{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/xk84j0d67z/manifest","type":"Manifest","label":{"en":["Dr. Bruce Bagley"]},"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":["2009-11-19 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Joseph Scherger (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":["Bruce Bagley, 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/154887/file/284061","type":"Canvas","label":{"en":["Media File 1 of 2 - Bagley_Bruce_PT_1_09.wav"]},"duration":1842.68124,"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/154887/file/284061/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284061/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/061/original/Bagley_Bruce_PT_1_09.wav?1754504522","type":"Audio","format":"audio/wav","duration":1842.68124,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284061","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284061/transcript/82290","type":"AnnotationPage","label":{"en":["Dr. Bruce Bagley interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284061/transcript/82290/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"You and I kind of grew up together and have not necessarily parallel pasts but contemporaneous pasts right along in so many different things. \n\nI still remember going to a meeting where you and Ross Black and whoever else was right there. But I wanted to break into the leader of the National Conference of Family Practice Residents. And I was like this new kid on the block and a year or two behind you and I had to sort of prove myself that I belonged. And then when you gave me the pleasure of doing the Resident Viewpoint column of Family Practice News, recommending me for that, that was really kind of a special gift. So that was really the start of our relationship. \n\nAnd the reason I brought it up is because in the manual for the interviewer that you sent me, it says don’t insert yourself too much into it. And I invite you to because it will be richer.\n\nThank you. This is Joe Scherger and it’s November 13, 2009 and I have the distinct pleasure of doing the oral history of my close friend Bruce Bagley. And we can’t help but reminisce because Bruce and I have been connected both personally and professionally since 1977 although we’ve lived and worked in different parts of the country through that time. It’s through activities with the Academy we became close. And others thought it was quite odd that I was interviewing Bruce because we ran against each other for President of the American Academy of Family Physician, an election that Bruce, of course, won. And often the person has hard feelings, but there is no way that I would ever have hard feelings. As a matter of fact, I think we both won because the things I got to do after that election were quite extraordinary. But nothing about me.  \n\nBruce, if you notice on the questions it’s basic biographical data. And rather than ask you each one of those first give questions, I’d like you to just go ahead and read off with your full name, present title, where and when you were born, parents’ names and what your family did. So go ahead and give us that as an opening. \n\nI’m Bruce Bagley. My official name is Bruce Allan Bagley. And my current title is Medical Director for Quality Improvement at the American Academy of Family Physicians. I was born on June 1, 1947, ten days before the American Academy of General Practice was formed in Atlantic City, on the tenth of June, 1947, and the same year that the transistor was invented at Bell Labs in Murray Hill which I later lived near. But things are in alignment for a reason. You never know. It’s always easy for me to remember how many years since the Academy, I just look at my age. I was born in Bangor, Maine and delivered by a family physician, Asa Adams was his name. And the word Asa means doctor. He delivered me. And my mom, at the time, had finished her nursing training and was already working as a nurse at the hospital where I was delivered. I don’t remember that - what I was told. Many, many years later I was building a home in Orono, which is where my dad still lives in the same home, and hit my thumb with a hammer. And Asa Adams drilled a hole in my thumbnail with his little jeweler’s drill. So I got to meet him as an adult myself. My dad was George Francis Bagley and my mom was Pauline Frances Bagley, maiden Cowen. Both of their parents lived in the Orono area. They met in high school. Both went to the University of Maine - my dad to be an electrical engineer and my mom to go to nursing school. And, obviously, it was 1947, the wind down of the war, if you will. And my dad, although he was in the Army, he spent most of his time in occupation forces type work, not so much in active battle. But he was in the Signal Corps. Since he was an electrical engineer, he did some management training and some training in the Army to do Signal Corps work. So I only lived in Maine for a few months. I moved out before I picked up the accent. And my dad moved to New Jersey with a family to take a job for the New Jersey Bell Telephone Company at the time. So most of my growing up years were in New Jersey. Certainly the part I remember was in New Jersey but it started out in Maine.  \n\nTell us about your immediate family, your siblings and that growing up. And then I’m going to have you move into your marriage with Anne and talk about the family you have created. \n\nMy dad’s whole family were potato farmers in northern Maine. And my mom’s father was the Assistant Postmaster in Orono, Maine for years and years and years. You know, the assistant is the one that does the work. The Postmaster is the political appointee. So he was kind of the nuts and bolts of the Orono Post Office for years. But as far as remembering my childhood, my first memories are living in Rutherford, New Jersey, right outside of Newark. And I can remember walking down the street with my dad to buy our first car. We didn’t have a car, so we had to walk to the dealership to get it. I can remember going in that car to pick up my brother, Dave, at the hospital when he was born. My older brother George was three years older. My younger brother Dave was four years younger. So I was old enough to remember the trip, let’s put it that way. But pretty soon we moved a little further out in the suburbs, out to Berkeley Heights, New Jersey which is right next to the Bell Telephone Labs in Murray Hill. That’s why I mentioned it before.  It seems like when I go back now, I can’t believe that it was as rural as I remember. It was rural at the time. It’s only nineteen miles from New York City where my dad would com-mute either to Newark or New York for his work. But it seemed like a world away from the big city, that’s for sure.  \n\nAnne has played almost as big a role in family medicine as you have, as you know, mostly behind the scenes. Let’s move this forward into medical school role, in a residency, meeting Anne, the creation of you as a family physician. \n\nAnne and I met in high school, so it’s going to have to start earlier. One of my best friends growing up and one of my Boy Scout buddies had moved to the next town. I was just finishing my junior year in high school and I bought a motorcycle, a Harley Davidson, a big 74 cubic inch, that’s 1250 ccs for today’s folks. He came over to see my motorcycle and his girlfriend was along with him and that was Anne. She wanted to go for a ride on my motorcycle, so she got on the back and he followed in the car behind. And after that meeting, a casual meeting, she said Ray, if we ever break up would you call Bruce and let him know. So six months later I get the call. So we got together and liked each other and have been together ever since. So we actually didn’t get married until our first year of medical school.\n\nTell us about college. \n\nI went off to RPI, Rensselaer Polytechnic Institute, to be an aeronautical engineer.  \n\nAnd that’s in the Albany area?  \n\nIt’s in Troy, but the Albany area, yes. My dad was an electrical engineer. I loved gadgets and mechanical stuff. I even had a job in high school working in a machine shop and I did lathe work and welding and torch cutting and painting. It was a job shop, so we were doing something different everyday. So I learned a lot about machines from a practical standpoint. So when it came time to get to college and do basically what amounts to mechanical engineering first couple of years, I was way ahead of everybody else in terms of the practical knowledge. And I still remember one course called mechanics, which is sort of applied physics, if you will. And everybody was struggling with that and I just thought that was the easiest stuff there was. That’s how stuff works, you know. So I was proud of that. The other thing about high school, I went to a Catholic boys prep school. It was actually a boarding school but I was a day student. And my mom wanted me to go there because my older brother had not done very well in high school and she didn’t want me to be painted with the same brush, so she wanted me to go somewhere else besides the school where he went. And it turned out to be a good education but an abnormal socialization. But I was astute enough to realize that and made sure I got my socialization elsewhere. But I can remember a couple of interesting things from high school. In my senior year I got put in this special advanced English class. And I told them I didn’t belong there. Some test I took said I belonged there but the other people in the class were just way ahead of me and I couldn’t write; I could hardly read. And Father Gerard said don’t worry Bruce, when you have something to say you’ll be able to write just fine. Had a lot of previous conversation about the Resident’s column, eventually it will work. And the other person I remember is Father Cletus who was my calculus and physics teacher. He always made it much more interesting by adding the history about the people who thought up all this stuff. So a lot of early formation about my education.\n\nWhere were the origins of your history in medicine and what led you to medical school? \n\nThat’s interesting. My mom was a nurse and just a wonderful, caring person and I’m sure that’s where it comes from. But I think that I always had considered medicine but I had kind of put it out of my mind because I didn’t want to spend that much time in school. I wanted to get on with life and not do all this schooling stuff. And I got to RPI and it was a very stimulating environ-ment. Wonderful, stimulating teachers who didn’t spoon feed you but made you think. And I really enjoyed that and said this education stuff isn’t so bad, maybe I don’t mind spending a little more time at it. So when I was a sophomore I said to myself I could do this engineering thing and learn everything there is about engineering and then it would be boring. But maybe if I switched over to people, that it would continue to be interesting for me. And I think that has played out very nicely. It continued to be interesting for me and it continues to be interesting for me. So I have no idea whether I would have ever learned all there was to know about aeronaut-ical engineering. I doubt it. But that was sort of the thought process I went through. So I switched to biology because I thought that would improve my chances of getting into medical school. They let me use a mechanical drawing as my foreign language requirement. I thought that was kind of cute. And I took Biology II before I took Biology I. They didn’t want me to do that but I said don’t worry - and I got As in both because I was interested and excited about it and had a good teacher. And I remember taking molecular biology and studying about this brand new stuff about the double helix and Watson and Crick’s work back at a time when nobody knew anything about that stuff. Now grade school kids can tell you about that. So I had a good, solid education.\n\nDid you have a straight through path from high school to college to medical school? \n\nI did absolutely. I did it the old way. Now I did go to school at both RPI and in Albany Med with people that run the six-year program – two years at RPI and four years at Albany Med. So I knew them on both ends. So that was an interesting perspective there. The people that survived that program were the mature ones. They were all smart. But the ones that could buckle down and do the work year after year are the ones that did better.  \n\nSo Albany Medical School was your medical school? \n\nYes. I applied to six schools, got into one, thank God. I think I got in by the skin of my teeth because I had really great math and science on the MCAT but my English and general know-ledge side was mediocre at best. So I’m glad that they saw the potential.\n\nAnd tell us now about in medical school, what led to the decision to go into family medicine. \n\nI kind of went into medical school like we think a lot of people do. I wanted to just be a regular doctor that went out and took care of the folks. And as I moved ahead and looked around for people to follow, if you will, there were none. There were no role models for family medicine where I was. And that’s still happening today, of course. But it was acutely obvious back then. And I actually spent after the first year of medical school a summer fellowship with Paul Patterson, a pediatrician doing cystic fibrosis. And I did some research on gil (?) cilia and rapid tracheas cilia which were the models they were using for the trachocilear elevator in the lungs for kids with cystic fibrosis to see if anything that we put on there would make it better or worse. And the second summer after my second year I did a fellowship in the neonatal intensive care unit with Martin Greenberg, just a very dynamic guy. So there was nobody else to latch onto. And as I got farther along in medical school, I really enjoyed everything I was doing. It was sort of like I didn’t want to give up anything more so then I wanted to specialize. I said if I do this, I won’t get to do that. And if I do that, I won’t get to do this. So I think that’s really the thing that attracted me. And you know there are only two people in the entire medical school that encour-aged me. One was Paul Patterson because he’s a big enough guy to understand that he should encourage me to do whatever I wanted to do and I thank him for that. And the other was Alex Fruen (?). She was an internist trained at Johns Hopkins, interestingly enough, and always a family doctor at heart. And at the time, she was Dean of Students and she encouraged me, wrote me letters of recommendation for residency and stuff like that and later became the first Chair of Department of Family Medicine when it was finally created at Albany. So I had come and gone long before that. But I do remember starting up the Family Practice Club, we called it back then, and now called Family Medicine Interest Group. And the advisor was a fellow named Dick Heinig from the Latham Medical Group. It was just when the third-year clerkships were coming in. I believe it was that long ago. And I spent my third-year clerkship, I think for a month or so, out in his office a couple of days a week. And the reason I chose his office is because it was right next to the place where Anne worked and we didn’t need separate rides, we only had one car. So it worked out well and I later joined that practice, having seen what they were doing.\n\nI was curious when your leadership activities began because you spent your whole career as a leader in family medicine and I was waiting to ask you for that. But it sounds like in medical school your origins of leadership in family medicine was to start the Family Medicine Club. Any other things about your career up to the end of medical school that would have prefigured your leadership work? \n\nI think it goes way back. I was active in Boy Scouts. I never actually got Eagle Scout but I was Assistant Scout Master. Had a lot of good leadership training, good models there for leadership. So that’s where it comes from. I can remember the day I became an adult. It was on a Boy Scout trip. We were on a bus and I was the boy leader and there was an adult leader as well. Up until that point every time somebody else puked in the same room, I would puke too. That’s just the way it was. So now I’m in charge of all these younger kids. And we’re on this bus and the kid next to me pukes. I’m the leader, I’m not allowed to puke. And I helped clean up that mess and get him straightened out. And I think that was the time I realized I went from myself to others.\n\nNow you entered family practice, as we called the specialty then, at its very origin. As I recall, you may have been in the founding class of the new family practice residency. You were choosing to enter right at the time. So tell us about what that was like, where you went. And I believe you were in that first class or whatever. But give us the story of being one of the original three-year family practice residents. \n\nI had been active as a student with the New York State Academy of Family Physicians and I had met Tom Wolff through that association. And I heard that there was this residency in Syracuse where one of the people that was coming back to the practice I was interested in was already there. Denis Chagnon was there. And there Frank Klee was their founding residency director. He was an internist but started this family practice residency. He had just died, I never met him but he was the founder. And to replace him, Tom Wolff was going to come on as the new residency program director. But he wasn’t there yet, he was still in the Army. So he was serving as Assis-tant Surgeon of the Army building residency programs in the Army. And I went to Washington to interview with him at his office in Washington, DC before I decided to accept the residency slot at Syracuse. Back then, as you allude to, there were only twelve or fourteen family practice residencies. A couple of very strong ones, one in Rochester, one in Syracuse. Interviewed down in Baltimore and a couple of other places but there just weren’t a lot of choices, especially for strong residencies. So I did get in kind of on the ground floor. So going out to Syracuse, the fall of 1974, our chief resident, Warren Escabalas, and one of our faculty members, it may have been John Desmond, had been out to the national meeting in Denver. And they came back and said the Academy wants to start a residency chapter or a residency organization, is anyone interested. So here I am three months into my residency and I raised my hand, sign me up. And I ended up going out to a meeting in Kansas City at the Breech Training Academy which is the place where Trans World Airlines or TWA would train their flight attendants, at that time called steward-esses. So we met there and that was the first meeting of the National Conference of Family Practice Residents. And our mutual friend, Alan David, was elected to be the first Chair to get things started and I was actually the second Chair.  \n\nWas that 1974 or ’75?   \n\nExactly. So I was Chair in ‘76, I guess. So it was ‘76 when the Congress of Delegates first seated residents. And Ross Black and I were the first two resident delegates seated at the Congress of Delegates in ‘75.  \n\nThat’s right, because I came after you in ’76 as one of those delegates.   \n\nAnd the next meeting was in Boston in ‘76 to commemorate the 200 year anniversary or whatever.  \n\nYou just raised your hand, got invited to go to Kansas City and the rest is history?\n\nRight, nobody else was interested.\n\nWhen you got to Kansas City and, of course, family medicine was such a new specialty then. You came out of the ‘60s generation, counterculture, don’t trust anybody over 35. Describe what it was like around that table that you were part of. What were the goals? What were you trying to accomplish back then? \n\nFirst of all, a couple of the players. Tom Stern was the person that was in charge of the project. And a couple of young guys that you may recognize, Dan Ostergaard and Bob Graham, both were newbie employees of the Academy. And they were put on the task of helping get this residence (?) started. So had a chance to work with them. But I really think it was about identity. You know, what are we really all about? I never considered myself a counterculture person. It was really about who we are and what do we offer and how do we do things differently than other folks and what’s important about what we do. I think those are the things in terms of where does family medicine really fit in the bigger scheme of things.\n\nAnd you did find the Academy completely welcoming, the leadership of the Academy, at the time? \n\nAbsolutely 100%.  \n\nSo it was quite a welcoming situation with Tom Stern? \n\nAnd the current President was Jim Price and Jim Price just died two or three weeks ago. I went to his service. But he was so welcoming and so encouraging and gave us extra attention and made sure we were at the right place at the right time. He just took us under his wing. And here’s the guy who was the President of the whole deal. So that was pretty special.\n\nSo here you are as a resident. You raise your hand and pretty soon you’re a delegate to the American Academy of Family Physicians. And then next year you’re elected the head of this National Conference of Family Practice Residents even before there was a medical student meeting. The residents came first. And had that national leadership role and you became a columnist. Tell us about becoming a columnist for Family Practice News.  \n\nI think it’s important to realize that there were so few residents active nationally that the leaders of that group got appointed to everything. We were on the Residents Student Affairs Committee. You and I both served actually on the RAP Project Board which is the committee that established the Residency Assistance Program which has run for so many years. And got to know all the luminaries in family medicine. So that was cool. I knew Nick Pisacano and Lynn Carmichael and Hiram Curry and just a whole long list of the people who kind of started this whole deal. But because of that, when the editor for Family Practice News was looking for a resident to write a column, obviously he was paying attention to who was the leader, so I was asked to do that. It was a monthly column. First I had to write them all myself, but that got to be a bit of a burden. So I invited a couple of guest authors and you were one of them. And I noticed that you could write pretty well. So when my year was up, we were looking for someone to take over because at that point I wouldn’t be a resident anymore and would lose my credibility. So that’s when I asked you to take over and write the columns.  \n\nI’m very grateful. So in many ways, Bruce, you were one of a core group of leaders, and if not maybe the most visible leader with your chairperson, of this second generation of family medicine leaders with being able to be witness and have close personal relationships with the whole founding generation of our specialty. \n\nAnd also work side-by-side with people who actually became the future leaders. I didn’t actually know this story. But when Bill Coleman was running for President he told me the story of his election as the third Chair of the residency group. And he was running against Gene Dayton who became the Chair right after Bill. But it was an absolute tie and we had to vote again, so we did. And I hadn’t voted, because I was the Chair, so I had to cast my one vote for Bill. And he said you’re the reason I’m here as President.  \n\nWho were your favorite mentors as you were starting your career and you were in this leadership role, had knowledge of the whole first generation there? Who were the key people that molded you into who you have become? \n\nRather than focus this on a single one, I really had great admiration for the leaders of the specialty. It was sort of like I hoped someday, in some way, to be worthy with them, to be considered with them. Not that I coveted the position but I hoped to be able to live up to that kind of leadership. So I would watch. I went to virtually every national meeting Congress of Delegates since then. I think I missed two over the years for various reasons. And I would always look to the leadership and the current President and watch what they were doing and say someday I may be worthy to do that.  \n\nWell, you’ve clearly done that. Now let’s talk about your transition to practice and life at the Latham Medical Group which actually you’ve had a history with back in your Albany Medical School days. \n\nIt started out with a third-year clerkship going to this practice because it was close to where Anne was working, Allstate Insurance. And I met Fred Leary there and Fred’s brother-in-law was Denis Chagnon. He said I understand you’re going off to Syracuse. If you’re out there, look up my brother-in-law, Denis Chagnon, he’ll take care of you. So we went out and interviewed and spent some time with Denis and Brita and interviewed the other people in the residency program. Denis was one year ahead of me in residency and he was my chief resident when I was a second year and third year. So we knew each other. And certainly when it came time to go back looking for a practice, I already knew the area and the practice and the people. And it seemed like the right thing to do and they wanted me to come.  \n\nAnd describe the Latham Medical Group, the size it was when you started and how long were you there and when you left. And then I’m going to have you talk about some phases of your practice career there.   \n\nWhen I started there were four docs there. And one of them was a resident that Denis had trained with, so the two of them went out together. So he left after one year and I came on. So it was a four physician group and remained that way. That’s the smallest it ever was and over the years grew to as many as ten physicians, almost seventy employees in various roles. But back then I joined a group because of considerations for lifestyle and family time and vacation. And these folks were clearly of like mind that they didn’t mind working their one night a week and one weekend a month but the rest of the time they liked to be off, and I could appreciate the impor-tance of that. And throughout my career I’ve always had a call schedule that was at least that good or better and always had six weeks’ vacation. Now the ironic thing is I used a lot of my vacation for Academy activities over the years. But it was nice to have that time.  \n\nI still remember because you and I, with me being in practice in northern California and you being in practice in Latham, New York, in the Albany area, we always shared notes. Our wives became close friends. But I always loved hearing about your home and some of the adventures of your home. So talk about your home and your family, the children. What was the Bruce Bagley family and home life during those years? \n\nFirst of all, our first son Brendan was born during medical school. I had a weekend off between third and fourth year and he was born on that weekend (you know how that works). And Austin was born during our second year of residency and Shannon was born one year after I started practice. So they’re all intertwined there. And we moved into our house in Albany. It was the first house we ever owned and it was the only house we owned until we moved out here. So we spent 28 years in the same house. And we raised all of our kids there. And we had a center hall colonial, it was the first house of its type on an older street but then later became quite a large neighborhood of similar homes. But I like to build things and we ended up building a fairly large great room on the back of that and we put in a pool and over the years kept expanding the com-pound, if you will. But never felt that we needed to move anywhere else. We really enjoyed that. So it was the center of all the Bagley activity. I’m married to an adventurer. Anne likes adven-ture and I do, too. But we’ve had lots of adventures. We like to camp. We would go every summer out to Cape Cod and had camped there for one or two or occasionally three weeks. And enjoy the beach and cook and camp and stop on the way back from the beach and buy some fish and cook it up and have a great time. So we like doing that. I had actually learned how to fly during residency. I won the Mead-Johnson Award back there, called the Bristol-Meyers Squibb Award [now]. And it was $100 a month for twelve months. Anne said that’s found money, do what you want with it. And I took it to the airport and learned how to fly. So later on when I was in practice I was able to join with another fellow and buy an airplane. So we actually owned an airplane for seven or eight years and flew all over the country. It was like the family station wagon. So we would travel mostly to Academy meetings, so it would be deductible. We saw the country from 7,000 or 8,000 feet, not from 35,000 feet. Like to do canoeing and camping trips and skiing trips and sailboat trips. So we do all that kind of stuff.  \n\nThere were a few times I was given a hard time because I wasn’t the handyman that you were. That’s very impressive. During your 28 years of practice at the Latham Medical Group, and that would date from the late ‘70s to all the way into this decade. So you really were there all through the ‘80s and the ‘90s?\n\nRight.  \n\nSo consequently, you became a leader of your group through different phases. And the things that I want to hear you talk about is your leadership in managed care because in the ‘90s when this sort of managed health care came along, you, I thought, did really amazing things of how to make your group successful in managed care and dialogue with the insurance companies and became a model for how a private practice can succeed in managed care. Talk about that. \n\nI think our practice was always pretty well-managed right from the start. I stepped into it and learned a lot from the people who were there before me. I can remember from day one, we would look at the numbers once a month. We would look at our budget, we would look at our income, our expenses, our overtime. Actually, I learned management in the practice because I had good people doing that before and we had a good accountant and good advisors and stuff like that. So I think I picked up a lot of that along the way. So it wasn’t that I had to transform the place into a well-managed machine. I think it already was a well-managed machine. But with that substrate, when I did become managing partner, and that’s sort of the guy that’s in charge but gets no extra money and no less clinical responsibility, I did that for about the last ten years that I was there. And my goal was to try to make us an agile organization, continue the strong financial and personnel management that we had but then prepare us for changing times. So way back before it was popular I would get the quality expert from the hospital to come out and talk to us about fishbone diagrams and Pareto charts and the Shewhart cycle and quality improvement and stuff like that to sort of train the people that were in the practice so that eventually they would be able to do some of this stuff if we would give them time and the capability to do it. So we spent a fair amount of time doing kind of development work, not even knowing for sure where it was going. So I think it’s because of that kind of organizational readiness that we did better than most. But it also was about that time when I started to be more active in the Academy. Was on the national scene more than most people. So although my partners complained about my travel schedule, I always kept up my call responsibilities, my weekend responsibilities. But they still complained that I was always gone. But I think our group was constantly about two years ahead of the com-munity in electronic medical records, service quality, customer service, availability, all that stuff. And when the managed care organizations began to pop up in the late ‘80s, early ‘90s, we al-ready had relationships with the insurance companies. So we actually went out at one point when we were still primarily fee-for-service and tried to do all this HMO type stuff and begged three or four of the insurance companies to capitate us because we were going under. And the increasing expectations and decreasing reimbursement...You wrote an article called “The Window of Hell” or something like that?  \n\nYes.  \n\nWell, we went through that. We went to them and said we’ll show you our books, we’re going broke. We’re not hiding any money. The way this is working, we’re going broke. And we negotiated some pretty large capitated contracts on a handshake and got them started and did very well with those. And each time we would define what our downside risk might be, so it was different with each company. But we were not taking a lot of risk as far as I was concerned because we always had an agreed-upon downside risk. But we usually had a risk corridor as well and we, for the most part, did perfectly fine with that.\n\nThe ‘90s was quite a decade for you and not only these changes in your practice, getting your practice through the window of hell into success with capitated managed care, but you got on the Board and became President of AAFP. \n\nBefore that though I was on the founding board of a physician-sponsored HMO and I was president of the maternity hospital. I was kind of out in the community learning about this stuff when so many other docs were just back slugging away and not looking at the bigger picture. So I think there was a lot of better understanding of what needed to happen to make it work.  \n\nAnd you served, I’m sure, on a number of commissions of the Academy during that time? \n\nI did.   \n\nHealth Care Services particularly. And, of course, Legislation. All of that leading up to becoming a delegate.\n\nAlso, I had a couple of interesting roles when I served as the Chair of the OB Task Force. You were on that, too.  \n\nWe were delivering babies throughout that time.\n\nThat’s right. And it was the committee that did two really important things. First of all, we got the RRC, the Residency Review Committee, to agree that there ought to be a rule that every program have faculty that delivered babies. But boy, there was a lot of weeping and gnashing of teeth over that.  \n\nI think Bill Rodney is the one who… \n\nThat made a big difference. And the other was to encourage the Academy to bring the ALSO [Advanced Life Support for Obstetrics] course in-house. And look what that has become not only in this country but worldwide. So I was very proud of that committee.  \n\nYou were clearly one of those people that kept the role of maternity care alive in our specialty. \n\nI used to be a card carrying ALSO instructor but no longer.\n\nThose were important days because the family doctor delivering babies became an endangered species starting in the late ‘80s and through the ‘90s. And you were very much a part of the Academy starting an annual meeting in Family-Centered Maternity Care. That whole OB Task Force did groundbreaking work to give a whole new generation life. \n\nI delivered babies throughout my career. And I had a wonderful role model, my partner, Howard Westney, was a family doc and his wife was the chief obstetrician and the owner of a proprietary 40-bed hospital, Bellevue Hospital, where we delivered all of our babies.  \n\nThe other Bellevue. \n\nThe other Bellevue. So we never had any trouble with privileging or backup or any of that kind of stuff because my partner was head of the credentials committee and his wife was the owner of the hospital. Although she was a tough taskmaster, she was a good doctor and made everybody else be good as well. So that was a wonderful environment in which to be able to deliver babies. I wouldn’t have been able to continue to do that without that kind of environment.  And I didn’t do C-sections, of course.\n\nAny other things you want to talk about before embarking on the major Academy leadership? \n\nOne other thing and that is that I chaired a couple of other committees that I think were central. One was the Hospitalist Committee where when Bob Wachter published his article on what are we going to do about that stuff, so we pulled together some people and came up with some criteria, if this thing is going to go forward, it’s going to have to work in this way or it will be problematic. And the No. 1 thing that we produced was a series of requirements for good communication between the hospitalist and the community physician. That it needed to be a partnership on the way in the door and on the way out the door or it wouldn’t work well. And look what’s happened right now. That has fallen down. So that was an important step that we made. And I was actually on the advisory board when the Society for Hospital Medicine started up (I think it was called something else then).  \n\nAnd was that even in the ‘90s? \n\nThat was in the ‘90s, yes.  \n\nFascinating. Boy, time flies.   \n\nYes. And the other one was I was chair of the Task Force on Electronic Medical Records a long time ago. Long before I had electronic medical records. But we were looking at this early on (this was 15 years ago) and what are we going to do and how can we make sure that it gets done right and how can we give our members advice about which ones to buy? I mean all the questions we’re asking right now. So that was a long time ago. But it really was kind of a segue into the leadership with the Academy. And if there were two flags that I was carrying throughout my time of leadership, one was electronic medical records and the other was quality improve-ment.\n\nSo some of those activities I’m sure you did as a Board member because you chaired some of those committees and commissions. Let’s talk about that three-year period where your life really converted into Academy leadership to a high degree: the President-Elect, the President, and the Board Chair. I think that Past President Board Chair came later, didn’t it?\n\nIt came before.  \n\nLet’s talk about that time.\n\nIt was 1995 when for the first time in many years only three people were running for the Board: Joe Scherger and Ron Christensen and Bruce Bagley. Three people running for three slots. So that made the political part of it less painful but fortunately we all got elected and it did set the stage for a lot of the other things. Back then Board members were chairs of commissions, so we would rotate around. And the most senior Board members would get their first choice and then it would trickle down, if you will, to whatever commissions were left. So in my first year I chaired the Commission on Public Health. And one of the things we saw there is that we had so many activities going on and so many different things that it was really hard to keep track of it. And I sat down with the staff and said how are we going to keep all this on track. And we came up with this grid that they still use today, keep everything so nothing falls through the cracks. To sort of organize the work, it just seemed to me the natural thing to do. I hadn’t used that technique before but we can’t do this work without having it organized, is what I saw. And it turned out to be very helpful to the staff and later commission members to do that. The second year I was Chair of the Commission on Quality and Scope of Practice. So that was really the nuts and bolts. At that time we talked a lot more about scope of practice and credentialing issues and a little tiny bit about quality. So that was a good opportunity for me to find out more and kind of drag it in the direction of quality improvement rather than so much emphasis on just credentials and scope of practice. So that was an important time as well. And the third year is when I was Chair of the Commission on Health Care Services which, of course, deals with payment issues and insurance and stuff like that.\n\nIt’s fascinating, I didn’t make the connection but you’re working in quality improvement full-time right now and have been for a few years. We’ll talk about that later. But your interest in quality improvement goes back 20 years with your medical group being a real early thinker there and then helping get this in the front part of the agenda of AAFP. \n\nYes. And I think it was a natural thing. Way back I sat down at breakfast with Bob Graham and I said am I pushing this in a way that’s not going to be helpful for the Academy? Because I clearly was talking about quality when nobody else seemed to be interested. Let’s put it that way. I said before I push this harder as I go up through the chairs, is this the right thing to do? He said this is the right thing to do. So good advice. Electronic medical records, that interestingly enough, even before I came to the Academy full-time spawned the Center for Health Information Technology. We just did a survey not too long ago about active members of the Academy and electronic medical records. And 53% of our active members reported that they use some kind of electronic medical records. Now who knows exactly what they can do and how much they’re using. But there are that many engaged. And when I listen on a national scene about what other numbers are, they’re in the teens and low twenties of other physician groups or physicians in general. So I believe the only reason that survey came out so well is because we started fifteen years ago.  \n\nProgressive Bruce Bagley. You’ve always been progressive, all along, and really moving family medicine along the important, historical flow of the times. \n\nNot intentionally. It just seemed like the right thing to do.  \n\nYeah, I think sometimes the best leadership is not so much the way the politicians do it, sort of intentional by design. But you’ve always struck me as a very mission-driven person and based on the important missions of the moment. \n\nWell, I believe in family medicine. Always have. And I believe in using information technology. My leadership roles have been vehicles to promote those missions, if you will. And it wasn’t that I got to be a leader and then did that stuff. I think I got to be a leader because I did that stuff.\n\nLet’s talk about your leadership years as the President, President-Elect of the Academy at that time and what happened then. And then we’ll gather thoughts for the last ten years plus. \n\nAfter three years on the Board, you and I had actually agreed not to run against each other. But the timing of the politics apparently took precedence.  \n\nIn our state Academy agenda. .  \n\nExactly right. So you’re not always making your own decisions, let’s put it that way. And we ended up running against each other in 1998. And we both knew it would be tough but we both believed in each other and both, I think, felt that whoever won, that the Academy do fine and there would be other things for the other one to do. And I believed that and I think you believed that and we actually talked about it.  \n\nNo question.   \n\nAnd Anne and I spent as much time or more time talking about what we would do if we didn’t make it than we did talking about what we would do if we did make it. We figured that would take care of itself. So we were ready for either eventuality. Either all of a sudden you’ve got a lot more time on your schedule that you can do something else creative with or your time is pretty well spoken for. So we were very okay with either result and I had the sense that you were as well.  \n\nI think the best man for the position won. And I felt that from the very beginning.\n\nI appreciate that. But that’s [    ] of history a useless game, you know. But who knows? You’ve done well at whatever you’ve done, so I’m sure you would have done well at this, too. So I was elected and although it was a very exhilarating moment it was also a heavy responsibility that I knew I was pretty ready for because I had purposely...I mean the reason I had wanted to be Chair of three different commissions was because I would be able to learn more about everything that was going on in the Academy. I did it very purposefully. And had gotten to know so many staff and people who were doing the work, so when I became President and Board Chair, if somebody asked me a question I could give them a name to talk to about that particular thing because I had worked with so many people on the staff. So it really was something that I enjoyed and I think I managed it pretty well. Speaking of management, and we talked a little bit about management back in the practice and I think there is an important thing about management. That is because I was managing partner of my group and I had full clinical responsibility just like everybody else, I had the same number of patient hours. As a matter of fact, I was kind of their No. 2 economic producer in the practice...and at first I got no money for being managing partner. It was just do it on your own time, have a good time, it just shouldn’t cost us anything. You know, that kind of thing. And because of that kind of environment, I had a very small manager group. Somebody would help with the nurses, then somebody with the office management. And probably three people altogether. And I just learned that if they were going to come up to me with a problem, I told them that they had to have a couple of solutions or I wouldn’t meet with them. It was usually a very brief meeting. It wasn’t a schedule meeting. We would often meet in the hall or around lunchtime or at the end of the day and they would present the problem and their potential solu-tions and I would refuse to tell them what to do. I would never tell them what to do unless they just weren’t getting it. And I would give them advice about the options. So when I began to travel as much as I did for the Academy, I was still managing partner, sort of absent. And this is back before there was a lot of email. This was more voicemail days. And I would be on the road and check my voicemail a couple of times a day and they would leave me just a little report about what happened and I would listen to all of those. And they would never call me up and ask me what to do because I wouldn’t tell them anyway. But they would leave me a report of what went on. So I would get back to the office and somebody would come up to me and say did you know that so-and-so and so-and-so and I would say yeah, I heard all about that, I understand it was handled great. It worked great for me and it worked great for them because they were learn-ing how to make their own decisions. So I carried that on throughout, that I was able to do a lot more because I didn’t have everybody coming to me to see if it was okay.  \n\nVery important stuff, a way of working.   \n\nLet’s go back. Who was the President at the time you were President-Elect? \n\nLanny Copeland.  \n\nOf course, his picture is right below yours downstairs. \n\nAnd Neil Brooks right before him. So we were the three amigos and spent a lot of time on the road together. So Neil and Lanny were great role models. And I can remember actually before I got elected I would watch what was going on and say well, here’s the President-Elect doing this or that thing or speaking at this or that event. I better write that down because if I get elected that’s going to be one of my responsibilities and I don’t want it to sneak up on me not having given it some thought. So that worked well for me and I continued that. So when I was President-Elect I would keep a real sharp eye on what the President was doing and what seemed to work well for him and what didn’t work so well for him and try to learn from watching the wind in his sails, which way the wind was going.  \n\nBruce, we’re going to pick up with your years as President-Elect and President and what that did for your life. \n\nLet’s go back to election time. It’s worth talking about how you get elected. I think that’s some-thing that you and I could probably chat about. I didn’t have any kind of big political machine or anything but I had a good partner. Anne has always been my best political ally sort of as an advisor about what’s the right thing to do. I would have to explain the situation but she would tell me the right thing to do when I was wondering what the right thing to do would be. And always my best critic in terms of how the things that I said sounded and what my emphasis was and stuff like that. So always my buddy. I have always been blessed by having things pretty okay at home. I think for somebody to go out and be creative and do as much stuff as I’m sure we both have done over the years, I’ve always said you have to have your ducks in order at home. You can’t take on all this stuff when you’re worried about what’s happening with the kids or the homefront. So Anne has been kind of that solid rock to make sure everything is running well. She writes all the checks and she manages the home and the family and does it with aplomb. The cool thing was that she loved this stuff as much as I did. We would go to a room of people that we may or may not know and we wouldn’t feel obligated to stand side-by-side the whole time. We would work the room separately, so-to-speak, and come back and compare notes and tell what we’d learned and kind of get a much better idea of what was going on at a particular event or issue or whatever than we would have had if either one of us did it alone. So it was always a team. And when we did get elected, when you were standing in the back of the room and I was standing in the front of the room and I couldn’t start my talk, I made her come up to the front with me. And she said take a deep breath, you’ll be okay. So she’s been a good partner. Moving on to the President-Elect year. The President-Elect year is supposed to be kind of training ground but there’s a lot of responsibilities that are put on the President-Elect. You have to get prepared. There are speaking engagements, there is chairing Strategic Planning which I thought was a very important part of that. Chairing some other task forces or study groups and things like that. So it’s a busy time and you’re constantly studying what’s happening ahead of you and you’re in the information stream in a way that you wouldn’t normally be, so you’re dealing with the day-to-day issues. So that’s really a learning time and a time when you come to the realization that you really are going to have to be the front person pretty soon and you’d better get ready and know what’s going on and be prepared. So I was excited about it. I got ready, so-to-speak. The President-Elect is sort of the commitment time and you’re obviously on the Board and have these other responsibilities.But really, it is to gain in knowledge and confidence and poise to be able to do the President job well. And I think that’s probably what I spent my time at, making sure that I knew the issues.  Not so much driving the issues at that point but just being confident and com-petent, I think is the task, if you will. So when it comes time to be the front person for the organi-zation, you’re well-versed in what are the right things to say. Not that anybody knows all the policy chapter and verse but at least you have to know enough about it so that when you’re challenged or somebody talks about something, you have to know where we stand to be able to speak for the organization. The other thing, and I’m not sure how much I had to do with it, but we got together, Neil, Lanny and I, and after me Rich Roberts, and said we can’t have a single person picking up an issue and then that’s their issue for a year and then they’re out and it’s no longer a frontline issue. That’s not good for the organization. And that the commitment starting the day you get elected is to carry the flags that are important for the Academy as well as you can carry them and not have your own little pet project that becomes the No. 1 priority of the Academy. We had seen that in other organizations but all recognized that it wasn’t terribly effective for the organization. So we all agreed on that and I think we all did it. And I think now it’s really become the expectation that you won’t have your year in the sun to sell something that the Academy might not have as a top priority. So that started back at around that time, in my estimation. Other things about President-Elect?  \n\nJust describe what toll it takes on the rest of your professional life, the famous number of days in a year. \n\nThat’s good because just being on the Board, I seem to remember it was roughly 80 days’ worth of commitment and travel. Basically away from home 80 days for a Board year. And my third year on the Board I was on the Executive Committee, so that meant you’re going to the AMA meeting. So that’s another couple of weeks. So it bumped up to close to 100 days pretty quickly. I used most of my vacation from practice or I made up days when I got back. All that time I did not have any reduced salary from my partners in terms of my time on the Board alone. When I got elected as President-Elect, we developed a new program and that was that we would take how many days I worked versus how many days they worked and my base salary would be reduced by that percentage. So it did take a lot of time. And just at its peak, if you will, during President year, I think I traveled just a little over 200 days but I worked 60% of what my partners worked in terms of office days and full responsibility for my weekends and night call schedule. So I kept that up. And one of the reasons I kept that up is because at Latham Medical Group we had this agreement that if you had been with the group for 25 years you could opt out of nights and weekends. And anybody that didn’t opt out we sent to the psychiatrist. So I was just about at my 25-year point and I wasn’t going to take a hiatus and go back to it. That would be harder than just toughing it out. So I was probably most of my way through my Board Chair year when I went off of nights and weekends at Latham Medical Group on my 25th year. So I kept up my part of the bargain. But if you do the arithmetic, there aren’t many days left. So I was either on the road or either working. And I thought it was a very interesting phenomenon because when I would be on the road for three, four or five days I would be anxious to get back to the office. And when I would be in the office for five days, I was anxious to get back on the road. And they kind of energized each other. I did far more work at that point in my life, if you will, or more committed, responsible time than ever before or ever since. But I didn’t feel like it was a burden. It was so energizing and there was so much going on and it made me be really disciplined back at the office. I would never leave my desk except clean and then I would be off to the airport in the late afternoon and all that stuff. Never have a chart undictated or any of that kind of stuff. If I had let it pile up, I would have been buried. So it made me be a better doctor back at home as well as somebody who could work well on the road. I always tell people if you don’t learn to work and rest on the road you’ll be dead. I mean it’s got to be okay. And at the time I was exercising a lot. I would be on a treadmill at the hotel at 6:00 in the morning and ready for the 8:00 meeting and all that kind of stuff. It got into my pattern and it worked well for me. So I never felt it was a burden. It was such an exciting opportunity.  \n\nThat’s great. Now Bruce, you became President and had that whole leadership run at the beginning of the internet age. The first web browsers came out in ’95. And you’re a gadget guy and I was always very jealous. So tell us a little about you and the new technology, the new toys and the new tools. \n\nI’m definitely a gadget guy and I get it from my dad. We would attempt to fix almost anything.  \n\nAny stories you want to tell about your use of gadgets to stay connected? \n\nMy ultimate gadget was the airplane. That had more gadgets than anything. That was my best gadget ever. I bought this computer when it was first called a computer. It was the kind of thing that would probably not do much of anything. I can’t even remember. And I had an Apple 2E when they first came out and it was four or five boxes and a [    ] tube, all monochrome green print. And learned spreadsheets using VisiCalc, which people don’t even know what that is anymore. It’s a precursor for Excel and Lotus and all that stuff. So I’ve always been somebody to try to pick up the new stuff. And not so much needing to know exactly how it works but what can it do for me and what I’m trying to accomplish. You know, how can it help me do my work better. So that’s a gadget in that sense of the word. But we were beginning to use electronic media a lot more, the Internet. One of the things I’m most proud of in that regard is my year as Board Chair. And when I started as Board Chair we were basically having four or five meetings a year. And each time you would get this binder that was from three to four inches thick with paper printed on both sides. And it had the tabs and everything. And you’d lug that sucker around and work your way through. And the weekend or two weekends before you’re reading through all that stuff and marking it all up with a pencil and writing notes in the margins. That’s how people kept track of this big agenda. And I said we’ve got to get with the program here. So I took this group, the Board of let’s say 18 or 20 people all told around the table, maybe 24 people who didn’t think they had a problem doing this. So they didn’t even know they had a problem. I said we need to move this onto electronic agenda. And over the year we went from the four-inch binders to a CD-ROM and you stored it all on your laptop and you can call it up three meetings later if you wanted to. And the laptop didn’t weigh any more after you installed the CD-ROM than it did before you put it in. So it just made the information much more available, much more researchable. But there was all this complaint about my eyes are going to go bad reading all this stuff on the screen. But what they really were saying is how am I going to do this marking up my stuff and highlighting and underlining and writing in the margins. And back then you couldn’t do that unless you had the full Adobe program. So we got the budget approval to buy everybody the full Adobe program so they could write the yellow sticky notes on and catalog their stuff and highlight and circle and all that stuff. And that seemed to quell that “I can’t read it all on the screen,” because that’s really what they were saying. So I love John Kotter’s Leading Change. Each step for sustained organizational change. And I absolutely went through every single one of those steps in order to get that to happen in a year’s period of time. It was a study in how you change people’s behavior when they don’t know they have a problem. So I’ve always been a gadget guy.\n\nHelp me with this bridge and you fill in anything you want. But after your leadership years with the Academy, the Institute for Healthcare Improvement in Boston started this idealized design of clinical office practice project, a collaborative where they put the word out for medical practices around the country that wanted to move into the future and in this new age. And most of them were big hospital-sponsored practices and then here’s this Latham Medical Group showing up at the door. And you probably spent a bit of money to have a place at that table. Talk about that. \n\nThat’s a great story because it actually was probably ‘98, ‘99 I would guess. So it was probably when I was President-Elect or thereabouts. And I was paying attention to what was going on in the quality scene and I saw this thing and I said that’s something we should be doing. Not only for our practice itself but something by getting my practice involved, but I would learn more for my work nationally. And at the time IHI was charging $50,000 a year for three years to have the opportunity to participate. And for that $50,000 you could send two office teams from your organization as long as you paid your own travel expenses. I called them up and said we’re just one practice - can we get it for $25,000? And they said well, nobody ever asked us that before but yeah, I guess so. And so then I went back to my practice and I said we’ve got this great opportunity to transform the office and redesign the whole thing. And they said sure, as long as it doesn’t cost us any money. And they were watching the books like a hawk. I couldn’t have slid this anywhere. Everybody watched the books all the time. I couldn’t have co-opted funds from anywhere else. It had to be above board. So we ended up begging, borrowing, stealing money from...We got some grants, we got some from health plans. Nobody paid the whole thing. I don’t think we ever even paid the whole bill, to be honest with you. We probably paid half or three-quarters of it. And I talked to IHI a lot about that and they said don’t worry, you guys are con-tributing, keep going. To their credit they didn’t beat us up too much. But we still had to come up with some travel money. And I wasn’t actually on the team that went from my office. I was busy doing all this Academy stuff. But we got a couple of people really enthused and they used some of their vacation time and some of their CME travel money and stuff like that. So we got it done by hook or crook. I remember applying for the ID project. There was this form you had to fill out. And they said we want to make sure that you don’t have any other big changes going on. We want you to focus on the ID [    ] project. And I said do you think we should tell them we’re installing electronic medical records or not - and we chose not to tell them that. And it was the best thing to ever happen to us because the best time to do your redesign is when you’re getting this new tool. And you can think differently about how you’re going to do your processes because you know you’re going to have the IT support. So it turned out that we were smarter about that than they were. That this was the ideal time to do redesign and to think through all the stuff that the computer could do for us that we couldn’t do without it. So it was a nice synergy. And Chuck Kyla (?) likes telling this story. But we get to the ID [    ] program and I went to a couple of meetings and [    ] takes me aside and says Bruce, all these practices are here from big hospital conglomerates and from big multispecialty groups and they’re going to take it back and spread it to all their clinics. He said you’re just one practice, where are you going to spread it to? I said to all the members of the American Academy of Family Physicians. So I think he didn’t really believe that because their biggest problem was spread. In other words, to get things to happen.  \n\nEven in the original groups.   \n\nYes. And it became pretty obvious that most of the benefit accrued to the people that participated in those rapid cycle redesign meetings and they got stoked up and energized and then they would go back and do great stuff at their own place. But to transmit that energy to others is not quite so easy. So the job of getting some of these same principles out to a much broader group that had far less commitment and financial backing to do this kind of work has really been the challenge, if you will. And for that reason it’s taken a lot longer. But I do think we’re getting there. The Future of Family Medicine project came right on the heels of that, which was really all about office redesign and reshaping the environment in which we work. Not only the payment environ-ment but the day-to-day office work environment. So it really was a natural progression of refin-ing those ideas and how do they apply to family medicine and what kind of things do we need to do with the payment environment to make this work. So it’s kind of being in the right place at the right time. I don’t think that I did all that. I just happened to take advantage of opportunities at the right time.\n\nYou now from your Academy leadership and getting your group involved in that redesign change, talk about the transition then from you at Latham to now going to Kansas City. Talking to you and Anne about that house we never thought you would leave and your whole heritage and traditional Albany, New York area. Tell us about that part of your life. \n\nAfter I finished up my Board Chair year, I went the last Board meeting which, by the way, was right after 9/11. We were in Atlanta for our annual meeting and a lot of people didn’t go because they didn’t want to fly. And it was only about a month later. I remember that last Board meeting was very emotional. You turn in your sky pager and your cell phone. It’s like turning in your gun and your badge on the TV cop show. I’d been doing this for so long that it was just the separa-tion, what am I going to do now? And I was perfectly happy to go back to practice. I love practice. I was the only doc in Albany who whistled on the way to work. They thought I was nuts or on some kind of medicine or something. But I love taking care of patients. So it wasn’t that part. But it became pretty obvious to me when I got back there full-time seeing patients that the opportunity for creativity was not the same as some of the things I had done. And the opportunity for leadership, doing stuff that was pulling others in the direction. So obviously I began to poke around and see what kind of things might be available. And you were involved when I was out looking around, and looked at a couple of Chair jobs and stuff like that, Department Chair jobs. Even though I’ve never been an academic kind of family physician, when you look at what the skillset required for a Chair, my stuff lined up with it a whole lot better than most of the other candidates for the job in the sense of the advocacy, the people skills, the communication skills, the conflict resolution skills, the crisis management skills, the organizational skills, all that stuff - project management leadership. I had that all in spades. And there was no recognition of that, that that was important. Even though it was pretty clear to some people that that’s what the job was. But I didn’t come from there, so I wasn’t going anywhere there. For my own side of it I said there is too much politics and not enough resources. Why would anybody want to do this? That was my perception after talking turkey with some people who were in that job or had been in that job. So I said why would I want to do that? So that became a little less attractive to me.  Al-though I know there are others who thrive in that environment, it wouldn’t be for me. And if I had actually landed one of those, it probably would not have ended well would be my guess. So I’m glad that that didn’t happen. So probably a couple of years later the Academy decided to establish this position of Medical Director for Quality Improvement. And Rosi Sweeney and John Swanson and Doug Henley (and remind me to talk about Doug later) had kind of put together this job description, position description and published it. And I happened to see it (was still reading my mail) and said my God, they wrote this for me. This is my gig. And I don’t think I would have seriously considered leaving if it wasn’t for the right thing, although I might have made a mistake if I had acted too soon. But this seemed like a perfect fit. I knew the organiza-tion. I knew a lot of people involved. I knew Kansas City. Anne and I said moving from Albany where we feel pretty comfy to anywhere else in the country is going to be an adventure. But it would be less of an adventure in Kansas City in the sense that we have some knowledge of the area and like the area and stuff. So even though we’re moving to the Midwest, it had a lot of familiarity. So it made that decision easier. So I applied for the job and I have no idea who else applied or where I stood in the pecking order or whatever. But I was successful and was offered the job. And I worked for nine months half-and-half. So I spent two week’s worth of patient time per month and two week’s worth of Academy time. One of those weeks for Academy was usual-ly going on a meeting or a trip or something like that and the other week I would spend here living at the Sheraton and being here in the office doing some office kind of stuff. And it turned out to be a great idea for a couple of reasons. First of all, the job needed to grow a little bit. In other words, if I had come out here boom, full-time, I would be twiddling my thumbs and wondering what to do next. So having the job grow while I was only part-time was a great thing. I didn’t figure that out ahead of time but it worked great. And the other thing was over my years in practice I had seen a lot of docs come and go and people that had been in our practice for a year and people that had been in our practice for 20 years - and none of them did it well. They felt like they were abandoning their patients. They wanted to disappear in the woodwork. They didn’t want us to send out a letter. They didn’t want to have a party. I didn’t get it. When you have all these relationships with patients. If you’ve been in the same place, the same practice for 28 years, I won’t say that all your patients are your friends but there is some percentage. Let’s say 25% are people you’ve known for years are your friends. You delivered the babies, you’ve watched them grow up, you’ve watched them get married. You’ve cried with them.  \n\nIt’s the hardest professional thing you ever do. I did it after 14 [years] and 28 just doubles it. \n\nSo I had that nine months to tell them exactly what I was doing. Make it clear that I was going to something and not from something. And it gave them time to make those fake appointments where they come to say goodbye and hugs and stuff like that and write some nice notes and stuff before you die - they actually say some nice stuff. And I can remember getting a lot of nice notes. But a couple stuck out in my mind because you would read down through page one, how you saved my life and if I hadn’t come in when I did, if you hadn’t told me what you told me, my life would have taken a different path. And you turn it over - I don’t even know who that was. And you never knew that you touched somebody. Anyway, it was a good thing to kind of do that slowly. Have some time to say goodbye, to kind of sever those relationships properly. And lots of people say do you miss practice. And what that really means is do you miss those relation-ships. And I kind of came to closure on those relationships like you’re supposed to. So I can say I don’t miss practice and people don’t know what I’m talking about. They think that I don’t miss the stress of the office.  \n\nDid you ever doubt whether you were doing the right thing during that transition? \n\nNo, not for a minute.  \n\nYou knew that you were doing the right thing as painful as it was?\n\nNo, but that’s just my approach to life. I don’t know where this comes from but I always make a decision and make it work. I’m not a good alumnus. I don’t look back much.  \n\nI think that’s a mark of your leadership, is make a decision and make it happen and not look back and not second-guess or question, equivocate and all that kind of stuff.\n\nYou have to make good decisions and there have been times when I’ve been on the wrong decision and had to back up. But that’s not the same as second-guessing your decision. That’s to reassess it.\n\nSo it was that nine months during 2003, 2004? \n\nI started on September 2, 2003. But that was the beginning of the half-time. So we didn’t move to Kansas City until July of 2004.  \n\nAnd the farewell from your office and that beautiful picture is all 2004?\n\nRight.\n\nThat takes us to five years ago. So you’ve now been in this role for five years. And it’s a role that you have really been able to invent. You always told me I don’t have anybody that I supervise.   \n\nThere are a lot of people here that are jealous that I don’t any supervisory responsibilities.  \n\nYou have this special role. Tell us about it.\n\nNo administrative responsibilities. I like to say that I’m in an odd place on the org chart. I’m kind of stuck on the side. And if there’s a simple way to explain what I am, I’m kind of an internal consultant, if you will. And the Academy kind of bought my time to train me, to some degree, because they weren’t buying a quality expert. They were buying some passion.  \n\nAnd your title has stayed the same or has it changed?\n\nThere’s been no reason to change it. I’m Medical Director for Quality Improvement. And it’s working so we’re not going to change it. And we don’t have a Center for Quality. We have probably a half dozen people on our quality team but I don’t supervise them. They’re my colleagues. So it really has turned out to be exciting and I’ve learned a lot. I would say that my responsibility divvies up into probably three areas - and I would like it to be four and I’ll talk about the fourth one at the end. But the first one is to be out and around with other national organizations that are doing quality. And in the last five years most of it’s been around perfor-mance measurement and some improvement work with IHI. But it’s mostly about performance measurement, so I’ve done a lot of work with NCQA. I’m on their Committee on Performance Measurement which is kind of the committee right before the Board that approves all the [    ] measures before they go out to the health plans. And I’ve worked with the National Quality Forum. I currently chair the Consensus Standards Approval Committee which is a committee just before the Board that looks at all measures and [    ] endorse it. So I’ve kind of worked my way. When I first started it was a question of earning a place at the table, if you will. And I think we’ve done that.  \n\nYou clearly have. \n\nBut now it’s what can I contribute? How can I use my leadership skills to advance the causes of those organization as well? So working with IHI, we have been partners with IHI on their spring Office Redesign Conference since it started way back in St. Louis ten or more years ago when Chuck Kyla was the first program chair for that. And this next year, in March of 2010, I will be one of the three co-chairs for that meeting that now draws almost 1500 people along with Carolyn Shepard from Clinic [    ] in Denver and Mary Mailer who is an advanced practice nurse faculty person at Penn. So we’ve been involved with this for a long time.  \n\nYes, you clearly have. You represent the Academy’s deep commitment to quality and quality improvement recognized nationally. How many other specialty organizations have a similar person? \n\nThey’ve had similar people. But like HCC (?)just created a position closer to mine. Janet Wright took that on. And other organizations, the American College of Cardiology, others have had efforts but not quite the same freedom to be out and around. The free time, if you will, to be out doing this national work and being involved in the scene and having some input into how it happens. Command and control are two words that are extracted from my vocabulary. I don’t use either one of those words. Influence is probably a better word. And in addition to those organi-zations, we’ve worked with the AMA Physician’s Consortium on Performance and Improvement since its inception. And Janet Leiker who you just met this afternoon was doing that work before I even came along. So we’ve been involved on a national basis with the measurement work right from the beginning. So that’s sort of one of the three things that I do. The second is to provide clinical oversight and practice common sense, if you will, from the office perspective about some of our in-house programs. So the METRIC program is something that started just about the time I started. It was kind of in the works before I got here, but I’ve become responsible for the clinical and quality parts of that. And things like the Practice Enhancement Forum which is training for change in practices. I’m sort of the advisor for that. Worked with Bertie Safford and Cindy Manning as sort of the primary faculty that developed that. Worked with Sherry Fernandez who manages that program. So those kinds of things. And more recently in terms of in-house responsibilities, we’ve had a major change in how we think about CME. As you know, education is one of the four pillars of our strategic initiatives here at the Academy and we’ve always been extremely strong on CME. If you ask our members what are the most important things we do for them, advocacy and education would be the top two. And they think we do well at both those. But the idea is that now it’s been pretty well-recognized that CME is not terribly effective in changing practice behavior and practice systems, if you will. And we recognize that we need to move into performance and improvement CME. In other words, what are you going to do differently next week than what you’re doing this week as a result of this educational opportunity? And I’ve been working more and more with the CME department to help them move even the traditional offerings where it’s kind of a lecture where somebody blabs at you for an hour. To go from an expert on diabetes talking about the newer things in pathophysiology and treatment and the going away to take the first fifteen or twenty minutes, talk about the new things in path, the physiology and treatment, and then spend the rest of the time talking about systems in your office to help you get a better job done, measures that might be used to see if you’re doing a good job and benchmarking with other organizations that have been doing top quality work and what’s achievable. Because docs don’t know that. They’re working on an island, if you will. So measuring what you do, trying to get those measurements better using systematic changes in your office. And then what does the optimal performance look like, because we don’t know that. And even in a traditional lecture format, if we can get people to start talking about those three things, we’ll move people a long way along the practice improvement, performance improvement continuum. And the ultimate poster child of performance improvement CME is METRIC where you assess your practice, you assess your clinical performance, you do an intervention. And three or six months later you reassess your practice which means what’s our approach to taking care of this condition and how are we doing at taking care of this condition. So you assess, intervention, reassess. And the intervention is much different from traditional CME. The interventions aren’t go read an article. The interventions are install a registry or develop a diabetes care committee or beef up your patient self-management support by doing these things. There are clearly out of the twelve or four interventions in every METRIC module are process change things or organizational change things. They’re not go read an article. So providing oversight for all that stuff is a key to it. So the third thing would be to provide support for our private sector advocacy effort. And we have two private sector advocacy specialists here who constantly monitor what’s going on out there with the insurance industry. And this is totally separate from Government Relations. And the strategy that the Board put us to, if you will, is to establish relationships with the big national insurance companies and then be able to use those relationships to help influence how they do business. That’s a pretty tall order. But to be honest with you, in the four or five years - and I go along because I’m a doc and I know a lot about this measurement stuff which is also a bone of contention, if you will. So we now meet twice a year with the senior leadership of Aetna, Humana, Cigna, United, Blue Cross/Blue Shield Association, Wellpoint, so we know those people. And from our member input if we find out places where there’s a systematic dumb thing going on, so it’s not just a single incident but because of some policy that they put in place, that they’re not going to get the results that they think they’re going to get and it’s hurting our members, we call them up and say this is what’s happening, this is why we think that’s a dumb idea and here are the reasons why - and they change it. It’s cool. Because we usually go to them with well thought of...We’re not just complaining. We go to them with solutions.  \n\nYou were doing that in the ‘90S at the local level and now you’re doing it here at the national level.   \n\nBruce, here we sit in November 2009, it’s the first year of President Obama’s administration. We’ve had this very large stimulus package dealing with the recession. There’s been this high tech funding out there. We’ve got this Patient-Centered Medical Home movement that has just kind of gotten underway. We’re on the eve of maybe major health care reform legislation to bring more people into health care and help primary care. What do you see next at this juncture in history in the role that you’re playing? \n\nI think the Academy is so well-positioned to participate in this and having some influence on it. Our work with the Patient-Centered Primary Care Collaborative which is a tremendous advocacy organization for reshaping the health care system around primary care and putting primary care at the center of that in a way that we could never accomplish ourselves. It was IBM that came to us and said we’ve studied our global business and we found that we spend twice as much per employee here in the United States as we do anywhere else in the industrialized world. And we can’t find any difference in the quality or the outcomes. And we asked ourselves why was it. And we didn’t take anybody else’s word for it. We did our own study. And here’s what we came up with: They were all based on primary care and this one is not. They came to us and they came to the American College of Physicians, the internist group, and they said what can we do to work together to reshape the health care environment around primary care? And that was the genesis of the Patient-Centered Primary Care Collaborative which has been a major player in this health care debate. We don’t go anywhere where we haven’t heard about the Medical Home, where Medical Home is a new idea. Everybody knows about it and it’s coming from every quarter. So I think we’ve been very effective in getting the message out and the research that’s been around for a while out in the daylight to show that we really need to move in that direction.  \n\nThat’s excellent. A new model for primary care and for family medicine.\n\nAnd the Medical Home has been what I like to call kind of a two-pronged useful approach in the sense that when we initially went out to payers and said you’ve got to pay us more, we’re dying here with this primary care stuff and they clearly said we’re not going to pay more for same old, same old. What are you offering? What are the different capabilities that we can expect if we’re going to pay more? We know that it needs to be better but what are you going to do differently? So it’s served as a wonderful list of capabilities or deliverables, if you will, for the payer com-munity, for the policy community to talk about hooking to payment and rewards and bonus money and stuff like that. But at the same time, we turned to our membership and said this is what’s going to be valued. And if we could click a switch tomorrow and change the payment environment, there are certain things you’re going to have to be able to do to take advantage of that new opportunity or you just won’t get the money. And it’s allowed us to talk to both of those groups with a common set of, list of things you’ve got to do.\n\nAs I listen to you with all this enthusiasm for what we’re doing now and what we’re about to do, I can’t help but see how all of your life was sort of preparation for this important work that you’re doing now. You mentioned our colleague Doug Henley. If my memory is correct, when you and I were resident leaders there was this medical student who came along and organized all the medical students into their own meeting. And I remember that Doug Henley was that person.\n\nI’m not sure where Doug came in because once again, I don’t look back much. But he wasn’t on the scene by the time I left the scene. But you came on right after... \n\nHe was a student from North Carolina.\n\nIt was Roger Wujek from Illinois was one of the first student leaders. Kurt Stange was a medical student in my office, a preceptee in my office. And we both laugh about that once in awhile. Not that I had anything to do with his success.  \n\nBut now that we’re all working for Doug as CEO…\n\nWe’re going to get back to Doug in a minute. But Kurt Stange, I made it pretty clear that the reason I was there was to take care of the folks. That that’s what it’s all about. And he still tells that story, it’s all about your ability to take care of the folks. And all this other stuff is probably not as important as taking care of the folks. So back to Doug. I didn’t really have much associ-ation with Doug until we were both on the leadership. Now Doug was going off the Board the year we came on the Board, so he had just finished his time. Now Doug was actually Board Chair twice because during the time when he started on the Board he became Board Chair as a third-year Board member which is the way they used to do it, and then got elected President-Elect. And they had changed it, so he became Board Chair after his presidency.  \n\nHe was accused of engineering.\n\nCorrect, but it’s a good thing for the Academy. A very wise thing. I think it’s worked out extremely well. I mean having your most experienced person as a Board Chair makes a whole lot of sense. They’ve been through the mill. They know what it takes. They make good decisions on a day-to-day basis. It’s just a great idea. And it takes the politics out of it. Because once you get elected to President-Elect, you’re politically bulletproof. In other words, you know you’ve got the three-year stint. You don’t take advantage of that but it allows you to make tough decisions that not everybody thinks is the right thing to do. And you don’t have to worry about your job. Whereas Board Chair and about to go for election, you’re very careful about that. So it’s a very smart thing organizationally. So back to Doug. Doug had been Board Chair, he had been President, he had been Board Chair again. And the year we started, 1995, was the end of his Board. So to fast forward, it’s getting up to the time where I’m President. And Bob Graham announces that he’s going to move on. And I had lots of nice chats with Bob. I think that he had been here 14 years or something like that. And he said you know, the trouble is that when you’re around the same place for too long, you become friends with your problems. And he said I need to get out of the way so some of these problems can get solved because I’ve cozied up with them. I think he said that a little tongue-in-cheek because I never thought of him that way. But that’s what he said. So I don’t know quite how to take it. He knew that I was going to be Board Chair during whatever transition there was. And whether that was a compliment to his thinking that my ability to handle that transition, because I would have a fairly major role in it, was better than some other options - who knows whether that had anything to do with it? So I was the Chair of the search committee for the new EVP. And we interviewed a bunch of folks and we got it down. This is a management story first and then I’ll tell you about Doug. We were interviewing seven people and nobody knew any of the other people. This is a true executive search where we had arranged to have nobody know anything about the other people and sneak them in the back door and send them out the other door and stuff like that. And we asked all of them what was their most difficult thing they had ever done as a manager. And six out of the seven said to fire some-body that I had nurtured. And I remember having that same experience myself. Somebody that you train, you coach, you cajole, you offer them every opportunity to grow that you can do. You make room for them to work. And you come to the realization that it just ain’t going to work. And how do you do that? It’s like sending one of your kids out of the house never to return. So it is very tough. And the one person that didn’t recognize that didn’t get the job, of course. So it turns out that Doug was the leading candidate. And Doug was so excited. And we had a long talk on the search committee about Doug’s enthusiasm. Doug’s a very smart guy and such passion for family medicine that you can’t buy either one of those things. And there was concern that he, like me actually, had most of our management training in kind of a small practice or a relatively small organization and that all of a sudden they would be going from managing 25 or 30 people to managing 400 people and is he up for that? Our conclusion was that that’s something he can learn. He’ll grow into the job - and quite nicely because he’s got those other two things, fire in the belly and the passion for the specialty and the ability to learn and the constant interest in learning. So that’s been a lot of fun. A lot of fun kind of getting Doug in place, if you will, before I left at the end of my Board Chair year. And about that same time, something that Bob had started up was just coming together, and that was a public advisory board that was a real bonus where we actually had a whole separate group of non-Academy members that would meet with Executive Committee initially twice a year and to make sure that we weren’t listening to our own B.S. too much. That they would pull us up short when we started to go out of the reality realm about what was going on in the community. So that was my Doug story.\n\nNow Bruce, part of family medicine lore is your heart attack that you had while on duty. Tell us that story.\n\nThis was three years ago. I was fifty-nine years old. I was in this position full-time and we were actually at a Practice Enhancement Forum, I’m a faculty member for that. And I was giving one of the opening talks to just start the two-day face-to-face meeting in Chicago. Just to back up a little bit, I had all my life told my patients if you get your exercise and watch your diet and handle stress well and stuff, you’re going to be fine. I had been running for years, not as much as you run, but I did my three miles a few times a week. And after I moved here, I probably walked quite a bit and didn’t run quite as much. But still, I was exercising regularly. So my index of suspicion for what was happening to me was kind of low. Doctors like you to think that this screen comes down in front of your eyes and says you’re having a heart attack, you idiot. And it just ain’t true. So I’m giving this talk and it’s 40 minutes I’m supposed to be up front. And we’re supposed to give some material and then set these groups at a table exercise. So about halfway through my talk I get this sudden sweat - geez, what’s that all about, it’s not even hot in here. So I keep talking. A couple of minutes go by and I get this sudden onset of heartburn. I couldn’t call it anything else. I wouldn’t call it chest pain, I would call it heartburn. And I thought oh damn, I had decaf coffee for breakfast. What’s that all about? So I keep talking. I finish up my talk and get people started on their table exercise and go to the back of the room and I just don’t feel right. I ask somebody if they had any Tums for my heartburn. Then a little while later I just didn’t feel well and I got a little squeeze in my upper arms and I said damn, I think I know what this is. But you have a little bit of denial and say maybe if I just rest awhile it will go away. And by this time Bertie is checking my pulse.  \n\nThis is Bertie Safford?\n\nBertie Safford, she’s a family doc from Bellingham, Washington. So she’s checking my pulse. I said I don’t really feel well. I was going to go up to my room, which I knew was not a good idea but I didn’t know what else to do. I was going to lay down for awhile. And the night before I had just met this woman. We had a faculty dinner the night before. So the woman who sat across the table from me was Carrie Nelson from Chicago. And she’s a family doc who was the quality officer for her hospital.  \n\nOf course, you’re in Chicago.\n\nIn Chicago, you need some local knowledge. So I go up to my room and Bertie didn’t think that was such a good idea and I knew it wasn’t such a good idea. So I said call me in five minutes to see how I’m doing. So she calls me and says you’ve got to go to the hospital. I said bring Carrie with you when you come up. She hardly knew Carrie. She had met her the night before, too. So she goes into the room and taps her on the shoulder and says can you come with me. And they came up to my room and were trying to get me to go in the ambulance. I said screw that, just drive me to the hospital because they’ll fool around starting an IV and all that stuff. So Carrie drives me to a hospital. Not hers, and I’m not sure how much she knew about this particular hospital but it had a good reputation for this stuff and she knew that. So she literally drops me off at the ER door of the hospital and goes to park the car. So I walk through the door and I come up to this little desk and there’s this one guy sitting there and nothing else going on. I said is this the emergency room? I didn’t see any chaos, so I didn’t recognize it. He goes yes, and I said I have chest pain. And he said what’s your name and what’s your birthdate. That’s all he asked me. Picked up the phone, dials it up and he says chest pain. Hangs up the phone and in less than 30 seconds somebody wheels out a wheelchair and I sit down in the wheelchair and I’m taken in a room and they do an EKG. And by this time Carrie’s back, she parked her car and found me. And she said is it okay if I stay? I said you betcha, you stay right here. You know, I’ve got my advocate in the room. And they’re doing the EKG and I say to her do you think we should tell them we’re quality professionals? That was the last time I needed to say that. I don’t think they heard me. So the EKG comes back and I had ST segments up to my eyebrows and Q waves down to my knees.  \n\nYou sent me a copy of it.\n\nA medical student could have read it from across the room. There was no question about the diagnosis. So I had a STEMI MI as ST segment elevation and myocardial infarction. Just classic inferior wall. Which brings me back...Bertie and Carrie were in my room when they were trying to convince me to go to the hospital and Bertie’s taking my pulse and it was like low 60s or high 50s. And we look at each other go steady pulse, slow rate, must be inferior wall, we’re saying to each other. And sure enough...So they do the EKG and once they have the diagnosis their whole thing cardiac alert thing that they have goes into place. So I moved over to an emergency room thing. And the emergency room doctor took one look at the EKG and he takes out his cell phone before he even said hello to me. He’s standing there, he looks at the EKG, he dials the thing and says “Cardiac alert. Cath room, we’ve got one coming. Cath lab, we’ve got one coming.” So they drew some blood, they took a chest x-ray. I got a rectal exam to make sure I wasn’t bleeding. Some of the absolute key things that you have to do. But there’s no reason to wait for results. You know what you have to do. You move to the next step. And I was so impressed with the fact that there was never any discussion about what the next step was. This was a team that had planned this whole thing. And there was no delay...So they had taken out all the authorization bottlenecks and all that stuff where it usually takes extra time. So boom, boom, boom. I can remember they had given me a big dose of IV...I’m on a stretcher. They had given me a shot of [    ] to slow my heart rate or to prevent arrhythmia in the ER, although I don’t think I had any. And so I was feeling a little faint, and I told them that. And, of course, my pulse was down to like 35, so they gave me something to fix that. But while I’m feeling faint, we’re wheeling up to the elevator, and I’m studying this whole thing. Here is the quality improvement guy studying teamwork. And we pull up to the elevator and somebody pushes a button and nothing happens. So the guy takes the key out, puts it in the thing, turns the key. The elevator shows up immed-iately, they wheel somebody off and wheel me on. I mean they had all this stuff figured out to try to take all of those unnecessary delays out of the thing. So by the time we get to the cath lab everybody is set up and ready to go. And the long and short of it is two things. One, I had an angioplasty 34 minutes after I said to that guy at the desk “I’ve got chest pain.” So 34 minutes after walking through the door I had my artery opened up and I’ve got the tapes to prove it. And the other thing is that when I look back at the whole thing, my gratitude doesn’t go solely to the cardiologist who was pushing the catheter around. My gratitude is to the people who put that team together, that organized that, that took the time to make sure that worked well. And the cardiologist who did the catheterization was just one of the players. It was very apparent. So a great lesson about what we should be doing in medicine in general.  \n\nBut here you are having a life-threatening event.\n\nI never thought of that. I never thought I was going to die.  \n\nSo you felt safe the whole time? \n\nI did.  \n\nEven though you saw the EKG?\n\nYeah. Well, because the anterior walls were stable. I remember seeing those EKGs on my patients. You would park them over in the corner of the CCU, you’d give them pain medicine and lidocaine if they had arrhythmia and wait to see how bad it was. Isn’t that what we did? I mean that was even in fairly progressive, back when we were residents that’s sort of, you kind of watch it happen. We didn’t have an intervention.  \n\nHow has that event changed you? \n\nA couple of things. When I’m riding to the hospital with Kerry, I had a talk with her about this afterwards to apologize. I said I can’t imagine what you were thinking. What if this guy craps out in my car? I figured well, then you could call the ambulance. But I kept talking so she would know I was okay, on purpose. I wasn’t afraid for my life. I didn’t even think about it that way. And after I saw the EKG, it was pretty obvious what was going on. I didn’t need any convincing. And I was so impressed that these folks knew what they were doing. It was so obvious that I just relaxed and let it happen. Why would I be fearful when I’m in the best hands and that was pretty obvious?\n\nBeing confronted with your own mortality risk or possibility and here you are now working professionally and fully engaged. I know, because I saw you a few times, and kind of with pride and amazement you shared what had happened to you. In terms of your own lifestyle adjustment, biopsychosocially? \n\nI think that’s very interesting because I don’t ever remember being afraid to die. I didn’t think I was going to, or I just didn’t admit it maybe. So I didn’t see it as a near-death experience. It never had that kind of profound effect on me that some people talk about. And I thought I was doing all the right stuff to begin with. If anything I was a little miffed. I was a little angry. Maybe that’s not right. I felt that I had been disingenuous with my patients, that if you do all this stuff you’ll be okay. Because I had kind of done all that stuff. Every morning for breakfast I would have bran cereal with skim milk and multigrain toast and put jelly on it instead of butter and had coffee with a little bit of whole milk in it, not cream. I was on a pretty low-fat, high-fiber, high-vegetable diet like you’re supposed to. Was eating fish multiple times a week because I happen to like fish. But I had spent my entire adult life sort of doing what I was telling other people to do. So that was a little bit troublesome to me, that I came to the realization that this advice that we give people is risk reduction, it’s not an immunization. And Denis Chagnon helped me realize that if you hadn’t done all that stuff, if you hadn’t exercised and had all those collaterals, you might have died and you may have had it five or ten years sooner before they could have fixed it up so nicely. So I struggle with those kinds of things. First of all, that I let my patients down. I promised them something we weren’t quite delivering. And that I was a little angry that I had done all the right stuff and it didn’t help. So now I have two eggs every morning and a piece of ham and enjoy it and I don’t have the toast. \n\nBut you’re on a statin?   \n\nI’m on a statin and my LDL and HDL are both about 50. And I’ve lost probably 20 pounds from the time of the event. So I never considered myself fat before but my BMI was probably 28 or 29.   \n\nWell, I saw the picture of your father and your two brothers and you’re the healthy-looking one. But I know you’ve had some morbidity and mortality in your family but you didn’t know what was lifestyle and what was genetic.\n\nWell, my younger brother Dave, four years younger than me, died a year ago. And he had had a stent before I had my problem. But he was four years younger, four inches taller and weighed about 350 pounds. He was a big man. He had diabetes he wasn’t taking good care of. And I just had glossed over that piece of family history as a lifestyle choice. So whether that’s correct or not, who knows? In retrospect it doesn’t seem so wise. But I guess what else was I supposed to do? Three weeks before this happened I was at the annual meeting in Washington and I got my cholesterol checked and I think my LDL was 83 and my HDL was 56 or something like that. What do you want me to do, man?  \n\nDespite our best efforts, bad things still happen.\n\nMy blood pressure’s never been a problem. So I just don’t get it.  \n\nI think you said it exactly, we do risk reduction, we don’t do intervention and bad things happen despite best behavior.\n\nSo I’m going back to kind of doing the same thing I was doing before. The other thing that’s interesting, we were talking about the role of the cardiologist in doing the cath. A different person came around to see me every day. Kind of the non-cath guy. Nice guy. Two things about him. One, I asked him, I’m not from here, I’m going to go back home. If I were your patient following up with you, what would I do? And he said two things. One, get in a cardiac rehab program. And the other thing, don’t get any more tests done right away unless you have exertion-al chest pain. And I don’t think I clearly understood what he was saying. I had all kinds of strange chest pains. Who knows what they’re from? Whether the stents that I had blocked off other small arteries - who knows what goes on. But I had all kinds of crazy things going on. And [    ], I could tell every time my heart skipped a beat. I knew every PDC. But I didn’t have exer-tional chest pain.  \n\nThat was nice practical advice. \n\nAbsolutely. So I looked into cardiac rehab. And if you don’t know, three-quarters of cardiac rehab is support for disability and depression and getting you back on track. I didn’t have that. And the other quarter is graded exercise. So instead of spending thousands of dollars on rehab, I bought a really good treadmill with a cardiac monitor and started out real slow. When I started on a treadmill, it was less work than I do walking across the airport. But I started real slow and wasn’t in any hurry to get back. The other part of the story that you may like is that...This happened on a Friday. And the following Friday I was scheduled to give a talk in Albany back to the home turf. And Anne was going with me, we were staying with Chagnons at their home and this was all set up. And I hadn’t canceled that and so far didn’t see any reason to. So I stayed in the hospital over the weekend and I actually had another cath on Monday because there were two other high-grade lesions. Figured I’ve got a couple of stents, having two more is not going to change the Plavix status. You’ve still got to take that stuff. So I had a second cath and went home on Tuesday afternoon, I think. So three and a half days in the hospital. And I stayed at my son Brendan’s house in Chicago because he lived there at the time. And Thursday Anne and I went to Albany and Friday I gave my talk. It was a whole long talk sponsored by the health plan about electronic medical records. So it’s a day-long thing with a whole bunch of different people talking about electronic medical records. And my job was to summarize the day at the end. And by the way, sending your slides two weeks early, that kind of thing. So I had actually sat in my son’s home with my computer doing my slides. So I sent in my slides like Wednesday for the Friday talk. And right before me on the program was Newt Gingrich, so he had told a couple of his hospital horror stories. I said I’ve got a story I want to tell you. One week ago today I had an acute MI. It was just a great story.   \n\nWe’re all grateful that it worked out so well.\n\nThe only reason I get to talk about it is because it worked out okay. Sort of the black swan phenomenon. You work back from what seemed to work.\n\nAlso, one other piece of your family that I would like to capture for this history for all of us that know you and love you and the family is that you’ve now got seven grandchildren and you have really exploded. And I remember those very young adults. Even one of them was a teenager back in ’95, ’96.   \n\nI talked about the airplane earlier. We owned this airplane and we would travel all over the country. It was the family’s station wagon. So when my kids were young, we were going to Academy meetings in the airplane. And we flew all over the country. We flew to California a couple of times for the San Francisco meeting and Grand Teton for Jackson Hole meeting. We just had a great time. Flew to Florida a lot. So the kids kind of grew up with Academy. And the great thing about family doctors is that they always treat children like adults - not like adults but like people that are worth talking to. And that’s what they thought adults did, that they actually communicated with children. So I thought it was a great opportunity for them, that we traveled to places we never would have gone. And although Anne once in a while would complain about the fact that we were only doing Academy stuff, we were doing some pretty cool stuff. And I think the kids are better off for it because they were participants. So my kids at the time that you and I got elected were all there, all rooting for us. I guess a couple of them were there for the President thing. Anyway, they had been part of this whole thing. And we moved out to Kansas City and had no grandchildren.  \n\nFive years ago? \n\nWhen we moved, it was a little over five years ago. So our oldest grandchild is going to be five in about a month and our youngest grandchild was just born about a month ago. And we have seven and no doubles. Brendan, our oldest, is a family physician and he practices down in Clinton, Missouri which is about an hour from our home, which is nice. And he and his wife, Mary Ann, are the ones that just had the little boy named Bryce David. Bryce, of course, is close to Bruce and David was my brother’s name.  \n\nI know your family physician son didn’t know he was going to be just like Dad his whole career. He was going to be an orthopedic surgeon part but he found his way.   \n\nHe found his way through many years of residency but ended up his training and moved down here just a little over a year ago.\n\nAnd your second son? \n\nMy son Austin is in Boston with Erika. And Erika and Austin have two children: Orlando, who will be five in January and Delilah Ocean who will be two in December.  \n\nAnd Austin got a degree?\n\nAustin has a degree in psychology. And he and his wife work as sort of brokers for organic herbs and produce. So they work out of their home. Plus, he does another job where he helps to sell these display units that people use at trade shows. The thing that wheels up and you pull up the slide and there’s your message. So their company develops the message, does the printing, produces the thing, ships it. Sets it up for you, if that’s what you want. So he just recently went to Germany with the big display thing at a trade show there. So he’s got an interesting job. And my daughter, Shannon, lives with her husband in Hoboken, New Jersey which is right across the Hudson River from the World Trade Center site. And she works in Manhattan at the Bellevue Hospital and she manages the emergency room physician group there. She has a degree in finance and a master’s in public administration. And one of her first jobs was to help the physician group develop their performance-based compensation system. I said Shannon, if you can do that you can do anything. So she did the spreadsheets and shepherded that whole discussion. But we’re very proud. And she has two little boys. One is two and a half and the other one was just born this summer.  \n\nBruce, I can’t help but ask this because I think your wife Anne is one of the strongest and most remarkable people I’ve ever met. While you were doing a lot of this Academy stuff she was going on international trips for Heart to Heart International. Now how many of those did she do? Where did she go? \n\nAnne went on five different Heart To Heart trips. I went on two. She went to Moldova, Azerbaijan, Georgia, Russia, to Tajikistan. But she loves this stuff. And she would work with Ruth Ostergaard on the Children’s Project. And one of the ones that we went on together was to Moldova. And we were actually supposed to go to Moldova in October of 2001. We were supposed to come home from Atlanta where we had just gotten off the Board and finished our leadership time with the Academy and trade suitcases and fly off to Moldova.  And you’ll remember the weekend when we flew into the Atlanta meeting, the airports looked reasonably normal. When we flew out, there were National Guard people with rifles everywhere. And that’s basically the weekend that we bombed Afghanistan. And the State Department didn’t think we ought to go, so we didn’t. And we ended up going in February of the following year, 2002. But the interesting thing that happened was when we were there in Atlanta we went to the theme park on some kind of rollercoaster-type ride and Anne complained that her back hurt. And so we went home and since we had this free time we went camping with my brother-in-law and sister-in-law up to the northern part of Vermont. It’s absolutely gorgeous. And she kept complaining about her back. And we had a heating pad with us and stuff and she had this back pain. We came back and Denis Chagnon is her doctor and he smelled a rat. He couldn’t quite put his finger on it but ordered a couple of tests. The long and the short of it is that Anne had tuberculosis of the spine which is unheard of in this country. It’s a true Pott’s disease. And I can remember as a medical student sitting in a talk by the Grand Poobah of medicine and he puts up this X-ray and this is what Pott’s disease looks like and this is a characteristic. And he said the disease is totally within the vertebrae. It’s not eating away the vertebrae. It occupies the vertebrae, it doesn’t eat it from the outside like a cancer would. And there were these two vertebrae that were kind of eaten up and there was a little bit of what’s called the gibbus where the vertebrae collapse and you get a little angle in the spine. So Anne gets this CAT scan of her spine and T10 and T11 look just like that X-ray I saw 30 years before. I said that looks like Pott’s disease. And the Radiology, of course, had little experience with that. You don’t see it. And they thought a tumor or infection of some kind but who would think TB? Well, in retrospect we think that it was the year before when she went to Azerbaijan. It has a little break-off part of the country called Nakhchivan where it’s actually the same country but it’s separated by Armenia because of the wars over the years. So they flew over the Armenian mountains to land in Nakhchivan in this old Russian airplane with people coughing and choking. It sounded like a perfect setup to get TB. But who knows? But that’s where we think she probably got it, on one of these Heart to Heart trips. So she ended up the weekend before Thanksgiving having a Saturday afternoon operation. So when a neurosurgeon is operating on a Saturday afternoon, you know it’s important. And had two of those vertebrae kind of scraped out and a piece of bridging metal put in there and these little carbon fiber cages that they stuff with bone chips and slide in there like Oreo cookies until it makes up the space and then fuses that space. And has recovered very nicely from that. She went from, could have been very easily paraplegic to...\n\nAs you know, most people we know that go through something like this end up with some degree of chronic pain and disability.\n\nShe’s had very little. She had more pain from her thoracotomy, that chest incision, than she’ll ever have.  \n\nI don’t think Anne would let something like that slow her down. She’s doing well. \n\nBruce, is there anything else about your life, your story, that you would like to share? \n\nOne thing, we talked about my job responsibilities and there is one part that I said I wish were greater. And that is that I’ve always felt that there is something that I could contribute here at the Academy in terms of internal quality improvement. So why aren’t we doing as an organization some of the things that we’re telling other people to do, if you will? We should lead by example. When I first came to the Academy I didn’t really have any quality credentials. So one of the things I did was sign up to be a Malcolm Baldrige Award examiner. And for three years I did that. It took a lot of time because of the way it’s set up. No matter how many times you’ve done it, you have to go every year for a week-long training session. So three years in a row I went off for a week in May and did their training session. And it really is a wonderful education in what makes a large organization work well. You know, what kind of things have to be in place if you expect to get good results. So I kind of tried to bring that back and was not terribly successful in getting much interest. So I’ve got a new plan to try to bring some of what I learned to the Academy to start getting them to ask, not necessarily applying for the Baldrige award. We shouldn’t waste our time applying for the award. We’ve got a long way to go. But to bring some of the principles and the critical introspective questions you have to ask yourself about how do you get this critical process done? What do you have in place that makes this work? And to start to look at some of our systems and management and balance scorecard-type activities and budgeting activities in a very critical, thoughtful way and see how we can improve them. So I’m trying to get some of what I’ve learned about organizations over the years to happen here. The other thing I did was I joined the American College of Medical Quality and took their board exam earlier this year, in February, and passed that. So I’m kind of developing my quality credentials around those two things.\n\nIt sounds like there will probably be an addendum to this oral history sometime in a few years.\n\nYeah, if I live long enough.  \n\nYou’re still vibrant and active and you’re riding in a critical juncture of rapid change in our specialty and what we’re doing. And hopefully sometime in this coming decade will be in a care model that delivers consistently a lot more quality that hopefully all Americans have access to. \n\nI don’t watch much TV but Anne and I were watching a series on national parks a few weeks ago. And I was really struck by the way they had portrayed each one of these national parks as sort of an epic struggle between preserving the natural of beauty or the natural resource for the common for posterity. And the special interests, either financial interests or the interests of a relatively small group over the interests of the entire population of the country. And they talk a lot about what happened in the Congress and the presidential leadership. And I was so struck by the similarity of what’s going on right now. I mean what’s more important, a natural resource could we have than the health of our people? And you see the same epic struggle going on between what’s right for our people and what’s right for some of the short-term entrepreneurial interests in our country. And I don’t know how it’s going to come out but I hope it comes out like the national parks did.  \n\nBruce, thank you very much for sharing your rich story and your history and the passion that you’ve put into your life.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284061#t=0.0,1842.68124"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284062","type":"Canvas","label":{"en":["Media File 2 of 2 - Bagley_Bruce_PT_2_09.wav"]},"duration":7586.55492,"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/154887/file/284062/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284062/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/062/original/Bagley_Bruce_PT_2_09.wav?1754504573","type":"Audio","format":"audio/wav","duration":7586.55492,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154887/file/284062","metadata":[]}]}],"annotations":[]}]}