Wisdom of Practice is a series of initiatives advancing the understanding, practice, education, and policy of integrated, personalized health care.
The Oral History Initiative - conversations with front line clinicians and policy makers - sheds light on the past, present, and future of private practice and its role in making personal doctoring possible. By capturing clinicians' rich lived experiences, this initiative brings to life changes in health care delivery during more than half a century and informs the future of medical practice.
This page includes an overview of interviews completed to date by interviewer Robin Gotler, MA, of the Center for Community Health Integration. New oral histories are added regularly, so please visit us again! Full transcripts of the Wisdom of Practice oral history interviews are available xxxx.
Erika Bliss, Seattle, Washington
October 25, 2023
Summary:
John Brady, MD, Newport News, Virginia
May 1, 2023
Summary: John Brady, MD shares his perspective as a long-time independent solo family physician and an active participant in primary care policymaking.
When Dr. Brady established his solo practice in 2004, the "Ideal Medical Practice" model was gaining traction. By greatly reducing overhead, utilizing available technology, and focusing on relationships rather than volume, Ideal Medical Practices aimed to increase patient access, care coordination, and physician autonomy. Dr. Brady's practice embraced this model at a time of rapid consolidation and corporatization in health care. In this interview he reflects on his experiences as a solo physician and practice owner, other innovative practice models, the implications of how we define and measure quality of care, the decline of small practices, the COVID-19 pandemic, the value of practice innovation, and the importance of challenging health care's status quo.
Excerpts:
In [our] practice...there wasn’t an administrator saying...'you’ve got to crank it up, man.' I was accepting a lower salary intentionally so that I could spend more time with people…it really was refreshing… I felt like what we were doing was special."
"…the biggest shift...in the past 15 to 20 years is, in the search for quality we’ve moved towards consolidation, toward larger groups, and I worry that...many patients nowadays have no idea what it’s like to have a high continuity practice, or to have really good access without having to go to urgent care...and so that’s my concern: is primary care actually potentially dying because we’ve lost what our fundamental purpose is?"
"If it’s your own practice and your name is on the door and you’re the owner of it, you’re going to go the extra mile, and I think that’s what’s lost. When you start losing the independent practices, you also start losing some interesting innovations…. At a time that we know the healthcare system is failing...in many different ways, this is the time that we need to really challenge processes."
Larry Green, MD, Denver, Colorado
March 7, 2022
Summary: Larry Green, MD, is a family physician with extensive experience in family medicine, practice-based research, and health policy.
Framed by his childhood in Ardmore, Oklahoma and the experience of having a local family doctor, Dr. Green views medicine, particularly family medicine, as a calling. His experiences include formative training at one of the country's first family practice residency programs, rural practice, serving as a department chair at a pivotal time of change, and leading his discipline's first policy research center in Washington, DC. His story sheds a personal light on the US healthcare's profit focus; the future of the medical profession; the importance of having a personal physician; academic family medicine; the rise of large hospital systems and loss of control of practice; curriculum innovations; policy issues; the importance of measuring what matters; and the importance of mentors and professional and personal support.
Excerpts:
"[My family doctor growing up] ...was involved with my mother’s health care, my dad’s health care, and he knew my sister, and he had been in our home. He had been in my grandparent’s home. He didn’t need a record of our social determinants."
"...in a capitalistic world with venture capitalists buying up practices and the fundamental purpose being to meet shareholders’ expectations or to retrieve the investment as quickly as possible...when those owners take charge of telling doctors what they can and can’t do, now that’s the end of medicine as a profession..."
"The core problem [in healthcare] is this: is the purpose of medicine to heal people, to relieve suffering, to place the interest of someone who’s frightened, scared, or very sick ahead of your own? If that’s its purpose, then that’s an ethical undertaking."
William Miller, MD, Allentown, Pennsylvania
June 15, 2023
Summary:
Sherrod Morehead, PhD, LOCATION
May 4, 2022
Summary:
Kenneth Qiu, MD, Midlothian, Virginia
August 17, 2022
Summary: Kenneth Qiu is the founder of EuDoc, a Direct Primary Care (DPC) practice, and a champion of the DPC movement.
When Dr. Qiu discovered DPC as a fourth-year medical student, he saw it as a means to combine his interests in policy, innovation, and the business of health care. Now, in light of those interests, and as a practice owner, he considers both local and large-scale issues: the processes of establishing and organizing a DPC practice, community and business relationships, potential practice innovations, the challenge of defining primary care, and insurance/payment issues including the limitations of employer-based insurance. He also looks to the future and ways to optimize chronic, acute, and mental health care.
Excerpts:
"…I get to think about innovation all the time…‘What’s out on the market? How can I make the membership more valuable for my members? How can I extend our clinical abilities…through new AI technologies or new devices…?’ …these are things that…primary care docs generally don’t think about because they’re so busy just trying to get through their 40 patients."
"…I think the technology has evolved, the medicine has evolved, but because our payment structure hasn’t, our payment structure is still archaic, it drags everything down with it."
"...people talk about work/life balance. I don’t have a line between work and life. It’s all fun for me."
"…a lot of this idea of Direct Care and putting primary care back at the helm is to say… ‘How do we make [primary care] better...so that we’re the ones…making the decisions?’ because I think we need to stop giving away ground, because...when we take over these processes and these operations, I think we can make it better."