{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/v97zk57p7d/manifest","type":"Manifest","label":{"en":["Dr. Jeff Wolfrey"]},"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":["2021-12-15 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Steven Brown (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":["Jeff Wolfrey, 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/159375/file/290349","type":"Canvas","label":{"en":["Media File 1 of 1 - WOLFREY_JEFF_(2-15-2021).m4a"]},"duration":4024.29678,"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/159375/file/290349/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/290/349/original/WOLFREY_JEFF_%282-15-2021%29.m4a?1756931342","type":"Audio","format":"audio/mp3","duration":4024.29678,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675","type":"AnnotationPage","label":{"en":["Dr. Jeff Wolfrey interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Speaker 1 (Steven R. Brown, MD) (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=0.0,2.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): This is Steven R. Brown MD FAAFP on December 15th, 2021. And I'm interviewing Jeff Wolfrey, who will introduce himself in a second, on the month of his retirement from a lengthy and productive career in, in family medicine. We’re in my office, which used to be his office in Phoenix, Arizona. So maybe if you just want to introduce yourself first, Jeff.\n\nSpeaker 2 (Jeff Wolfrey, MD) (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2.0,32.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah. Jeff Wolfrey I have been here in, at this site affiliated with, at this residency department for 30 years. I served in a variety of roles from core faculty to medical director to program director, and most recently as department chair.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=32.0,56.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Very good. Thank you. Maybe can you just start by sort of outlining in your career path and maybe some of the key milestones in your career?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=56.0,65.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Sure, sure. I was born and raised in Charlottesville, Virginia and stayed very close to home for undergrad in medical school, went to the university of Virginia for both of those experiences. And then decided that I wanted to take the opportunity of residency training, to try a different part of the country much as I loved being in Virginia, I really, you know, had a kind of a draw to the west, to the Southwest. So I looked at programs out here and really felt a connection with what was then called good Samaritan. The family medicine residency there, which was the first family medicine program in the Southwest. And so I, I trained did my residency here in Phoenix, considered staying on here, but the pull to the home was strong for my wife and I.\n\nSo we actually went back to Charlottesville and I, I was in, in practice in central Virginia for five years and I was on the clinical faculty of the university of Virginia family medicine residency during that time really enjoyed that teaching experience a lot. So in after five years, I got a call one cold dreary February morning from one of the faculty here who had been one of my faculty members as a resident saying that there was an opening for a core faculty position, would I be interested in looking at it and my wife and I decided that, yeah, we wanted to explore that and the pieces fell together and came back in 1991 and, and have been with the residency in those various roles that I mentioned since that time,\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=65.0,173.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Do you mind, can you just talk a little bit about the major milestones in your 30 year career here also?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=173.0,178.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I would say those different, those different roles that I took on certainly all involved a little different area of, of emphasis. I, , , also, , as the, , the president of the Arizona academy, , , during that, during that stretch and, and was on the, on the board, , of directors of the Arizona academy for about 10 years and, and really enjoyed, , that experience some of the other big milestones here during my time. , some of the, one of the biggest changes I faced as program director was that we, , after years of not having any core faculty doing OB full OB care, that became a requirement. And I, , , recruited our first faculty members who, who did full spectrum , , of, of OB care. Another big milestone was the creation of banner health from two different health care systems, one being the Samaritan health system and one being the Lutheran health system.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=178.0,252.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And those two systems, their CEOs basically engineered a merger between the two to form banner health back in 2000. The, and, , so that was a time of some cultural shift and, and, and change within, within the organization. And, , I would say another big, big milestone was, , the introduction of electronic health records. , , that was a around 2007 I believe was, , when, when that was introduced, actually our program was the, was the initial site a rollout for an electronic health record. We were the first, , clinic, the first ambulatory site to use, , EHR in the banner system. And that was before, , that, that the, that, that had even moved into the inpatient realm. So our, our, , medical director at the time, Greg Raglow , really did the, the most of the, the search and, and implementation of, of that first, , electronic, , health record.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=252.0,318.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): So that was a big milestone. And then the most recent, I think, big milestone in terms of change was the, , affiliation between banner health and university of Arizona. So when banner took on the clinical operations of not only college of medicine, Phoenix, but also college of medicine, , Tucson, that was, , a very major cultural shift, , in, , in our life here in the program. \n\nSpeaker 1: Can you talk about what was it like the first time you came to Arizona? \n\nSpeaker 2 The first time I came was, , during my interview, , visit back in the fall of 1982.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=318.0,357.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And, and I I've heard you describe what you…\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=357.0,360.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I was completely naive about the desert. , the Southwest, I, , had never been west of the Mississippi in my, , life up to then. And, , I, I, my expectation, , of the, of the desert was gonna be that it would pretty much resemble the Sahara. So I did not expect any vegetation. , I was, , kind of totally ignorant when I landed in Phoenix. I, I was very confused because I, I saw actually a lot more plant life than I expected. , and it wasn't until I visited Yuma a a few years later and saw the, the white sand dunes there that I said, now, this is what the desert is supposed to look like, but I'm actually glad that I was, , , erroneous in my, , expectation cuz , you know, I really, I really think the Sonoran, , desert is, is a beautiful place, very, very different from, from where I grew up, but , beautiful in its own way. I, but yeah, I was, , I was quite, , quite naive to what the Southwest was gonna be like.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=360.0,424.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Cheryl Pagel was the, was the person who called you, who is, was a mentor to both of us. Right. , what was, , how would you describe like the faculty in a family medicine residency 30 years ago\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=424.0,441.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Compared to now much, much smaller? I mean, when I, when I trained here, there were three faculty members, there was a program director, there was, , an associate program director and then there was a third, , core faculty member, but those three individuals that, that was the, you know, entire compliment, , of, , of faculty members. So, , it was, , smaller and, and because of only having three people, they all, you know, had to do a lot of different things in the program. All three of them had, you know, important leadership roles, , with the residency, , were, , I think much more independent in terms of their clinical work back then, we did not have all of the, the, , CMS guidelines for, , doc entation of, of, , staffing. And, and so we, , as residents, we spent less time when we were seeing patients talking with the faculty about that, , people, you know, call that a little bit more that the cowboy era where you really, it was a little bit thrown in and sink or swim. , but, , , it, but we, we had to, you know, access, we felt like we needed to faculty and they were very, you know, engaged, , , and, you know, dedicated, tremendous effort to making it work with only, you know, a small n ber of individuals, but, , but, , a little, little less structured and definitely a lot less people involved in the, in the, , , leadership of the program back in those days.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=441.0,538.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And the program has been 8 88\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=538.0,541.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Forever. Yeah. It was eight, I think from the very, very beginning in the early 1970s, it's been a 24 residence total. Yeah.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=541.0,548.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Still is. , how long were you here before, , it's someone asked you to be program director and what was that process\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=548.0,558.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Like? I, , had been here for, , six years because, , that transition occurred in early 1997. And I, and I started, , in the, in the fall of 91. So it was six years. , it was totally out of the blue for me. , I did not know that the, , that sitting program director was planning to, , vacate that, that position. I had no, , inclination, , or really, , desire to become program director at that time. , and, and Howie Silverman, , who was the residency director, , felt that, that I would be the, the best choice of the current faculty to take that role. He had decided to, to switch to his, , to some different pursuits fair, quickly. And, and the transition time was really a matter of less than two months. , I was the junior member of the, of the core faculty then. So that also felt, , pretty bizarre to, to, to consider becoming the program director. But, , you know, it, it was a good example of, you know, an encouragement from a were and somebody that saw maybe a potential for, for you that you didn't really see for yourself. That was a good example to me that, that, , that could be a help to, to, to young, , faculty members, , and, and kind of nudging them along their, their pathway. But that, that was a, a fairly, fairly sudden unexpected transition. How,\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=558.0,657.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): What are the biggest differences between going from core faculty to being program director?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=657.0,663.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Well, I think the, the, the main, , issue is that you really do feel more of the weight of responsibility, you know, that, that the buck really does stop with you, that, that those important elements of rec rooting and the relationship between your residency and the rest of the GME system and the, and the hospital and the medical staff, , that, that the, that performance of the, the residents and the continued accreditation of the program, that, that really all those factors, , before, you know, you're part of a team. And, , you did not feel the, the gravity of, of some of those issues the way you did as a program director, when you really felt like, you know, ultimately, , if the program succeeded, you, you got to take some, you know, some, some sense of responsibility for that, but, but when the program did not succeed in areas, you really felt the weight of that on, on you. Yeah. Yeah.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=663.0,725.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And so you were the fourth program director in the, at that point 30 some years of the program. Do you remember when you decided that you weren't gonna be program director anymore or when you had another idea?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=725.0,737.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, well, , I, , you know, I had done, had done the, the position for, , , I guess about 13 years when I really started to think, you know, maybe, , you know, this has been enjoyable, but, , but, but maybe I'm ready to, for, for, you know, change in my own, , areas of focus. And I recruited a young core faculty member, , named Steve brown. And, , it became quickly apparent to me that he really was, , well suited to be a program director, that he had the right temperament, that he had the right skillset, , that, , that he, that he really seemed to have a strong desire, , intentional desire, something that, , that I had, had not had when I became a program director. And I really felt that he would, would thrive in that role. So it was kind of a combination of me starting to move into a, a time where I was maybe looking for a change myself. And then I saw a very logical error apparent to that role that I, that I really thought it would be good for me. Good for him and good for the program for that transition. So that's really kind of how that came about.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=737.0,809.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , yeah, but you're, , to use the cowboy analogy you're writing off into the sunset, didn't exact go as planned. , could you just describe maybe this last chunk of\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=809.0,820.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Your career and what's that been like? Yeah. When, when I, , , stepped down from the program director role, things were, were starting to evolve toward maybe some further, , development and formalization of the academic structure here, , in, in the, , in the residency. But, but more importantly, I think with, within the, the medical education program here, , within banner and within the community, , we had been a, , large tertiary referral center for, for many years, , with a, with a strong teaching tradition, but we're really, , it really was a, a large community hospital that had a, a well developed GME program, but did not have all the rest of the structure that an academic health center has. And so we were a bit in a, in a transition that way here, , at good Sam, , , and, and, and within banner.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=820.0,887.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And so we roles for academic chairs began to develop in several of us that had been program directors and were kind of senior people within GME here, ass e those roles. And then shortly thereafter, the relationship with the university, , of Arizona really took, took more shape and finally was, was, , , enacted basically in 2015, early 2016, a n ber of clinical chairs for, for formal departments at the college of medicine, Phoenix were established. And, and so, , I, , I was on the short list of usual suspects for that kind of kind role. And, , , and so once again, , as it happened several times in my career, find myself even either in the right or the wrong place at the right or wrong time. , and, , so, , so it took on that role and, and, , and it, , it's, it's been actually re rewarding and challenging both.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=887.0,953.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): It, it, , it's been, , a challenge to take the culture of a large corporate healthcare system and try to find the common ground with, , , with, , an academic institution like university of Arizona and a college of medicine, Phoenix. , there is a lot of common ground, but it's not always readily apparent to all the, the parties, , where that is, and, and so helping or trying to, to help banner and the university, , really see that common ground and, and, and foster, , some for active ways to, to work together, you know, has been very rewarding, but it's, it's, it's far from a completed task. And I, you know, I think they'll, that'll, it'll evolve that relationship will evolve for years. , but, , but it's, it's, , it's been rewarding to work in that area. And it's also been an opportunity to continue to try to advocate for family medicine and primary care, which are, you know, often fighting an uphill battle in the us healthcare system. , and, , , are, are really often, , family docs are often somewhat a fish outta water in, in, , academic environments, , especially in big tertiary coronary environments like this. So, , that has made it both difficult and, and rewarding and meaningful to, to work with excellent colleagues, dedicated colleagues to kind of continue to, to, to fight for family medicine's place in the system.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=953.0,1047.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah. , something that I try to, , put my, sorry, something that, , people ask me about as, you know, as I recruit or, or with faculty, or, , you know, we, I'm only, we're, there's only been five program directors in 50 plus years, and I have a sense, and I think a lot of people do that. We've created something special here. I wonder if you could just, , speak to what it is about here that has, that's been a special place, , you know, to have a residency, to have family medicine training over the\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1047.0,1086.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Years. Yeah. I agree with you. I think I, this is a somewhat unique place and, you know, I, I can't take credit for that. Cause I was attracted to the feeling this place had. I had come from a pretty traditional Eastern academic health center where not only family medicine, but all the departments seemed to be somewhat, , at odds with each other all the time. And, , when I came here year, I was struck by the fact that the structure looked very similar. All the major specialties were represented, but the feeling of the place was different. It felt more collegial. It felt more collaborative. I think that's because it really evolved as an organic medical neighborhood, you know, where to specialists recognize the importance of generalists and, and that, , you know, they shared patients and they interacted, , a lot clinically to, to around a common unifying goal of taking good care of patients.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1086.0,1145.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , and so the, the tribalism and the silo that, that you sometimes see at academic health centers did not really get established here as much. And, , so when you join something good like that, you, you mainly try not to mess it up and you try to, to, to, , continue that tradition and build on it. So that's, you know, what, I've what I've tried to do, but I, but I think that, , that culture has persisted, you know, for are better or worse. Culture is durable. It, it tends to persist. So when it's a good culture, that's, that's fortunate. , it has had its challenges and continues to have challenges. And I think this affiliation with the university represents a major, , , , challenge, a potential challenge to, to, , preserving that culture. But, , but I, I think that, , it is largely persisted and, and I, I still feel like this is a collaborative environment that the, that the program directors work well together, the chairs work well together.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1145.0,1200.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And there really, , is a sense of, we have common priorities and values and goals here in medical education and patient care that we're working together toward, toward achieving, , financial challenges, often threaten healthy cultures. And, you know, healthcare certainly is facing major challenges and the pandemic has, has greatly exacerbated that. , so those will be things that will, you know, continue to have to be navigated. But, , but I, I think this is a, a special place. I think family medicine really has been, , hi, fairly highly respected here, , and, and, and definitely more respected here than in many other communities, , in, in the, in the country. , and, and I think it's a, you know, it's a good place for people for, for young family docs to train and practice, , despite its, you know, the coronary, , , level of care that's delivered here at banner university of medical center. Yeah. I've,\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1200.0,1260.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , I've also interviewed Dr. Price, which was, , a great experience for me. , do one of the things that I think is unique about this place is our patient mix. , and I don't, and especially the, you know, high level of pediatrics that we have. And I don't know if you have a sense that that's lightning in a bottle, or if that was something that Dr. Price established or, or how did we end up with this really perfect family medicine patient mix?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1260.0,1286.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, I think, I think that, , Dr. Price was a big part of that because he was, , really, I think he's considered the founding program director. He was not the technically the first program director, but he became the, the director of the residency within the first couple years of it, of its existence. And he basically brought his private practice. He had, he had been a, a GP, a general practitioner in the valley for some time before family medicine even was, was created as a, as a, , medical specialty. And he, , basically brought most of his practice over and he had a, , both a payer mix and a demographic age, , mix that was typical for a, a generalist, , at that time in Phoenix. And many of those patients, , , , have remained loyal for decades in including I have some patients that Dr. Price referred to me when he left that have literally been either in his practice or this practice for 50 years. , so that was a big piece of, of why we have a fairly unique, , , patient mix you year.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1286.0,1372.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Another element, I think, was the fact that, that, that this was a community hospital. Yeah. So this was a, was a hospital that, that, , had a, a pretty broad in influx of patients across socioeconomic spectr . , and, and so has a, maybe a, a higher commercial mix than some inner city residencies, but yet has, you know, a lot of patients that are, that are medicated, you know, access patients. I think, I think really the cross section of patients here is very similar to what a private practice family physician, , would have in, in Phoenix, which I think is, is really, , for, for training residents and students.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1372.0,1412.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah. , so we already talked about Dr. Price and you can definitely say more about him, but when, when you think about your most important mentors in your career, who, who do you think of,\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1412.0,1424.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , the first one that would, would come to mind is Louis Barnett Lewis was, , the, the, , chair at, , a family medicine at university of Virginia. When I was a student. He, , had been a, a general practitioner in rural South Carolina for many years before he, , joined the faculty at medical university of South Carolina. And he like Dr. Price was in the Vanguard of the early sort of founding leaders, , that created the specialty. So he, he, he and Bob price really can, can count themselves among those that, that built the specialty. And he was very approachable. He, , , you know, his, his, , , love for, for family medicine and, , for, , for generalist practice, , was, was so apparent. And so I spent many, , , sessions, you know, in his office talking to him about family medicine. , and then Bob pride here in, in residency, , , training was, was a similar figure, also a, , , , an early leader, , of, , of the family medicine movement.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1424.0,1497.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , so those two really stand out as people that I, I can really say that, , that I got to know some of the pioneers in, in family medicine. And, , and then I, , I had an, an advisor at UVA. My, my student advisor was Mike coach who actually was a disciple of Dr. Barnetts and had come with him from medical university of South Carolina. So he, you know, shared the same, the same love for Fanny medicine and, , and, , dedication to, you know, working with, with students that were, , were considering it. So he was, , he went on to become the chair at, , wake forest. , but he was a, he was a important early influence. , and then, and then here in the residency, in addition to Dr. Price, , she PayGo, , was, was one of the core faculty while I was here.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1497.0,1547.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Don Mulvaney was, , basically the associate program director and later, , he was actually the program director that recruited me to the faculty and, , and, and all of these individuals, , they, they shared, , a, a real passion for, for medicine, for family medicine, for teaching, , that, that was the element that really made all of them such effective mentors is that, , you could feel the enthusiasm, the dedication, the passion they had for what they were doing. And it was infectious. You know, you, you, , if you were curious about this, this kind of crazy specialty with it, then, , you know, an increasingly sub-specialize healthcare system, , and you, and you had some, a little bit of, , anxiety about, , , kinda swimming up stream. , they really made you feel like this is something to get on board with. , you could tell that they had, they had never really looked back and, , they were, they were people that you felt comfortable following did.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1547.0,1615.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , so when you did a residency in family medicine, it had been a specialty for about maybe 10, 10 in ish years, or something like that. Did you consider other things? And what, what was the thing that made you decide on family medicine? Yeah, I, I, I did consider a few other things. , I wanted, , a practice that was fairly, , broad rather than something that you were just doing the same thing all the time. So I actually, I thought lot about, , E N T because I liked the, I liked the procedural aspects of medicine. I liked the idea of doing procedures, doing, , surgery even, but I also really liked, , ambulatory, , practice. So, you know, E N T struck me as something there's a lot of both, you do a lot of office management, but, but you have that procedural piece.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1615.0,1662.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I was, , really interested in, , infectious disease because infectious disease was important across such a broad spectr of medicine. , so they appealed to me and I think they really appealed to me because of their generalist sort of nature, even though they're both, you know, considered subspecialties. , but, you know, the, the real, the real draw was interacting with patients and, and really, you know, having your relationship with patients be a key part of what you did. , and so many specialties, I realized that, , while you might be dealing with patients, they were often not conscious while you were dealing with them, , or that you didn't get much longitudinal experience, you know, with them. And that was what really, , drew me to family medicine. So I kind of started with, with a leaning in that direction, even though it, it was still kind of a new kid on the block in, in, , medical specialties, but my early experiences working with, with the mentors and other family medicines faculty, and with, with, , family medicine residents really, , , reinforced the things that I was looking for, and that family medicine was the best pathway to that.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1662.0,1736.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Was it a bit of a counter culture choice even then? Oh, absolutely. You know, , there, it was, , there was definitely some tension, there was definitely a hidden agenda, , at, , at the medical school. You know, I was a, I was a pretty successful student with, with, you know, pretty, pretty good, , scores on, you know, various examinations and, and, you know, so heard that what a lot of med students here is that, well, you could go into anything right. You know, and use that translated to, you could go into my specialty of, you know, fill in the blank, interventional fill in the blank. And, , , so, , yeah, it, it, it was, it was still, , , you know, kind of the, the, , , fish outta water kind of perspective, , which is why those mentors were, were, were so important. The fact that, that, that they were in that environment and were clearly, , , feeling very comfortable and solid in their decision, despite the environment they were in, , that, , that, that, , really helped me overcome any of that anxiety I had. Yeah.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1736.0,1807.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , so, so maybe let, maybe switching to more, , medicine in general, , what, what have been the biggest changes that you've seen, , in your 40, 40, I guess 40 ish years of, of, of practice of, of medicine?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1807.0,1823.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Well, I'll start with what I, I think was maybe the biggest change in the culture of medicine and particularly in the relationship between physicians and that was the hospitalist movement. Yeah. You know, the hospitalist movement in the not only changed fundamentally, , the, , the care of patients in the hospital, it totally changed the relationship between generalists and specialists. , and it, it had a big impact on the scope of care of, , family physicians. And it happened very rapidly. It, it, it basically, it, it happened long before it was really even tested to see what its impact was gonna be. Not only in terms of outcomes of care, but, but also the financial aspects. It, it, it, , you know, it clearly, I think, , indicated how challenging that broad spectr was lifestyle wise, , because as, , internist rapidly adopted that as an option for themselves and family docs fairly rapidly gave up, , inpatient care, , you know, in, in large n bers.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1823.0,1896.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): But to me, it was a sea change in the medical neighborhood because no longer we're generalists and specialists together every day in a common setting, working on a common goal. And so very quickly specialists had no real sense of where their patients were coming from. And I think a lot of the culture that, that permeated places like this got diluted quickly, because no longer was there of, we've got this common, important purpose here, you know, this patient that we're working together to take care of, it was as if that patient had just anonymously, you know, airdropped in, right. , so that to me was, had many, many on continued ramifications, you know, in terms of, , , healthcare and, and, , , the, the relationship between specialties, another tr sorry,\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1896.0,1948.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Just back to the hospitalist. So you took care of patients in the hospital in Virginia, and then for the first, , 25 years of your career here in Phoenix\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1948.0,1958.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Also. Right. And, and we took, we took care of, of, , patients inpatient here. We took care of, , , children, inpatient, you know, really sick children over at Phoenix children's hospital. , you know, we were doing things that today, , you would not even be allowed with many medical F yeah. , guidelines and bylaws to be able to even do anymore. , so it, it, within just a few years, , it, you know, I, I saw it really, it change, , you know, the scope of, of practice and also, , increasingly the training environment changed fairly drastically from the community practice environment. Because if you look around Phoenix right now, and, and, and you look to see which physicians are doing fairly full spectr care, including inpatient care, virtually all of them are, are academic physicians, very few community physicians that are still doing inpatient.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=1958.0,2021.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , but a, but another big change that has occurred during my career is, , what I would call the franchising of, of medicine. And, and it parallels the franchising of many areas of sectors of society. , kind of the big box phenomenon, because started, it was very common to have a lot of private groups that had an affiliation with a hospital, but they were their own entity. They controlled, , the, the staff that worked with them, they had, , a lot of autonomy control over the way their practice was run. And, , increasingly over the last us 30 years, , private groups have been absorbed into integrated healthcare systems. And there's been a corporatization of ambulatory community healthcare, such that you're not in charge, , as a physician in an ambulatory office of hiring and firing of control of your staff, you're not in control of the policies and procedures in your, , in your office.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2021.0,2086.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): That's, , really done kind of across a corporate, , scale. , and, , and we are really, I think, moving toward, , , a situation where there will be probably only a few winners in the, , healthcare game that, that control most of the care in this country. , so that that's been a big, big change. , it's clearly one of the technological, , game changers has been electronic health record and, and the electronic health record is like, , areas of change. , it it's very disruptive, , and it engenders a lot of frustration. And yet, if you were, had to pick between going back to not having it or having it, you would probably pick having it every time, but you, but you continue to complain about the ways that it has has changed things. , it has made a lot of things that we do, , much easier and, and, and it made a lot of things more efficient, but it's also made it easier to include a lot stuff in the medical record.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2086.0,2158.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And I think the signal to noise ratio, , has, has moved in an unfavorable direction. Overall, when I look at a note from a, an ER visit for one of my patients, the, the, the signal to noise ratio feels like it's about 2%, that's about 98% stuff up in there that doesn't help me one bit and seeing what happened. And so it, I think it's, , it's actually ironically, perhaps increased the workload, , and decreased the satisfaction of interactions. The main source of noise in the, in the written record was the physician's handwriting. , but now it's just the, just the burden of, of stuff. That's there. Another, , ongoing evolutionary change is just that there is more stuff to put in the medical record. There's such an explosion of diagnostic tests of, of laboratory tests of imaging studies. , and that's also driven the signal to noise ratio in a, in a negative direction.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2158.0,2222.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I feel because, , as much stock as we put in test results, the reality is when you really study the, , , accuracy of tests, , it, it, , they are often found much less, , helpful in getting to an answer than we would think. And they can really, I, I think create more confusion than they do clarification, not only for patients, but actually for physicians. Yeah. And many physicians order tests routinely, and they really don't have a very good grasp on the, the, , power of those tests to help them care for a patient better. , so the, , , the less is more credo that a lot of family docs, , really, , espouse I think is, is, is very much needed because I have really seen, , the, , the so-called progress in terms of, , the, the things that we can, , , order in medicine, not really advancing, , healthcare as much as, as, , as we would, , would hope it would.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2222.0,2290.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And connected with that. I I've, I've seen sort of an increasing, , veracious appetite for data over wisdom. Yeah. You know, , in my early days, perhaps there was too much, , reliance on kind of a paternalistic model of the physician is the source of wisdom. And patients really went to the, to their position for that wisdom to, you know, to help them, , navigate their, their life. And now the, the appetite for data, , you know, and I, and I really, , like the, the model that there's a hierarchy from, from raw data, , it really has no intrinsic sense of its own and then information, which is one step above it, and then knowledge that, that is actually something that can really guide, , appropriate decision making. And then there's wisdom, you know, there there's, there's then knowing how to apply even knowledge.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2290.0,2353.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And, , I think, think that the, , appetite has moved in the opposite direction of that, , hierarchy, , to the point where people want data IR, regardless of really how much useful information and knowledge it's going to impart, and they not only want it, but they want it right now. You know, I think society is used to getting things that used to take quite a bit of patience and waiting for they don't, they're not willing to wait. They want it right now. And I think, , that's that's, , unfortunately to the detriment of, of optimal care, I think it's been to the detriment of continuity patients. Aren't often willing to wait for continu. They really value data over that. And I think that's a, , unfortunate choice. Yeah. , what, when you think about, when you think back on your accomplishments, what do you feel like were your most important accomplishments as a clinician, a teacher, and also as a leader?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2353.0,2416.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Well, as a doctor, , I felt like I, I I've felt like I have been able to relate to a broad range of patients and be comfortable. You know, I was, I was raised, , in rural Virginia, my dad had a high school education. , I, I grew up, you know, really, , you know, and a, and kind of a, a middle class, rural family, , but, , was, was not relating to early on in life with a lot of, you know, professionals and, and, and, , so I, I feel like I've been able to relate across a broad spectr of, of, of, of patients. And because relationship is so important to me and taking care of people. That's, that's, that's been, I think, very helpful. I think I have really followed a model that I was taught from my mentors and, and, and, , teachers over the years of really leveraging the relationship and, and really being in a partner, it with patients and really trying to do care for them rather than to them.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2416.0,2483.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , and from a clinical perspective, I think it's, I, I am grateful that I've been able to remain a family doc despite the different other roles that I've taken on. And as I've taken on some increasing leadership roles, there's been a pull to, you know, maybe need to stop being a, a family dot, but I, I, I never been willing to, to give that up and, and some, some educational leaders do. , and, , so I am I'm, I, I, I think it's been important to me, but I think it's actually helped me in my role also as a teacher and a leader to continue to be a family doc and to have some street credibility, , in terms of, of, , what I'm trying to teach and, and lead as a teacher, I I've really tried to focus on, , helping residents and students, , develop their clinical decision making.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2483.0,2540.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/53","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): You know, I really believe in, in trying to give them a fishing pole, not a fish. , and, and so, , I, I've tried to role model, , curiosity, , and, , enthusiasm, you know, the enthusiasm of my mentors was really a huge factor for me and I, and I, I think teaching is fun. And, and I think watching the light bulb go off in a, in a resident or student, , about a new concept or procedure, that's, that's very, , fun to be a part of it. It was very fun personally, as I went through my training to, to have those moments, but you get to have 'em every day when you're teaching. Right. So, , that, , that that's something that I think is, is, , been important to my teaching. , I've really tried to be a, , a champion of generalism and a high, highly specialized, , system, , and really help students and residents to understand that, you know, it's not a matter, which is better.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2540.0,2604.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): It's a matter of, we really need both working in concert. We need a, we need a, you know, we need more generalists in our system. , and so I really tried to help students and residents, you know, understand how important, you know, general medicine is. And I've been a pretty persistent advocate for continuity, continuity is under siege. And, , and I think it's, , , impossible to be a really effective family physician without, , using, you know, leveraging continuity. And I think it's important that residents, you know, get, get to experience it because it takes some time to even understand the value of it as a doctor or a patient. And, , so, so as a teacher, I've really, really tried to emphasize how important, you know, taking care of the very difficult patient that, you know, is still easier taking care of a, you know, moderately difficult patient that you don't know.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2604.0,2662.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , and then as a leader, I think for me, a, a theme has been, , that, you know, I've tried to help manage my, , , my teams through a lot of change. There's been a lot of change in medicine. , and I outline some of the, the various, , changes that, that, , you know, I've experienced and that's very disruptive, , if you're already doing a difficult, , job, , and then you have a lot of change that you are thrown in, , that, that makes it hard. And when you have change that involves cultural shifts, such as large mergers, , and, , , change in the, in the day to day, , nature of what, what you do in your work, th those are, those are, , , difficult. So, so I felt, I, I felt like I've really tried to help navigate those changes.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2662.0,2725.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , I, , feel like, , the, the, the thing I maybe value the most about my experience working with leadership with the academy has been, , to, , to help with, with the help of others, including, , yourself to, , decrease the reliance on, , industry funding for a lot of the activities. And the thing I'm proud about, , with the, with Arizona academy is, , the program that, that, you know, that we, , you and I and others, , put together to transform the nature of the annual, , CME event, , which is, which is now, , known by the acronym ACE, , the, , annual cliff educational conference. And, and, and now it's a very highly evidence based, , non-industry supported, , activity, which, , was, was very gratifying because a vote had actually been taken by the board to dissolve that conference.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2725.0,2791.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, it wasn't, , financially very, , effective. , it did rely on a fair amount of outside support, which, which tended to distort the, , the, , , the makeup of the content, , in a, in a bias sort of way. , and so the fact that we were able to, , form it really radically to be very highly evidence oriented without outside funding and have it be very successful. And it surprised, I think all of us, including myself that, , that the rank and file family physicians, , and Arizona, and from other other places, you know, really valued that kind of, , conference would was, you know, very different, not a lot of slides and, and, and, , certainly not, not any sponsored content, , but really a, , a, a very objective review of the best available evidence. So that, that was very rewarding.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2791.0,2850.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And then in my most recent chapter, , I'd say what I've really tried to do during these years as chair is, , continue to advocate for family medicine here within banner, but also to really try to work, work on that hidden agenda that, that somewhat disparages generalism, family medicine, primary care, , at, , at medical schools. And I felt like we've been able to build several programs there. We've built a certificate of distinction program. I think, you know, strengthened, , the family medicine interest group developed a primary care scholarship, , that, that not only years and supports students that are, , planning primary career family, medicine, careers, but even attract students in the first place, because it's much easier to, I think, nurture a student that's already leaning, , toward family medicine than it is to create, , , a student with that interest that started with another interest.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2850.0,2909.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And, , actually Gail Stevens who was really, I often considered the, the, , , philosopher, , poet Laureate of, , family medicine during its, its founding. He, he actually, , he actually believed that, , that you should, and even, , offer, , family medicine experience to all med students, because he really felt like, , it's a special breed of student that that's going to, , to benefit from that. And, and, and, and rather than drag students kicking and screaming, he really felt like, , the students that, that, that are gay geared for this, that, that want this, that are gonna be willing to kind of fight, , the counterculture battles. They're the ones that you should really invest in. , so, so we've really, I think made some headway in attracting students that are kind of, of that, of that mindset and put some things in place that, that will support them, , on a, on a difficult path, , that that really does feel like it's, , going against the grain. Yeah,\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2909.0,2977.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): No, the, the, just the financial, the, the primary care scholars program is, will be a great legacy for you. Definitely.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2977.0,2985.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Well, it's been a team effort, but, , I'm really, really, , grateful that we were able to get that, get that established and get good support for it. Do you mind just\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2985.0,2994.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Talking a little bit about, , , change ways that we've transformed our practice in the last, maybe starting with open access scheduling 15 years ago, and some of the other things we've put in place to, to make it a, a place where lots of different professionals work to take\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=2994.0,3010.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Care of our patients? Yeah. , I, I think that, that we've really tried and, and I think in, in a large degree succeeded in some, some changes that have, , promoted the core principles of family medicine and primary care, we've done things to, , improve access to care. Yeah, we, we, , we were one of the first family medicine residencies in the country. One of the first residencies of any, , , specialty to put in the, the open has access, where we leave most of our appointments open until shortly before the visit. , we've more recently put in an after hours, , access programed for, for patients that, , that the, the standard eight to five hours really don't work very well for them. We've done a, some things to improve, , the coordination of care, , like our transitional care program. And, , and we've, , we've, , added team members, , to, to support, , that coordination and that collaboration such as clinical pharmacists, , population health managers, you know, we've used medical assistance.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3010.0,3087.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): We've used nurses, we've used nurse practitioners. We've used pharmacists, we've used social workers, , to, , to, to, to build programs that, , extend the reach of a family doctor, because there, there's no way we have enough family docs, , currently, , to, to the primary care need. And the outlook is actually somewhat gloomy because we're losing more than family docs than we're gaining every year. So, , so these kind of programs I think are critical for, , for driving access. , our integrated behavioral program has been really successful. It's been a nice example where the state Medicaid program, the access program has actually, , invested in the development of a program like that. And, , and, , I think that that's off to a really good start. , so, , I, I think team based care, , I think recognizing that the loan ranger, family, doc solo, family dot, you know, doing, doing it all, , it doesn't, it's not gonna work, , even if it ever worked, it's definitely not gonna work with the shortage that we now face. , so, so I feel like we've been able to do some things to kind of prepare residents for the, the world they're going to be working in instead of the world that we all worked in, because, you know, the, , Wayne Gretsky was very, very effective as a hockey player, you know? , and I think he really originated that the, the cliche about trying to go where the pucks going and, , and, and I think that's what we've tried to do here. And I think we've had some, some measure of success. ,\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3087.0,3194.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Any, maybe any other changes in family medicine? I think you may have touched on this already, but any other changes in family medicine that you saw over your career that we haven't\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3194.0,3204.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Talked about yet? Well, , we we've, we've touched on the scope of practice, but that's beyond just the inpatient real yeah. Right. , family docs. , when I started did a larger variety of, of outpatient procedures, , and, , you know, that's a, that's a critical issue for us in medical education because we, we talk a lot about competency. , and, and, , there there's been an increasing attention to, , looking at how competent our residents are, but really, , maybe the further goal is how confident are they, because there's a pretty large gap between being confident to do a procedure and being confident. And if you're not confident in doing a procedure, you're likely not to do a procedure when you leave residency and you don't have a, , somebody with gray hair like me over your shoulder watching you do it. So, so, so, , , you know, I think that trying to broaden that scope somewhat, , would, would be a goal is gonna be a challenging goal.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3204.0,3276.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Cause it's hard to go back when, when, , when you don't have that, that scope in the community, you, you can start to lose it even in the, in the practice as well. And the Uber specialization that's occurring in medicine is, is part of the reason that generalists don't do the, the same scope. So, so I, you know, I think that, , that decreased scope of practice, I think it's a threat because I think one of the real positive, , elements that, that primary care and family an offer is the ability to deliver the majority of healthcare needs for patients. Yeah. , and, , and that, and that's one of the things that leverages continuity when you don't have to go to eight different doctors to get most of your care needs met. So, so that one, , that one I think is, is, , is a, is a big change in an important change. , and we, we touched on that big box phenomena, which I think has a real, real, , real impact on, , family medicine, maybe disproportionate impact on county medicine, , compared to most of the rest of the healthcare system. What are some unrealized transformation that you, that you didn't see in your career and, and maybe what are your hopes for the future of family medicine?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3276.0,3356.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I, I would say the fundamental, , challenge that, that I have seen, , throughout my career and have not seen a lot of pro progress on is just the E the core identity of family medicine, , within the healthcare system. Family medicine is, is very misunderstood, not only by patients, but actually by many others in medicine. , and, , the, the fact that that is the case 50 years after its inception is, is, , is frustrating. , I, I would dare say that many family members of family docs have no clue what their own family members do and their, and their scope of practice, and many hospital CEOs have no clue, , what their, , family physicians do. And, and, and CEOs of large healthcare systems don't have a, a great grasp on that either. So, so, , an unrealized goal is that for family medicine to really be well understood and appreciated, , and, and the need for that generalist component, , in, , in medicine, another unrealized, , , aspiration and goal for, for family medicine is to have better investment in it.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3356.0,3438.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , you know, we invest in the us about six or 7% of the healthcare dollar in primary care, and some European nations invest twice that much, right. And the, and the needle has not moved in a very positive direction. So, , , I, , I, , I think it's gonna be critical if we're going to have a more effective and efficient healthcare system, if we reallocate, , funding toward primary care. And, and that is again, gonna be a, a counterculture battle, and it's gonna be difficult. I mean, even some early attempts by the center for Medicare and Medicaid to do that are already being forwarded by large healthcare systems in terms of trying to value the, the work that, that family physicians do that care docs do compared to surgeries and, and interventional procedures. , so those, I think would be, , you know, two of the biggies related to that investment in primary care would be more emphasis on value based care.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3438.0,3504.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah. , because, , there, there is a preponderance and I think an increasing trend toward paying for, for doing things too, or for patients, depending on your perspective and less investment in caring for patients over time and, and the best way to get good outcomes at a, at a, at a good value is to, is to invest in caring for patients over time. , so, , so, , I think the investment in, in primary care in family medicine will go hand in hand with more emphasis on value based instead of, of vol e based care. , do you have another, do you have something, do you have a meeting? I got, and I got a little bit, I got a couple minutes. Okay. , , may, so maybe, , would you, would you mind just, , reflecting a couple minutes\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3504.0,3561.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): On what people outside of medicine, , say about you or know about you or, or what your roles are outside of being a family, doc and leader?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3561.0,3572.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , I would hope that people, , would feel that I'm fairly balanced, that that I'm, that I'm, hopefully they, they would feel that I'm dedicated to, , to my work, but not obsessed by it, or, , you know, not a, not a workaholic that, you know, that really value family. I really value things outside of medicine. I really, you know, value, , , , music, , , sports, , , you know, enjoying, , , , nature. , and, , and so, , hopefully folks would say, you know, that, that, that Jeff is of is, has got good balance. It got kind of harmony between his work life and, and his personal life. I, I, I feel that, that, , that I've got, you know, somewhat, , lively sense of h or and that, and that, that, you know, I, , I like to, to, to, to, to laugh and, and, and to play as well as work and actually trying to harmonize play and work is something to that's important to me.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3572.0,3643.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I think it's important as a leader to, to foster that. So I hope people would say that, , that, you know, Jeff liked to work hard, but he, he liked to incorporate some fun and some play and, and, , , , and, you know, and I hope, , that, that people, people would say that, that, , that draw toward working with people in medicine, you know, carries over to my teaching teaching, , life and, and leadership life, you know, really, , having relationships with, with residents with fellow faculty, , is very, , satisfying and, and, , and, and rewarding as is relationship with patients. So hopefully people sense that, you know, that I do this because I really do enjoy those, those, , , those relationships that you get to have. And, and, , that, , that something that, that helped make me effective. Yeah.\n\nSpeaker 1 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3643.0,3706.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I think, , applicants ask me, , you know, they even virtually they see something about our culture and they ask me, what is the, what is the key? And I, and two things that you talked about today were two things. I talk about the curiosity, but also the not taking ourselves too serious. And, and, and I don't know if that was modeled before you got here, but it's certainly been modeled for, for me in my time\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3706.0,3731.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Here. Yeah. I, I, , I think that, that, that, there's a lot of element of that, you know, I like to think that maybe I've, you know, moved that along some too. Yeah. Maybe I'm a little less maybe formal than, yeah. Than some of even my, , predecessors. , I mean, I think it's a challenge in medicine that, of taking our it's a serious occupation. Absolutely. But, , that doesn't mean that, that we get too caught up in how important we are. , and, , you know, I think relatability is critical if you're going to work with patients the way that, that we need to. And so I think, , , , you know, a lot of it to me is breaking down the hierarchical structure. Yeah. Right. Both in patient care and in teaching yeah. That, , a collaborative model, a give and take, , parallel interchange as opposed to hierarchical is healthier and it's more rewarding.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3731.0,3793.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): , and, , so I've, I I've seen that be effective in other people and I, I, I try to emulate it, try to promote it. Yeah, absolutely. , do you mind talking a minute about the other family physician in your family? Yeah. It's, , been, , very, , , enjoyable to me to see, , my only child, my daughter Andrea, , somewhat following my footstep, you know, I think for, for any parent, , you know, it's, it's, , it's very gratifying if your, , child, you know, sees your work and, and wants to, , to follow and, and, and pursue that. And especially when it's, when it's in a profession that is a little bit counterculture and, and challenging. So, , my daughter, , decided fairly early on that she wanted to go into healthcare and, and, , went to medical school at the university of Arizona, , college medicine, Tucson, and, , fairly early, she considered other special is through late, , years of, of last year or two of medical school, but she really increasingly gravitated to she, she saw that I really enjoyed what I was doing and, , she, , found that it resonated with her too.\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3793.0,3876.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): So she, , she chose to, to, , train in family medicine, , through kind of an ironic set of, , circ stances and against my initial, , judgment sheet actually trained here in this program. And I, I got a lot of support encouragement, , , from the, the faculty at the time, , that, that, that would be okay and we structured it so that I think it, it did work out well, but it was, it was really fun to watch her develop as a family physician. And now that she's in practice and, and kind of trying to harmonize being the mother of four, , boys, , ages 13 to six and, and, and the, , , continuity family physician, , it's really been fun to watch and kind of relive some of those, you know, early years of my own career. And some of the, the, the things that, that, , that I experienced along the way to get to kind of vicariously experience them through her has been very rewarding. Yeah. , anything else to add?\n\nSpeaker 2 (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3876.0,3937.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349/transcript/83675/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): No, I think this covers things pretty well. I mean, my, my hopes for the future would, would sort of follow from the things that I, that I see as challenges I would, I would really hope for the future that there'd be an increased appreciation and valuation of family medicine, that our healthcare system would move more in the direction that, that, , many of the European, , , countries have gone. And that is what, with a much more robust, primary care family medicine component in their healthcare system, more investment, , more appreciation that, , that, that less really can be more we in healthcare. And that focusing on value rather than just doing a bunch of stuff is, , is the pathway to, to more, , a more whole, , , healthy, , , life for people. , and, , it, it's gonna continue to being uphill battle, but I know that there's a lot of very talented, dedicated people, , that I've had the privilege of working with, , that are gonna, you know, continue that, that quest. And so, , I have cautious optimism that, that, , they will, you know, to move things in the, in the desired direction. That's definitely one of your catch cautious optimism. Well, thank you so much, Jeff. That's great. Thank you. All right.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159375/file/290349#t=3937.0,4024.29678"}]}]}]}