then halfway through the year, the third person dropped out for personal reasons. So we had to make up for all that time. We only had family medicine and a transitional internship at that community hospital. And at that time, obviously this was long before any regulations or limitations on residents. And they also did not have the ability to bring in any other residents. So, for probably six, eight months we were doing things like every other night call or every third night call when previously it had been either every third or every fourth – and that was a rough year. Plus, in December of that year my mother died suddenly of an aneurysm. So I remember the internship year being a very bleak and dark year, which internship year is for everyone. But for various reasons, it hit me pretty hard. Luckily, the next two years were much better and the remaining six of us had a wonderful relationship and still one of my best friends was my co-chief resident from that year. And we were able to make changes. So, for example, since we had gone through the shortage, we made certain that successive years would not be put through that. We developed with the residency director and the staff a commitment that if there were shortages, even short term because of illness or pregnancies or what, that the staff would step up and help cover some of those shifts as opposed to simply expecting the residents to cover it. And that was a philosophical change that we had to get through. And it took a lot of … I think my first sort of political maneuvering within the hospital, to be able to get that through. But it was the right thing to do and everybody came to that point and the faculty embraced it as well as some of the other faculty from the other departments.\n\nSo residency ended in 1989 and I had, as my fourth year elective, been selected to go to England for six weeks of an externship. I was the first exchange student with the Royal Air Force. And I went to a hospital in Wrotton, I think. It’s out in the hinterland close to Wales. But that probably prepared me for my first assignment out of the Air Force the best perhaps of anything because it was six weeks where the British doctors took me back to physical exam 101 and were incredibly demanding. But it was wonderful. They taught me nuances that I hadn’t picked up on before maybe because I got it the first time as a first year and now as a fourth year I had a greater context in which to put some of the physical exam skills and cement them. So, I came back from that, it was right at the end of the year, to find out that the Air Force was going to send me to a remote site in Turkey. And remote only meant that it was an unaccompanied tour, so my husband was not going with me. He remained in Maryland and I went to Izmir, Turkey where I was supposed to be one of three doctors at a clinic that simply did outpatient and any hospitalizations, the patients would go to the Turkish hospitals where we did not have admitting privileges but we would go every day just to sort of supervise. Well, not even supervise, but check up on the patients. And in order to be successful at that, we had to be on very good terms with the Turkish doctors in part to keep communication open but also because there were times when we disagreed about what was the best treatment for our patients. And to be able to try to get them to do what we thought was best while not insulting or ruining this relationship. Now, there’s another trend that I raised to --: When I first arrived in Izmir, Turkey, there were, once again, supposed to be three of us. However, one person got diverted right away, so we started out with two. And then during the course of that eighteen months, my commander got relieved and the doc who was supposed to be senior to me, he was nicknamed Dr. Zero by the community. And so they didn’t trust him enough and they wouldn’t go to him unless they were new or desperate. So I seemed to be always completely overbooked. And the appointment clerks would try to get people to go see somebody else or postpone it. They were wonderful to me to try to protect me, but unfortunately there was just an unmet demand. So that taught me to be a little more efficient. And the person who was senior was supposed to be what we called the Chief of Medical Services, SCH. It’s sort of like the chief medical officer. Well, he was relieved of that spot. And even though I was just out of residency maybe six months, I became the Chief Medical Officer. And timing being what it is, that was about three to five months before our major inspection. So, in the military we have JACO as well. We also have inspections like JACO but they were focused on the military medical requirements. And so I was learning how to go through an inspection at the same time. Now, I was quite lucky in that people were very supportive. The rest of the staff was very, very helpful. I had a chief administrator and a chief nurse who were both experienced officers and they were wonderful. And I had a community of friends who were absolutely marvelous. And they also taught me things like how to pick up a phone and I could call the Command Sergeant in Germany when I had a question about what was the interpretation of this or that regulation or requirement and just would say, I don’t have a clue what this means. Where am I supposed to be looking for this? What sort of policies am I supposed to be writing? And I think they were impressed by my openness to acknowledge what I knew and what I didn’t know and they were, again, extremely helpful. We passed that exam, that inspection and did well, so my career was not cut short because of those early decisions. \n\nAfter that assignment, I was actually supposed to go, kind of as a reward for having gone through a difficult transition and a difficult first assignment … I was supposed to go to the Pentagon as a flight surgeon. That would have reunited my husband and I back in the same town. And being a flight surgeon had appealed to me quite a bit. Well, the General, at the time, for some reason wanted me to not go to flight surgery school but wanted me to go back to the residency that I just graduated from and go on staff. That was not in my career trajectory at all, but in the military when you get orders, you have to do it. And unlike what my father was concerned about, I accepted it with grace. I did not have any hesitation. That was my mission. They did however still allow me to go to the flight surgeon training. So I got a look into that world which is a lot more about physiology of flight and physiology of people and it helped me in my future Air Force career because I understood more what the pilots were feeling, what their limitations and risks were. And it was just plain fun. So that was a great boon even though I felt like I had gotten the short end of the stick and had to go back into education. \n\nNow, being back on faculty in the residency there’s one big advantage to the military over the civilian sector – and that is that my pay didn’t get cut. So many times when I look, we don’t pay our educators as much as they would be compensated in the civilian sector which means that if you’re going to be an educator, you do it because you love it. And I think that may dissuade some of our family physicians from going into that career. I was not dissuaded because of that. I simply didn’t think that I had the skill set to be a good educator. But I had some wonderful role models when I was in residency and so I tried to pick from the people that I really liked and from the people that I didn’t like, characteristics that I wanted to embody as a faculty. The faculty at that time, I think we were maybe eight. And there was only one other woman on the faculty. And Carol was a delight. She was very smart. However, she allowed the male staff members to really, I think, take advantage of her good spirit and were incredibly sexist. She was the one who was always expected to make the coffee and do all the social things. So, when I came along and made it very, very clear that I felt they were chauvinist pigs, I earned the nickname among them of bitch. So I then recruited my girlfriend, my co-chief, from residency to come back on staff with me. So now we have three women. We were still in the minority, but I had Bonnie with me. And Bonnie and I decided that if we were going to be called bitches, we were going to make it a label of strength, so we formed the Bitches Club. And it meant that you weren’t mean, you weren’t aggressive, but you were assertive and you stood up for what you thought was right. And that actually started a trend. The Andrews residency, both when I went there and certainly when I came back on staff, would have one, zero or two female residents. By the time I left, the classes were half or over half women. And I think it’s because, and the students told us that they thought our club was very funny. We even had t-shirts made up at one point. Everybody had their name. But it was an attitude that women were going to be treated the same as men, but you couldn’t be mean. So, if there was any meanness, male or female, it was not tolerated – but everybody was to be treated with respect. And the staff then also became much more balanced in terms of male and female. So my remaining years at Andrews on faculty, again, from a collegial and a professional standpoint, were exactly what I had been hoping for in family medicine. And the residents were a delight to work with. Many of them we recruited back to be on staff and many others have continued to be lifelong friends for me. \n\nThe residency was also a tremendous opportunity to expand my career. Again, working with patients most of the time, precepting, but also two other facets I perfected, or didn’t perfect but I expanded: One was procedures. So I became involved with doing nasal laryngoscopy because of my connection through the Uniform Services Academy of Family Physicians to do nasal laryngoscopy. And that gave me the opportunity to go to different meetings to help teach that course. I think because of my involvement in the residency, doing procedures and I was also, at that time, I think a board member of the Uniform Services Academy of Family Physicians, I was also invited to go to a two or three day workshop on presentations. And we were then expected to form a cadre of military family medicine who would be available to give educational lectures. And because of that, I’ve lectured in Japan and Guam and Germany all through military connections, which I think helped me when I was later involved with the AFFP and provided a jumpstart that would have, I think, taken me much longer to learn just through the normal course of giving lectures. \n\nThe other facet about the military is that your pay is obviously determined by your rank, but there is no sex discrimination in pay because it’s all transparent. There is a discrimination in terms of your specialty in that there were bonuses provided for military physicians above and beyond your base pay that was supposed to be there to try to equalize between what physicians could earn in the military versus the civilian practice to try to persuade people to stay in the military more than just get out at the end of their commitment. And since family medicine and primary care and pediatrics are all so poorly paid in the private sector, the military then reflected this as well in terms of our bonuses. So there was a pay differential in the military but it wasn’t based on what your particular job. So, when I was on the residency, as I said, there was no difference in pay. There was also no difference when I became a commander or when I went up to the military medical school and I was an assistant professor where often times those career changes in the civilian sector, at least at that time, may have actually resulted in a pay decrease. \n\nThe residency game me the opportunity to travel. I was deployed during my time at the residency at Andrews but it was to Cuba. This was during the Cuban and Haiti, when they were leaving the island and they were trying to get to Florida and the U.S. had established a camp at Guantanamo Bay at the Navy base to house the folks that were going to be either brought to the United States and given immigration status or were going to be returned to their home country. So, again, I was working an austere environment. My clinical that I ran was simply one room, kind of a log cabin, and we had some sheets in between. There was no opportunity to do blood gasses or much in the way of blood work. But this simply reminded me of my time in Izmir, Turkey, so I felt very comfortable in what we were doing. The difference was that I encountered conditions that I had really hadn’t seen before. There were some cultural differences that I had to learn. Obviously the language. Although I’d lived in Panama as a child, my Spanish was still incredibly rusty and obviously did not have any medical knowledge, so we relied on our translators to help us. And the other big difference was the amount of intentional harm. Because at that time the Attorney General had said that if you were sick, you would be taken to the United States. And so people were burning themselves, they were damaging themselves. We saw some horrific wounds. And I also saw more shoulders dislocated. I’m not sure if that’s because they were playing or because they were intentionally trying to hurt themselves. But I became very good at reducing shoulders – and obviously this is without a pulse ox to monitor sedation but careful monitoring with the med techs and myself. But that was actually my only deployment ever. I tried to go overseas later, but by that time I was in command and they did not have any command positions open during any of the other conflicts or they felt that I was mission essential back where I was, so I missed that opportunity. \n\nAfter I got back and I was about six years on the residency staff at Andrews, my total commitment time was about up. So I was at the point in my career where I could have finished my obligation and go into the civilian practice. And Jim and I went out to California. We looked at some places in Chico. And I had a contract that I was going to sign to leave the Air Force and go into private practice in a group. When I was notified that I had the opportunity to go on CODEL, which is a Congressional delegation, some of those Congressmen have health conditions for which they want a physician along on the trip when they’re overseas. And I was lucky enough to be selected with Senator Daschle, Senator Reed, Senator McCain and their wives as they went to Albania and Romania and I forget where else for a delegation and I was the medical personnel. Nothing happened. I didn’t make any news. But it was a fabulous experience and the opportunity to have very in-depth discussions with these three senators was one of my eye-openers into the world of politics. I had, since I was a child, been raised in a rather liberal but very political-minded family, so I was fascinated by being to talk to these senators about their perspectives. And during that trip, during the time I was gone I was notified that the Air Force was going to send me to the Uniform Services University again. But this time instead of being a student they wanted me to go on faculty as assistant professor. So, at that point I had just come off of this fantastic opportunity to go with the Congressional delegation. I was being offered the opportunity to once again do something different and go teach at the university. My husband had a fabulous job he liked in D.C. and I thought why am I leaving the Air Force when it’s given me all these great opportunities that are so fascinating and professionally rewarding. So, I stayed in and eventually did over twenty-five years.\n\nI went up to the Uniform Services University where I taught classes mostly on, I did some ethnics and physical examinations. We also ran the student health clinic. So I got to know the students on a variety of different levels and enjoyed that very much. But I found that it was probably the least attractive part of my professional career only in that I found the students were not challenging enough and were very needy. The other part of my job description, obviously, as a professor, is to do research. And I didn’t mind research so much, but I had left journalism because I didn’t find myself to be a good writer. And here I was now going to have to do a lot of writing and I was editing a book chapter which was very interesting and I enjoyed it, but I hated the writing. I felt that it was just a skill that I did not have and I had to work way too hard to do it. So, the academic life in medical school I knew was really not going to be my long term career path. But what was wonderful about the job was Jeanette -- (?), who had been the woman who really was my first role model, she was the department chair. And I’m sure that’s one of the reasons why I selected to go as assistant faculty. And working with her, in her department, was another professional life changing event only because she was such a good leader. She promoted her folks. She guided you. She was like the last residency director at Andrews, Jan Lee, (?) both in terms of giving professional development to their staff members. And I had been missing that before and those two women really showed me how important that is, to be able to do that and bring your staff along, bring your troops along. And I found that later on in life that became one of my goals and one of the things that I think I am most proud of looking back, as a number of other women who eventually said that I was their role model and their mentor. \n\nBut I think I would have stayed at the university longer except that I was promoted to Lieutenant Colonel there and another friend of mine on staff was being promoted to the Colonel Fulbert (?). As a result of his prior relationship with the Surgeon General, the Surgeon General of the Air Force came and did the promotion ceremony of my friend. And since I was being included, he, unfortunately for me, took a look at my record and he found that I had been in the D.C. area, with the exception of that eighteen months over in Izmir, Turkey, for my entire career. This was something that was called home steady (?) – and it was frowned upon, to say the least. So I was a newly promoted Lieutenant Colonel and before the Surgeon General left he turned to me and said, Lori, you had best be looking for a new job or I will find one for you. So the very next day I was on the phone calling all of my friends and mentors saying, who’s got a good job out there for me because I don’t want them choosing for me again. And I found an opening. A friend of mine was the Residency Director and Chief of the Department of Family Medicine down at Eglin Air Force Base.\n\n(Break.)\n\nDr. Heim: So, at this point I go down to Eglin Air Force Base, which is in Florida, and it was the last family medicine department where the residency director was also the chair of the department. And there had been talk about splitting the position in two at that time, but I was glad that they didn’t do that in part because both positions were something I wanted to do. I think I have better organizational skills than the average bear, so I wanted that challenge, to be able to do that. At USHU’s (?) I’d been the head of the clinic and had brought us there a JACO. And I had learned during that time especially that I could do this and I found it very rewarding. So, I go down to Eglin and in less than, I think it was two or three months, we were due to have the RRC five or seven year review (I forget what it was at that time). But this was a new challenge. I had been involved, of course, at the residency when we had had an RRC come through, but I’d never run it. And luckily my predecessor had done a lot of the prep work, but there were still two or three months of frantic scheduling, long, long nights and trying to learn it. But from my experience of having been thrown into a short notice inception when I was in Izmir, Turkey, I used the same skills that I learned during that. I called people. And the military has a good network. I was not involved with AAFP or the residency director’s group at that time. I really didn’t know that much about it. But I had all my other residency directors through the various military branches. And once again, my colleagues were supportive and helped me figure out what I needed to do and I had a fabulous faculty to work with. So we got through that. We did not have any issues. We were given the longest (I forget the term), but the longest certification that you could possibly get. And my command at the hospital were very pleased, which meant that my life was much easier. So, then, having gone through that, I set about trying to decide what was going to be sort of my legacy as Chairman and Residency Director. And one of the things that I saw we were deficit in was in research. When I was at Andrews on staff, my leadership team had been supportive of my going to Chapel Hill in North Carolina where I went through a fellowship. It’s a year long distance and local fellowship in faculty development and research. And the Air Force, I think, was very long-sided and visionary in making sure that they chose people to go for these additional trainings. Because that’s when I learned really about cultivating people and I learned research that I didn’t know before. So when I came to Eglin Air Force Base and their research requirement was essentially to do a case report and I went before the faculty and convinced them that this really did not meet the needs of a family medicine resident. Because in our profession, it’s imperative that we understand what’s good research and what’s not good research and there’s a lot of supposedly research that is faulty. And the only way that I felt that the residents would really grasp those concepts is if they had to grapple with it themselves. And the case report doesn’t do that. So, much to the chagrin of the residents, we changed the requirement and said they actually had to do a real research project. It did not have to be sophisticated, but they had to be able to come up with questions. They had to understand selection bias. They had to understand the basic statisticals and how those stats could be used to confound your research. And I explained that to the residents, that that was really what I wanted them to do. I wanted them to learn what were the pitfalls of research. And not that I expected them to come out with anything even that would be published. If they did or they presented papers or poster boards, great. So, over my tenure there, we developed that program. And as much as the residents bitched about it at the time, and trust me, they bitched. They moaned and groaned until I finally had to put up a sign in my office that said “no whining.” But years later those same residents have come back to me at various meetings and said that now they get it. Now they can read literature and they’re much more skeptical about what they read. And they may not understand as well as they would like and some of them went on to do much more research than I had ever expected, but that, I think, was my most satisfying time.\n\nThe other thing that I did there was, I started to really look at the faculty and try to develop a team. So many times the faculty are simply who’s available to move at a particular time and that’s a limitation in the military. You don’t often get a chance to choose your team for what weaknesses and what strengths are you good or deficit in, where do you need to fill out your team. But I had the support of my command in the Air Force, so I got people in that I think we formed a good balance of what we could provide to the residents. Including, one of my dear friends, I was one of his resident attending, but he was on staff, Lou Hoffman (?). And he wanted to get into acupuncture. And although I don’t believe in that modality, I’m still very skeptical of it, but he was very committed to wanting to do that. And so we found a way to get the Air Force to pay for and allow him to go get that certification and get that training. And what did was twofold: One, it brought back those skills to the residencies. It showed the residents that there were lots of other alternative ways of progressing professionally. It provided a service to our patients. And I really, I think, impressed upon the staff that even though we may not agree with each other or may not professionally all agree with a certain modality or treatment plan, but there is room for professional acceptance and room to allow everybody to try to progress. And I think that helped our department become much stronger as well. And then Lou actually wanted to go be a White House physician. And although we hated to lose him, he then left the department to go be one of the White House physicians. And it was another example of even though it may be a loss to your department, you have to think about what is good for that person and what is good overall for the mission. \n\nThe other sort of my life changing event at Eglin was when the … This was a hospital, too, so we had full lines of service there. And the chief of the medical staff there was retiring and he wanted me to take over his position and walk down the hall and leave the residency. And this is the same position that I had done when I was less than a year out of residency. So although I knew something about the position, I certainly had never been in that sort of position in a big hospital. Not a huge hospital, but for the Air Force it was a good size. But I had the support of the leadership and worked for one of my first bosses that I thought was truly brilliant, Dr. Jennings. And he was a surgeon and probably the smartest man I think I’ve ever met. Maybe not so good in some other areas, but being able to watch him as he ran a meeting and watch him as he did vision planning and strategic plannings for the hospital and where he thought we needed to go was an incredible opportunity. You can read about doing that sort of thing. But when you’re in the middle of it, and I was still pretty junior, I was a lieutenant colonel. Being able to see that and participate and have him challenge me – where do you think we need to go? How are we going to get there? What are the things that we’re missing now that in ten years going to need? That was a very shaping experience for me.\n\nSo I did that and found that I enjoyed command and I enjoyed working at the systems level more than I did at the individual level. And although I continued to see patients, it was really my calling, I thought, to be more in command. The patient aspect has always been critical, however. In fact, when I was in Eglin, I was walking in to do one of my clinics, and they weren’t much in the way of continuity because I wasn’t there all that often, maybe two, three half days a week at the most. But I walked into the room and saw a woman vaguely familiar. And she said, you don’t remember me? And I said, I’m sorry, I don’t. She said, you delivered this girl. And sitting on the exam table was a teenager that I had delivered at Andrews Air Force Base. So even in the military, even though we move frequently, at least most of them do, I had the continuity to be able to see this teenager. Then I was able to see her for several more visits just because we would arrange it that way. And that’s the sort of enjoyment that I always needed to have even though I was doing by far much more administrative work. The other reason I think is really important if you’re in administration is to get into the clinic because not only do you need to be grounded in terms of what folks are doing, but you see what are the things that are going right, what’s going wrong. It’s kind of an early warning system. And staying connected with the staff. And I think that they respect a leader who is doing what they’re doing enough to be able to still be conversant about it. Later on when I was Deputy Commander out in Washington State, I walked in to do one of my clinics and the keyboard that I was using, one of the keys was either missing or stuck, I couldn’t remember. But here I am, trying to type my electronic medical record note, and I literally could not because the darn key was not there. And I walked out later and I talked to the doc whose office I had been using and I said, how on earth could you do your job? And secondly, why didn’t you say something? Well, that interchange was again very enlightening and got to the root of some real problems that were going on in terms of doc scheduling and reporting and all sorts of stuff that I would have never known about had I not been down there trying to live their life. So, despite being in administration, I’ve often felt that it was really important to be able to do both and be connected.\n\nSo when the time at Eglin was up, I was offered to be a squadron commander which is above a clinic (?) commander but less than a hospital commander. And the Air Force gave me several options but none that I really wanted. Except one was at Pope Air Force Base which is in North Carolina and we thought it was close enough to the east coast that my husband might still be able to work, so we chose that although I had grave misgivings, grave, because, again, it was going back to a clinic as opposed to a hospital and I felt that it might be a step down. But we came to this community which is essentially where I ended up retiring and fell in love with the area. And the team, again, that I worked with was remarkable. Once again, I had a hospital commander, that one and the next one … Ron was at Pope and Tim McCalley (?) was at Washington State where they weren’t doctors. Ron was a dentist and Tim was an administrator, so they really relied on me to give them the medical aspect. And they taught me again the importance of being a leader, of listening to your folks. Whether or not it’s your nurses or your second in command, but listening and respecting what they say and being able to develop them and ask the right questions to be able to get the best solution for the clinic. So this is not about the doctors getting one thing or the nurses or the technicians – and trying to break down those silos so that it’s a team effort that goes forward. And we loved Pope. It was only a two year assignment. The Air Force wanted me to go be a hospital commander somewhere and I was able to call up all of my buddies, generals, everybody that I knew and ask them to please take me off that list because my father was in Washington State and he was not doing well and I really wanted to be close enough to be able to visit with him. My mother had already died and I felt that was very important and time limited. So the Air force and my buddies all went to bat for me and they landed me a job at McCord Air Force Base as Deputy Commander. Again a clinic, but a little larger clinic and a set up in that I was the Deputy Commander. And I had three years working under, again, another great boss who had great staff. This is during the time when we were deploying folks to Iraq a lot and the reservists were coming in. So we got a chance to make I think a difference in the lives of the troops whose families were left behind and they were off being deployed and they needed to make sure that their medical care was solid, that they were going to be taken care of. So that worry wasn’t there. The other professionally interesting part of this was during the Avian (?) flu, and -- all came through about this time. So I was appointed to work with the state on basically infection control when you have an epidemic working closely with the Army, with the civilian practices. What was going to happen at Seattle Tacoma International Airport if something came through, what we were going to do. That was again doing planning that ironically now, when they talk about the Ebola, I was thinking back to what we had mapped out and what the best experts at the time were saying how we were going to do it. And it really pointed to how hysterical people got and how it became an immediate thing as opposed to really listening to what the sciences. And I think that actually highlights one of my frustrations both within in the military and in subsequent positions, is that are politics, then there is public approval, and then there’s just plain stupidity. And those three make a horrible combination. You end up with regulations, either military, civilian, whatever, that don’t make any sense. You end up with JACO expecting things that really don’t improve patient care. I think the RRC has done things that personally I don’t think have fostered the advancement of family medicine education. And certainly the government has come up with some regulations and restrictions that I think have really hurt the advancement of medicine. While they have done some good things, they have also made that terrible combination of stupidity, mixing public opinion and bad science and bad politics. \n\nAfter some of my frustrations with the politics, I was actually very pleased with the planning that was going on in Washington State around this issue and was thinking more and more about system changes throughout my career. And it came to a point where I had to make a decision because at that point I had run unsuccessfully one year for the American Academy of Family Physicians, to the board, and was trying to decide if I would run a second time. And I did a very, I think, honest appraisal of what I had done wrong in my first attempt and I thought that I could fix that and I thought that I could be successful. And I was able to convince my chapter and my command at the hospital to support me again. And so I ran and sure enough, the second time I was successful and I was elected to the board. Now, at this point, I was coming up on a career decision because I was going to rotate off the board unless I ran to be the president elect of the Academy. And about the time I could retire from the Air Force with full retirement, over twenty-four years, and I was actually in a little over twenty-five plus. But on the other hand, I had been groomed and I was trying to position myself to potentially be a general in the Air Force and had thought that I even might be the first female surgeon general, if I got the right jobs and did a good job. So, I was trying to decide, do I want to try to pursue this military career and, again, be able to affect system changes or try to work through the Academy to do system changes. And I chose the Academy because although it was in some ways more of a long shot, because I thought that the opportunity was greater. While the military had a sense of mission and a send of purpose that I have always missed because everybody was so committed to keeping the troops healthy and keeping the families healthy so that the troops could do what they needed to do, it was still a closed population. And the Academy, on the other hand, was dealing with promoting the communities across the nation because it’s the family physicians who take care of the nation. And without an adequate family physician workforce I knew that the communities of this nation were not going to be healthy. So I decided that I wanted to try to do something in the Academy further and ran for the presidency and was successful. And that started then a requirement to retire from the military because of military rules, you cannot be on active duty and in a position of leadership where you have to go before Congress because that’s considered a conflict of interest. So that was the decision then to retire from the military. So we moved back to the area outside of Pope Air Force Base that we had fallen in love with and bought land and we proceeded to build a horse farm so that I could then devote the next three years to the senior leadership, the volunteer leadership of the Academy. And, once again, have had such a fabulous experience working with the board and then being able to be a part of the organization for another three years has probably been one of the highlights of my life. \n\nThe Academy and I actually went back quite a ways. When I was in the military, I was encouraged by one of my early mentors, the same gentleman who got me to the job in Eglin. He was the one who turned to me one day at the residency in Andrews and said, Lori, you should run for Uniform Services Academy board. And I said okay, Chuck, I’ll think about that. Decided to do it and was elected. Then from there was elected to being the president of the chapter. And during that time had the opportunity obviously then to begin to meet more of the AAFP, other chapter members and was selected then to serve on the Practice Improvement Committee of the AAFP Commission where I had my first most chilling meeting. Sitting in this first commission meeting, and I had been given a stack of materials that was literally probably three inches deep, most of which sounded like I was reading Chinese. Because here I was coming from the military background and although I could pick out some similarities, there were so many things that I had no clue about. And I sat in that first committee meeting thinking boy, the AAFP really messed this one up because I don’t think I’m going to have anything to contribute whatsoever. But as it turned out, there were a lot more similarities once we got into it than I had anticipated. And that formed the basis of my really wanting to be involved with trying to get the Academy to be more politically effective and savvy in what we did. Because it became very, very clear to me that if family medicine was going to not just barely survive but was going to take the rightful place that it should, the payment and practice environment was going to have to change. We could do everything else that we were already doing and we were not going to make the long term improvements and gain the commitment from either the practicing physicians or the students coming in without fundamental changes in payments. So, when I was elected to the board, again, a very steep learning curve. But also learning more about the politics and the politics of medicine. I knew a lot about DC politics, especially living there and then after the Kodel (?). But I didn’t understand, really, the politics and the finances of medicine and how intertwined they were. So, working with other board members who also shared my concerns and my philosophy, I think that we became voices in support of the Academy moving to be more politically involved. And this had started before that because we already had the med tech (?) by the time I came on the board, so this was not like we were the vanguards. We were just trying to make sure that that momentum continued and that we honed our skills and that our DC office was sure to have both the financial but also top cover to be able to try to move further and further into that arena. Because remember, the Academy had really been pretty apolitical for a long time. We wanted to be the folks with the white hats on and not ruffle feathers. And we didn’t know the political realm very well, we didn’t play it very well, we weren’t very effective and we were pretty mealy mouthed. And we were seen as such by I think the political forces in DC and, quite frankly, from our members. So, I think one of my goals of being on the board, then being in the volunteer leadership was to try to continue to push that envelope so that we made a stance. And, of course, we did. Despite much debate on the board, we supported the Affordable Care Act and we took a backlash for it. I’ve got to tell you, that was probably one of my darkest days, was when I was getting emails and phone calls from people who quite personally went after me for our stand in the ACA. From the right because we supported it all; from the left because we hadn’t supported the single payer system. And then just as I thought I might get out of there with my skin, then we did the Coca-Cola commitment, relationship. Then what liberals liked me before now seemed to be wanting my head for being involved with that. So getting through that was difficult. But, again, I’ve had luckily experience as a commander … When you make decisions that are painful, that you know it’s the right thing to do but it’s not easy and you may not be very popular for it. But once the decision is made and you think it’s the right decision, you have two courses – and I’ve used both. One is that you say this is the right decision. Yes, it does have some potential ramifications but the positive outweigh the negative ramifications, so we are sticking by our decision. Or periodically you have to say okay, if there are negative ramifications, have we a) done enough to try to mitigate those and on the other hand, did we make a bad decision and do we need to redress that. So, I think going back and examining. But I’m not one to agonize over something. I will re-examine it but not agonize. So I felt like although it was personally a very difficult time, professionally I still thought that the organization had done the right thing and I was very proud that I had been a part of the voice trying to move us in that direction. And I’m still proud of that. And I think the fact that the Academy membership has gone up so much in part reflects the part that we have become seen as more relevant to family physicians. Yes, we lost some members over some of the various decisions but we gained far more than we lost and I think we’ve established a much more powerful persona and reputation as being willing to fight. We, I think, as an Academy still back off from some important decisions. One was after I left the board. I thought the decision about the RUC was perhaps the wrong one. But I was not there when they had the final board decision and so my thought is that you’re a past leader and you support the Academy, so I did not publicly come out and say that I thought it was a bad decision. But I think everybody knew that I had been very disappointed with the RUC. In part, again, because my philosophy on how to save family medicine, not save it but strengthen it going forward, was that fundamentally the way in which we pay physicians, and particularly family medicine hasn’t changed and I still believe that that is the cornerstone of success. And right now we are still nibbling around the edges of this, but family medicine will not be secure until that is fixed. All of medicine I think is going to have to come to the recognition that the way that we pay on a per service basis simply leads to more care, not better care, and does not improve the health of our population. And because of the RUC and the way that formulations have been made in the past, simply leads to underpayment of primary care which is one of the things that diminishes our importance and pragmatically the decisions that medical students make when they decide what career they’re going to go into. And I think that’s going to be probably one of the few good things for the Academy that I’m going to be watching. But is also, again, one of my satisfactions of thinking that I was a part of making that a refocused vision or important for the Academy. Because the “Future of Family Medicine,” I can remember when that came out and I was asked to review and make comments. And the one thing I came back and said was that I found a glaring lack of emphasis on payment. And if you look between “Future of Family Medicine 1” versus now “2” and the vision that we have established now, that’s been a huge fee change. And to have been a part of that is very rewarding. When I ran the AAFP task force on payment, essentially primary care and family medicine payment reform, and we had just a few meetings, but great leaders within family medicine and within other specialties and within the government, I was very heartened to see the number of very smart, brilliant people and forward-thinking people who recognize that this was true. The problem is how do we get there. And I think that I was part of being able to lay that foundation and very grateful to the Academy for having the opportunity to do that. And I think that could wrap up, although there were a few other things. \n\nThere are some other thoughts that I would love to talk about on family medicine but I’m not sure, they’re more my pontificating on where I think we need to go.\n\nSandy Panther: I have a question. What are you doing now in North Carolina?\n\nDr. Heim: I am a hospitalist. When I got elected to the Academy, that was the time that my contract with my boss in private practice was up. He was an internist and despite the fact that he knew I was going to run for this position when he hired me, he was not all supportive. And the contract that he gave me, the renewal contract, I would have lost money every month. So, essentially he forced me out. So, I looked around and I had a non-compete clause with him, so I had to go out of the county. One of the counties over had a hospitalist group who was hiring and I went to them and they were glad to have a family physician and they were again very supportive of the travel days and the crazy schedule that you get when you’re in the leadership of the Academy and just have worked with me. So I continue to do that although I am looking to get back into doing more direct outpatient primary care, if I can find way of doing that.\n\nSandy Panther: I will tell you, these two hours have just flown by.\n\nDr. Heim: Well, thanks. But you’re so nice, you wouldn’t tell me if you were bored to tears.\n\nSandy Panther: Well, no, I wouldn’t say anything. But this has been wonderful. And what Don and I over the break were saying, this is the ideal interview in that I don’t have to ask questions. You took it along as we went and we covered everything I would have wanted to cover; otherwise, I would have jumped in. So, this was really, really interesting and I thank you so much. And we will get you a copy of the tape.\n\nDr. Heim: If we do have more time, there were a couple of other things that I was going to talk about in terms of the board. But we don’t have to. It was just in terms of some of the aspects of working on a board when you, again, don’t get to choose your team but you have to work as a team and the differing opinions. And touching on the nurse practitioner and her battles and our inclusion. The benefits of including the resident students and young physician on the board, of which we are a leader in the organizational world to do that. \n\nSandy Panther: Right. Don, are you there?\n\nDon Ivey: Yes, I am.\n\nSandy Panther: Could Dr. Heim go on with this interview and touch on those items?\n\nDon Ivey: Well, I believe we have the room until 5:00 which would be 6:00 eastern time. So, sure, we could do that.\n\nDr. Heim: Great. It won’t be long. I’ve got the notes and I’m just going to roll through them.\n\nDon Ivey: No, no problem. I can stay on the line. And Sandy, thanks for everything that you did.\n\nSandy Panther: Lori, would you be offended if I …\n\nDr. Heim: Not at all. Go do your .. have a great dinner. \n\nSandy Panther: Thank you very much. Good, that will at least allow you then to finish up.\n\nDr. Heim: That would be perfect.\n\nDon Ivey: Thank you, Sandy. Thanks for all your work.\n\nSandy Panther: You’re welcome.\n\nDon Ivey: I should allow some time for flipping the tape. And we can do that, it’s no problem. Like I said, we have the room for another hour. So, we could probably go another fifteen minutes or so.\n\nDr. Heim: That’s all I need.\n\nDon Ivey: Okay, no problem. Please continue.\n\nDr. Heim: One of the things that I learned when I was a residency staff at Andrews about leadership was personally I got the feedback that I was too intense, that I was intimidating and it was a cohort of another residency staff who began to try to get me to see how to be more open when people came to the door. I would be so focused on my task that I really didn’t want the interruption and my whole body language would tell people that even though the door was open, don’t stop. So I learned that. And then a resident was the one who actually said to me that not only was I too demanding, which I think she was wrong about, I think later on she came to understand it – but she said I was too intimidating. And so learning over time to try to be a little more, not quite as commanding, was going to be more effective. My regret, when I came on the board I think sometimes I slip back into some of my previous habits and I was at times too intense and perhaps too imposing. But those are one of those personal struggles that I think that I will have to deal with forever. But always trying to improve because I think it helps how we function as a team. And the Academy board is very different than some other boards. The advantage of the Academy board is that it is elected, so there is a diversity that comes about through that process. One of the big disadvantages, however, is that you don’t get a chance to establish a team that you think is well-rounded. So if you have a bunch of folks who are from academia or private practice or their practice styles or their personal styles, you would probably, if you were doing a board that you had control over hiring, you would want to balance all of those things out so that you’ve got the voices, you’ve got the introverts, you’ve got the extroverts, you have balance. And that creates, I think, often times the potential for a more highly functioning team. With the Academy you have to be able to mold that team. And to Doug’s credit and to almost all of the board chairs, we have had that. There was one board chair who I thought was disruptive in that way and at one point I even considered resigning from the board because I thought that it was not productive. But in the long run, I’m obviously very glad that I and my colleagues did not resign, as we had discussed. But it is a big challenge for an elected board. And one of the reasons why my fellow year mates, that we didn’t leave, was because of the staff. Because there were senior executives, AAFP staff, who essentially took us under their wing and helped us and supported us and gave us just an ear to talk to. They were entirely professional. They supported the current board chair. And the way in which they supported us, yet while not trying to undermine somebody else, was, again, another role model and it points to the exceptional staff that the Academy has been able to get. And to Doug’s credit, I think that he has, Doug Henley, I think that he has done a masterful job of trying to balance out his team. And it’s not easy. Sometimes there are EVPs that turn out that they don’t work and you have to change up your team and then you have to go forward. And it’s a sign of a good leader, like Doug, that he did that. And also to Doug’s credit, I must say that he is probably one of the … Not only is he the most committed person I have ever met to family medicine and to AFFP but he is also very open to examining his strengths and weaknesses, taking feedback and developing action plans to improve. And as I was saying before when I was thinking about my biggest weakness, is probably ending up being too intense. We all have to examine and try to improve our leadership skills. \n\nOne of the things that I think family medicine will grapple with for quite a while is we have a lot of states who are hell bent on maintaining turf battles for various reasons. Some are personal, some have more validity. But the notion of trying to keep the nurse practitioner is the one slot and the pharmacist in another while in other states they have, because of legislative changes, they simply have to learn how to deal with that. And I think if you look at the states that have learned how to deal with it, you see that there are ways that work. That it works for the community. And the Academy is still stuck with so many states wasting a lot of resources, a lot of manpower fighting a battle that personally I think will not be won and will result in a negative backlash. So this is, again, another example of where I think decisions that are made need to be re-examined. But because AAFP is governed by the congress in terms of our overall policies, I think that the board is going to be hamstrung in terms of trying to make any meaningful changes in that. Although we on the board, when I was there, we did try to reach out. We tried to establish better communication. And certainly part of that, because of listening to delegates from places like Alaska where the nurse practitioners were being totally utilized, my own personal opinions have changed on that. And I hope that the Academy going forward will continue to re-examine where they are. \n\nThe other and final big challenge that I see for family medicine that was brought home when I went to Family of Family Medicine which is leaders of all the related family medicine organizations. So AAFP, the Foundation, the residency directors, etc. And we were all talking about what should family medicine look like. And I think you see that a lot of those same sort of discussions came out in the “Family Medicine 2.” Because family medicine is not going to be what I think it was when I went into it. When I went into it, I learned OB, I learned procedures, I learned hospital, I did home visits. And that’s what I was expecting that I would do throughout my career if I stayed in full time practice. Well, that’s not the case now. It is the case for a minority of family docs, but they are the minority. And I think that they’re going to continue in those pockets where they’re supported, there’s a need, and the folks who do that want to go there. So we as leaders and as a specialty have been and will continue to grapple with how do we then do the training? How do we think of ourselves? What sort of compensation packages? And where do we feel on that? I had some people tell me that because I was a hospitalist, I really shouldn’t even call myself a family doctor. And I felt some shame having taken that position at the hospital and not doing full spectrum. But it was, as many of the folks who have narrowed the spectrum, a decision that had to be made based on other commitments and my other desire to serve the organization. And the docs that I know that have given up hospitals or have given up OB or the variety of things where they have changed their practice from the full scope that we traditionally have thought of, I think they’re becoming the norm. And so how do we embrace them and help them and help them transition when they want to do other things? That’s a huge challenge. The idea that we have to be apologetic when we change a facet will not help our members and it won’t help us as we present ourselves to the public at large. The docs who want to do full spectrum need to be supportive. And they probably have one of the hardest jobs and our organization I think will always need to be there to be able to advocate and enable them to be able to do as much as they possibly want to while helping the other physicians in whatever the degree of scope they want. But combined with this is that the family physicians have to step up to the plate. Whether or not you’re doing full spectrum or whether or not you’re doing just outpatient, I have been disappointed personally with the number of family physicians that I see that are not fulfilling their pledge to their patients. They’re not patient-centered, even if they say they are. They are closed on Fridays. They don’t answer their phones. They’re not available. And they are because of financial pressures again. So it’s not docs who want to do a crappy job, but they are driven by trying to get a life balance because of finances. But they are more a consulting mill and a prescription mill. And we have to change the finances. We have to change the practice environment to enable them to go back to being the full physician in whatever practice environment that they do. Otherwise our reputation as family physicians will also be diminished. And as we know, the vast majority of family physicians are not that. They are trying to do full scope. Not full scope, but they are trying to be the complete physician for their patient. Not just writing prescriptions and referrals. But if the financial constraints continue, I’m afraid that we’re going to push more and more physicians either out of family medicine or out of a practice that they find rewarding. \n\nBut I don’t want to end on a negative note because when I traveled on the board and when I traveled as part of the volunteer executive leadership, I was incredibly impressed by the number of family docs and their families who support them who were willing to give to their communities, do volunteer efforts. Who were willing to volunteer their time for the Academy all because they care about their patients, they care about their communities, they care about the Academy. And those are the people that I think are in the majority who want to commit in some way. And I am so thankful that I had the opportunity to meet them and am so impressed with my colleagues who are out there doing just an incredible job and who will continue because that’s who they are. And the Academy for doing what we can to support those folks. And on that, thank you for this opportunity to be able to give my history and my perspective on family medicine. Lori Heim.\n\nDon Ivey: Thank you very much, Dr. Heim. 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