{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/xd0qr4qw1t/manifest","type":"Manifest","label":{"en":["Dr. Michael Fleming"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eDr Fleming has a fascinating and varied history, as captured in this interview. He finished a family medicine residency in 1978 and started a solo private practice. Over time he expanded his practice to 15 physicians, allowing him to address other interests, including the AAFP, where he served as president in 1986-1987. He became interested in advocacy, and his role with the AAFP allowed him access to Washington, DC, including the White House Medical Office and congressional offices. During this time, he helped organize a PAC, which ultimately became the Fam MedPAC. A trip to Tajikistan with Physicians with Heart fostered a strong international commitment. He retired early from practice and became involved in starting a CME company that focused on International trips. He also served on several nonprofit boards and spent six years as the chief medical officer for a home health and hospice company. He remains active in both for-profit and nonprofit organizations and has had a significant impact in showcasing the importance of family medicine. \u003cbr\u003eLocation: Louisiana \u003c/p\u003e (summary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2017-11-17 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Dan Ostergaard (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family physician","family medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["Michael O. Fleming, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eDr Fleming has a fascinating and varied history, as captured in this interview. He finished a family medicine residency in 1978 and started a solo private practice. Over time he expanded his practice to 15 physicians, allowing him to address other interests, including the AAFP, where he served as president in 1986-1987. He became interested in advocacy, and his role with the AAFP allowed him access to Washington, DC, including the White House Medical Office and congressional offices. During this time, he helped organize a PAC, which ultimately became the Fam MedPAC. A trip to Tajikistan with Physicians with Heart fostered a strong international commitment. He retired early from practice and became involved in starting a CME company that focused on International trips. He also served on several nonprofit boards and spent six years as the chief medical officer for a home health and hospice company. He remains active in both for-profit and nonprofit organizations and has had a significant impact in showcasing the importance of family medicine.\u0026nbsp;\u003cbr /\u003eLocation: Louisiana\u0026nbsp;\u003c/p\u003e"]},"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/152991/file/281579","type":"Canvas","label":{"en":["Media File 1 of 3 - Fleming_Michael_Pt1_08_a.wav"]},"duration":2516.07458,"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/152991/file/281579/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281579/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/579/original/Fleming_Michael_Pt1_08_a.wav?1752069527","type":"Audio","format":"audio/wav","duration":2516.07458,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281579","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281579/transcript/81598","type":"AnnotationPage","label":{"en":["Dr. Michael Fleming Interview Transcript  [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281579/transcript/81598/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tape 1, side 1\n\nDr. Ostergaard: My name is Dr. Dan Ostergaard and today is November 17, 2017 and we are in the Center for the History of Family Medicine of the American Academy of Family Physicians Foundation in Leawood, Kansas. This is going to be an oral history provided by Dr. Michael Fleming. \n\nTo start, Dr. Fleming, do you concur that this can be recorded and that you will see a copy of that, that it will be your oral history?\n\nDr. Fleming: Yes.\n\nDr. Ostergaard: Thank you. I will dispense with the formalities with that and say Michael instead of Dr. Fleming. Tell us a little bit about your origin. First of all, your name in full and then where were you born and a little bit about your growing up.\n\nDr. Fleming: Michael Fleming. My middle name is Oma, O-m-a, which is an old family name which means grandmother in German. And it goes back several generations, but it stopped at this one (I wouldn’t do that to any of my children). I was born in Monroe, Louisiana, in northeast Louisiana, and grew up there. Went to LSU in Baton Rouge, then went to LSU Medical School in Shreveport in 1971. And I was in the third class. It was a brand new medical school and there were only thirty-two students in my class. After graduation in 1975 I entered the residency program in family medicine in Shreveport. It was the first year of that residency program. So I had this thing about doing things in the early periods. And during that residency met my wife. I was actually looking at going into practice in a small town in east Texas and invited by then girlfriend over to visit me and she made it very clear that her children weren’t growing up in Linden, Texas. So went into practice in Shreveport in 1978. Started a solo practice doing deliveries, doing everything, and going to three hospitals. And stayed solo for three years and brought my first partner in and then the second, built a medical building, and now that practice has fifteen physicians. So I’ve often said that I would write a book about starting a solo practice doing deliveries – and that would be don’t.\n\nDr. Ostergaard: So why did you go to med school in the first place? Why did you want to be a doctor? What was happening back there in Monroe?\n\nDr. Fleming: That’s a great question. I don’t know. No one in my family is in medicine at all.\n\nAnd from the earliest time that I can remember I wanted to be a physician. And I really can’t say why. I had several mentors. I had a now family doc, a GP who cared for me and my family. And he really wasn’t an active mentor, but I looked up to him. And then there was a general surgeon who transferred that mentee, mentorship role and I liked what he did. I liked the ability to mean something to families. He obviously meant a great deal to my family. And so it was a given in my mind. If you had asked me when I was ten years old what I was going to do, I would have told you I was going to be a physician. I don’t know what drove me in that direction. \n\nDr. Ostergaard: That’s amazing. And it’s a little unusual, too, because usually there was some precipitating factor. Back, still, to your early years. Tell us a little bit about your family, your wife. What’s her name? How many kids?\n\nDr. Fleming: My wife’s name is Sally. We have a blended family. She had two children and I had one child when we got married. I adopted her two boys when they were very young. Then we have a son together. So we have hers, mine and ours. Two of those boys now live in the Dallas area. One lives in Baton Rouge, Louisiana and one lives in Nashville, Tennessee. We have seven grandchildren, which is the most important thing. And interestingly, also, none of my children went into health care. Although one of my sons is involved in medical education, but his degree is in engineering, of all things.\n\nDr. Ostergaard: That would be Matt?\n\nDr. Fleming: That would be Matt. \n\nDr. Ostergaard: I’ve got to give a quick personal note because I knew you were Michael O. Fleming, I did not know you were Oma. But our grandchildren call my wife Oma. She is Oma, she is not Grandma. So now I know another Oma.\n\nDr. Fleming: That’s exactly right, because you know why I don’t let that around.\n\nDr. Ostergaard: Do you have any particular precipitating factors in med school which made you go into family medicine?\n\nDr. Fleming: Yes, very much so. When I entered medical school I thought I wanted to be an obstetrician - and in medical school I enjoyed it very much. And then I developed a strong friendship with a pediatric cardiologist, of all things, and I really liked pediatrics. And he and I hunted together and became good friends. And it was while I was doing that, that an elective was offered during my fourth year with a practice of family physicians in east Texas, in a small town, a very rural town of only 3500 people in east Texas. And I went over and spent a month with them. And at the time I can remember the feeling, I was amazed at what all I could do. I enjoyed pediatrics, I enjoyed obstetrics, and this was something where I could do both of those. As much as anything else, I think the thing that impressed me is I watched the interaction of those patients with those physicians and how those patients just loved those physicians – and I liked that. And so I made my decision then that I wanted to go into family medicine.\n\nDr. Ostergaard: In med school did any of the more traditional specialties and their teachers try to talk you out of family medicine?\n\nDr. Fleming: They did almost daily. And I heard that thing that all of us, particularly back in those days, heard - is that you’re too smart to go into family medicine. And I heard it all the time. And I people from the Department of OB/Gyn that were pushing me, people from the Department of Internal Medicine pushing. And my comment back was always that I can do that and all the other too. \n\nDr. Ostergaard: Well, your response, I suspect, was I’m too smart to go into a limited specialty where there’s only one thing to do.\n\nDr. Fleming: That’s it.\n\nDr. Ostergaard: That’s it. Well, a little bit more about your time in med school and residency. Did you have any aspirations or interests in organized medicine, medical politics? If so, what were they and how did that lead you to where you’ve been?\n\nDr. Fleming: When I was in medical school, no. I wish I had. We were a brand new residency program at a brand new school. The first chair of family medicine at this school was brought in and when I was a senior in medical school was killed in a plane crash. And so we went for a year, almost two years without a chair of family medicine. It was empty. And so the chair of family medicine, when I entered residency, was chair of internal medicine too. And he was a major influence in my early career. A gentleman by the name of Ike Musloe (?). Sort of an icon at our medical school in Shreveport. But he strongly encouraged me to do this, even though he had that background. I got interested in medical politics from another mentor. A gentleman from a small town in north Louisiana named Don Hanes. And he had been an instructor in our Department of Family Medicine. He would come over and work in our family practice center teaching us residents. And he was one of those people you just looked up to. He was a country doctor. He was personable. He had tons of stories (I like stories). And he called me one day when I had just started solo practice and he was pretty direct and he said Saturday morning, 7:30, Holiday Inn downtown Shreveport – be there for breakfast. And I had no idea what I was going for. And it was a board meeting of the Louisiana Academy of Family Physicians and he was the director from our area of Louisiana and he invited me to this meeting. And I went to the meeting and I met people who just were icons. Jerry Garringer, Jerry Keller, Ralph Sanchez and some of these people were at that meeting. And I hooked onto them immediately. I was a sponge for some of the stuff they talked about. So that’s where my interest started – because he was bold enough to call me and say be there.\n\nDr. Ostergaard: That’s a wonderful story. So what did you do in terms of your organized medicine activity at the residency level? Was there anything going on?\n\nDr. Fleming: There was nothing. We weren’t involved in any way with AAFP. None of our residents came to the Student Resident meetings. Again, it was brand new and so we weren’t involved. The residency director would talk about that every once in a while but nobody got involved.\n\nDr. Ostergaard: So the seed was planted though by that meeting of the Louisiana Academy to which you were ordered to go. And then you started solo practice. So when you started the solo practice early on, did you have any time to do organized medicine or did you just do practice? Just do practice – I mean that was obviously a huge job. But what was the marriage between your time in early practice and any potential activity beyond?\n\nDr. Fleming: It was difficult. I mean there wasn’t any time. Louisiana is a state that is defined by its geography and north Louisiana is another world. Most people in south Louisiana don’t think we exist. And so meetings are almost always in south Louisiana. It was very unusual that they had that meeting in Shreveport. So for me to be involved, I had to travel – and usually to New Orleans. The headquarters of the Louisiana was in New Orleans at the time. So it was a commitment. And that’s how much I was moved by my being at that meeting, that I went. And I would hire residents to work for me when I went to those meetings because I was solo.\n\nDr. Ostergaard: So you did do that while you were solo?\n\nDr. Fleming: Yes.\n\nDr. Ostergaard: When did you make the decision to actually run for something in the Louisiana system?\n\nDr. Fleming: Probably about ’85. And by then I had two partners. So I was involved for seven or eight years. Seven years, I guess, by the then. And about ’85 I decided that I wanted to be more involved. I’d been the district director for a while and I wanted to be more involved. So I put my name up for president-elect. And in Louisiana our numbers were low then, and particularly the numbers of involved people. And what I went for, I wanted to be the speaker because we had a Congress. And one of those mentors, Jerry Keller, called me up and said, no, we’re going to put you up for president-elect. And you know Jerry Keller well enough to know that you don’t tell him no. \n\nDr. Ostergaard: I know Jerry Keller well enough to know you don’t tell him no. And I also know that he had an incredible political sense. Oh, absolutely. So his political sense obviously bore out, at that point in time. But I must say, I can’t think of any other situation where a young doctor in a state Academy ran from nothing to president-elect and won. Yes, and won – that’s right. \n\nSo there were three of you in the practice. Right. So it made it a little bit easier. While you started your trajectory into organized family medicine, could you maintain a full scope of practice?\n\nDr. Fleming: I did. We did deliveries in our practice until 1989 and I was president of the Louisiana Academy in ’86, ’87 – so, yes, we were doing a completely full scope at the time. We had limited it to two hospitals instead of the three that I started with because that was just nuts. But, yes.\n\nDr. Ostergaard: So you admitted to all three hospitals in that early time?\n\nDr. Fleming: I’ll tell you a real quick anecdote: Right after I went in practice and was on staff at three hospitals, had privileges, the wife of one of my high school classmates came to me and said she was pregnant and if I delivered her at hospital A, because my classmate worked there and the technology and things, they got a third off their bill, which they could do at the time. And then about two weeks later the wife of someone else that I knew, a scrub nurse at a fourth hospital came to me and said that if I would deliver her there, they got a third off their bill. And I had privileges at this fourth hospital, I just didn’t admit there. It’s across the river from Shreveport, in Bossier City. But they were due two weeks apart, so I figured this will work. And you’re hungry when you’re young and I said I can make this work. Well, they delivered within thirteen hours of each other. And so, actually, for three or four days I was making rounds at four hospitals.\n\nDr. Ostergaard: Let’s talk a little bit more about your political time. And I know you practiced for many, many years, so I don’t want to ignore that part of it. Can you talk about how you balanced the two up until you became an AAFP involved person?\n\nDr. Fleming: Both of those things were important to me - and when I recruited physicians to work in our practice, that’s one of the first things I told them. Even back as early as the early nineties, I knew that I wanted to be more involved with AAFP. And I can very well remember an interview with one of the new physicians we brought in. And I told her that I need you to know, coming in, that I’m building this practice and I want to have enough people here in call that I can do these things. So they all were well aware of that going in. So I committed to both.\n\nDr. Ostergaard: Tell us about your next steps then in the Louisiana Academy and then on to the American Academy.                     \n\nDr. Fleming: I stayed involved with the Louisiana Academy after my year as president. The past presidents in Louisiana had always maintained a very active advisory role within that organization and they still do. And then in the early nineties I applied for an Academy … Somewhere in the mid-eighties, and I meant to look this up, I came to my first AAFP meeting and it was a state officers conference here in Kansas City at the Alameda Plaza. And I was absolutely enthralled to the point that I remember going back to my room after one of the sessions and John Wooten (?), the iconic coach from UCLA, spoke, did the final plenary at that meeting. And I was blown away, I got to hear John Wooten speak. And to the point that my wife recognized how blown away I was by this. And I knew that I wanted to be involved however. And so in the early nineties, I guess it was, I applied the first time for a committee role. Probably the late eighties, maybe ’89. And for the first two years did not make it onto a commission or a committee. You kept trying? Kept trying. And the third time was a charm and I got on the Marketing and Public Relations was my first committee. Interestingly enough, I never served on a commission of the Academy. I served on Marketing and Public Relations. And you could do two tours at the time – and then got on the Committee on Insurance, which was a separate committee, if you remember. And that was combined with … It was a committee then on finance. So I was never on a commission, just on committees. And then in 1995 was a really pivotal year for me. I was forty-five years old and actively practicing, building a practice, and found out I had a renal cell carcinoma. I remember that very well. I was very worried about you. And had an abrectomy (?). And I am so blessed, I had an abrectomy (?) and I go for follow-up, but I’ve been healthy. But that was one of those awakening moments, a real ah-ha thing. So if there were things I wanted to do, I needed to go ahead and get them done. So the very next year I talked to our Louisiana Academy folks and said that I wanted to run for vice-speaker of the Academy. And Jerry Keller, going back to him, was very negative. He said I should run for the Board of Directors, that speakers didn’t get elected to anything else. So in 1996 I ran for vice-speaker of the Academy and was fortunate enough to have won that election. So that was my beginning on serving on that Board of Directors.\n\nDr. Ostergaard: Go for just for a quick thought to that first state officer’s conference. Who was in lead? I know John Wooten was there. And I would agree that that was an inspiring talk. But who were the Academy leaders at that time?\n\nDr. Fleming: The president was, and I’m sorry, I’m blocking out his name, he was the Admiral from Bremerton, Washington. Oh, Bob Higgins. Bob Higgins. He was the president. I remember him very well, clearly at that meeting. At the very first of SOC, and they used to do this, I remember – they did a skit and they were really bad. And someone else that became a close friend and a mentor, although I knew him for only a short time, was Frank Webber. And Frank was a professor from the Medical School of Houston. I think he was chair of the department at that time. And I got to know Frank then and through some subsequent things, then, sadly, he died just a couple of years later. But he really became a mentor and helped. He was somebody I could call and talk to, to be a sounding board. But parts of that meeting are still very vivid in my mind.\n\nDr. Ostergaard: So, now, in your trajectory to great things, you are just starting your role as vice-speaker of the Academy. What was that like? Just give us some stories or some feelings about your time as a vice-speaker, as a young family doc.\n\nDr. Fleming: The first thing I learned very quickly is that the role of a vice-speaker is to follow the speaker around. And you have to remember, the speaker at the time was Rich Roberts – and sort of be quiet, not say a lot. So I don’t do that well. You probably know that very well. And I remember my first board meeting, we were at 8880 Ward Parkway. And after the first day I realized that I couldn’t be silent. I really tried hard that first day to not talk. Only one day? It was actually a half day, I think. And to be fair, Rich was very encouraging. Sitting in that meeting the first day, I remember thinking of all the things we were dealing with for the specialty, for my partners, for me, for my practice, and I realized this is a heavy thing. And I really enjoyed that time a lot. And, again, I developed a whole new set of mentors that came from those meetings. People that I had known and really had looked up to. So it was a heady thing.\n\nDr. Ostergaard: Was that the period of time where the vice-speaker had to provide libations for the board suite?\n\nDr. Fleming: No, I came on after that. Apparently that went away after Neil Brooks. And Neil had been two vice-speakers ahead of me and that went away. By the time I got there they had ironed that out. And, also, the vice-speaker had a vote. Because I understand not too many years before that the vice-speaker did not have a vote at the board table. So I was treated very equally.\n\nDr. Ostergaard: So Dr. Rich Roberts, who also has an oral history in these archives here, was the speaker while you were vice-speaker. And how many years did that duo persist in leadership?\n\nDr. Fleming: Three. Rich got elected speaker the same that I got elected vice-speaker, so he moved up. And you well know, within the Academy the vice-speaker really doesn’t move anywhere until the speaker moves. And so he stayed in that role for three years, then he was elected as president-elect. And the year he was elected as president-elect, I was elected speaker, and I did that for three years. And three years wasn’t a magic number. Honestly, I guess I’d become politically savvy. I was looking at the people that you might run against for the president-elect role. Also, as much as anything that was a time when our practice was growing rapidly. We were six at the time and we added a three person group. There was a three person family medicine group in town who had failed. They had been around for many years and their location had pretty much gone downhill. The first place they went was into a multi-specialty clinic that had no clue how to do family medicine. And the senior member of this group was someone that in medical school I had worked in his office and he was another one of those mentors. And his daughter was the second physician, then the third that they had brought in. And we thought about it a long time, how to do this, because I didn’t want to harm relations with this multi-specialty clinic. We were close to them. I didn’t want to just walk in and steal these physicians away from them, but I also knew that they were not doing well because the system didn’t work for them. So it worked out better than I thought. We took this group to dinner with us and we had planned it out so that by cocktails we would talk about this and by dessert we would make our offer. You were just with the FPs or the … Just the FPs. And before we finished cocktails, we made the offer – and they wanted to know what took us so long. One of the beauties of this though is that the senior member of this group who had been a mentor to me, he retired the year after I did actually. But he made a comment to me that in this multi-specialty group that they entered, he hadn’t gotten a bonus in two years that they’d been in there – and he bonused every quarter with our group because we knew how to do family medicine and this other group didn’t. So that happened the second year I was speaker and I just couldn’t take that much time away to put my name in for president-elect. I knew what it would take. \n\nDr. Ostergaard: But the politics are such that sometimes you might have been better out staying an extra year as a vice-speaker. Yes. So then you made a decision to run for president-elect. Tell us about that.\n\nDr. Fleming: My wife Sally knew that I wanted to do that and we spent a great deal of time talking about it and praying about it, honestly, if that’s where I wanted to go. Because I particularly knew the time requirements that were there. We were very fortunate, all of our children were away from home by then and so that wasn’t an issue. And our practice was to a point then, there were ten then, where I could take time away and continue things. So I talked to her and she agreed. Then I sat down with all of my partners. And not just the board of directors of our practice, I brought them altogether. I took them all the dinner actually and said, okay, this is what I’m considering and this is what it will take. And I’m the eternal optimistic, I can always see green, but I really did focus on painting them the real picture of what it would really be like, how much time I would be away. And to their credit, unanimously they said I ought to do it. So that told me that I should go forward with it, so I did.\n\nDr. Ostergaard: That was very reaffirming, I’m sure, and empowering for you to go forward. And then you won. I did. So tell us about that.\n\nDr. Fleming: We ran in San Diego and I ran against two close friends, Dan Menderme (?) and Carl Burkholtz. That’s one of the wonderful things about this organization, is that our political races, even though you’re running against each other, were friendly. In fact, we were the first year that anyone … We held our hospitality suites in the same room when we ran for president-elect as opposed to separate places. So it was a very friendly campaign and it was something I enjoyed. It was a fun time. I enjoyed doing it. I enjoyed the idea of putting together a speech – although I didn’t think of it as a campaign speech, I just wanted it to be about me and what I would bring to the role. And I was fortunate enough to have won.\n\nDr. Ostergaard: So you were president-elect of the American Academy of Family Physicians. What was that year like? What are some high points and maybe some low points?\n\nDr. Fleming: I think the high points – I’ve always been very interested in politics and advocacy in national politics. And it gave me the opportunity to start going to Washington and spending time in Washington. I’d done that a little bit just on my own, but this gave me the opportunity to be part of the Academy’s advocacy efforts and I really enjoyed that. I enjoyed the people I got to meet and some of the things that I got to do and move on with that. It was a heady time. I mean you’re president-elect of the American Academy, for heaven sakes. Dan, I can’t remember a negative from that year other than a few times you get stuck in airports with missed flights and checking in to hotels that don’t have your reservations and other things. But I enjoyed every minute of it. And I particularly enjoyed going out and visiting the states. Going to state meetings but also talking to hospital medical staffs in some places, talking to residency programs. I loved that. And medical students – I had the opportunity, that’s when I first got associated with Tulane. And even though I’m 350 miles from New Orleans, I still keep a faculty appointment at Tulane and go down and get to talk to medical schools – because I just love it. I’m sure you were and are very good at that with your enthusiasm. That’s a wonderful thing.\n\nDr. Ostergaard: I have a political question. You were representing now the AAFP, the national organization at places like not only the Academy but the American Medical Association. Were there ever times in which your Louisiana colleagues were not appreciating the positions taken by the American Academy of Family Physicians – and how did you handle it?\n\nDr. Fleming: Almost every day. That was an aging piece. First of all, I had not been very involved in the Louisiana State Medical Society. I was member and I had been a delegate to their meeting from northwest Louisiana, but I was not involved in the leadership at all. So I really didn’t know those guys that were on the Louisiana delegation very well. But there were several times when we had issues where I was a pariah, clearly, from the way they … I haven’t been to the AMA in years but that was a time there was still a pretty good divide between the specialties and the states over power, for want of a better word. So I was not received well. Now, interesting, if we fast forward to now, I know all those guys much better now and we’re good friends and colleagues and we talk back about some of those things that we dealt with then. But it was edgy. \n\nDr. Ostergaard: President-elect is a time where, as you knew and in your situation, although you didn’t immediately follow him, your prior speaker, Dr. Roberts, was a couple of years ahead of you at that point and probably out of the picture, but his style and everything was still there as the previous speaker. Did you have any trouble finding your own voice? I suspect the answer is no, knowing you.\n\nDr. Fleming: No, I really didn’t. And, you know, Rich and I, we’re still, to this day, friends but we have very different styles. And that worked okay. As much as anything else, I won’t forget, I went to the Annual Meeting in New Jersey the year that I was president-elect. And they made a comment about my southern accent, as the people in New Jersey would. But talked about they could understand Rich much better than me because of his Wisconsin … But our styles were very different, but I never felt any conflict with that at all. And I’m not somebody who tends to adapt to other people. I kind of think it my own way. But we stayed good friends. That’s not a negative towards Rich, it’s just the way we work together.\n\nDr. Ostergaard: What were your high points as the president?\n\nDr. Fleming: Oh, I had several. Let’s hear some of them. I think one of the things that I will never, ever forget – I was invited to the Armed Services Academy meeting, the Uniform Services Academy. They met in San Diego. And at the installation luncheon where I’m going to install their new president they seated me next to this guy, their new president. And he’s an Air Force colonel and we started our conversation because I’ll talk to anybody. And I said, Lou, where are you stationed? And he said, the White House. Well, it turned out that he was Dick Cheney’s personal physician. As a matter of fact, Dick Cheney has written a couple of books about his time there and particularly his medical issues with his heart and Lou is prominently mentioned in that book. And so we talked about this a little bit. Then Lou said you should come visit us. And it turned out at the time, 2003 or early ’04, I guess, that all five of the White House physicians were family physicians. So he invited me and I spent a day at the White House in the medical facilities. Had lunch with the President’s family physician and with Lou. The Vice-President spent the entire afternoon in the sub-basement of the White House in the medical facility there. And then, as I was leaving, walked out and said, you know, it would be great if we could invite the whole Board of Directors. And he said when do you want to come? And so we had our board meeting in March in D.C. and they had all of us, our entire board, to the White House. And that was heady, that was big, strong.\n\nDr. Ostergaard: Was that when we met President Clinton? \n\nDr. Fleming: No, President Bush. And we didn’t get to meet him. I did on an earlier occasion. So that was big. And I’ve always been involved in politics and interested in politics, so I wanted the Academy to be more politically involved. And my predecessor as president was Jim Martin and Jim had a phrase he used all the time, that I borrowed: He said that when anybody in Washington talked about health care, he wanted the first thing for them to say is what do the family physicians think. A wonderful statement. So we didn’t have a PAC and we needed one. So interestingly enough, my sister is a Washington lifer. She’s been there for many years and has worked on the hill as well as peripherally. And she, at the time, had a business that did political compliance for PACs. So I started my own PAC, it was called Healthy Families for America. Started that actually at the end of my president-elect year and didn’t get many contributions from anywhere other than me. But our PAC joined the national senate Republican committee, the Democratic senate committee and joined all these things because you got to go to these meetings and meet people and network. And just as an example, I found out that Senator Frist (?), who was then the senate majority leader, had a deal through the Republican Senatorial Committee, that if you were a member of that … He had a roundtable once a month in the majority leader’s office in the capital and he invited me to three of those. And it was not only fascinating, I enjoyed going, but it was an opportunity for me to talk about things that were important to us as family physicians. And one of the first things I would say in those meetings, because I went to some on the other side of the aisle as well, is that I’m there representing the people, that they can get health care. I didn’t say I was representing family physicians. I am a family physician but I’m representing the patients we care for. And I got listened to. And from that actually came FamMedPAC. \n\nDr. Ostergaard: Let’s go back to FamMedPAC because that’s a big deal. I do believe you are the founder, at least the inspiration behind our PAC, our FamMedPAC. So just talk a little bit more about that. Was that hard to pull off? Because the Academy considered having a PAC many times over the years and always said no. This time they said yes.\n\nDr. Fleming: I have this opinion, it’s called the rule of five’s. That things have to get brought up five times before they’re ever accepted. And the first time it’s just hell, no, and then each there’s a little bit more acceptance. And I think by the time I brought it up again we were ready. So I think the timing was good for that – because I know it had been brought up before. \n\nDr. Ostergaard: That may be doing you a disservice. That may be true, but obviously your advocacy in the Congress with Dr. Frist and others helped.\n\nDr. Fleming: I think it got us places. It put us on the radar and that’s where we had to be. There’s a phrase I used, and actually I used it in my campaign speech for president-elect and I’ve heard it other places before: Either you’re at the table or you’re on the menu. And we were on the menu at the time and we needed a seat at the table and that started getting us a seat at the table because you can feel about it the way you want to, that’s what drives politics in this country.\n\nSo it started getting us seats at the table. We started getting invited to things. An example real quickly is Tommy Thompson was the secretary of HHS at the time and he held, every once in a while, round tables in his office and would invite a number of people and we had never been invited there before. And I went to four of them, seated at the table with him. But I know where that came from because people talked and people talked and we got invited. So it got us to places that we needed to be and I think it’s paid off. I worry that we’re still not as much focused on the patient as we should be. That’s what got us where we are because we didn’t represent some group of physicians, we represented the patient and that’s how they saw us. They saw as different.  Senator Grassley from Iowa said that: The reason I want to hear from you guys is you represent the patient.\n\nDr. Ostergaard: And I don’t believe I have heard of any other organization – in fact, hardly any other family physicians who said it quite like you did, that I’m here to represent the patients. We talk about patient advocacy but you made it much more personal in that endeavor.\n\nSo still on the PAC for a moment because you were then the chair of the FamMedPAC while you were president or after you were president?\n\nDr. Fleming: No, after. We actually started it the year after I was board chair. So it was when I was board chair that we actually passed the board action to start a PAC. So I was the founding president starting in 2005, after I rotated out of the board chair role.  \n\nDr. Ostergaard: So in the Academy’s system the past-president was the board chair? Correct. So it passed when you were board chair and then you became the leader of the PAC (pardon the phrase from an old song). Leader of the PAC for the next three or four years after that? That’s right.\n\nWe don’t want to not talk about your presidential year. Are there other things you’d like to mention about your year as president? Any low points? Being an optimist, I suspect there weren’t any.\n\nDr. Fleming: I’m sure there were, but I really can’t remember many. You know, patients would complain about me not being there and that was low because I would always worry about that, things that I missed. But in the grand scheme of things there weren’t many low points at all during that year. And there are so many things that go on in my life now that came from contacts that I made during that particular time that it’s just amazing.\n\nDr. Ostergaard: Save that thought because we want to talk a little bit about your post-president time and that will be very interesting.\n\nLet’s take a break, then we’ll come back and talk a little bit about your other things in your past-president year, your board chair year, because I want to talk about when you went to Tajikistan  a little bit. \n\nTape 1, side 2\n\nDr. Ostergaard: This is November 17, 2017 and this is Dan Ostergaard having an interview with Dr. Michael Fleming. And this is side B or the second side of tapes on both of the taping instruments we have here.\n\nSo, Dr. Fleming, we were just talking a little bit about your president year and a little bit about your past-president year which includes, in the Academy system, being the chairman of the Board of Directors. One of the things that I remember so well when you were the past-president is that you went to Physicians With Heart in Tajikistan. Tell us a little bit about that, would you?\n\nDr. Fleming: Absolutely. That was a life-changing trip in a lot of ways for me. First of all, it was the first time I’d been to … I travel all over the world and I enjoy travel, but it was the first time I’d been to southeast Asia or central Asia. And the second thing that made it very special is I took my youngest son with me. He had never been to England and to France and Switzerland, but he had never been to countries that we went to. So we actually went a few days earlier to Moscow and stayed in Moscow for two days on the frontend and then went into Dushanbe. And we were there for a night before most of the people came in. Then we all went back to Moscow for a day, or a night, at least, on the way back. But it was a trip to the point that I still tell people stories about things that happened on that trip that were so poignant but also important to me, that we found. Like what? I well remember … We all met to talk about the drugs we brought in and each of us was going to do a little educational piece on the particular things. And so I was going to talk about insulin because we brought a huge amount of insulin that we had been given. And I started talking about Type I diabetes and the physician, Chip, I believe his name was, who was a family physician who had been in the country for a while, he very sweetly reached over and put his hand on my arm and said, Michael, don’t talk about Type I diabetes. And I said, well, why not? He said there aren’t any because they all die. And that was sort of my eye-opening moment when I realized where we were and what was going on. The second thing that goes along with that: We went to the endocrinology hospital and we took that insulin, and we had a lot. I don’t remember how much, but we had a lot. And the lady who was the head of that hospital, an endocrinologist, was not real happy to see us. What I remember is that she sat with arms crossed. The body language was not real accepting until we gave her that insulin. And she left the room and she came back and she brought something and it was a tea cozy. It was a hand-embroidered tea cozy with silk. And actually the archives had that because I gave it to them. And she gave it to me and she gave me this big hug. And this was a little woman who may have been 5’2”. And I found out later, through our interpreters, that the endocrinology hospital had been without insulin for over a week and here we had brought all this insulin to her. So those were two things I remember especially. \n\nDr. Ostergaard: Those are great and sobering stories. And even though part of our Physicians With Heart mission was to work with the family docs, it would make no sense, as you pointed out, to provide insulin to any kind of a generalist because the only place it could be used was an endocrinology hospital that had even run out of insulin. Exactly. \n\nDr. Fleming: And I think the system of not only health care but of health education is so different. Another thing, and I remember you in this, Dan: We were in --, I believe was the name of it. We had traveled there. And what had learned was that they were trying to retrain specialists because the Soviet system was strong about training specialists and they were trying to retrain specialists to be generalists, to be primary care physicians. We were sitting around a table in a room with physicians from this hospital and in the back of the room were the faculty. And one of these physicians, through an interpreter, asked – she said she had been trained in neurology and how in the world should she know how to take general care of a child because she had never done that before. And I had a smart answer at the time. I wasn’t sure, and I remember looking at you and you shook your head. So what I said is that you didn’t learn how to ride a bicycle by reading it in a book, you learned it by doing it – and that’s what you have to do. And I think we rankled the feathers of some of those faculty members in the back of the room. But you told me it was okay, so I …\n\nDr. Ostergaard: Well, it was okay. And it was important that we not only talk about what we do in the United States but we talk about what they can do as their system very, very slowly and grudgingly changes in the minds of the current academics. Because when we talk about family medicine, a) they’re interested but b) they’re also very threatened. \n\nDr. Fleming: And to that end, the other thing, and I still have this - actually, I put it in a frame. The Minister of Health, who we met and went to dinner with one night, went to tea with (that’s a general term), that night that we had dinner together he gave me a little box. And inside it was a coin, it’s a Jek coin that basically equals a U.S. dollar (and I don’t know what the name of the coin is). But the reason he gave me that is because at the time, in the U.S., we were spending over $5,000 per year per person on health care. We’re obviously much higher now. But that year, 2005, they had achieved spending $1 per year per person on health care and that’s what that was a recognition of. And I’ve kept that coin and I show that to people and tell that story because it’s pointing out where we are. \n\nDr. Ostergaard: That’s a great story. Quite a demonstration of the difference between systems.\n\nThat Physicians With Heart experience was obviously meaningful to you, but I also know that you’ve had a lot of other international experience. So let’s talk a little bit about what you do post-president because my knowledge of what you do is, I think, such that you do a greater variety of avocational and vocational things after you were president than almost any other president the Academy has ever had. So let’s just spend quite a bit of time talking about what you do now, international and other.\n\nDr. Fleming: From an international standpoint, back in 1991, so even before elected to the Academy I started a company that does continuing medical education. And early on that company was really focused on international trips. It all came from – I had gone to an educational internationally and I thought that the CME was such poor quality that it bothered me and I thought I could do that better. That company still exists and it still does education internationally. And we still do it so that we go into a country and in most countries we don’t carry a speaker with us, we use speakers from that country to talk about the health system. We have lots of relationships with ministries of health, with organizations of family medicine or general practice in these countries. We’ve viewed the Royal College in England and Scotland, have been good partners. The FMG in France have been good partners. And they talk about how things are done in that country which is always fascinating. It never ceases to fascinate me. We’ve done New Zealand and Australia. So we’ve done a lot of that. So I have an interest in travel in general and that sort of helped feed that interest. What is the name of the company? The name of the company initially was Medical World\n\nConferences and in the early 2000’s we changed it to Antidote Education Company. So it still carries out that role. Although we don’t do as much international work as we did, we still do. And I still enjoy the piece particularly that we work with doctors in those countries rather than just carrying someone from here. I’ve also been involved in medical mission work. Humanitarian aid work similar to what we did in Tajikistan but then also medical mission work. I’ve done several trips to Cuba. I’ve done a number of trips to Mexico. And those are things I just love to do. I love to see the people and care for the people. You know, the patients that we care for in all of these countries and in the United States is not much different. They’re looking for somebody to care for them. I’m going to parenthetically say something here. We worked together actually on the board of the Academy back when we did the Future of Family Medicine project. And one of the tenants of that was the Patient-Centered Medical Home. And my only comment on that is, it’s not intended to be negative but I think we got one thing wrong. It should have been the Person-Centered Medical Home because patients have diagnoses but persons have socio-economic issues and spiritual issues and other issues and diagnoses. And I think the thing that really separates what we do as family physicians, we see that person as a person with all of those things. I used to go down the hall in the hospital and hear a nurse talk about the heart failure in room 202 or the broken hip in room 301. No, that’s a person in there who happens to have heart failure. And that’s something I talk a lot about now when I talk to groups, is the person-centeredness of what we do as family physicians. And I think the international work has helped me sort of define that in my own head. \n\nDr. Ostergaard: When you go to places like Cuba and Mexico are you doing clinical care or are you doing advocacy with the Ministries of Health? What are you doing when you go there?\n\nDr. Fleming: In Cuba we’ve done a little bit of actual health care for some small populations. There’s a seminary we work with there and there are some students there that have had some medical issues and we’ve helped with them. In Cuba most of it has been advocacy. And have met with the Ministry of Health in Cuba one time, which was a little bit scary because you’re in a building where no one is friendly to you. And as you know, physicians, in general, family physicians specifically are not looked at very highly in Cuba. Most of it has been advocacy and really supporting the physicians that are there. In Mexico it’s actually been caring for patients, which is also fascinating. I was just there last week and I mentioned that to you. And I had something happen last week that’s happened to me several times before there. I was in a village in the mountains where the first language wasn’t Spanish. And we were seeing all these elderly people who didn’t speak Spanish at all. They spoke a local dialect. And so I had to have an interpreter from the dialect to Spanish and then Spanish to English, which really is difficult when you’re trying to achieve something. But that’s something that just plays to my heart a lot.\n\nDr. Ostergaard: Well, I bet you do enjoy it and I’m sure you’re very good at it. And you have mentioned many times now about the person comes through in that kind of a situation. You have been involved in many business. So not only Antidote Medical Education but many other things. Kind of go through some of those things you have done post-president. Were you ever back in practice post-president? And what are these other things?\n\nDr. Fleming: I stayed in active practice for about two and a half years after my time with the Academy, after I finished my board chair year. I look back at why I retired the first time and I don’t have a good reason. I just did. And during that time in between I did get involved. I was on several not-for-profit boards that I stayed involved with. There’s something in Louisiana that we started after hurricane Katrina called the Louisiana Health Care Quality Forum. It came from a group that was formed by government after Katrina because we’ve always been the last in health care quality in the nation. So I was on the founding board of the Quality Forum and I was the designated north Louisiana representative. You know, I mentioned that we’re a state divided by geography and they thought they needed somebody from north Louisiana, so somebody recommended me. And it was a twelve person board and I was the only one from north of Interstate 10. But because, I think, of my Academy involvement, because I had done the Academy presidency and board chair, they elected me the first president. So I spent three years as president of that organization in its formative years and now it’s an organization that’s just blossomed. It became the designated entity for Health I.T. through CMS. The president after me of that organization was Karen DeSalvo who was the national coordinator for HIT. So it’s an organization I still feel strongly for. And as a matter of fact, they just talked me into coming back on that board for another term. It is a statewide organization and its focus is what I’m really interested in, collaboration in care. And it’s a multi-stakeholder organization which I really like. It’s not just physicians, it’s consumers, hospitals, physicians, payers, employers. And so that’s an organization that I got involved with in that first retirement area. I did several other not-for-profit boards and a couple of for-profit things.\n\nDr. Ostergaard: Before you do that, how did you make the decision at that three year point or whatever after your board chair year to retire? And then why did it fail?            \n\nDr. Fleming: Looking back I don’t have a good answer for why I retired. I think this is the best answer, and this is a terrible answer – I could. Our company Antidote was doing very well. I saw other things that I wanted to do in my life. I enjoyed practice. I loved practice. I loved my patients. I didn’t love all the administrivia, which is a new word I’ve just learned, and I realized what that was. And it was weighty. I just didn’t like that as much. And so it was a stupid decision to retire the first time, but I did nevertheless. And I failed because I can’t play golf every day. My body won’t let me. And I need something to keep me interested in going, particularly in the things I’m interested in. So it so happened that through the Quality Forum there was a guy on this board that I met, another one of the board members who had founded a home health and hospice company, a national company that had been very, very successful. And we became friends and then he asked me to start doing some consulting for him. Well, I’d never done that before, so I said sure. And I honestly think that he and my wife colluded on this, although until the day he died last year, and I still miss him terribly, he never would admit this but he would smile – I think they colluded. He asked me to be his chief medical officer. And the company was headquartered in Baton Rouge which is about 250 miles from Shreveport. And we worked out a deal that I would be there once a week but I would travel. And they had 450 locations around the country. So I did it. And I had used home health care and I have always been a proponent of hospice. I’ve been interested in end of life issues. But I never immersed myself in it until I took that job. I had never been an executive at a large company. That’s the first thing I told him, that the only person I’ve worked for in the last thirty years is me. But it was a good experience for me. A lot of the places that I went were augmented by my Academy experience. I would go to Washington. For this company I became our chief Washington person because I had so many contacts there. And I would go to Washington with this guy that’s the CEO and we would walk in somewhere and they would say hello to me and I would have to introduce him. So that was a great experience. And I got more involved with particularly the end of life issues. And then also something had always interested me was home health at large. Not just the home health agency but how physicians play into that, house calls. I had done house calls throughout my whole career in practice and how that could play into that and how that builds into the role of the family physician – again, that person care thing. So it was a good role. I did that for six years and retired from that about two years ago.  What percentage of time were you doing that?  100%. I was full time. So it was a full time role. And I usually traveled two weeks a year. Had an office in Shreveport, but then I would always spend at least one week a month, sometimes two weeks, in Baton Rouge. And then around the country? And around the country, right. So I was on the road a lot. I was in Washington a whole lot. \n\nDr. Ostergaard: You’ve said two or three times now how the Academy experience and the contacts you made opened doors. Yes. Talk more about that, at least maybe in general terms or in specific terms, about some of your other activities. \n\nDr. Fleming: It’s primary and secondary. There were people that I met during my Academy experience who when I met in another role, such as my role with this company, Amedisys is the name of the company - yes, I remember you, and that would open the door. And then the other secondary, people who would see in my resume or anything else that I had been president of the Academy. And that met a lot. That would open the door, that role. One of the best examples of the primary was there’s a congressman from Nashville named Jim Cooper, a great guy. His dad was a former governor of Tennessee. And one of the most interesting things about Jim, his background, he’s a health care economist. He taught health care economics at Vanderbilt. And the first time I met him was with then our government director, Kevin Burke. And Kevin was always my chaperone. They were afraid to let me go anywhere by myself, so … We went in to see Jim and we were waiting in Jim’s outer office and Kevin had to go to the restroom. Well, while he was gone they called us back to meet Congressman Cooper. And when I went in, on the sofa in the office was a guitar and a banjo and I said do you play? Well, we started talking. So when Kevin comes in, the Congressman and I are doing dueling banjos. So we became friends rather fast. But I worked with the Congressman a bit in my role with the Academy. Actually, he got me invited to speak at several meetings during that time for the role of family medicine and where we fit into things. Well, then when I went back with Amedisys we went to see Congressman Cooper. And I won’t ever forget this – we went in with my friend, the CEO of this company, but also the board chair of this company who had been on the board of Marriot Corporation and Northwest Airlines, a lot of stuff. And we walked in and Congressman Cooper said, oh, I remember him, he’s the real deal. So those kind of relationships opened the door. Again, I can’t tell you how many people that I come in contact with now … Now I have, I call it a consultancy. It’s really not, it’s more advisory to some companies. But when they see what I’ve done with the Academy, it’s an immediate door opener and it changes the level of our conversations.\n\nDr. Ostergaard: So does the Academy give you credibility or do you give the Academy credibility?\n\nDr. Fleming: That’s a great question. I don’t know the answer to that. I think certainly the Academy gives me credibility because you’re dealing with an organization made up of all the family physicians in the country. I would hope that I give the Academy a credibility as well. And I think the thing that I push all the time … As recently as two weeks ago I was doing some advisory work for a company and meeting with their board of directors and I commented again on the fact that this is the group of physicians who is all about what’s best for the patient. And we were talking about some other more specialized health issues and they said why are you, a family physician, coming and talking to us about this (these are a bunch of business guys) as opposed to a specialist in this? And that’s what I came back with. And I wasn’t sure how that was going to play. Then after, they had invited me to their board of directors dinner that night and they commented how important that was that I talked to them like a real person without having a slide full of numbers.\n\nDr. Ostergaard: Well, I’m absolutely sure that you also give the Academy credibility over these contacts and multiple conversations. And I suspect that if the next Academy official walks into Congressman Cooper’s office and he finds out or he knows ahead of time that it’s a family doc coming in there, that’s credibility that you have offered. He will know, for sure. That’s good.\n\nDr. Ostergaard: So, again, you’re doing lots of things post-presidency. What else?\n\nDr. Fleming: The most wonderful thing now for me is … I’m retired the second time, but I’ve learned to say no, which is a really difficult thing. I’ve told people this, I’ve said no more in the past two years than I’ve said in the rest of my life put together. But I can pick and choose the things that I’m passionate about. An example is I agreed to take on this role with the Louisiana Health Care Quality board. I’m going back on that board because that is something that I feel very, very strongly about. I have probably turned down two or three things for every one that I’ve agreed to do. I joined the board of … Louisiana now has Medicaid managed care and there are five companies that are doing business. And I was invited to join the board of directors – it’s a for-profit company of one of those companies. And I did that because we, in Louisiana, do a terrible job of taking care of our Medicaid patients and so I thought we could make a difference there.\n\nSo it really is nice to be able to pick and choose. A couple of the companies that I’m doing some advisory work for are – one’s in the medical device field and they great interest in dealing with the future of where post-acute care is going. And I was involved in that for six years. And the work I do for them is almost like a futurist, looking at where … Post-acute care is a messed up field in the United States. About where that’s going to go, what’s going to happen with that and then where opportunities may be for them, business opportunities. And I really enjoy that. The other is in the field of analytics. I’m involved in a company that’s taking in data and looking at specific patient data and then predicting things particularly for their future care. And, again, this is in post-acute care and in hospice, so that we can provide better care by predicting the future of what’s going to happen to these patients. One of the examples, this company is doing a lot of work in preventing readmissions. And there are so many things that predicted modeling can do. There’s so much data that it’s not humanly possible to assess all that data and know. But with the machines that we have now, they can do that. And some of the things that they have been able to figure out, they can be life-changing. And particularly when you’re dealing with patients in palliative and post-acute care. What particularly medicine or what care paradigm may be best for this particular patient. What facility is best. One of the things that we deal with right now in post-acute care is we have no clue why patients go where they go. Some patients go to --, some patients go to home care, some patients go to a long term acute care hospital, some patients go to rehab, some patients get nothing. And the reason is the worst possible, it’s because of who gets paid what. That is the worst possible. Yeah, health care in this country is driven by payment. That’s awful. And payment is driven by a set of rules that are so incredibly arcane that they make no sense. And I would challenge anybody to be able to … Having been involved in that world for a while, home health care, for example, is driven by a set of conditions of participation that says whether or not you qualify for home health care. And one of those, just a quick example, it’s one that drives me nuts, is that you must meet the homebound status. It doesn’t say you must be homebound because that’s not what it means. And the homebound criteria says – there’s a list of qualifications to that, that are multiple pages long. But it means that you can leave your house for certain things, to go to doctor appointments or to get medicine or for religious services. And so there’s a question that I asked at one of these meetings that says that my patient is a member of a tribe and once a week she walks two miles to a tribal meeting. Does that meet the homebound criteria? And they answer was yes. Well, I have another patient who can’t get out of the house but she could if she had someone to take her out of the house, but she doesn’t need it. So all that’s nuts. So I get excited about thinking about what we could do take the patient’s characteristics (again, that person thing), to take their individual characteristics and identify what would be the best care for them in that situation.\n\nDr. Ostergaard: Wow, that’s fascinating. And what it would be, what a great advantage it would be if you actually were able to pull that off. I’m sure you’re giving advice which will lead to that. And it’s interesting to me that I think in the last few minutes you’ve talked about post-presidency activities that are local, that are national and international. So your working in all those arenas – local, national, international. Do you spend most of your time in Shreveport or do you spend most of your time elsewhere?\n\nDr. Fleming: The majority is in Shreveport. I still do travel a bit though, particularly for some of these board assignments that I had and also for some of the advisory things. Now with technology so many things can be … Two weeks ago was an unusual week, but I had either a conference call or a video call four days out of that week. One from Australia, one from Dublin, Ireland, and the other three were within the United States. But none within Louisiana. So you can do that. And, again, the one from Australia and the one from Ireland, I was visually present. So that does make things much easier. \n\nDr. Ostergaard: You sort of got into your philosophical thoughts about health care in this country and the fact that post-acute care is, as you said, messed up. Over your career, from the beginning to your current non-retired status, how has medicine changed? Good, bad, indifferent? What’s the status now from the beginning, the middle and your current observation?\n\nDr. Fleming: It’s a little of all of it. What’s good is that we’ve had so many advances in care. People are living long and they’re living well longer. We can keep them in a state of health for a much longer period of time. The bad is the exact opposite, that we have so many people that are living long lives but not in a state of wellness and we haven’t been able to do much about that.\n\nI think the biggest change I’ve seen though is the amount of other stuff that gets in the way of taking care of patients. The amount of burden. And that’s a word right now that’s popular. People talk about the administrative burden. But that burden has just exploded since I retired. I still do some advisory work for my old practice. They talk to the old guy every once in a while. And I’ll go spend some time watching them and I’m just overwhelmed by the amount of administrative burden that they have. And some of it so nonsensical that it boggles the imagination. A physician having to make (and I witnessed this) a phone call to a medical director of an insurance company to get a prescription approved. What’s odd about this though is she wrote the prescription for the generic and the company denied the generic but would approve the name brand which was more expensive. I mean go figure. How can that be? How can that be, exactly. The other part is so much of that administrative burden comes from our desire to get better, but all this administrative burden hasn’t really made that that much better. It’s like it’s been added without need. And I’m really sad for that and I think that’s a negative almost. I think the other thing is, and we talked about this, Dan, from the time that I first got on the board of Academy. I remember a conversation in the board room at 8880 Ward Parkway, so that’s a long time ago, about how misaligned health care is. And I’ve come up with my own theorem of this. I think that there are, in any country or entity, four domains of health care. There’s the science of health care, all the things that go around the evidence-based and all the other things, the education, and there’s the provision of health care. So there’s those of us who see patients and care for patients in hospitals and all those providers. Then there’s the payment for health care that we all know about that drives everything. And then there’s the domain that nobody seems to think about, and that’s the patient for whom we provide the care. And it’s very rare in our country that any more than two intersect – and that’s unfortunate. \n\nDr. Ostergaard: Then let me ask you the same question about how have you seen family medicine change from when your first blush as a physician to the middle career to now? Some of the things are the same because we’re part of medicine, but what about family medicine specifically?\n\nDr. Fleming: I still love the idea of what we do as family physicians. And when I watch it locally, when I see my friends that see family physicians and I hear them talk about it, that’s why I did it and that’s why I love it. I have some criticisms though on two areas: The first is that I really fear that we – and it started probably when we quit doing deliveries because of the pressure from insurers and payers and others because of the medical legal issues. When we quit doing that, by and large, because most of us don’t do that anymore. And then second is when we quit going to the hospital. And I think that changed. And I realize I’m an old guy and I’m looking at the past, but there’s so much about the dynamic of patient care that I was able to do when I saw my patients in the hospital, when I knew what was going on with them, that I don’t think that you can do from somebody that you see one time ever. And I can tell you my own experience. Unfortunately, I’ve spent way too much time on the other side of the bed since my retirement. But going into the hospital and seeing a physician that doesn’t know me from anyone, that we have no longitudinal experience whatsoever, there’s a disconnect there. That doesn’t work for me as a patient, it doesn’t work for me as a family physician. I think the other area that I worry about is from an academic standpoint. And this is a very personal thing. We’ve almost become part of what we were set out to reform and that is that in the residency program in my city that I was in the first residency class of, there is no faculty member that’s ever done community primary care, that’s never been in practice. And it’s been that way for over ten years. So the residents that are going through that program have almost no exposure. The only exposure they get is when somebody like me goes in and talks to the residents. But as far as seeing patients and dealing with the issues that a private practice is going to have to deal with, they don’t know that. There’s none of that. Well, that’s sort of what we were formed to get away from, that ivory tower so-to-speak. And I worry about that a lot. I participated in some interviews for my practice that was hiring a new physician and I was so impressed with some of these people we interviewed. In fact, they hired two and those were two that I was very much in favor of. But there some that when we interviewed literally just didn’t have a clue about the realities of a community practice. And I think that’s not a good thing for our future.\n\nDr. Ostergaard: Any positives in the way family medicine has changed over the trajectory years?\n\nDr. Fleming: Yeah, they know so much. My physician is a young physician – and I did that very much on purpose. I actually hired her the year before I retired. I have to tell a story about her because you know I love stories. She came to work for us after she finished her residency program. You know that all residencies end on June 30th, so she was going to come to work the first week in July. On June 30th, the last day of her residency, she had a c-section. And they were giving the boards on July 13th, and this is before they were doing them on the computer, and I told her that she didn’t have to take the boards, that she could wait until the second, and I would give her an okay to take them in December. She took it anyway. She drove to Dallas which is a three hour drive from us. Took her boards and she finished up in the very top rung of people. And how much post-op was she? Two weeks. That’s why I chose her as my physician. \n\nBut when I talk to these young folks that are in my old practice and that’s who I have primary … I speak to some residents as well. I mostly have contact with medical students. But, boy, they’re so smart. There is so much that they know. And I’m almost jealous of that. I wish that I was as up-to-date on all the things as they are clinically. Well, I think we all would be better served if we collectively had the combination of wisdom from experience over time, knowledge that’s now available and the absence of administrivia of which you spoke. Exactly.\n\nDr. Ostergaard: Over the course of your career, just give me a couple of names of people who were most influential for you.\n\nDr. Fleming: There are so many. You mentioned Jerry Keller several times.  Don Hanes is the physician who got me to go to that first LAFP meeting. Ike Musloe (?), who was a chair of family medicine even though he was a general internist. Ralph Sanchez who was a teacher in Louisiana that’s well-known in the American Academy. He was such a … The way he thought was just real world. And he could take a problem, I would talk to him about it and he would give me a solution that I knew was the right thing to do. Jerry Keller, particularly within medical politics. A very astute politician and a friend as well. Within the AAFP, there have just been so many that I look up to. Neil Brooks is a friend but also used him as a wise soul, particularly in dealing with the AMA. Rich Roberts. Rich and I are the same age. But again, he was ahead of me, involved with medical politics, and he was a mentor. There have been so many in family medicine that I just wanted to hook onto. There’s a gentleman in a little town of Linden, Texas that I talked about who started a practice there named Vernon Glenn. And here he is in a rural practice and he taught in my residency program. He gave a day a week out of his practice to come to Shreveport, eighty miles away, and teach. But was the voice of the person-centered care way back in the mid-70’s. I’ve always patterned the way that I care for patients after the way he did that I learned when I was a junior medical student under him. That’s wonderful.\n\nDr. Ostergaard: We’re coming to the end of our time together. Tell me, what would you like to say to the posterity of this audiotape that I haven’t asked you?\n\nDr. Fleming: I think the most important part … My time with the Academy and my service to the Academy was very important to me and it has opened so many doors for me post that I’m so grateful for. But the way that I have seen myself and that I hope everybody has is a family physician. Those other things came along because I was a family physician and I got involved. But what I did was as a family physician, not as a medical politician.\n\nTape 3, side 1\n\nDr. Ostergaard: This is November 17, 2017 and this is an interview by Dan Ostergaard with Michael Fleming. And we are now actually on the third side and this is going to be very short, to try and finish up what we didn’t do in the main tape. So for the transcriptionist, this is will be brief and should follow the very end of side B on the other tape.\n\nSo we were talking about, I guess in my verbiage, how you want to be remembered. And you had some quotes from others which to me sounded a little bit like kind of one of the ways you would like to be remembered. Can you talk about that?\n\nDr. Fleming: Well, it is. There was a physician who was one of the mentors that I mentioned, a small town in east Texas, Dr. Glenn, who was very intense in his thought. And we were having a conversation one day, and I was a medical student, and he suddenly pulls to the side of the road. And what he said, I remember it so well, he said the biggest compliment that anyone can ever pay you is to have you present at their birth or their death. And that’s what we’re about. That’s what family medicine is about. And I think about deliveries but I also think about the number of times when I was present at the last breath of a patient. And there’s family there, it’s such an event, and yet think about that – people invite us into their living rooms. People invite us into their families to be part of these life events. I don’t know of any other (I mean there may be) medical specialty that I can come up with that gets the opportunity to do that. To do both. To do both, exactly right. I guess if there’s any way that I would want to be remembered, it’s that, that I was a part of that. I was a part of their lives. \n\nDr. Ostergaard: You have done a multitude of things, extraordinarily important things. Most of which related in some way to family medicine but not all of them, because some of the others were other parts of medicine that were not innately family medicine. But I think I interpreted from what you said a little while ago, and I’d like you to comment on this, that you would like to be remembered (this is my words now) as a family physician who did lots of things rather than one of those things. Talk about that.\n\nDr. Fleming: That’s exactly right. I think that I come from the perspective at which I come from everything I do, is as a family physician. Even to the point almost of dealing with my kids and grandkids. I come at it with that view of things of the way family physicians do. We want to know the history, we want to know what’s going on, we want to figure out what’s going to happen after that --. And I just have to say that’s who I am. And part of that came from … One of the best things I ever did in my life was to go into solo practice because there were so many things that were on top of me. But I think that’s where I got that perspective, when I realized that I could be involved, that I could be on the board of the a bank, that I could do that with my background of family medicine. I could do these other business things and come at it with my background in family medicine. And that’s so invaluable. It’s amazing to me how many large corporations right now that deal in health care don’t have any physicians involved. So I’ve had the opportunity to speak to some of those boards and I’ll ask them that question, why don’t you have physicians involved.\n\nAnd if you’re going to have one involved, it ought to be somebody that deals with the entire person, the person with family medicine. So I do think that’s who I am and certainly                           how I see myself. So I hope that’s the way I portray it to the world.\n\nDr. Ostergaard: I believe it is. Certainly that’s how you have portrayed it to me. And I have had the privilege of knowing you for many years and watching your career. And I didn’t know some of these details of your post-presidency time but I’m impressed with the fact that you have carried family medicine with you in that as well.\n\nSo you’re still not old. What are you going to do for the rest of the time?\n\nDr. Fleming: Kind of winding things up actually. I always look forward to the next trip. We share that. Yes, we do. So I’ll be going back to Cuba in January and then to Mexico in March and Mexico again in July. The Mexico trips are mission trips. So I’m always excited about those things. \n\nI like to plan and I like to have things set. As far as business opportunities or involvement opportunities, I’m always kind of listening. I love dealing with medical students. I do a set of things at LSU in Shreveport now. I talk about quality of medicine, that’s with my quality forum hat on side. Talk about involvement in medical politics to medical students. It turns out they really like to hear that. I’ve done a number of talks for them. And we went back and looked at their evaluations and kind of pointed to the things they wanted to hear. Talk to medical students a lot about, and this is a particular passion of mine personally, the importance of independent practice. I worry a little bit about the trajectory we may be on with hospitals involvement in medical practice. So I talk about independent medical practice and how you can do that. Is it real? Can you still do it? One of the other things I really enjoy, I talk to medical students about the ability to talk to people and listen to people and diagnose rather than tests. I always worry about, when you see a young physician, the first thing they want to do is order a list of tests. And so when I was a medical student the dean in our medical school was an icon in Louisiana. A gentleman named Edgar Hall   \n\nwho had been at LSU-New Orleans for many years. He was probably in his late seventies when he became the first dean of the medical school in Shreveport. And every Saturday morning he would invite medical students, it wasn’t required, it was an open invitation to meet him in the emergency room at the hospital and just walk around. And he would stop and talk to someone and observe and then tell you what they have. He would ask them some questions - and he was almost never wrong. And that stayed with me. And I often told people that I was interviewing to work for me that I would much rather have a physician with good clinical intuition than with an AOA average (I’ve got to tell you about that too real quick). But I think l clinical intuition, the ability to talk to somebody and have an idea of what’s going on, I think that’s a talent that we have. That’s what we train for. That’s probably one of the most valuable things we can do. And if we give that up, if we make ourselves … Tests can be wrong just like we’re wrong sometimes and we spend a lot of money doing things that are probably worthless or needless because we don’t use our clinical intuition as much. So I do this for the medical students at LSU and they love it because they’re not exposed to anybody that does that. So that’s fun. \n\nOne thing I have to tell you is that I got a call a few years ago from a friend who was then the chair of medicine at LSU-New Orleans and I’ve known him for a while. And he invited me to go to New Orleans and be the visiting professor for the AOA banquet and weekend. So I said, Chuck, I have something to tell you: In my medical school class, I was in that third of the class that made the upper two-third’s possible. (Laughter.)  and he not only invited, that’s how he introduced me that night at the banquet. But I do think that using what we’ve been given, the intellect and the training we’ve been given is hugely important and I love to talk to medical students about that and work with them. So that’s one of the things that I do that I enjoy the most. And you’ll be doing that for a long time, I’m sure. Oh, absolutely.\n\nDr. Ostergaard: One last question, which is kind of the same question but on  a personal level. Knowing that none of your kids or grandkids live in Shreveport, does that cause any tugs to somehow be closer to them? I know it does in my family.\n\nDr. Fleming: It does indeed. In fact, I would not be at all surprised if within the next year I don’t own a condo in Nashville where our two youngest grandchildren are. It does. And our older grandchildren now are teenagers and Dallas is just three hours from Shreveport, so that’s not that far. The younger grandchildren, not so much and so we don’t get to see them as often. But, yes, it does. And we have family left really in Louisiana for either my wife or I. So, yes, I suspect that will be happening. And it so happens Nashville is kind of the epicenter for health care business in the United States now. There are so many health care companies that have headquartered there. And several of the companies that I do some advisory work for are in Nashville, so that wouldn’t hurt that either. So if you go to Nashville, you have the combination of family and more business. You might have to fail retirement again.\n\nDr. Ostergaard: Dr. Michael Fleming, I must tell you this has been a fun time to visit with you. You have had an incredible career, an incredible life, and I expect to hear more about you as time goes on. Thank you very much.\n\nDr. Fleming: It has been incredible. Thank you.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281579#t=0.0,2516.07458"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281580","type":"Canvas","label":{"en":["Media File 2 of 3 - Fleming_Michael_Pt1_08_b.wav"]},"duration":2516.03993,"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/152991/file/281580/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281580/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/580/original/Fleming_Michael_Pt1_08_b.wav?1752069528","type":"Audio","format":"audio/wav","duration":2516.03993,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281580","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281585","type":"Canvas","label":{"en":["Media File 3 of 3 - Fleming_Michael_Pt2_08_a.wav"]},"duration":659.09834,"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/152991/file/281585/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281585/content/3/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/585/original/Fleming_Michael_Pt2_08_a.wav?1752070188","type":"Audio","format":"audio/wav","duration":659.09834,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152991/file/281585","metadata":[]}]}],"annotations":[]}]}