{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/z89280739d/manifest","type":"Manifest","label":{"en":["Dr. James Martin"]},"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":["2012-08-20 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Sandy Panther (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family medicine","family physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["James Martin, 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/153749/file/282858","type":"Canvas","label":{"en":["Media File 1 of 1 - Martin_James_12_a.wav"]},"duration":3222.66109,"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/153749/file/282858/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153749/file/282858/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/282/858/original/Martin_James_12_a.wav?1752675225","type":"Audio","format":"audio/wav","duration":3222.66109,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153749/file/282858","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153749/file/282858/transcript/81710","type":"AnnotationPage","label":{"en":["Dr. James Martin Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153749/file/282858/transcript/81710/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Let us start with where you were born, parents’ names, what they did, children. And then why don’t you go ahead and lead right into your schooling.\n\nI was born in Coleman, Texas. A small town of about 4500. My father Ray as a large animal veterinarian and I spent a significant part of my youth traveling with him and kind of serving as an unofficial veterinary assistant. My mom was a stay-at-home mom. She had previously been a school teacher. Her Name is Lois. So I did all of my first grade through senior high school in Coleman. Went to Abilene Christian University for two years. Was fortunate to get accepted into medical school after two years of college. Then came to the University of Texas Health Science Center-San Antonio. At that time, called the University of Texas Medical School at San Antonio. I was in the first full class they had here in San Antonio. While in school I had planned to be a general surgeon. Took all of my electives and work in the general surgery. I was actually set to do my internship at Marquette in Wisconsin and come back to San Antonio for my residency. And at that time after leaving the operating room one day to go out to the waiting room I realized I had no idea on whom I just operated or anything about the family or who I was going to see in the waiting room. I suddenly realized that was not what I had gone to medical school for and went to visit with my medical school advisor who happened to be an obstetrician. He told me at the time “I was wondering how long it would take you to realize that you need to use your people skills more.” And that’s when he told me about a new specialty called family medicine. It was just starting. We were getting ready to have our first faculty member from that discipline. I went on and took a couple of rotations where I was working primarily with families and children either in pediatrics or in the emergency room. And Dr. Herschel Douglas who was the first Chair of Family Practice, as it was called then, wound up being a significant role model for a whole lot of us that came through at that time. I had the chance to serve as the Chief Resident my third year. Then sat for my boards and became a board certified family physician in ’76. As I mentioned the other day, I was unaware that there was such a thing as the American Academy of Family Physicians or AAFP or AAGP at that time. And Dr. Perry Post was one of the initial members of the American Academy, met me and invited me to start attending the Alamo chapter of the TAFP. They rapidly got me onto a committee which happened to be the liaison with the medical schools. And in working with them became aware of the fact that there was so little family medicine that was being taught in the medical schools at that time. We made our committee, which was a reporting committee and became more of an advocacy group and together participated and pushed in trying to get the medical schools to develop a curriculum for the exposure to family medicine in the ---- clerkships. It was during that time that I met Roland Goertz. Roland had been practicing in a small central Texas town, Smithville, something like that, and decided to go and work in a residency program in Corpus Christi. Roland also was convinced that we needed to have a ---- clerkship in family medicine. The two of us started working politically to move the Academy into the position where it could have some power and influence in an advocacy role. As I mentioned the other day, while we put in a whole lot of work to make this happen and to the credit of the Academy, Jim White and other significant leaders at that time were supportive of us, it was a very difficult course as we initially started. And as mentioned the other day, we found that our best efforts were in developing relationships with other organizations so that it would not appear that we were self-serving. Recognizing that if there were enough family physicians, there would be enough for the older people and the rural people of Texas. So the Farm Bureau and the AARP were identified and we worked very closely with them and developed significant relationships that when it came time for voting and the approval of the clerkship, we were successful with that. So it was an exciting time. And again, with Roland Goertz taking a significant lead initially in making this happen and then Jim White’s willingness to change the Texas Academy to become a more advocacy-focused organization was, I think, really key both in terms of the Texas Academy and what influenced me.  \n\nIn the late ‘80s, as I mentioned the other day, there was kind of a revolt in the Texas Academy. We had been truly a good old boy network with the same group of physicians who would attend the Congress of Delegates but had no particular interest in being on any committees or seeking any type of elected office. And so about 1989 there was a revolt by the core delegation, that’s everybody who is represented on committees within the AAFP, and a new group of members of the delegation were selected. It was Jim Winn who was from rural Texas. Very articulate, very actively involved with the Texas Medical Association and the AMA. Later became the executive director of the Federation of State Medical Boards throughout the United States. And Glen Johnson who later became Vice President of the Academy. Glen and Jim led our delegation. Barker Stigler and I were selected to become the alternate delegates. And that’s how I began to become aware of the Congress of Delegates, how it worked. Had the chance to serve on several Academy committees. Fortunate enough to become the chair of those committees. During that time the Academy nominated me to become a member of the American Board of Family Medicine [Board of Directors]. And I was selected by the Board in 1993, served with them for five years. Had a chance to become the President, then the Board Chair of the Board at that time. Had a chance to work both with Paul Young and Bob Avant. In ’98 and ’99, after discussions with Lanny Copeland who is another person influential to me, who had been President of the Board and then later ran for the Academy Board presidency, wanted me to move over and seek membership on the [AAFP] Board of Directors. And I ran for office then, was fortunate enough to be elected. It was at that time that I really began to think that what we had accomplished in Texas. It was a very strong chapter that was successful in advocacy complete with the education of our physicians, special training sessions, special events, conferences to help us be more engaged and involved in advocacy for our patients. \n\nBegan to think that we could do the same thing at the national level. And then when I ran for President, that was the major platform, that I was tired of people saying the Academy could not do what we felt we could do in the way of advocacy. I was telling somebody about this interview today and they said did you tell them the final line of your speech, and I said no, I didn’t. But in my speech running for President I talked about how important it was that the Academy become more engaged in advocacy and try to develop enough influence to where that we would be known enough that whenever any issue that related to health care policy in primary care came up, the first question would be how does the AAFP feel about this? So I felt strongly that we could do that. And I finished the talk with quoting from a Chinese proverb that had been given to me. When I quit working at the state level, people were very nice to me and gave a going away party for me. And they gave me a Chinese proverb that said “May those who say it cannot be done not interfere with those who are doing it.” It spoke to the fact that we had been able to accomplish things that naysayers said we couldn’t do. So I finished my quote with that, modifying it, “For those who say we can’t do this, get out of our way.” And apparently it resonated well with the Congress of Delegates, and I was elected. Continued to push very hard in that direction. Fortunate to have another person important to me, Michael Fleming, who came right behind me. Michael also was focused on advocacy. He understood the importance of relationships. So between the two of us, we began to spend a lot of time in Washington, DC, not just meeting with members of Congress but also meeting with organizations where there might be some shared commitment to health care. And I think we were pretty successful with that. AS I mentioned the other day, when the President signed Medicare Part D with prescriptions, Mike and I had been spending time with the committees working on it. I was with the AMA delegation in Hawaii and Rosemarie Sweeney called me and said that the President specifically wanted me to come for the signing of the bill. Which kind of surprised me because there were so many people doing so many things that I truly was one of the million. But I think he wanted the Academy represented and I was President at that time. So I had a chance to fly back and be a part of that and that was an interesting time. \n\nStarting in 1999, 2000 I was very concerned about the pipeline of interest in family medicine and what I thought was a tremendous drop-off in interest in family medicine not only by the students but also by the patients and the population. I spent a lot of time with Larry Green who had been part of the original Keystone meetings with Gayle Stephens. And we spent some time talking about how do we address that. At that time, Larry was in Washington with the Graham Center and had developed a working relationship with Bruce Bagley and Stephen Spann. So with Bob Graham, they had been meeting and talking about the same things and decided to have another Keystone meeting. And then from that came the recommendation that the Family of Family Medicine start to work together and relook at our discipline. And that’s where the plan came for the Future of Family Medicine Project. I was very fortunate enough to be elected by the Family to be the Chair of that. And as you can imagine, a very busy time during that year. So although I still was very concerned about the advocacy, during that time we were able to get approval from the Congress to have a PAC for family medicine which I think has been very successful. Michael Fleming had the chance to serve as its first president. But my focus certainly became the Future of Family Medicine with the research, then the presentations to local organizations over the next three years and eventually to the recognition of TransforMED as a recommendation from FFM. I was also very fortunate and pleased to be the first Board Chair of TransforMED and hired Terry McGinney and bring the staff that he was putting together, the infrastructure that has proven to be so incredibly successful. And we were able to fight through the days of being a department to where we were a separate LLC. Certainly in the general umbrella of the Academy but be able to be seen as something other than just an Academy department. So those were very exciting times and I think the Academy did a whole lot of stuff back then that has stood in good stead. \n\nAfter I left the Academy Board, I was asked by Dr. Buford (?) if he could submit my name to become a member of the RRC for Family Medicine. One of the recommendations of FFM was that we need to look at whether the time intervals we placed for the training of family physicians is appropriate. Is it three years? Should it be four? And I really felt like we needed to be putting the elements of the Future of Family Medicine recommendations into our requirements for graduate medical training and again to plant the seed that maybe we need to look at a research project to address length of training. And I was fortunate, my last three years at the RRC, to be elected to the Chair. And it allowed me to participate in so many other things within the ACGME. But it also allowed us to be able to bring forward what’s called the Length of Training Pilot which will start this year where a cohort of programs will move to four years instead of three. And then we’ll have a second cohort of controlled residencies that will stay at three. And we’re going to compare the outcomes, especially as they relate to the competencies of patient-centered medical home, population management, integration of behavioral medicine into the practice. So I’m very excited about that. And I’ve been asked to chair that committee, so even though I would like to slow down, that’s going to continue to be something that I think is important that the Family has asked me to lead. In fact, this last weekend I was given the first update and continue to get a lot of positive reinforcement to what we’re doing. So those are the highlights of my medical career.  \n\nYou skirted right into Mom and Dad and then right into your school. Did you have any siblings?\n\nYes, I have two younger brothers. One who is a dentist in north Texas and the other is a family physician in a small rural community in central Texas. \n\nAs I recall in our last conversation, you were married as a freshman in college?\n\nYes, that was a neat time. When I went to school, I was playing varsity tennis for Abilene Christian. So obviously my afternoons and evenings were always taken up on the tennis courts. About the third week of school I was despondent because I had not found any girls, someone to date yet, because they were all around in the afternoons when I was working. I was eating breakfast early that morning and the most beautiful girl in the world walked in and sat down across the way from me. She took my breath away and I stared at her for a long time. So as the person sitting next to her got up to leave, I raced up and said “Tell me who you are with.” She told me it was Mignon Bruce and she said “Do you want me to give you her phone number?” I said no, I can look it up, not realizing she had just come to school, so she was not in our school registration book. So I went another two or three days and discovered I couldn’t find her. Then I walked into my science class and here she walked in it. It was two weeks later, at the end of the semester. I was so enthralled by her. She was just everything. I was shy and didn’t want to say hello to her. But I would stand and make sure that when she got ready to come to the door, that I was there to open the door for her. And at that time, they were rebuilding part of the science center and there were a lot of wooden temporary sidewalks that were kind of difficult and you had to kind of hang onto the rails. And I kind of walked next to her to make sure she didn’t fall. So after about three weeks, I thought she knows who I am now, maybe I can safely ask her for a date. So I asked her for a date, she looked at me and said I have never seen you in my life – which made me feel real good about my trying to impress her. She also could not remember my name. She said “Jim Martin is kind of like John Doe.” She said “It has no meaning whatsoever.” So she actually had to start writing my name down so that when we would be on a date, she could look it up and remember who I was. So it was not very good for me ego at that time. Also, her father had taught her that athletes were stupid. So when she found out I was on the tennis team, that did me no good either – because then she really knew I was stupid. But we eventually worked on that and it was a very interesting and fun time. So that’s how we met. We married in March of our second year of college. It’s interesting that I had original plans to go to medical school. Then I got really interested in baseball and play a lot of baseball. Played on the city pro team after high school. And just really began to look at that as an option to medical school until I really started playing against the players that later played professional ball and I realized very quickly that that was not going to be my career. So when I started college, my father-in-law who was double-boarded in eye and ear, nose and throat said “Why don’t you sit for the MCAT this year and go through the process just so you’ll be kind of used to what the application events are to go to medical school?” So when September of my second year I took my MCATs. I had a year of college and had a lot of advanced hours. I had a marvelous high school educational experience. We were a tiny town, no resources to speak of. But I look back…and I’ve gone back to every one of them gave them my appreciation. I had a math teacher, a biology teacher, a chemistry teacher and an English teacher who identified about four or five of us in the class. One of those who actually became one of the lead investigators, PhD University of Cincinnati on HIV. He was the valedictorian of our high school, the valedictorian of college, made straight A’s through all of his PhD courses. But they identified him and two or three other guys and me and they began to give us extra assignments and extra books to kind of push us. So we got advanced credit before we went to college. They had us really well-prepared. In fact, Mignon, who went to the largest high school in the state at that time, Bryan Adams in Dallas and took all advanced courses which they offered there, she was just dumbfounded how far ahead I was of her I all of our studies. When she first started studying with me, she said by then I got interested in you and I didn’t want to show you how smart I was. So I would kind of play dumb so that you wouldn’t be intimidated by me. She said after about the third or fourth session she realized that she could be just as smart as she wanted to and I would not be intimidated by her. But she repeatedly said she could not believe what background we had gotten. So for Miss Decoursey and Mrs. Blanton and Mrs. Burris, they saw something in a group of folks and they went that extra mile. I’m not sure that happens in the cities. But certainly in a small town like that, it was very successful. So I applied to medical school in the beginning of my second year and took the MCAT and shockingly enough did really well on the MCAT. And my grade point was good enough with playing varsity tennis that Medical School of San Antonio accepted me provided I would go ahead and get ninety hours before I would be allowed to enter the school. So that did away with my tennis. Because as you know, all the science labs are afternoon and evening labs. So I had to resign from the tennis team and spent the next year in laboratories essentially every day so I could get the necessary credits to move forward. Mignon and I married Easter of that second year. And then in August we moved down to San Antonio to start medical school.  \n\nAnd then you had children?\n\nMignon always wanted to have children. She had originally been pre-dental. That’s why I met her in our science classes. And she hated pre-dental. She did it because her father wanted her to do pre-dental. So after we got married, I said we need to get something that we can live on, which was teaching. So she went on and got her degree in English. And fortunately all of her science was still there. So her minor was in advanced chemistry. She had amazing p-chem and all these incredibly difficult chemistry courses that she had taken. So she became a teacher, then went on and got her master’s in counseling and guidance at Trinity University. But she counted the days of when I would be an intern and would be bringing in a paycheck. So we had our first baby my first week of my internship. Then we had them four years apart so we would never have more than one in college at the same time. We had three: two boys and then a girl. Unfortunately, the first son decided college was unnecessary. So he did not go to college when he graduated from high school, for a year, and then came back. We said okay, but you live off what you kill. So he moved out of the house and his apartment and food, whatever he earned working as a waiter at Olive Garden. After a year he came back and said I’m tired of being hungry and stupid, let’s start over again. So he went to college, but a year late. Our second son who was really a bright guy, a good athlete, played college basketball at Abilene Christian and was a National Merit Scholar. So he had a full ride anywhere. When he was in high school, he walked in toward the end of his junior year and said I don’t want to go my senior year, I want to start college. He had done all the work on it and sure enough, with the credits and grades he had, he could go into college after three years of high school. So our best plans of the kids four years apart in school didn’t work. One that came in late, one that left early. So we still spent a lot of money for some college and obviously the activities that went along with that. Our older son Jeremy became an appellate attorney in Dallas where he has four of our grandchildren. His wife also is an attorney. She’s in labor law. Our second son Blake is in information technology and lives in Fort Worth right now. He has two daughters. Then our third child Haley also became an attorney. She is now the health attorney for the University of Texas Health Science Center. She has given us one grandson and has another one due at any time now. Another little boy. So that’s kind of where our family situation is. \n\nThat’s wonderful and I wanted to make sure we captured that. I wanted to make sure we captured how you met Mignon and then the children and how they’ve come through. You really took us through all of the political side of medicine. But could you discuss a little bit, what you have done careerwise?\n\nAs soon as I started the residency program, it was very clear to me that I was doing what God wanted me to do. I loved it. I loved the relationships with people. Then as I got through the residency and we were looking for a place to practice, we had developed a really strong relationship with the church where we went here in San Antonio. And so many of the families and couples really encouraged us to stay in San Antonio, so we did. And it was the most wonderful full practice for twenty-five years. I was a solo practitioner. I shared weekend call with a couple of other family docs. But we took all our own call and everybody kind of did their own thing. I was blessed with a fabulous clinic staff which stayed with me the entire twenty-five years. So I didn’t have to worry about a lot of turnover and retraining. I had a wonderful group of people to work with. And had a very loyal set of patients. I just continue to be awed by what they did. This was when managed care was kind of coming into its own and I refused to sign any managed care contracts. And for about five or six years almost all of my patients paid cash out of pocket rather than change. So I was grateful. But it also put a lot of pressure on me, as you can imagine. You know, if you’re going to pay out of your pocket instead of use your insurance, I better be doing a dang good job of taking care of you. So it put a lot of pressure. And when I used to get home at 6:00, 6:30 at night, then it was 7:30 or 8:00 because I would be taking so much longer to kind of make sure I was meeting the needs of the patients. But during that time, as an independent self-employed person I had the opportunity to stay involved with my kids. All three of them played a lot of sports. So I was Little League coach and soccer coach. Soccer coach for about three days – I hated it, so didn’t take that any further. But I did football and basketball and baseball. Thinking that my boys would have the love of baseball that I had had and certainly kept the skills that I hoped genetically had gone on to them, but it was quite disappointing. When I grew up, at least in west Texas, you played baseball from January until September. Then you played football September until November, then went back to baseball. So you played baseball year-round and you read baseball history and you knew who the players were. You learned strategies. And I guess I felt that would continue. So when I started coaching the boys when they were fourteen, fifteen, sixteen, I knew I was too competitive. Believe it or not, I was an incredibly competitive athlete in terms of not keeping my cool. I knew I couldn’t coach Little League without showing that. So I wanted to wait until the kids were old enough to have more of a mature approach to baseball. And I was so incredibly disappointed when I still had to tell them this is what a baseball is and this is where second base is. My whole ideas and dreams of really developing a strong love of baseball were lost in teaching basic fundamentals. But had a chance to coach both boys in that. And since I was my own boss, I could leave at 4:00 in the afternoon and go do the coaching. It was just a fabulous time. I don’t think I missed any of our kids’ games. When they had award ceremonies at school, I was able to stop and go to do those things. And the kids have talked about that since then, how they look in their own busy lives they understand what that commitment was and it registers with them really well. But to me that was very important. My wife was truly the keeper of the home and I was the breadwinner. But I was able to be there for the activities that they had.  \n\nSo I practiced for twenty-five years. I think I mentioned to you last time that about ’91 or ’92 the University of Texas Health Science Center which had the huge clinic in the downtown underserved area decided to move out to the Medical Center area which was a much more affluent population. And there was a big outcrying to see what was going to happen to the poor people. And we had been so successful that Mignon and I were talking one night and said let’s see if we can put a clinic down there. So I went to a lot of my friends on the north side, the affluent side, and got a really good agreement. They said yes, we can each give a couple of nights a month, so we started setting it up. And at that time I was approached by Santa Rosa, which is the Catholic hospital system. I had done part of my residency training here because it’s the city’s children’s hospital but had had nothing to do with it since that time at all. And they approached me and asked me if I would help develop the residency training program because they also were concerned about the underserved and the inner-city. I told them absolutely not, had no interest at all in doing that. And they kept coming back. Finally Mignon said look, make an offer to them that’s so outrageous, they can’t do it and they’ll leave you alone. So I sat down with them and said if we’re going to do this, you’re going to give me the resources to become the best training program in the United States within ten years. I get to go find the faculty that I want. Pay them what they deserve, bring them here. Number 3, you’ll build us the most modern doctor’s office in San Antonio. And number 4, there can be no other competitive residencies in our system without my permission. And much to my surprise, they immediately said yes. We forgot to ask for a million dollars, but they really did step up to the plate and let the program do that. So starting in ’95, I began to transit out of my private practice. I did tell the patients if they wanted to follow me downtown, which is eight or ten miles from where we were in the suburbs, they could do that. But need to recognize it will be a different setting. And was very pleased that about 2500 of them did become patients in the new facility. So I had been able to maintain a steady population of patients that I’d known since 1975, ’76. So that was very rewarding in itself. As I mentioned last time, I’ve delivered about twelve of the babies where I delivered the mother also. And that’s kind of neat and unique, especially in a city situation. I think some of the older rural docs have gotten to do that repeatedly. But in a city, that’s been a little unique. \n\nIn ’95 we started developing residency programs. Started in ’97. I’d gone back and taken a fellowship in academic medicine to at least learn something about what it meant to be in academic medicine. Was able to bring together a really great faculty that helped us accomplish what we wanted to do. We were able to start recruiting very well, very quickly. And our program, within about four or five years, was seen as we were consistently in the 10% of board scores. And again, we created only U.S. gradates. So it was a very successful program. When I was asked three years ago to become the Chief Medical Officer in the hospital system region, I felt very comfortable that I could leave. Obviously, it’s your child and you’re totally devoted to protecting it. But I felt like I was at a point where I could leave. The person who took over me, Dr. Todd Thames, is just a whole lot smarter, a whole lot better than I am at it and he has done a great job with the program since I left. But it gave me the freedom to be able to then focus on what an administrative position does, both the good and the bad. I was really pleased last year that the ACGME which has begun to go overseas, they’ve started to develop residency training in other countries. One of the biggest interests in our graduate medical education has been Singapore and certainly has the ---- to do whatever they want to do. And about a year and a half, two years ago they became very intrigued with the concept of family medicine. They didn’t have it there. So not only were they willing to start developing that as part of their health care infrastructure but they also said we want to come look and see how the training goes. And so they asked the ACGME, where is the best program? Where should we go? And I was thrilled to death, because I had nothing to do with the decision, but they asked them to come to San Antonio and watch our program. Although there is no U.S. News and World Report that lists the top family medicine residencies, I felt like that within about that ten-year period, we had reached that goal of being recognized as the best residency program. So it was exciting to see all these Singaporeans come in, all who spoke better English than I do. To see them spend time and watch and see how we train our residents and the focus that we have. So that was an exciting time. And for us it was kind of a sense of accomplishment that at least there was some measure that we could say we have done what we wanted to do. \n\nAre there any philosophical overviews you would like to leave or additional items you would like to discuss and put on the tape?\n\nI think you’ve heard me repeatedly say, I have had the best job in the world. I just feel so strongly about that, to be able to become a part of people’s lives, for them to be so open and transparent, that they can be safe in that relationship. That, of course, is one of the best things in the world. In fact, as I was leaving the residency, there was a party for me. And one of the residents said Dr. Martin, what has been the best thing to you about being a family physician? And he told me later, he thought I was going to say deliver the babies of the babies I delivered. I said no, what has been the most meaningful to me is that now I have been with people for twenty-five, thirty, thirty-five years and I’m bringing them to the end of their life. And I have a chance to play a very important role to help them reach that stage. There was a book written by Nuland, I believe is his name (I could find that out for you). He’s a surgeon out of Chicago initially, now he’s on the east coast. I believe his name is Sherwin Nuland. He had written a book on the end of life. It was a very graphic book on how we die, what happens to the cells and what happens in ICU. But in the prologue of the book, he said I hope you can read between the lines of this book, a call for the return of the family physician. He said we need people who know us as well as the path by which we face death. And at such times it is not the concern of caring strangers but the love of a long-term friend. I just thought that so much captured the essence of what we’re about in terms of continuity and relationships in family medicine. So I quoted that and obviously have kept the quote in my mind. That’s the beauty, being able to take people through the times in their life to that endpoint and do it with grace and dignity. So that’s the philosophical part that I love. I hope sincerely that this generation of physicians which really sees medicine different than we did, I hope as they go along, they will value that. If you remember back in the Keystone days, Sandy, there was a huge debate about family medicine. And Keystone actually divided up into three groups: Those family docs that had trained before ’73, those who trained between ’73 and ’93, and those who trained after ’93. And the pre-‘73s were the docs who had totally committed their lives to their patients. They worked 60-, 70-hour weeks and were never home. It was amazing how many of the times they were divorced and their children were estranged from them. They had every plaque and certificate the community gives them out of appreciation but they didn’t have the home life. And then you had the ’93 and after who look at that group as a bunch of anal retentive screw-ups, totally dysfunctional people. And their focus was very much to make sure that their attention was to their families and that the profession was simply a job that they did from 8:00 to 5:00 or whenever they were on call. So the in-between group, which is my group, were the ones that tried to get both sides to see the good points of the other one and recognize the ways to compromise. And what bothered me, Sandy, is we were not able to accomplish that. Neither group would budge. The old people said the young ones don’t know what it means to be a physician. They’ll never have the relationship that we had. The younger ones were saying we don’t care, we’re going to have families and all that. So I do worry that as this generation moves forward, whether they will truly embrace the concept of long-term relationships and commitment to those relationships. If that happens then that will be fabulous. I also philosophically, as you know well, have concerns about our health care system, how dysfunctional and fragmented it is and the absolute lack of leadership in what needs to happen. It was a 50/50 toss – I was asked to give a talk somewhere nationally about what needed to happen. And I was talking about family medicine and the patient-centered medical home. And someone said Dr. Martin, I understand what you’re saying. But we need to make sure that all of us are focused first on the patient and making sure we take care of the patient. And I said that’s exactly what I mean. If we protect family medicine and it’s allowed to be what it wants to be, you will not have to worry about the patient. The patient will be at the center of that. So all of my concerns are about developing that family medicine infrastructure and that will solve your problem, and they began to understand that.  \n\nI think the Academy is working at it hard, they got to be in the [White House] Rose Garden a couple of years ago for signing of legislation. But if you stop and realize that at least one-third, and probably closer to two-thirds, of everybody in the United States has a family physician that they are open with and have a relationship with. And we ought to be in a better position to advocate for them and have the political clout, because of that, to be able to do more. And I’ve been a little frustrated with some things that we were wanting to do when I was still at the Academy to kind of nurture that. In fact, as a person in Washington who I respect very much, told me, because I was frustrated with her one day and she said why aren’t we doing this, and she said Dr. Martin, we have always done it differently. She said you and Dr. Fleming will be here two years and you are gone. So we will probably continue to do things as we have always done. Which kind of hit me hard, but it was clearly reality. I think Doug understands it. As you well know, I’m not sure Doug knows how to let go of the control to let other people begin to play roles there. You know, when he had a crossover with Michael Fleming over the control of the PAC and stuff like that and Mike eventually left, that was just really dumb again. And they had such strong leadership and was pushed aside for it. So I hope that we will not lose the thought of becoming an Academy of advocacy. In fact, as far as I’m concerned everything else could go away. Our focus should be on how do we advocate for the American people and for the protection of the discipline so that we can carry out that role. So I guess philosophically those are my two big deals. And I worry about what’s going to happen with an absence of health care leadership in this country. It’s so funny, I think most of us family docs really do have a good idea of what needs to happen. But none of us have been in the position where we could really influence that. \n\nBut based upon our last conversation, you are hopeful based upon the new Health Care Reform bill?\n\nNo. As I mentioned last time, when I left the Academy…and again, I spent a year in ’94, ’95 going all over the United States speaking to family medicine groups, speaking with other physician groups, internists, AMA, policymakers, stakeholders everywhere talking about the patient-centered medical home. And Washington seemed to be very understanding of it, accepting of it. I think I mentioned to you, my own senator, John Cornyn, I think I mentioned to you that John and I are both from San Antonio. He graduated from law school the same year I graduated from medical school. We have a small church, 300 people, so it was kind of cool that had a doctor and a lawyer graduate on the same day. John, who goes on to become a United States Senator, his interest at the time, he had the Future of Family Medicine Report when I walked in to see him. He said “This is where we need to go.” And it was very clear at that time that he and his group had a clear understanding. When we went to CMS that year, and you may know that every year the Academy leadership goes and visits with the head of CMS. And the first year that [Tom] Scully had sat down, it was Mark McClellan. Mark and I had known each other here in Texas. His mom was a politician here. My other three previous times I had been to Washington to see Scully, not always would we even have the Director of CMS. Maybe it would be the recording secretary. And we came in this time and all of his staff, there were about fifteen, twenty people in the room with McClellan. And they had a couple of video connections to CMS’s other Arlington, surrounding Washington area, members of his department all wanting to talk about patient medical home. So I left those meetings in Washington thinking that we were really going to start to get somewhere. And then nothing happened. So the next two or three years there was nothing. In fact, I called Mignon in about 2009 feeling sorry for myself. I said you know, we put a lot of effort and essentially lost our homes during that three years. Because when you’re gone that much, you’re not at church anymore, you’re not in your community anymore, you lose some of your connectiveness with a significant number of your patients. So the life you had known in memories is gone from having gone through that. And I’m sure as you’ve talked to other presidents, that’s become very obvious to you that what they go back home to is very different from what they left when they began that commitment. So I really thought it all kind of fizzled out. When President Obama, the first town hall meeting where he talked about what he wanted to see happen, he could have been speaking from the Future of Family Medicine Report. The issues that he discussed, the order in which he discussed them, his recommendations were identical to what was in the FFM Report. And I was encouraged really for the first time. If you go back, his focus was on developing the primary care infrastructure, increasing payment to primary care, increased accessibility to primary care. And his feeling was if everybody went through that route, there would be a significant amount of cost savings and we could save the health system. So, obviously I was extremely excited at that point and was very frustrated once his plan moved into Congress that you had the same old ideologic polarization that took place and none of that was to become about. So what we have from the health care reform act is the possibility of 30 million more people being insured in a health care system that’s expensive, and they did nothing to address the cost of health care. So it’s just going to add to the debt. I truly believe if we don’t address it, the country will be bankrupt. I remember Bob Graham telling me in 1998 when the GDP for health care reached 12%, he said “I don’t think we can go much further than this.” And now it’s around 18%. And finally everybody started to acknowledge that if we don’t do something about the cost, we will go bankrupt. So to reiterate, I was excited when the President first began to talk about his health care reform and then became, once again, incredibly discouraged by the partisanship and the lack of ability to get beyond that partisanship. So now, I don’t have any confidence at all that anything will happen until we go bankrupt.  \n\nWe have to figure something else out…\n\nI agree with that. Somebody’s got to step up and say…as I said many years ago, at some point somebody’s got to ask the family docs what do we need to do here, you guys? We’ve got a solution. The Future of Family Medicine Report was a health care policy for primary care. It was written out there. And it had shown to be correct, --- by insurance companies. It has been successful at increasing quality and lowering costs. So it’s not an unproven concept. It’s just that it has just never taken the hold it needs to. \n\nI thank you so much for doing this a second time. \n\nThe one thing I did mention the last time ---- and I was talking to Jim ---- about it when we were going to the airport Saturday…when someone was asked to write the history of the American Board in the late ‘90s, early 2000, I had a chance to review it. And boy, Sandy, it was the dullest. Dr. Pisacano became CEO of the Board in such-and-such a year and he was married to so-and-so and he died in such-and-such. And then the president became Paul Young and here were the directors under Paul Young. And what I was  hoping to be able to catch with Jack and I’m sure some of the other presidents, we have an incredibly rich and exciting history of characters who believe strongly, one way or the other, and who were willing to take a stand on those. And Nick Pisacano was dead by then. But his wife, who obviously was very intimately familiar with all that was going on, was still very much alive. And at that time, her mind was just as sharp as it could be. She’s pretty demented now, but she was pretty sharp at that time. And I said “You should have gone to her and to all of these people.” [Inaudible name] was still real bright at that time. You would have to remind me of the names, but there was a whole group of those early presidents. \n\nHolverson?  \n\nYes, all of that group that had strong feelings. They could tell the richness, the stories of their interactions, relationships both in the Academy…and I look back at Sam Nixon talking to me about what it was like to run for office back in his time where there were secret negotiations and politics in the back bedrooms. So everybody was talking around, each state would have kind of an open house for people. So everybody’s out front drinking punch and eating cookies. In the back room there were gifts exchanging and promises being made. I didn’t have that. It was a much cleaner political process by then. But I think to be able to have those folks be able to talk about what it was like. \n\nA lot of this has been captured. I know Tom Stern who was intimately involved with Nick Pisacano and the Board, he had huge sections where he discussed all about the Board. So I think through some of the past presidents, we have captured the Board part of it.\n\nThat makes me very happy. And I know if anybody would, you would understand that, Sandy, to capture those stories. \n\nDon, you did multiple tapes on Jack Stelmach, didn’t you?\n\n[Don Ivey] Yes, over the course of several days I interviewed him.\n\nThat is wonderful. That’s where the richness is going to be in this. \n\nI think we’ve captured some of that. Because when we go through this process, we do go through all of the organizations not only in family medicine but the medical society, organizations like that – we capture all of that. So I think we’ve got a good, rich supply, quite honestly.\n\nI’m excited. It sounds like you’ve circled it and are paying attention to it. \n\nThank you again so much.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153749/file/282858#t=0.0,3222.66109"}]}]}]}