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1985-10-23 Interview with Thomas R. Ford, October 23, 1985 1985OH232 UKMC 07 01:24:28 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Ford, Thomas R., 1923- -- Interviews University of Kentucky. Medical Center -- History University of Kentucky. Dept. of Sociology University of Kentucky. Dept. of Behavioral Science Kentucky Medical Services Foundation Thomas R. Ford; interviewee Richard C. Smoot; interviewer 1985OH232_UKMC07_Ford 1:|12(5)|28(3)|37(6)|44(6)|54(5)|62(5)|77(1)|94(8)|112(3)|130(3)|156(7)|165(4)|182(3)|197(2)|212(2)|221(8)|239(2)|249(3)|260(1)|276(8)|287(4)|300(1)|308(8)|320(13)|338(1)|352(4)|368(3)|384(3)|402(12)|429(7)|444(1)|467(6)|483(8)|498(11)|512(11)|529(10)|545(8)|563(6)|580(11)|602(9)|621(11)|645(6)|660(12)|686(11)|698(13)|715(4)|729(3)|745(10)|757(13)|765(10)|779(11)|792(8)|802(4)|815(12)|829(7)|843(4)|862(7)|873(15)|897(7)|910(3)|919(3)|941(5)|959(10)|975(5)|992(12)|1007(4)|1019(2)|1032(10)|1047(2)|1054(9)|1066(11)|1077(10)|1093(3)|1110(11)|1135(4)|1146(4)|1155(4)|1162(10)|1173(7)|1184(7)|1198(5)|1208(8)|1218(11)|1229(2) audiotrans UKMCoh interview SMOOT: Dr. Ford, to begin, uh, would you give me a beef--brief, um-- autobiographical sketch. Tell me a little bit about yourself, you home life, your educational background and so forth. FORD: Well, I'm a native of Louisiana, um, the city of--of Lake Charles. Was educated in the--in the public schools there and started in--spent my first two years at a--a uh, a community college, what--what was then a junior college--McNeese, a junior college which is now McNeese State University as such things--things go. Um, right after it was started in the--I think I was in the second class that was started, uh, there. I spent one summer after I finished there at LSU, trying to beat the draft, uh, and enrolled at--at Sewanee after that and again to beat the draft, I enlisted in the Air Force and was promised that, uh, I could finish my college career and three months later I was called up (both laugh) into the--into the Air Force. SMOOT: This was the Army Air Force, wasn't it? FORD: This was the Army Air Force. SMOOT: World War II. FORD: World War II. So I spent a tour, uh, as a navigator with the Eighth Air Force, uh, and after the war I returned to LSU, uh, where I finished a degree in mathematics and physics because I had started out as a mathematician, but I then changed my field from mathematics to sociology, though I had never taken a course in sociology (laughs) prior to the--my senior year, uh, in--in college. I probably wouldn't have majored in it, done graduate work in it then except that they offered me a graduate assistantship (both laugh) after I had taken introductory sociology. Uh, I then went ahead and took a master's degree in sociology, uh, at LSU. Started in as a graduate student for a Ph.D. at, uh, the University of Chicago, but meanwhile the chairman of the department of sociology at LSU had moved to Vanderbilt and he wrote me and offered me a fellowship, uh, at Vanderbilt and since my funds were running low (laughs), I left the University of Chicago and went to--to Vanderbilt, where I completed a, uh, degree in--um, well, I completed my course work in sociology, uh, there with a minor in Latin American studies--mostly Latin American history--and, uh, took a teaching job back at LSU and then I received a--a grant from, um, Vanderbilt and a travel grant from the U.S. office of education to go study land reform in Peru, whi--which is what I did for my doctoral dissertation and uh, while I was in Peru--uh, I had to start job hunting (laughs)--uh, there and was fortunate in being able to--I applied to se--a number of different schools, including at that time the University of Kentucky, to Vanderbilt, uh, and the University of Alabama. And, uh, it so happened that a--an anthropology professor under whom I had taken a course at the University of Chicago, during the summer I was there, had been named chairman of the department of sociology and anthropology at Alabama and he remembered me and offered me a job. Uh, so I took that--that position there and it--it was related to your interest in health here for two reasons, one is that we very soon got involved, uh, in health research and med--uh, uh, I was in a health--community health survey at Talladega, Alabama. Uh, I was replaced in that--my field position by Marion Pearsall, who later, uh, came to the College of uh, Medicine here. The d--head of the program was Dr. Solan Kimball, uh, and the uh--I later did some studies of nurses in hospitals, in three hospitals in--in Alabama. So this was the--kind of background for my later, uh, interest in medical sociology and the beginning of, uh, an association with Dr. Pearsall that lasted through the remainder of her, uh, life, I had left the University of Alabama, uh, after several years and very little advancement in pay (both laugh) because I had a family coming on and went to work uh, as, uh--with the Human Resources Research Institute at Maxwell Air fir-- Force Base in Montgomery, Alabama, with a former, uh, colleague at--at Vanderbilt University. And I remained there for three years. SMOOT: Um-hm. FORD: --uh, and then took a position here at Kentucky. So I had arrived at the University of Kentucky, um, shortly before the medical school. SMOOT: About 1956? FORD: About 1950--'56, uh, here at the--at the University of Kentucky. So that was how I came to be here and uh, because of my uh, interest in health research and the--the two studies in which I had--well, there were three studies because I did another one of Licensed Practical Nurses (laughs)-- SMOOT: Hmm. FORD: --in Alabama while I was working for the Air Force. It was kind of a moonlighting operation, but they had--they wanted somebody to do some research in that area and I agreed to uh--to do it. There weren't a whole lot of people in Alabama doing social studies (both laugh) of nursing or health--health studies--at that time. SMOOT: There weren't very many people in sociology doing that much in health, w-were there? FORD: Well, it--it was a--a growing area, uh, and some of the studies that, uh, I was doing there on--on nursing were later integrated, uh, and there was--there were a number of studies, uh, and I think they were funded by the National League of Nursing. SMOOT: Um-hm. FORD: I hope it wasn't the American Nursing Association, but it--at--at any rate, one of the two major, uh nursing organizations was very much interested in social studies of nursing. So there was a national program that was headed by a sociologist, uh, named Everett Hughes, un-under whom I'd also taken a course (both laugh) at the University of Chicago. Yeah, all these things tend to get interrelated, uh, and the study whi--in which I had participated, of nurses in three hospitals, was funded and was part of this uh, much larger study that was carried out under a master plan that the nursing -- nurses had developed in conjunction with um, professor Hughes. SMOOT: Hmm. FORD: So uh--now, there weren't a whole lot of people who were involved, uh in it, and certainly not as many as there were later. I don't--I don't know of anybody who was where they had something like uh, behavioral science courses to any great--any great degree, but it was a--a growing interest and I think one of the reasons why a behavioral science department was developed here. SMOOT: Um-hm. FORD: --at the University of Kentucky. SMOOT: Um-hm. When you came to the university you were affiliated with the department of sociology? FORD: Yes, the department of sociology. Actually at that time there were still two separate departments--sociology and rural sociology- -and so I was split fifty-fifty, but one in the College of Arts and Sciences, one in the College of Agriculture. They had a--a joint, uh, graduate program, so uh, I was in both--had appointments in both colleges at--at that um--at that time. SMOOT: Any affiliation with the Medical Center that was going up at that time when you first came? Of course, this was something that was brand new. FORD: Well, of course it was just--it was just starting-- SMOOT: Um-hm. FORD: --at that time. There weren't any departments-- SMOOT: Right. FORD: --and I did work fairly closely, uh, with the group that was working with, uh, um, Bill Willard in developing, uh, the--the program. So later I did have an appointment in behavioral science-- SMOOT: Um-hm. FORD: --um, which was headed by Dr. Straus and I taught over there for several--for several years. SMOOT: Um-hm. FORD: Uh, so I--once it got started I did have an affiliation there and, uh, did teaching and--and some--some research. Uh, but at the beginning I did produce this little book Health and Demography in Kentucky, which um, was funded by--I think by the Commonwealth Fund that had made a grant to uh, the medical school to help developing--develop it--and since I was a demographer by trade with interest I--I did an analysis of um, demographic data, both population data and vital statistics data and related it to the health situation of uh--of the state and it was our hope that this could be used to orient new faculty member--members, to the state, uh, as they came in and I think it served that purpose. SMOOT: Um-hm. Had you looked at the materials--I'm sure you had--that had been uh, produced, uh, by say, John Sharp Chambers, he had been working for-- FORD: Yes. SMOOT: --years to get a Medical Center at the University of Kentucky and had written several uh, pamphlets, uh, that sort of thing. FORD: Yes, I had--I had read, uh, back. I'd gone back in that when I was trying to--to see what had been done, uh, with this, uh, in the whole area of analysis of um, vital statistics, uh, data of--morbidity data, which in general were no good (laughs). Uh, oh I--I had read a lot of the--of the early history and, as I say, participate--worked fairly closely with the people, uh, who were involved in setting up the program, particularly Bob Straus, but also uh, Howard Bost and Alan Ross and Dick Wittrup and a group of four or five people, uh, who had come--uh, who were charged with developing the medical school program. SMOOT: Um-hm. Well, in a nutshell, what were the--what were your findings about the, uh state of Kentucky, uh, at that time? I may be jumping ahead a little bit, but since we're on the subject, do you think that at that time, from what you had found, we needed another Medical Center, uh, we needed another school of medicine in Kentucky, uh? FORD: Well again, we had in--in a sense the same kind of problem, though not as serious, as uh, we do with some of the dental and medical resources today. It--it depends on whether you are measuring by need or by economic demand. SMOOT: Yes. FORD: Uh, if you were measuring by economic demand, it may (both laugh)- -we may not have needed another medical school. If you were measuring by what the actual need was--uh, and I also did a study of the distribution of physicians uh, in--in Kentucky as a rural sociology, uh project--there was no question, there were a lot of counties--in fair- -fact some fairly substantial areas--that had no physicians at all. Uh, in Kentucky as in other areas, you um, tended to find your physicians concentrated in your larger metropolitan areas; uh, the rural areas largely neglected and the physicians who were there terribly overworked (laughs). SMOOT: Yes. FORD: Uh, so there--that it was more a matter of--of maldistribution. Now, the question was--um, that we had w--in mind and I guess it's still a question was would the production of additional physicians, uh, fill this rural gap and I think we didn't believe that it would of itself, but uh, because the idea was to recruit maybe a different type of student than the University of Louisville recruited and to provide them with different incentives and training, that we would then sensitize them to the needs of a rural Kentuckian. Kentucky was still predominately uh, a rural state at--at that time and begin to try to meet some of the needs of the rural areas, particularly Eastern Kentucky, but certainly not limited to Eastern Kentucky. SMOOT: Um-hm. What had been your impressions of the original team? You mentioned Dr. Willard and uh, Dr. Straus, Howard Bost. FORD: Um-hm. SMOOT: Um, these men came in and were a team, um, in the development of the Medical Center. What were your impressions of--of the--of those men and what they were trying to do? FORD: Uh, I was very favorably impressed by them. Uh, I thought they were competent. They were idealistic, perhaps a bit naive (both laugh), but uh--no, I felt that the idea that they had of um, looking at--of trying to provide a basic social orientation rather than a clinical orientation-- SMOOT: Yes. FORD: --was something that was--was greatly needed in American medicine, um, and having studied the situation, not only in uh, Alabama, but--but also Kentucky and I had interviewed a great many doctors in A--in Alabama, uh, I could--I could see many of the problems that were faced, uh, in trying to meet the needs of rural people, not the least of which was the kind of training that was provided that was uh, geared to working with the latest equipment, uh, that was likely to be only available in large metropolitan areas. It was a clinical hospital orientation uh, and there was a--a need somehow to say look, there are other kinds of things that need to be--to be looked at, rather than how--than the technology of--of--of medicine and I thought that their orientation--that they recognized this. I think particularly, uh, Willard, uh, recognized it. Later when Kurt Deuschle came in as the chairman of um--of um, community medicine and he had worked in the Navajo reservation and he was very familiar with the, uh kinds of cultural differences in medicine and h--that--that this really was I thought a um, uh--a healthy reorientation of American medical training and there were a lot of other people who shared--uh, shared that view, I think both within medicine and outside of medicine, but maybe more outside (laughs) than uh--than within. Just as a kind of a s--aside, but a sense of deja vu - a few weeks ago I was in Indonesia and talking with the medical faculty at, um, the University of Sriwijaya in Sumatra and they were talking about the need to develop a community oriented (laughs) uh, medical training program instead of a hospital (both laugh) oriented medical training program. SMOOT: The problem lives on (laughs). FORD: On twenty-five years--years later. SMOOT: Right. FORD: Um, but they're faced with essentially the same problems, although they don't have nearly the advanced types of medical technology that we have here, but their doctors are still being trained in urban hospitals and many of them simply don't know how to deal with the problems of-of rural medicine and this is what they were looking for. Encountered the same thing when I worked two years with the Association of Columbian Medical Schools, uh, in Bogota, Columbia. Oh, again all of the physicians want to move into the big hospitals where they not only have the equipment, but considerably better salaries (laughs) than in the--in the rural areas. So it--it, you know, in many respects, uh, Kentucky is an underdeveloped state (laughs) that corresponds with the developing countries that uh, I have had occasion to visit and--and work with. So, I thought this was a great idea and I thought that uh, the people who were--were giving it a good shot. I was very sorry to see that this orientation largely disappeared, dissipated uh, within, let's say fifteen or twenty--twenty years. I see very little evidence of it now and I think it is, uh, regrettable. SMOOT: Um-hm. Uh, what do you think accounted for this new way of looking at uh, medicine in the initial team of developers and--and why has it dissipated? FORD: Well, I think--of course Bill Willard had training in public health, um, and he w--he was aware of that and I think he was--he was simply a um, uh--it wa--it was his own background and--and training. The people that he brought in, you see, there were--uh, um, if you look at--at the ones who came in with him, Straus was a sociologist; Bost was an economist; Alan Ross was a statistician (laughs); uh, Dick Wittrup was a, um, hospital administrator and so he--um, these were people who were socially oriented and I think he had selected them on--on this purpose--uh, for this purpose because he recognized what- -what the general trend of American medicine had--had been. The--the traditional--and he was--he was deliberately trying to break--to break that. Uh, I think the reason that it--it failed was simply that uh, the forces supporting traditional hospital, clinical, technologically oriented medicine, uh, were simply, uh, a majority--uh, that they had more force--and the people who were brought in were trained in this tradition, who c--who came in later. Um, you know, you can't make a blanket statement; I'm sure that there were many of them who did have strong social concerns, but um, the proportion of them with strong social concerns dissipated considerably ov--over the years and this may not have--this may have been necessary simply because they couldn't stand (laughs) uh, a--a hospital, uh, or a medical school simply with people with strong social concerns. SMOOT: Um-hm. FORD: Uh, and--now, uh, once uh, the uh--that Willard had left as dean and they began to bring in more traditional deans, there was less concern with this aspect-- SMOOT: Um-hm. FORD: --of it. It was less of a--of a conscious issue and then be--you know, there became more and more until the orientation that I see today. And one of the real concerns is, you know, how much grant money can you bring in? And what do you need to bring in grant money? You need a laboratory. You need all of these things. You need the equipment, uh, and so then you begin training your own students, uh, in the use of the technology that is available only, uh, here. So it is--um, it is extremely difficult to uh--to move out of--of this--of this channel-- SMOOT: Um-hm. FORD: --that uh, we tend to find ourselves uh, in and I think that it has not been--it may have strengthened the medical school financially; I don't think it has strengthened the state in helping to meet its medical needs. SMOOT: Um-hm. So would you say then, in the final analysis, that the- -the change that took place was really an inevitability, uh, going from an innovative, socially conscious Medical Center into a more traditional style Medical Center. Was that something that just had to happen? FORD: Oh, I think there's always a certain, uh, uh, drift toward (laughs) the--toward the norm or--or--or the mean. Uh, I think that it need not have drifted as far as it appears, uh, to have moved toward just another medical school. I think what was unique about the medical school and what attracted attention when it was organized was this social orientation and once that is gone it is very difficult to find, um, any uniqueness (laughs) uh, to--to the medical school. It--it simply finds itself competing with uh, any other clinically uh, oriented, hospital oriented, technology oriented medical--medical school. I don't think it was inevitable. I think it would have required recruiting a dean comparable or to looking at the kinds of qualities that Willard had. And uh, there weren't a lot of medical deans (laughs) available with tho--with those qualifications. And I think we have to recognize that not everybody was supportive-- SMOOT: Um-hm. FORD: --of this--of this view. SMOOT: Um-hm. FORD: You know, the--a lot of them saw it as a kind of provinciality (laughs) and it may have been, but it also may have been what Kentucky needed. SMOOT: Yes. When did you start to notice the--the change, the drift? FORD: Oh, I guess, um, after Willard had left, pretty much. SMOOT: Um-hm. So you would say this--this was a post-Willard, uh, occurrence? FORD: Yeah, I would--I would say s--I would say so. And of course you tended to get--uh, the--and the loss of people like, uh, Kurt Deuschle for example. And when he left community medicine, community medicine went downhill and that--that was probably the strongest--um, that-- community medicine and behavioral science were the strongest foci of this social orientation. SMOOT: Um-hm. FORD: Um, I--and--but I think community medicine was particularly important because it provided a kind of field training, uh, and once this--uh, I think there was a--a movement away. They were not able to find a Kurt Deuschle to--to replace him and ultimately, uh, they eliminated the department of community medicine, uh, and, you know, that was--it was more than symbolic-- SMOOT: Yes. FORD: --but it was certainly in itself--in itself symbolic. SMOOT: Um-hm. FORD: Um, and I'm sure that um, behavioral science was never as strong, uh, as it was. It was never as influential as it was under the Willard, uh, administration, even though people continued to pay mouth honor to the need for social concerns uh, in--in medicine. SMOOT: Hmm. Um, Let me step back once more and uh, ask you about your knowledge of the political problems faced by the development of a--a Medical Center at the University of Kentucky. Of course it had been opposed by various forces throughout the state for one reason or another. FORD: Um-hm. SMOOT: Some of them with rather noble reasons--at least in their own minds--and others not so noble, but--all right, what can you tell me about the--the uh, politics of the development of the Medical Center at U.K.? FORD: Well, I think you had, one, a state level politics (laughs), but there was also university politics-- SMOOT: Yes. FORD: --which you shouldn't overlook because there was very strong opposition within the university-- SMOOT: Yes. FORD: --uh, to the--to the medical school, being est-established. I think that without a doubt that the--um, no question about it that the medical school never would have been established without the political power of Happy Chandler (laughs), uh, who was able--who had the political clout to withstand the objections that were raised by uh, many of the physicians--a lot of whom were graduates of the University of Louisville-- SMOOT: Yes. FORD: (coughs)--where he did not have as much political clout. And in--in part, you know, it may have been--and I-I really can't speak to this, but you can speculate--uh, he was not dearly beloved among Louisvillians (laughs) and that uh, there may have been a certain sense of getting back (laughs) at Louisville and Louisvillians by establishing another medical school at the University uh, of--of Kentucky. So um, you know, about all I can say is that he wanted it here and he had the political power to bring it here and he did it. SMOOT: You have no inside information on the motivations of-- FORD: No. SMOOT: --of Governor Chandler at that time? FORD: No, you'11 have to ask Charlie Rowland about that. (both laugh) SMOOT: Okay. Well, what about the uh, opposition here on campus? I know a lot of people were fearful, especially I think, that uh, here was a medical school coming in and all these physicians are going to take an awful lot of money away from programs, say in Arts and Sciences, uh, and other uh, projects, uh, other departments--salaries. FORD: Um-hm. SMOOT: What do know about that? What can you tell me about that? FORD: Well, I know a great deal about it because I was involved in uh--in supporting the medical school here against the uh, criticism of a number of my colleagues and--and friends. And it is true that they felt that the funds that were going to be made available to the medical school would be taken away from the rest of the university. I thought that was foolish; they were not going to get the money anyway or they would have gotten it (Smoot laughs). Uh, my argument was that this would eventually raise salaries because it would--uh, it would make readily observable the salary dif--differentials, uh between one side of the campus and--and the other--and which in fact it did. Well, it started off right at the beginning. They had to raise the president's salary in order that he could make more money (laughs) than the dean of the medical school. SMOOT: Um-hm. FORD: And I'm sure his salary never would have been raised at that time if they uh, hadn't had to beat--you know, they decided well, the president really should make more (both laugh) uh, than the dean, so that they increased--uh, increased his salary. SMOOT: Um-hm. FORD: Now, I sh--I think where a lot of the opposition came from was uh, in the biological sciences, because it was there that the invidious distinction (laughs) was so great. A--a biologist over in the medical school was making considerably more money than a biologist over in Arts and Sciences and we had some very distinguished biologists here and they were furious (laughs) that uh, why should these--you know, they- -the salaries were public knowledge. Why should this young, whipper- snapper be making five or ten thousand dollars more than I am making when I have this distinguished record, so on and it--you know, it did hurt. Uh, and so they--you know, they felt--felt bitter about it. Yet in the long run, I'm sure--you know, they may never have made as much as the people and in some cases--the ones that really hurt--there were desertions (laughs) of faculty members who moved across campus, uh, and made more money. But the ones who were on this side of the campus also began to make--to make more money because it was extremely difficult to justify the kind of salary differentials that--that e--that existed. So more money I think was channeled in to this part of the campus simply, uh, to relieve this deferential which would not have been so noticeable-- SMOOT: Um-hm. FORD: --had the med school not--not been--been over there. But uh, there were certainly--I would say that a lot of the jealousy and a lot of opposition was purely based on the salary differentials that existed, uh, maybe not so much between the physicians--you know, well, everybody knew the physicians would make more money. What hurt were these Ph.Ds-- SMOOT: Um-hm--Um-hm. FORD: --uh, who were also making more money than the Ph.D.s on--on this side--side of the campus. So there were some, you know, who--who um, never were accepting of this fact of life, um. SMOOT: Was there any organized opposition on campus? Was--was it an organizational sort of thing? FORD: No, uh, not--I think there were little cabals of (laughs) little groups, uh, of professors and faculty club groups and this kind of stuff that would work each--(laughs)--work themselves up into a rage (both laugh) and probably go to the president's office. And I'm sure you can find in the archives letters of protest written to--to the president about the injustices of--of pay, uh, and uh, feeling that the--the medical school was responsible, uh, for this-- SMOOT: Um-hm. FORD: --but I--there was nothing like any organized strike or anything (laughs) of that--of that nature of uh, groups of professors marching (both laugh) to the president's office to demand, you know. SMOOT: What about organized support? Uh, any of that or do you just remember certain individuals that were-- FORD: No, I--I don't th--I think there were some individuals, um, like myself, who were supportive, uh, of the--of the medical school um, and again, there--it was no more organized support in the sense than there was organized, uh, opposition. SMOOT: Um-hm. FORD: It was just the sort of thing you debated. Was the medical school good or not good for the university? And there were uh--in the AAUP [American Association of University Professors] meetings, this kind of thing, there were uh, arguments, uh, that--that were raised uh, about it. And I've forgotten most of it, but there was a lot of high--high feeling and a lot of jealousy (laughs)-- SMOOT: Um-hm. FORD: --which I think, you know, was--was really the basis of it. It- -it was to hard find any rational argument except the--you know, it was rationalized that we really don't need this medical school--the same sort of thing that you heard--heard in the state-- SMOOT: Um-hm. FORD: --because we already have more physicians than we need. Uh, but uh, it was very difficult to--to support this kind of argument with any sound data. SMOOT: Um-hm. Would you say that the strongest opposition in the state came from the University of Louisville and its supporters or somewhere else? FORD: Well, I--yeah, I'm sure that you--what you found and I--I haven't made any thorough investigation, uh, of the thing, but I think you'll find the same sort of thing that you'll currently find with regard to the Dental Schools, where a lot of the opposition came from the uh, uh, physicians who felt that if the state needed more physicians they ought to put more money into the University of Louisville Medical School-- SMOOT: Right. FORD: --and imp--increase it, improve it rather than develop another whole--whole medical school. SMOOT: Yes. FORD: So, uh, you know, you could make an argument of--of that type, that it would be a much cheaper way to--to meet physician--physician needs. The counter argument and of course one of the reasons maybe for the initial emphasis on the social orientation was that the University of Louisville was training people in traditional medicine in a metropolitan center uh, and it was--had demonstrably not met the physician needs uh, of--of rural Kentucky. SMOOT: Um-hm. FORD: And this was the kind of thing that the university was supposed to be able to--to meet. SMOOT: Do you recall any of the uh, legislators aside from of course Governor Chandler's support, but legislators that were su-supportive or strongly in opposition to-- FORD: I don't really. I'm--I know there were such people, but uh, uh, I probably could have told you twenty-five years ago (both laugh) who they were, but I--I just don't recall at this time. SMOOT: Community leaders? FORD: Local? SMOOT: Yes, Lexington-Fayette County. FORD: The--I think probably it was mostly--uh, you've--you've probably found a--a division in the county, uh, me-medical association, but uh, there were certainly a number of the local physicians who strongly supported the establishment of the medical school here and I don't--I don't--some of them may have been University of Louisville, uh, uh, graduates. I think probably Glen Dorral may have been one of the--I don't know--remember where he graduated, but I think there were a-a number who recognized the kinds of um, problems that were faced since Lexington was then, as now, a Medical Center serving Eastern Kentucky; that they recognized this great need that wasn't about to be met by the University of--of Louisville. [Pause in recording.] SMOOT: When you came in 1956, the-the university administration itself was in a transition. We were going from Dr. Donovan to Frank Dickey as president of the university. FORD: Right. SMOOT: Uh, do you recall anything about Dr. Donovan's position, uh, on the Medical Center? FORD: I don't really. SMOOT: Okay. FORD: I uh, um--he uh, retired so soon after I came here and I don't remember that uh--uh, any position that--that he would--he had taken. I would've, you know, just guessed that he would have been supportive, uh, of it. SMOOT: Um-hm. Well, how about Frank Dickey? FORD: Frank Dickey was supportive, uh, of it certainly. Uh, I don't know, that's very difficult to say to what ex--what extent um, it was a matter of his personal sentiments, to what extent it was a response to political (laughs) pressure, uh, but uh, then as you know, the governor was the chairman of the board of--of trustees (laughs). SMOOT: Yes. FORD: And so you know, from what I--from what I re--I remember-- certainly from all of his public statements--that uh, Dickey was supportive of the thing. He may be one of the people you ought to interview--[telephone rings]--uh, about this. [Pause in recording.] SMOOT: All right. You worked quite a bit with um, the Medical Center personnel, uh, particularly I suppose Bob Straus because he-- FORD: Um-hm. SMOOT --also was in sociology. Um, what were your, uh, special concerns and then what special work did you do with the development of the Medical Center? FORD: I didn't do a whole lot, uh, I guess with the--with the actual development of the Medical Center except serve as a resource person-- [telephone rings]-- [Pause in recording.] FORD: As I was saying, they were--they were mainly as a--as a resource person. I suppose one of my major contributions was that I stockpiled Marion Pearsall um, as the--in the department of rural sociology, even though she was an anthropologist (Smoot laughs) until she could move over into behavioral science; that I had worked with her at the--as I had said earlier at the University of Alabama and worked with her on field projects and she had gone and had studied nurses at--at Boston- -in Boston General Hospital--and was looking for another position since the racial situation at Alabama had become untenable (laughs)-- SMOOT: Yes. FORD: --at that situation and so I had acquainted Bob Straus with her and he had interviewed her and was very favorably impressed by her, but at that time they--there wasn't a department of behavioral science, so I arranged an appointment with her as an anthropologist, uh, in the department of rural sociology because anthropology didn't have any money. So she worked as a rural sociologist (both laugh) for a year-- SMOOT: Hmm. FORD: --until we could transfer her over to uh--to behavioral science where she became uh, their first anthropologist and I think did one of their first publications which was a bibliography of data and of course uh, worked very well. I think she was an exceptional person over in that, uh, department until she died last year of cancer. SMOOT: Hmm. Something else I wanted to--I failed to ask about earlier when dealing with the--with the politics of the development of the Medical Center. Uh, do you know very much about the Kentucky Medical Foundation? FORD: The--yeah, I know some about the Kentucky Medical Foundation (both laugh). SMOOT: Can you--what can you tell me about the KMF? FORD: Um, well, it was a--I guess uh, a way--and maybe the only way -- to--uh, or a way that was devised to uh, provide some of the, um, perquisites that uh, the medical faculty, uh, needed--or felt they needed--to make them comparable with medical faculty in other--in other universities, uh, and it--it was a--established for a way of channeling additional funds to where they thought they were needed. SMOOT: Um-hm. FORD: And uh, it's kind of--it was not uh, the first such organization. There was a one time a--a similar foundation or organization that was established in order to increase the salary of the president of the university when it was legislatively restricted to I think twelve thousand dollars. SMOOT: Hmm. FORD: And so there were ways that were--there was some sort of foundation that was developed and pro--uh, provided additional revenue for him. I don't remember what--as secretary of the board or these kinds of things that--that are devised and of course the Kentucky Athletic-- (laughs)--Association was a similar kind of arrangement and I think it may have served as more of a model (laughs), in a way, for the Kentucky Medical, uh, Foundation than the one that had been set up, uh, to enhance the remuneration (Smoot laughs) of--of the president. But um, it was a kind of um--well, I think it--it served two things, one, a way of channeling additional funds to them, second, a way of resolving the issue of what to do about uh, um, the funds that physicians, faculty members derive from handling private patients--in-individual patients. SMOOT: Um-hm. FORD: And this is always uh, a--a problem unless there is some resolution of this--of this sort. And I think it creates a lot of problems when they are permitted to keep, uh, their individual earnings. I've seen it in foreign, uh, medical schools. So uh, uh, I--I--I recognize the--the need for such a thing simply because of the faculty members in a competitive world (laughs) need more money than can be channeled, uh, to them through uh, normal um, university salary channels. But uh, at the--at the same time, I think that it--it was a source of some of the um, um, strains between the medical faculty and the faculty of the rest of the, of the university. I mean there is a general awareness of--of the--uh, this as a source of funds, but, you know, not just per--uh, uh salary increments or--or this sort of thing, but the kinds of material items that are (laughs) available in the--in the medical school--of a--everybody seemed to have computers (laughs)--personal computers-- SMOOT: Yes. FORD: --long before anybody--(laughing)--except the computer science department had them on--on this side of the--of the campus. And a lot of these are the perks that seem to um, uh, abound in medical schools and are--are expected. And at the same time I've heard the medical faculty complain bitterly (laughs) about what their colleagues in other schools have and uh, they were in such desperate and dire straits here at the university, which wasn't doing right by them and this, that and- -and the uh--the other. So uh, again, you see the--(laughs)--the--the comparison working both--both ways. SMOOT: Well, how successful do you think the Kentucky Medical Foundation was in its efforts to enhance the uh, professional development, Medical Center development? FORD: Uh, it's difficult to say. I really am not in a--a position to- -to evaluate, uh, its success. I know they lost a lot of people that they would have liked to keep, uh, and they may have been lured away by higher salaries or-or a lot of--of other things, simply because even with the Medical Foundation they were not able to match the kinds of uh, uh remuneration that could be provided by other places. A--again, not just a matter of salaries, but all the other kinds of--of um--of perks. Um, I don't--uh, by the same token, you know, I, uh--I guess it may have been instrumental in the--in the reach--reorienting (laughs) of the university back into more traditional grounds. I wouldn't want to charge this 'cause I think it was just part of a whole culture complex, but when you--when get in to the business where you're--you're competing on monetary and financial and remuneri--ative grounds--and I don't think this was what motivated the early people who came here and they had some very good people and I think they--they were motivated by the innovations, by the idea of--of getting in on something new, of being able to create a new and different medical school and that this was more important. I'm sure it was, to many of them, than how much they would be--they would be paid. And of course once you lose that, that is no longer incentive. Then you are forced to compete, uh, on-- on other grounds and we're in a poor position (laughs) to do that. SMOOT: Hmm. Do you recall the uh--anything about the uh, acceptance and procurement of Cave Hill by the Kentucky Medical Foundation for a residence for the uh, dean of the Medical College? FORD: Not really. I just know--knew that it occurred and it didn't--it wasn't the sort of thing that I stuck my nose (laughs) into. SMOOT: Okay. Um, et--let me switch gears a little bit then and ask you about uh, some philosophical considerations and we've already talked a bit about that because the--that was part of the--really the thing that made the Medical Center unique, the--the different point of view that they had, the social concerns integrated with medical, clinical sorts of uh, training concerns. Um, I have seen material that has made it clear that this philo--this philosophy not only was something that was to be expounded upon and broadened by the faculty and staff, it was even to be reflected in the architectural design of the medical school and the hospital Medical Center itself. Uh, are you aware of that, know anything about that--that process? FORD: No, not--not uh--not really. I didn't certainly didn't see a whole lot of reflection in it in the--in the architecture. I think that the--it was certainly, uh, in trying to set up the field internships-- SMOOT: Um-hm. FORD: --which they did. I think that--was a very important--important factor. I'm sure it--it affected the curricula, uh, but um, other than the fact that the medical school was developed on the experiment station farm (laughs), I don't think there was a uh, great deal of reflection of it in the--uh, in the architecture. At least it--it escaped me if uh--if there was, once they left the old farm house that served as the headquarters (laughs) while they were building the med school. SMOOT: Did that create resentment among the people in agriculture? You were affiliated with rural sociology over in agriculture. FORD: Uh, no, I don't think s--uh, I don't think so, particularly because Chandler was--made them--and the uh, Coldstream Farm was part of the compensation for the money that was--for the land - that was taken for the--for the med school. SMOOT: Um-hm. FORD: So uh, I don't think there was--or at least I was not aware of any great resentment in this. They--I think they recognized that the way the the city was going to grow that the experiment station farm here was going to disappear eventually anyway-- SMOOT: Um-hm. FORD: --so they were already planning and had farms uh, in--in other areas, but my recollection is that uh, when the governor purchased Coldstream he said, well, you know, we're taking this part of the farm for uh, uh, the Medical Center and we want to make available this beautiful land (laughs) and--in compensation. SMOOT: Um-hm. We've already touched upon uh, the changes that have occurred over the years, um, in the medical programs at U.K. Uh, so I'm going to try to synthesize some--several questions into one then, since we have touched upon it, um, an evaluation of--of the medical programs and the departmental rankings and personnel in a--in a nutshell--how would you evaluate them from beginning to present? FORD: Uh, I'm not sure what you mean by that. Do you mean who has gained and (laughs) who has lost? SMOOT: I--yeah, I--I think that's--that's something that's--s--should be looked into--and it is from your perspective certainly-- FORD: Yeah, well, I--I th--I think--again that uh, it is pretty much what you'd expect, that I'd already said that community medicine really went--went downhill. SMOOT: Um-hm. FORD: I think that behavioral science, uh, has lost a lot of the prestige and-- SMOOT: All right. FORD: --and support that it initially had. SMOOT: Um-hm. FORD: I think that uh, uh, where you uh, found the increased--I mean the--the shift was pretty much going to nat--to national norms--to the regular, uh, clinical medical areas, uh, you know--internal medicine, all the various, um, surgery areas, all--I--I don't see much difference now between Kentucky and say any other medical school that you would take. Uh, um, psychiatry never did have very much prestige, but I think it lost (laughs)--uh, it went along. The whole idea--uh, the whole uh--all of the departments I think that were s--were viewed as strongly associated with this social orientation, uh, lost in prestige-- SMOOT: Um-hm. FORD: --and probably lost in--in power, uh, as--as well. And I think one of the--again, one of the kinds of things--and I remember hearing a former dean talk on this in the case of community medicine--it didn't bring in grants. You know, cancer research--my God, you've got all kinds of money available--who's going to give money for community (laughs)--community medicine. Well, they did bring in some grants earlier, but not the big--not the big grants and uh, when you then be a--measure your success by how much money you're bringing in to the system, then those that don't bring in money (laughs) go down the--go down the drain and I suspect that there's a pretty close association between the ability to, um, bring in outside funds, uh, and to um, um--the kind of prestige that have. And I know that they have some dep--departments, uh, in actual violation of what the uh university regulations state--put the amount of money, you know, the obtaining of grants as a criterion for promotion and tenure. I've seen that in black and white in one of the--at least one--well, I've seen it in one of the medical school departments, but I'm sure it exists, uh, at least uh, in understanding in--in the others. If you want to stay here and move up, you've got to bring in research monies. Well, this automatically limits you-- SMOOT: Yes. FORD: --uh, to the kinds of things you're--you're going to be able to uh--to do and most of it is going to come in high tech medicine. SMOOT: Um-hm. FORD: And is--is not going to find a very--a--a better way to provide nutrition to the children in Eastern Kentucky. SMOOT: Yes. FORD: And this--you know, this distresses me. It's, um. SMOOT: How would you, uh, evaluate the success of the graduates of the University of Kentucky Medical Center? FORD: Again, I would--you know, the ones that I have known, uh, personally I have--who are mostly those (laughs) in the earlier classes-- SMOOT: Yes. FORD: --I--I think have been--have been very good people. SMOOT: Um-hm. FORD: Uh, I think they were dif--more different then than they are now from the graduates of other medical schools, but that is simply a--a personal assessment. Uh--it would be an interesting study to go back and in some of the earlier years we were looking at the values and beliefs of the--of the medical school students, uh, and if some of that--those data were available, it would be nice to compare them with some of those who are corning out at the present time and uh, if there were any national norms available I would say that the differences between Kentucky and national--students and national norms now are much less than they were. And again, part of it was recruiting, you know, they--the people who were recruiting students were looking for those, uh, who had a strong social orientation. This is what they were going to--to build on and uh, they had a lot of interesting, very good students in the--in the early years when I was uh, teaching over there. They may have--I'm sure they've got some very good students now as well, but I doubt that most of them have this kind of--the same kind of orientation--that they are looking to be successful in the--today's medical world-- SMOOT: Um-hm. FORD: --uh, and uh, their standards of success are the standards that they observe in the--in the hospital. But this, you know, this is more or less speculation on my part. SMOOT: Do you think that the um, Medical Center at U.K. has uh, enhanced--improved--the situation of medical care for Eastern Kentucky substantially? FORD: I'm sure it has to some extent, yes. Uh, not only in the supplying of physicians, but in the opportunities for the people out there to have contacts and to--to, you know, those who are practicing-- SMOOT: Um-hm. FORD: Uh--to--to come--come in. So I--I feel sure that it has had, uh, an influence, that it has improved medical care in Eastern Kentucky. SMOOT: Would you say that it has improved medical care in Lexington and Fayette County? FORD: Uh, probably, yeah. SMOOT: Increased, uh, standards perhaps or just simple competition? FORD: Well, I th--you, um--I think uh, anywhere that you're--you're going to have a--a medical school, that they provide a kind of s--of s--of access , uh, to--to new medical knowledge and almost remove an excuse for not keeping up (laughs), you know, you--you are a uh--if you're practicing in Lexington and you're coming in contact with people who are f--who know what is going on in contemporary medicine, you don't have any excuse for not, uh, being up on uh, some of--some of the developments. Whereas if the medical school, you know, I--I suspect that there are different kinds of pressures, uh, on a, um, professor- -on a--a physician here. I was going to say a comparable situation might be a--a research professor here at the university compared with somebody who is teaching, uh, in--well, say--say Georgetown or some other university where there is--the emphasis is primarily on teaching and that the ones here are much more likely to be familiar with the latest writings and keeping up with the journals and this sort of stuff. Uh, even those who may not be doing research still feel a certain--through contacts, through a-a compulsion and I think there is that kind of diffusion that--that may, uh, exist, uh, simply because of the presence of the university here. SMOOT: Um-hm. Do you recall whether--uh, we've talked about Governor Chandler a bit--uh, how supportive uh, other governors were after Chandler left office, say Governor Combs, Ned Breathitt? FORD: My recollection is that both Combs and Breathitt were--were supportive, uh of the--of the medical school, even though they were not necessarily supportive of Chandler (both laugh). SMOOT: Very much the opposite at times, I would say. FORD: You know there was a uh--there--a period when the medical school itself was embarrassed by the Chandler name and they, uh, referred to themselves as the University of Kentucky Medical--rather than the Chandler--and this, uh, later got reversed (laughs) uh--again. But uh, I think--I know both Combs and--and Breathitt were--were supportive. I had more contact with Breathitt than I did with Combs. SMOOT: What would you say have been the major achievements--successes-- of the Medical Center over the past twenty-five years? FORD: Oh. SMOOT: Can you narrow down on something on that? Or have there been? FORD: Well, yeah, I think--I think there have been some succe--some success. I think they have certainly, uh, provided opportunities for medical education to Kentuckians who would not otherwise have--have, uh, had such opportunities. I think that they have had an influence, uh, on the medical care, uh, provided, not only in the area, but serving as a--a center here--a referral center. There are a lot of, uh, people who were able to come to the, um, hospital here and get care that they otherwise would--would not. I think that they have, um, certainly made some advances or individuals in--in particular fields of, of um--of medicine, but uh, in this I feel that they have been comparable to other medical schools. That is, I don't feel that uh, you can say that they have made a unique contribution. SMOOT: Um-hm. FORD: Um, certainly I'm sure that um, uh, the people who originally started would have liked to have been back and say, well, this has revolutionized medical care in the rural areas of Kentucky--uh, it hasn't--that it has really sensitized our physicians in Kentucky to the social needs and economic needs of the patients and not just their physical needs--it hasn't. Uh, so in that sense I don't think it has realized the goals that were--or the--uh, certainly the ideals that were held for it at the time that it was established, but at the same time, I wouldn't say that it had been a complete failure (laughs). I'm just saying that it--its successes have been pretty much the successes of other um, medical schools--um, state medical schools. SMOOT: Well. I wonder--in your opinion--what could be--what could have been done, what should be--be done perhaps, uh, to sensitize new physicians, uh, to these social needs? Of course, the ideas it seems were right, of the founders of the Medical Center. Uh, what could have taken place that would have changed--a what if question? FORD: Yeah, I would--I would think that uh, probably the only way that it might have been done would--would have been to select--uh, as a successor to Willard--uh, a dean who had the same kinds of very strong uh, feelings of the social (laughs) obligations of medicine uh, that he did. SMOOT: Um-hm. FORD: And I don't know whether such a person was available or uh, how strong a search--you know, it--this may not have been, uh, what was in the minds of the search committees--that this may not have been what they were--they were looking for. They may have already felt, well, it isn't going to work-- SMOOT: Um-hm. FORD: --so we've got to get back in--to quit the noble experiment and get back in, in competing with mainstream medicine. But at any rate, that's what happened. SMOOT: Yes. FORD: And I think that the only what if would be--would have been--to have had, uh, a group of--of successors--administrative successors--who would have been willing, uh, to continue this. Now, you might say, well, maybe this was a failure of uh, initial administration, that they did not provide for their successors, they didn't make a convincing enough case-- SMOOT: Um-hm. FORD: --uh, that the succeeding administrators were willing to follow that line. I don't--I, I simply don't know. I was not privy (laughs) to the deliberations that went on. All I can I say is that the deans, uh, who did succeed did not seem to have this orientation-- SMOOT: Um-hm. FORD: --and it was--it was just lost in the-- SMOOT: Had the support been maintained, uh, all along? You know, uh, it was 1963 when Frank Dickey stepped down as president-- FORD: Um-hm. SMOOT: --and Jack Oswald came to campus. FORD: Um-hm. SMOOT: Was his commitment, uh, pretty much the same to the Medical Center as had been Frank Dickey's? Do you know-- FORD: I think he was committed to the Medical Center. Uh, I don't know that he had any, uh, particularly strong social (laughs) sense. SMOOT: Um-hm. FORD: Uh, that is that he said, by, we've got to get somebody just like Bill Willard, uh, as his--as his successor. I'm inclined to doubt it, but I don't know. SMOOT: Um-hm--Dr. Ford, tell me a little bit about your own activities, uh, organizational activities, um community activities and so forth. FORD: They are--well, most of my activities are I guess university centered and in professional, uh, organizations. I am the director of the Center for Developmental Change, which is a multi-disciplinary unit, and I enjoy multi-disciplinary work. Uh, it is interested in applied work and I am interested in--uh, in that. I uh, have uh, been a member and officer in various professional organizations, uh, in sociology, rural sociology and demography. Uh, I have--I like international work. I've worked in Peru, Colombia, Spain, uh, and I find that enjoyable and in these cases I always like to compare the situations with (laughs), with Kentucky--and particularly rural Kentucky. Uh, I think I have been helpful in some of these countries by--simply because the problems they are facing (laughs) are many of the same kinds of problems that uh we've--at least in Eastern Kentucky and the Appalachian area--have faced. A lot of my research has been concerned with uh, Appalachia. Uh, I enjoy working with the various uh, departments and--and colleges uh, here--in this particular position because administratively it is in the--in the graduate school. Uh, uh--I have worked, uh, you know, in develop--looking at the plans for the future in the um, uh, evaluation of--of the university, trying to get a--a holistic view uh, of--of the--of the university, so, uh--as an agency uh, working with the people in--in the state. I've always been fascinated by the idea of a state--state university, uh, and the--what its responsibilities were to the people who were providing support uh, for it. Part of that comes out the, you know, land grant tradition (laughs) uh, that uh--that I have worked with and I am interested in, you know, seeing the contributions that higher education can make in developing countries as well as--uh, as in this country. And I guess in most cases I feel that we haven't lived up to our--our potential in any of--of these. And I think this is what I see as part of the tragedy (laughs) of the--of the med school--tragedy is too strong a word--part--part of the failure to realize the social mission that was set for it. Because I think as a state medical school it had certain obligations to the people of Kentucky that it has not--it has not realized. Uh, and so I--I've--I feel very strongly about this and about all of the--all of the uh, colleges in the--in the university, that they were established with the idea of helping to advance, uh, the causes and conditions of the people of the state, and that the people who are working in them should assume part of that--of that obligation- -part of that social responsibility. And if they don't feel it, they are a lot of private (laughs) universities that they--that they can go to. So I think that is part of the orientation that I--that I have in that and, uh, as I say, I've taken on positions--I worked for two years with the, um, population council uh, out of New York, worked two years in Colombia in their family planning operations there, and I--it's the kind of thing that I find fascinating in providing a social service. There's nothing like providing family planning in a conservative Catholic country (laughs) to increase your sensitivities to the problems that are faced in trying to render, uh, social services. So I think I'm appreciative of some of the problems that are faced by people who are trying to provide services, but at least I think they ought to make the effort (laughs). SMOOT: Yes. Are there any other subjects that you think we should touch on, uh, related to the medical school, the University of Kentucky, your own work? Uh, undoubtedly I've--I've missed a few things and-- FORD: No, I don't--I don't think there is a whole--whole lot. I think it might be useful--I know that several years back that um, um, Chancellor Bosomworth did have a--a--assessment of the medical school and was trying to look at the directions uh, in which it--it was going and I never did see the results, uh, of that. It was about the same time that we were making our, uh, decennial, uh, evaluation for the uh, Southern Association, but I think it--it would be useful to--to try to identify, if possible, what is the current philosophy of the medical school; what are--are its directions; where is it heading; does it have any philosophy, uh, and um, if so, what is it and how is it--how is it publicized? I think this is what I find lacking. At the time--in the early stages there was a clear philosophy and everybody knew what it was. Uh, now, there may be one, but I certainly don't know what it is and I'm a (laughs) reasonably well-informed person. I don't know where it's heading, what it is trying to do, you know, it--uh, other than provide good medical education, uh, to the--the people. And I re--I realize that it has--is beset, as is the whole, um, health and medical area, with all kinds of problems--financial and--and otherwise--that has to--have to be dealt with and it may be that simply trying to deal with day to day problems has prevented the uh, establishment of any long-range philosophy. I don't--I don't know, but uh, certainly I don't have any clear sense of the mission of the medical school. But I'm not--I'm not in the middle of it--never really was--and so there may have--there may be one and I am just not familiar with it, but I feel that, as a citizen of the university, that I should at least be, um, provided with some knowledge of what the philosophy of the medical school, uh, is and though I may be in perfect agreement with it, I may be in disagreement with it, but as the moment stands I don't even know (laughs) what it is; I'm in no position either to agree or--or disagree. I'm sure they have competent people, uh, over there and you know, I'm not in a position to condemn them or to praise them. I'm just a--uh, in a feeling that I no longer know what--what is going on or what they're thinking, uh, uh, and they have not done, certainly, a good job of communicating it, either to the rest of the university or I feel to the people of the state, to whom they have an obligation-- SMOOT: Um-hm. FORD: --and--and maybe that is something that uh, needs to be looked into. SMOOT: I want to thank you very much for your time, Dr. Ford. I've enjoyed it and I've learned a lot. FORD: (laughs) Well, I enjoyed it too. I don't know that I've taught you anything. SMOOT: I think you have. Thank you. [End of Interview.] Dr. Thomas Ford (Chair of the Department of Sociology and Rural Sociology 1956-1990, Director of the Center for Developmental Change 1956-1990) recounts his educational background in sociology, his early impressions of Kentucky, and the unique nature of the University of Kentucky Medical Center. He also describes standardizing the Medcial Center to be in line with other medical institutions and the negative and positive effects of standardization. In addition, Ford discusses the reasoning behind the school's opposition. insert here