Edward M. Copeland III, MD, FACS, was the 2006–2007 President of the American College of Surgeons. In this interview, he talks about his early life, his education, his work as a surgeon, and his work with the College. This interview was recorded on October 8, 2013.
Copeland died March 31, 2024.
Copeland spoke with Jane Kenamore.
Transcript
Edward Copeland: So I found out. No, it’s like anywhere else. Oh, okay. Point A to point B is not a problem, particularly with the government closed down. I know there’s no traffic.
EC: Kind of sad to say, but that’s the case. Yeah.
EC: Me? Yes. I was born in Augusta, Georgia, but lived there a very brief period of time. Then my father was a little too old for World War II, so he was moved around to various cities—actually smaller towns in Georgia—to run the Georgia Power Company. When people who were drafted, he took their place and then we moved back to his hometown and actually the Copeland hometown of McDonough, Georgia, our family settled the town and yes, Sherman burned down the house and all that stuff. I thought you can edit that out path right from—
EC: Family home, yeah. Really there are two of ’em and one still stands, so we moved back to McDonough and my dad went into business with a cousin in Griffin, Georgia, and they opened a business in Atlanta. He was a plumbing, heating electrical contractor, which I knew I did not want to do. Having said that, in the Copeland family, I would say easily 25% of us are docs of one sort or another.
EC: Family before, and actually, the family after, no. The family before, yes. I have four first cousins who were actually, they’re dead now, unfortunately. Went to medical school and did various things, and I have an uncle who was a mentor and he and his wife, my aunt Jean, uncle Murray Copeland had no children, so they were kind of like a second family. But the bottom line is the only thing I was good at was basically science stuff I made A’s in that, and I made B’s and C’s and everything else. I really had no choice, that simple. So my upbringing, I mean my mother taught school, all of those kinds of things, and I was a fairly good athlete, et cetera. But the bottom line is, I went to Duke University for me to make decent grades to get in medical school, I had to take chemistry and biology and those kinds of things because philosophy and economics was not my forte.
EC: Yeah, it was a foregone conclusion. I wouldn’t have been able to make a living if I had not become a doctor or something.
EC: I’m obviously being facetious, but it is just sort of a natural path.
EC: To. Well, in terms of how good I am, which may be way down here, that was where I was best.
EC: Well, I think most of us in academic medicine follow our basic science interests, quite frankly. And my basic science interest and the one I was best in was anatomy. I think three dimensionally. I think most good surgeons do, but you don’t know other people don’t. So it was easy for me today to tell you the anatomy of the hand because I can actually see it. Don’t test me.
So I took an elective. I went to Cornell Medical School in New York City, and I took an elective in the dog lab, but we’re doing a project required operating on animals to see if I had any technical skills. I’m left-handed—I’m very left-handed. And so I had to be sure I could actually use the tools or right-handed people with my left hand. The answer was yes, and I enjoyed it and I was good at it. And so from that moment forward, I knew where I needed to be.
This may sound strange, but surgery is a hobby. There aren’t very many professions where you can actually get paid for a hobby. Now, you help people, you get paid for it and all that kind of thing—teaching medical students, all that’s a hobby. So for us who have grown up as surgeons and grown up in the university atmosphere, we’re one of the lucky few who actually get paid for something we’d pay them to do.
EC: Well, that’s true.
EC: I did. And that’s because you’re in the Berry plan—a man named Berry obviously set up a program. Do you know about the Berry plan?
EC: So I was signed up for two years. When I got done, I was offered the opportunity to go to the Walter Reed Research Institute and offered the opportunity to go to Europe and offered the opportunity to go to the burn unit. But I’m left handed, so I didn’t want to spend a couple of years out of the surgical discipline.
I quite frankly was afraid I might lose my skills.
EC: No, I thought it did. I didn’t know whether it did or not, but so I said, well, I’ll just go. So I went.
EC: And here I sit. I survived.
EC: Well, I don’t think it affected me personally at all. Professionally, It was a great experience. University of Pennsylvania did no trauma. I think I once saw a nurse who cut her wrist. I’m very serious about that.
So, I had to learn how to do trauma surgery. Wartime trauma is a bit different than trauma in a stateside area, but I was stationed in Saigon and there was something like 200,000 people that we took care of—either employees of the federal governor or Vietnamese that worked for us or the military. So we had a lot of civilian trauma.
So I became fairly accomplished as a trauma surgeon and have taken trauma called and all those kinds of things throughout my career in various times. Although I’m a cancer surgeon, if you will. So, without any question, that was a great boon to my own personal development.
It also gave you a look, see into the rest of the world and to what maybe this country should and should not be doing. I think if we had had more people who’ve made decisions lately go to Vietnam, they wouldn’t have made the decisions they made, to tell you the truth. So, I can observe that, be frustrated by it—I can’t do anything about it, but it was certainly broadening from that point of view.
And it was interesting for me to realize that why this country is so great just because of the immigration of other people here. There’s 18,000 Ethiopians living right here in Washington, DC, the majority of whom is citizens. So this country’s great because of people who immigrated.
Your folks immigrated, so mine, they just don’t look like us now. So this country has always been, it’s built on immigration. You got to keep people out you don’t want. But immigration is the heart of America, and it was not more than two or three years that medical students from Vietnam began to show up in medical school [in the U.S.].
Very simple reason: the top 5% of their, this is just my opinion, the top 5% of their population came here. And why do you think that was? Because they had opportunities here. First of all, they had the “get up and go,” if you will, to come. They had the resources—although many came on boats—and they realized that their kids and themselves had a better opportunity in this country. Same reason everybody else came. And so sure enough, we skim the top 5% of that population and look around you now. Two of my—I had residents, I retired—were from Vietnam, and I pay attention because I know their names, I know their Vietnamese names.
So it gave me the opportunity to talk to the Ethiopian cab driver who brought me over here. He lived here 30 years, and as I say, it’s 15,000 Ethiopians in this very town, the majority of whom are citizens. So this country is the same as it always was. It is based on immigration here from what happens to be the “get up and go” people from other parts of the world.
EC: I did. I did. A lot of us did. I can’t brag about being the only one. Bronze stars are based two types. It’s bronze star with a V for “valor,” which means you got shot at, and they’re bronze stars for doing a good job. And the thing that they showed interest in me more than maybe other people is I went down to the Australian first field hospital frequently to help the Australian surgeons do surgery, because they rotate every six weeks. So that was a little bit unique for me. And there’s some other things that I could tell you, but they’re not germane to this interview.
They actually are, but I don’t want to tell you about it.
EC: Well, no, the situation with going down to Bình Thuận was a province that we took care of a hundred percent burn patients from there for a while and then—
EC: Yeah, they were going to die and they did die. A hundred percent is lethal now, lethal then. And so we knew they were going to die. They didn’t and we didn’t tell ’em, but they died.
And so they invited me—Dave Munson is the person, he just retired I think in Chicago. But Dave Munson and I were invited down there. And actually, I’m not sure if Dave went now come to thinking about it.
Anyway, I was invited down there to sort of pay us back for taking care of these two people as best we could. And we got up in a firefight and all those kinds of things and shot at and missed. fortunately. And that was interesting. So that was also somewhat part of the deal. And the way I got involved in going down to their hospital to help out with their surgeons, surgeons who were changing every six weeks, I went down for a week and worked with them.
EC: They were all older than me. It was kind of interesting. I was a young guy helping them, which is a new experience.
EC: Yeah, exactly. Oh sure. And they had a lot to learn from me. And I have some Australian friends. They’re still alive and working and—I haven’t seen ’em in a long time, but they’re still there. We keep in touch.
EC: I did.
EC: A lot of reasons. First of all, I have an interest in the disease, but I have even more of an interest in the people who have the disease. If you want to cure somebody, that’s the specialty you go into, because virtually everybody you operate on who has a malignancy, you’re operating for cure. Not always. Sometimes you’re operating for palliation, obstruction or something, but you’re operating for cure.
Secondly, you operate all over the human body. And remember, I told you that my interest in anatomy and being good at it also led me to being able to operate on the foot, or the leg, or parts of the body that you don’t go into very often because I could review it and do it.
Also, the surgery was big, and I enjoyed that. So those are the primary reasons. Plus quite frankly, I’d always planned to do that. My uncle Murray Copeland was a surgical oncologist. So all those reasons.
But when he was at Memorial Sloan Kettering Cancer Institute, he and a man named [Charles F.] Geshickter actually started doing radiation therapy in the basement of that institution. And then Geshickter was a pathologist and was at Georgetown where my uncle, who spent four years in the military working with a man named I.S. [Isadore Schwaner] Ravdin, as a matter of fact, who was at the University of Pennsylvania, which is why I went there. But so he was the real deal and I could appreciate that. And so I wanted to emulate him, if you will.
EC: He was well organized. Hopefully, we can all operate. I’ve been training residents for a long time, and some are better than others. They all as good—one is as good as the other when they finish because you train them differently, but operating is—hopefully they can all do that. And my residents have all proved that they can. So I can say that without fear of being contradicted because they’re out there and I’m not going to train anybody else.
But he also was well organized. He was interested in cancer as a disease. He and Geshickter, as a matter of fact, classified bone tumors. They’d never been classified before. And so he gets credit for having done that—sarcomas of the bone and those kinds of things.
So he was interested in Georgetown for a long time. He was interested the academic side and people looked up to him and LaSalle Leffall, as an example. LeSalle Leffall—we talked about my Uncle Murray today. So I didn’t do it for that reason, but it appeared to me that people liked him and he liked what he did and his patients liked him. And I was good at what he did. So seems sort of obvious to me.
EC: It did.
I in fact stepped down as chair before the 80 hour work week took its place, not because of just by happenstance. So I have trained residents under the 80 hour system. I’ve trained residents under the other, I’ve never trained residents under the 80 hour system as chairman, but I certainly have trained him under it. And in fact, I don’t think Connie Lee would mind mentioning her name. She’s going to take a pediatric surgery residency. Connie Lee clearly enjoyed surgery, enjoyed the patients, enjoyed every aspect of it. So she, lemme put it this way, she may have occasionally violated the 80 hour rule.
And our faculty, which most of ’em are still, my faculty, said, gosh, she’s just working too hard. She didn’t have any social life. I said, leave Connie Lee alone. I think Connie Lee enjoys what she’s doing, leave her alone. She likes to operate on people and take care of ’em. It’s ridiculous. So I’m very proud of Connie Lee.
And so the issue there is I don’t see the communication and the absolute compassion that you see in the 80 hour work week people, as I saw in the people who were on call as much as the surgeon that was in charge wished them to be. That may not be accurate across the board, but that’s the thing that bothered me. And I have seen that to some degree, and it’s morphed into surgeons becoming employees.
I don’t think employees have the same interest in your patient across the whole spectrum of their disease. IE: Start, operative, postoperative, follow-up.
EC: Well, I think it’s the XY generation, you read about that all the time. The so-called X generation of people, the ones that followed along after the group that was “Baby Boomers,” if you will. And their style, is to—like a lifestyle.
Now, quite frankly, my lifestyle was practicing surgery. I married my wife because she thought that was wonderful. And we’ve raised two kids—she raised them—and they did well. And we’ve been married 50 years. We’ve both done well. So I don’t think tolerant is the issue for her. I mean, I think that she tolerated, I don’t think she noticed it, because she anticipated that when we got married.
And I think most of the people who you’re interviewing here, their wives would probably tell you that. They’d probably tell you the same thing about their wives.
So, well my uncle, my uncle quoted Osler. [William] Osler was, you know who Osler was?
EC: People listening to this will. Osler said that “medicine’s a jealous mistress.”
No more accurate statements that have been made and we’re getting away from medicine being a jealous mistress. Is that good or bad? I don’t know. Time will tell, but I don’t particularly want somebody at taking care of me eight hours and turning my care over to somebody else the next eight hours and turning my care over again to somebody the next eight hours. I’d just as soon the same person do it continually. And I think that will be a potential problem with the system.
I wrote an article called The Perfect Storm, and the perfect storm is we have students in the XY generation who enjoy a “better lifestyle” than we ostensibly did as surgeons. And they’re wrong about that from my point of view, but that’s what they wish to do. They wish to spend more time at home with their families there—I don’t want to say more involved. Nobody was more involved than me, but it was my family. But that’s the way things are.
And about a year ago I asked the third year medical students, how many of them planned to work for some type of health system as an employee. Every one of ’em raised their hand. I think that’s not a good thing, frankly. I’m probably not in the minority in that regard, but that’s not a good thing I want to be.
Now, I’ll tell you what proved to me that it’s okay to see different people. I never thought that a woman would go to see her obstetrician for all of her pre-delivery stuff and then accept another person delivering her. I was totally wrong. And you know that, because you probably lived that. So it’s obvious that some people, probably most people don’t really care to have different people move in and out of their medical—a particular disease process medical care.
EC: Well I made my point. So that’s my… My wife, just, not with me because she’s ill, she broke her hip and she needed a blood transfusion. I mean, I knew that. She knew, she’d get up and get dizzy, but she couldn’t have a blood transfusion because she did not have a hemoglobin below eight. And the protocol call for hemoglobin has got to be below eight.
So I said—this is in a different hospital than the one I work in. One I work in, she’d have gotten a blood transfusion, but I said, if she stands up and gets dizzy and falls down, does that meet your protocol? She stood up, got dizzy and fell down—with me holding her up—and sure enough, she was able to get two units of blood. I’m sure protocols are great for 95% of the population, but who’s going to figure out who the 5% are that don’t meet the protocol?
EC: I think I have. And when somebody listens to this in a hundred years, if they do, because then everything will be on different kind of disc. The stuff that we’re doing will be trash because they didn’t save it and all that kind of thing.
EC: Hopefully, hopefully not. But that’s the way the world is. Copeland? Who the hell was he?
[Off screen voice]: Don’t say that to an archivist.
EC: Well, you don’t have as much contact with ’em.
Your contact time is making rounds and operating in the middle of the night and having the residents be available to you and you’re available to the residents whenever you’re together at a time. And if they’re not there because they’ve got to punch a clock, then they’re not getting as much mentoring from the person who they select to admire and model their life after.
So as I walked through the audience here, I have people tell me things. I had no earthly—and this is—I have no ego. Well, I do, I’m a surgeon. But I have people tell me that are 50 years old, you can’t imagine how much you meant to me and point X.
I had one of our current faculty members at Florida who’s a quite good surgeon, and we were at a dinner last night and he said to me, “You don’t remember this Dr. Copeland, but you put your arm around me when I was a third year medical student, and you said to me, you should be a surgeon.” He’s a surgeon.
And he claims—he may have told 50 other people the same thing. But anyway, it strikes a note that maybe you have [an impact], but that isn’t going to happen if they aren’t there, right?
And that talk, remember, that particular address is given to the, it’s a convocation address to individuals who’ve been out at least one, two or three years who fulfill the requirements for joining the college. That’s who’s sitting out there, and they’re going to get junior partners who were not trained in the same environment in which they were trained. And they need to know that.
They also need to know that they may not be as technically, or judgmentally, versed in all the disease processes that they learned when they were coming through. So they’ve got to accept that, and they’ve got to be—what I’ve said was a mentoring process has got to continue, and you people sitting out in the audience have got to recognize that you now will become mentors for the young people who come in after you.
That’s true. That’s happened.
EC: Well sure.
I mean, radiation therapy for rectal cancer is an example. You can radiate rectal cancers and they go away in some instances, so you can just locally excise them. We’ve been doing that since 1976.
One of the beauties of our profession, particularly in the academic profession and to some degree in the private practice arena, is you talk to them about your successes and you talk to them about your failures. And you can talk to ’em about your failures without fear of punishment, without fear of criticism because they know that you are as good of a surgeon as they are.
So I can say, how do you handle this situation? Lemme tell you what I’ve gotten. Do you feel like you can get your residents out of trouble as well as you could in the past? And they’ll say, I just don’t let ’em get into trouble, which is my philosophy. John Cameron and I share that philosophy. Don’t let ’em get in trouble, you haven’t got to worry about how to get ’em out trouble.
This profession is not rocket science. The human body does not change from specimen to specimen. Once you know where the appendix is, it is pretty much there in everybody, same place. It moves around a little bit, not much. It’s easier than being a Volkswagen mechanic.
EC: Sure. Because the Volkswagen moved.
Look at the Volkswagens today. If you learned to be a Volkswagen mechanic on a little tiny Bug with the engine in the back, you’re out of date because they moved the engine all over the place. I obviously use this for students, but once you learn where things are in the human body, they pretty much stay there.
EC: Well, it’s problematic because it’s not going to be any broad-based surgeons.
EC: Oh, you bet.
EC: Oh, sure. Oh sure. The trend today is for residents to get a fellowship in something somewhere. They all do. You seldom see one go into private practice.
Now, we had two last year actually went into private practice with a group, not with a health thing. So I was quite proud of them. But the people that I trained can pretty much operate wherever you need to be operated on. They do thyroids and parathyroids and they don’t do neck dissections. I did, but they don’t. But they can take the esophagus out, they can work all over the abdomen. They can take out a uterus that isn’t rocket science either, although other GYN people do it, and we have some that do peripheral vascular.
One of my residents, when Texas Tech was just getting started, did the peripheral vascular for Texas Tech. Mark Pessa. It was a long time ago, but he never took a vascular fellowship. We just had enough vascular work that the guys who left could do it if they were called on to do it.
That’s the broad-base surgeon. In today’s world, everybody becomes… Do you think it takes seven years to learn how to become a breast surgeon?
EC: Yeah. I proved you could do it in three months with Connie Lee.
No, you don’t need to go through a full five or six year, or even seven year in some places, surgical residency to learn how to do breast surgery.
Now the judgmental aspect of what to do and when to do it is another thing. But the technical aspect of it is not difficult, if you pay attention and you’re willing to do a little bit more work to get a good cosmetic result and not get paid any more for it.
But that’s a good thing about being a hospital employee. You don’t have to worry about the fiscal implications of what you’re doing. But that’s a topic for another day.
But so people now are becoming laparoscopic surgeons. They’ll eventually cut the common duct. What if they’ve never seen the common duct except on a video screen? Who’s going to fix the common duct? The answer is the trauma surgeons. Even in oncology, people have paired themselves off at only doing liver, only doing pancreas, only doing breasts, only doing whatever. But yes, if you want to be a breast surgeon and get a certificate from the Society of Surgical Oncology through the American Board of Surgery today, you have to take a breast fellowship, which means you have five years at least of general surgery first. It doesn’t take that long.
EC: Well, yeah, but you don’t ever practice it.
EC: You might. Some do. The woman who’s on our faculty, Anna [Christiana] Shaw, she’ll do whatever shows up, but she is a “breast surgeon,” if you will.
Steve Grobmyer, who was my partner before her, Steve can do anything he wants to, but the world tends to categorize you. And so Steve gradually became categorized as a breast surgeon, and now he’s chief of the breast surgery service at Cleveland Clinic. But I can assure you that he could do anything that was required of you in the general surgery realm today.
Is that going to be true in the future with the 80 hour work week, and people knowing that they’re going to become a this, that, or the other?
I began not to see people showing up to do breast surgery. They knew they were going to be a trauma surgeon or a laparoscopic surgeon. Didn’t bother me, I’d do it myself. But that’s what you see. So therein lies the problem.
So broad-based surgeon of today—of today, not tomorrow, today—is a trauma surgeon. Now, you don’t want him to do your mastectomy. That’s not trauma. You’ll seek out someone who is a breast surgeon and that person or will probably be a woman, which is fine. And she—in this case stick to she—will have gone through all this training, to take two years of training to become a breast surgeon. It just doesn’t take that long. From my opinion.
And I’ve written it probably in that article we are quoting,
EC: Lifestyle, lifestyle, lifestyle, lifestyle, lifestyle.
Breast surgery is not easy. It is a whole lot harder than people think because of the different things you want to do and maintain cosmetics and cure the patient, all that stuff. But it doesn’t take seven years to learn it.
But it is nice if you’re going to be, you’re a surgeon and you’re going to have two or three kids, and—we’re in the lifestyle generation. That’s just a fact. It’s written multiple, multiple places.
So laparoscopic surgery, that’s schedule surgery. You do your surgery and not acute, and you go home. Acute care medicine and trauma surgery is where the action is in terms of doing a lot of things around the body. And now we have acute care trauma surgery, trainees and acute care trauma surgery programs, and we have about six acute care trauma surgeons at the University of Florida.
When I was chairman, we were all acute care people. We just put that into the mix of whatever else we’re doing. And I think if you were to look at our quality, which is the big thing now, which is good. I think if you looked at our quality back there, it’d be about as equal to the quality now. I would certainly hope so. Certainly my own was personally.
But that’s the answer. It ties into all the other things you’ve been asking me.
Is there anything wrong with that? Well, it’s not the way… I don’t have an answer to that. The answer to that will come in the future. I think it is, but I don’t know that, and I’ve been wrong before on this.
I thought with the institution of Medicare requiring the surgeon to be in the room for virtually everything was going to affect the training of surgeons. I was trained where the chief resident was by myself. Well, I had residents with me. I had an attending who’d do whatever I wished, who told me, you don’t really need me. You’re qualified to do that. And I would do it. And then when I joined the faculty at the MD Anderson and the University of Texas Medical School of Houston: new rules. You had to be there with ’em all the time. And I wondered whether we could train surgeons adequately in that environment.
The answer was we did. So that’s who’s out there now. So I don’t know. This may all work fine.
I just—I’d be a trauma surgeon. If I had to go into an oncologic residency and choose an organ and eliminate all the other organs,. I’d be a trauma surgeon. When I was at MD Anderson, we switched every six months because it’s a referral institution. You want to seek out the court of last resort. So you eventually build up a practice where people wanted you to do it.
But for people who were referred in, because Anderson was Anderson and everybody was wonderful, which actually was true—probably still is. We did GI for six months and we switched to soft tissue the other six months. We got tired of doing colon, liver, stomach, and we switched to doing breast and thyroid and sarcoma. We got tired of it.
If I had to do one thing all my career, I would be a trauma surgeon. That simple.
EC: That’s just my makeup.
EC: Very different from the current makeup, but that’s what you’re asking me about.
EC: Well, being president of the college is a continuum.
The board of Regents and the executive director do the accomplishing. The executive director does the accomplishing under the—”supervision” is the wrong word—with the members of the Board of Regents. And so in my tenure as a regent and then chair of the board of Regents, and then the vice president and the president, you’re talking about what, eight years? Eight years of time.
So a lot of things happened then. We’ve already talked about a lot of them, the 80 hour work week, et cetera, et cetera, et cetera. The thing that I noticed was we had somewhat of an issue with the members who’d been trained. These people pay their bills. I got paid nothing. By the way, if you’re a president of the AMA, when I was president of college, the AMA president whom I knew made $600,000.
EC: Yes. They probably made more than that. Yes, I know you don’t. I didn’t either. I quit paying my AMA dues.
EC: Well, the guys you—and everybody walks around the AMA with little tags saying, vote for, so-and-so—that’s real because so-and-so gets paid.
Now, the reason they say that is they’ve got to give up their practice, which in some degree is true. And we don’t. No, they make $600,000 and I’m proud that they do.
Yank Coble, very dear friend of mine, was president of the AMA. I think Yank, if anybody was worth $600,000 it was Yank Coble.
So the changes. The changes that took place were we had people that were trained in the old system, and we had a new system evolving the quality care system. Thank goodness for the quality care system, because you want to know the quality of the person operating on you in the current day.
In the old day, you could make assumptions that the quality of that person, because he trained at the University of Pennsylvania, or in Galveston, or the MD Anderson, that his or her quality was superb.
Today, if you’ve got someone who does laparoscopic surgery, who cuts the common bile duct and opens up your abdomen, who tries to fix the common bile duct, you want to know that that person’s qualified. So the measurement of quality is very, very necessary. And the American College today is big into quality, as it should be, and measurement standards for quality.
But over the transition, you had people that saw—I won’t say thumbed their nose at quality, but they were quality people. And so you had them as the primary number of people in the College. And you had some of the College hierarchy realizing what was coming to pass. And so the ability to appease the members of the College who were basically paying the salaries of the staff and also get the College in position to move forward with the new system was a little difficult.
And it all happened. And Dave Hoyt’s fantastic. Tom Russell was too. Tom Russel a dear friend of mine, I hope. But Tom, Tom was ahead of the curve. Tom knew what was going to happen before it happened. And it was hard to communicate with 72,000 people while you’re doing something.
So he was trapped in a transition year, but he was executive director for 10 years.
EC: The president, helps with that—the president helps with that kind of stuff. The president does the ceremonial stuff. The chairman of the Board of Regents is where the action is. That’s where the action is. I traveled Australia and all these places that invites you to come because you’re president of the College. The guy that’s got his hand on the pulse is the chair of the board of Regents because you meet frequently, et cetera.
And that person eventually becomes, usually—it has changed a little—becomes the president of the college. I don’t want to say as a payback, but as you’ve earned the right to be considered as the president of the college. That’s why I say, what have I accomplished? I didn’t accomplish anything.
But during my tenure, we made this transition, which David Hoyt is wonderful at. During my tenure, we built the F Street property, which is right around the corner here, someplace, where the communication with people who are interested in Congress and getting them interested now occurs. David Hort just gave the report to us at the past Presidents luncheon, and it’s amazing what he’s been able to accomplish.
Now, it’s quality, quality, quality, quality. And that’s what the federal government is saying: quality, quality, quality. And the federal government is a right to say quality, quality, quality. Because the training programs are so different, in my opinion, than they were in the past.
Now I can tell you who’s good, I can tell you who’s good now. I know them, I train them. But it’s getting tougher. So quality measures are very, very important. And attaching payment to quality is also a good thing. So all the things that I never needed, I used to tell our faculty members who would say, God, I don’t want big brother looking over me. I’d say—Steve Vogel (immaterial, but somebody may remember Steve)—listen to this, Steve. I don’t want big brother watching me. I’d say, Steve, yes you do, because you’re the best pancreatic surgeon in the United States. And so as they start measuring your quality and your outcomes against the rest of the country, you’re going to stick out like a bright star.
So quality is a good thing for those who have good quality, but wasn’t an issue there because you had it. It’s just never thought much about, but it is appropriate to do it now.
EC: Well, we don’t know yet. I’d put it in place. See what happens. I mean, it’s that simple, obviously. I don’t see what the big deal is. Put it in place. If it works fine, doesn’t work, change it. That’s the beauty of democracy.
HMOs, everybody wanted HMOs. You knew they weren’t going to work. HMO, you’re paying a doctor to take care of a certain population of people, and he gets whatever’s left over. So he provides no care. He gets a lot of money. He provides a lot of care. He ain’t get any money, so that ain’t going to work. Here, ever, anywhere. So you know of any HMOs out there now? Yeah, Medicare has an HMO, but all the HMOs… They had a pretty good one here in Washington, by the way, that there’s some good ones. But HMOs disappeared. They’re gone because they didn’t work. It wasn’t going work. And we vote.
So if this healthcare doesn’t work, it’ll show itself quickly and we vote. We’ll vote for people who want to do something else. But by and large, I have always been an advocate of universal healthcare. Always.
We live in a country where every single person should have access to care, and we do. Everybody gets care. Everybody does not get preventative care, and everybody does not feel like they can go to the doctor when their upper abdomen begins to hurt them. They wait and go, and their gallbladder is virtually ruptured.
So hopefully we’ll have enough doctors to take care of all these people, and we will because of the Caribbean medical schools, interestingly enough. We’re predicted 20,000 short physicians in 2020—where are those guys going to come from? They’re going to come from Americans training abroad.
As we sit here today, 80% of the individuals in Caribbean medical schools don’t have to worry about a visa. They’re already citizens of this country, and they want to be doctors or they wouldn’t be down there. It’s costing ’em $200,000 a year. Most of ’em are 28 to 30, so their quality is going to be fine.
The human body that they study in the Caribbean? No different than the one they’re studying in Galveston. Now they’re going to, they’re be primary physicians, but there are those of us, including me, who say, huh, Caribbean Medical School, this guy down there taking advantage. That’s not true. It’s a wonderful source of physicians for us.
Doctors of osteopathy, wonderful source of doctors. North Carolina, where I have a summer home and where we are now, well, my wife broke her leg, but they just opened a big DO school called Campbell Osteopathic Medical School. And a lot of those people who want to go to medical school in this country will not go to the Caribbean. They’ll go to that one. It’s going to be large.
So weird things. Medical schools have fallen way behind. Yes, in Florida, there were only three. Now there’s six. But if you’re going to be a breast surgeon, it takes you 10 years to become one. It takes a while to fill up the pipeline, and the pipeline is going… And new osteopathic schools is going to take a while.
EC: —In the seventies.
Now, the ones that they started came through the VA system, predominantly through VA affiliations, and those were all doing fine. Texas A&M, University of South Carolina Medical School to name a few, Norfolk, Virginia. That was not a VA, but it was a new school. That thing’s been there 40 years, probably. 30 years at least, or maybe even 40. Those were the new schools in the seventies, and there haven’t been any since.
Florida’s got 17 million people living in it. We only had three medical schools, well, four. We had the University of Florida, University of South Florida, which is relatively new, University of Miami, which is the oldest, and Nova Southeastern, an osteopathic school. Perfectly good school. That’s what we had. 17 million people.
Doesn’t make any sense. Now we’ve got, well, we’ve got some more, but we’ve just got those. It’ll be a while before they start spitting people out to take care of the public.
It was not a smart thing, and people took advantage of that and made a lot of money.
Nursing school. We have a nursing school to turn out three year nurses rather than the diploma people who go and don’t really.. Anyway, we have a school for nurses that’s taught to take care of people. They have 60 spots. We get 300 applications for those 60 spots, all Americans. So there’s a nursing shortage. It’s not because there aren’t people that want to go into it.
I mean, you look, you’re looking approach. Why is that? I can’t tell you. I’ve been writing about it for 20 years, paying attention to me. It’s in that thing to some degree, Presidential address. And now this is coming to fruition.
But fortunately, we have this pool of doctors. You might say, gee, you’re trained in the Caribbean, you’re not as good as somebody trained at the Massachusetts General. And that’s true, but the guy in McDonough, Georgia who wasn’t all that well trained saved my life a couple of times. They’re certainly qualified to do that.
EC: Actually acceptance as a Board of Regents.
EC: Yeah. When I became a regent.
EC: I’m going to make assumption. You’ve been listening to me.
EC: Then that statement makes a lot of sense. Now, Dr. Rhoads was president of the college. He was president of American Surgical Association. He was president of American Cancer Society. He was our chairman at the University of Pennsylvania. He was a Quaker, a very nice man.
I once heard him say, “balderdash.” That’s the worst word I’ve ever heard him say. And he’s dead now, unfortunately. And Dr. Rhoads had a long memory. We didn’t think he remembered any of us, but he remembered all of us. And now that I’ve trained a lot of people, I remember all of them too.
Last night, somebody said, Ted, how do you remember all of this? I said, well, I lived it. So I remember a mole on the side of your face. It’s just there.
And I know Dr. Rhoads said to me when I was going to Florida from MD Anderson or from the University of Texas, same thing. I said, what do you think Dr. Rhoads? And he said, “it’s a little out of the way.” Which it is, which means you’re not going to be a big deal in Europe and travel all over the country, but it’s six, five, I don’t really care.
I started to care later on, but I belonged to all those organizations, but I don’t really know those people. And that would be nice to do that, but I never will. And I was offered several other jobs, and I never left Florida because Florida was a good place to be. It was good for me. And there was 17 million people living there. HMOs weren’t a problem. And patient accrual was not a problem.
So I was essentially protected. Had no trouble recruiting people. They had to look on the map to see where it was, but once they got there, they never left. Still there.
Now, the thing with Dr. Rhoads. So Dr. Rhoads remembered that, he remembered what he’d said. And he also, in that same letter, he says, he wrote that letter to say that I had pointed something out to him: the value of going to one place and staying there your entire career. And he congratulated me on having chosen Florida and remembered what he had said.
He also, when I asked him whether I should go to either the MD Anderson or the Memorial Sloan Kettering for a cancer fellowship, he didn’t answer me. We’re on the elevator by ourselves. I’m the repository of all the Dr. Rhoads stories, and this is just one of them. He didn’t answer me. And this was in the middle of the night. And we went to his office. He said, I’ll see you tomorrow. And I said, fine. And about two weeks passes by, and we were scrubbing at the scrubs sink and he said—I asked him questions all the time—and he said, “Ted, I thought of,” I can imitate his voice, but I won’t. He said, “Ted, I’ve thought of that question you asked me. And the answer is neither.” I thought, neither, neither. I thought, what in the world is he talking about? He meant neither MD Anderson or Memorial because we were a cancer place. That’s what he did. And we did a lot of cancer surgery.
So he thought, I’m sure a lot, and decided I didn’t really need to do that because of the training I had. Well, I had to correct him a time or two when he would tell people I was MD Anderson trained, because he was wrong about that actually. And so I had to correct him. Dr. Rhoads, I was trained at the University of Pennsylvania, not at the MD Anderson. And so he also one day told me that he realized the value of going and taking one year.
Now it’s three—way too long. One year if you go to Penn, one year’s plenty. But at least it was then.
So he remembered those things and they were incorporated into that letter that’s about that, because that’s about the college. And he realized that the patient comes first and all this other stuff is important, but it is not… Patient is A, B, C, D. And that’s why the advocacy program the college has today for the patient is a big deal and people are paying a lot of attention to it.
And David Hoyt, well, they all do, get a lot of credit for that. We are the advocate. In fact, we now at the college have an advocacy division. So what he’s talking about, and he’s dead on the number, he was concerned that we were going to shift our gears. He lived long enough to see the gear shifting start. That’s what that means. That’s what I meant by it.
