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1986-07-09 Interview with Peter P. Bosomworth, July 9, 1986 1986OH184 UKMC 54 02:07:11 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Bosomworth, Peter P., 1930- -- Interviewees Physicians -- Kentucky Physicians -- Salaries, etc. Curriculum planning University of Kentucky. Dept. of Anesthesiology University of Kentucky. College of Pharmacy University of Kentucky. Medical Center Peter P. Bosomworth; interviewee Richard C. Smoot; interviewer 1986OH184_UKMC54_Bosomworth 1:|12(10)|24(12)|40(5)|62(5)|74(3)|86(11)|106(9)|119(11)|131(5)|146(5)|160(7)|173(6)|184(2)|195(13)|211(1)|223(11)|235(1)|246(4)|258(9)|272(10)|286(9)|298(7)|311(6)|322(11)|339(5)|351(1)|360(9)|371(10)|384(3)|397(1)|409(12)|424(7)|439(3)|447(8)|457(7)|470(8)|486(2)|498(4)|509(5)|522(5)|534(11)|549(6)|560(6)|577(8)|590(9)|602(7)|615(3)|628(6)|641(8)|676(4)|694(3)|706(1)|717(4)|729(6)|742(11)|756(4)|772(1)|786(6)|798(3)|814(1)|825(6)|844(5)|858(8)|871(1)|882(7)|896(5)|915(3)|926(9)|938(10)|949(9)|960(11)|974(4)|984(9)|998(6)|1012(6)|1028(1)|1040(11)|1053(11)|1064(11)|1076(10)|1087(11)|1097(10)|1110(5)|1121(10)|1139(4)|1152(1)|1164(2)|1180(9)|1202(12)|1214(14)|1225(5)|1235(6)|1248(3)|1261(1)|1273(10)|1284(8)|1302(2)|1332(12)|1341(2)|1352(11)|1365(2)|1377(10)|1390(6)|1403(3)|1416(6)|1429(10)|1440(4)|1454(4)|1466(3)|1485(5)|1496(11)|1508(1)|1523(3)|1549(11)|1562(14)|1572(7)|1583(2)|1597(12)|1608(3)|1622(7)|1642(1)|1652(1)|1661(11)|1673(13)|1685(2)|1697(3)|1710(9) audiotrans UKMCoh interview SMOOT: Dr. Bosomworth, to begin could you please tell me a little bit about yourself, your background, where you're from, when you were born and your educational background? BOSOMWORTH: I was born in, uh, Akron, Ohio on May 2, 1930. My parents were both immigrants from England. Uh, my father was a chief of engineering for Firestone Tire and Rubber Company. I have one brother, and my mother still survives. I went to college at, uh, Kent State University and Graduated in 195l. Attended the University of Cincinnati College of Medicine and graduated in 1955. I completed an internship at the University of Cincinnati in 1956, and went on to a residency program in anesthesiology at Ohio State University, and simultaneously completed a Masters in Medical Science degree in physiology at Ohio State University. Then I was on the faculty briefly as an instructor at Ohio State University prior to military service in the Navy, which was of two years duration at Great Lakes Naval, uh, Hospital, where I served as the chief of anesthesia service at that institution. I returned to the faculty of Ohio State, remained there until 1962. At which time I had intended, and then actually accepted, an appointment on the faculty at Stanford University, in California, with the intention or completing a PhD. However, I was invited to visit the University of Kentucky at the time of its opening, or just before the opening of the University hospital. Uh, they were searching for a chairman of the Department of Anesthesiology. And so I was invited here--had a visit--went on to give a paper in Florida--was invited to come back--on the way back--and accepted the position and never did end up going to Stanford, although I've served as a visiting professor subsequently two or three times. And I was appointed as the- -at that time--as the youngest professor and chairman of a Department of Anesthesiology in the United States. And that's essentially my--that took me to the beginning of my Kentucky connections--I guess. SMOOT: Let me ask you one question related to what we've just discussed. Why did you go into medicine in the first place? Because it doesn't seem like--there was anybody in your family--immediately at least-- that, uh, was interested in--in medicine. BOSOMWORTH: I was, uh, influenced from the age of twelve, uh, to go into medicine. I never thought of any other career from that point forward--primarily by my family practitioner, who took an interest in me personally and professionally through the years. He's still alive. He's ninety-seven years of age. SMOOT: What's his name? BOSOMWORTH: Dr. Robert Lemon, he lives in Akron, Ohio. And, uh, uh, he sort of nurtured that interest--encouraged it--and, uh, as a result, my family was very supportive of that objective. And, uh, so I--I never really deviated from that. SMOOT: You were obviously impressed with the developments taking place here at the University of Kentucky in the early stages-- BOSOMWORTH: Right. SMOOT: --of its development as a Medical Center. Could you tell me a little bit more in detail about your earliest impressions of the Medical Center as it was developing? BOSOMWORTH: Well, Dr. William R. Willard was the, uh, dean, uh, and vice president, uh, of the university in charge of the Medical Center. He'd been the individual who had been brought here by President [Frank] Dickey and--and with the encouragement of Governor [A. B.] Chandler to start this Medical Center. And he brought to this institution a, uh, vision of the future of health science education, uh, in a way that was broader than just medical education. And when I came to visit here, I had actually been proceeded by about eight or nine candidates for the chairmanship of anesthesiology. And, uh, it began as a division of the Department of Surgery in its original concept, and most of my colleagues who had considered the position prior to my, uh, arrival had rejected that. So they had changed the plan and decided to make it into a department. Uh, and so that was attractive to me. I probably got into it before I should have. But I--I--it turned out to be a successful venture for me professionally, and I think for the institution. Uh, the--the most attractive part was the people who were here. There was a very small group of people at that time, there were only thirty-five, uh, faculty members as I recall and there was a lot of space. Uh, there was a lot of opportunity for growth and development, uh, both professionally and programmatically. And I saw an opportunity, in my own field, to do something that probably in any established institution I would have been six to eight years later before I would have had that opportunity. And, so I--I felt that there were quality programs, uh, developing here, some very good ideas, uh, some of which have persisted, and, uh, some of which didn't work, uh, but it was a very attractive professional opportunity. I was also attracted to the people in the community and the physicians, uh, particularly the anesthesiologists, who were very cordial to me in their initial reception. They basically played a role in recruiting me. I was nominated for the position here by one of my former students, who was actually older than I am. He--he was a, uh, family practitioner practicing in Eastern Kentucky, who decided to leave family practice after seven years of practice and went to Ohio State for a residency training program--uh, completed that at Ohio State--and I was a junior faculty member there--and came back to Kentucky and started practicing here in Lexington. And that was apparently the connection that got my name up on the list of persons to be considered for this particular initial post that I held here. SMOOT: Who is that person? BOSOMWORTH: Dr. Ben Crawford. SMOOT: And did he go back to Kentuck--in Lexington? BOSOMWORTH: Yes, he's still here--he's still practicing. He's been a lifelong friend, and--and he's still practicing here in Lexington. SMOOT: Were you made aware of the mission and goals and philosophy that was being espoused by Dr. Willard and his original team of--of medical educators here? BOSOMWORTH: Yes, uh, both, uh, in a written format and then through, uh, all discussions with, uh, Dr. Willard and Dr. [Howard] Bost, uh, uh, and some of the people who were here on the scene--Dr. Ed Pellegrino and Dr. Ben Eiseman, Dr. Kurt Deuschle, and some of the basic science people. I was intensively interviewed by, uh, Dr. [Tihamer] Csaky, who was the professor of pharmacology. I almost felt like I was getting a, uh, oral examination in the pharmacology of anesthetics-- (Smoot laughs)--but the, uh, uh, the philosophy was--was I think, uh, fairly clear. There was an interesting--even at that time--oh, uh, sort of division of--of how the institution should go forward and, uh, Dr. Willard had espoused a philosophy that was basically a team- oriented--a team approach to patient care--family-centered, primary-care based. But in order to make this Medical Center run they needed a group of physicians who were, uh, specialists and subspecialists, like myself and--and the surgeons and others. And those people had their own goals, which were somewhat divergent from the core philosophy. But that philosophy, uh, grew and basically was maintained, and we've always been committed to it. Uh, uh, but the subspecialty role in the institution has--has become increasingly a dominant one and we've done many things in the interim to try to keep the original mission an objective of serving the needs of, uh--continuity-care needs--teaching that approach, uh, producing primary care physicians and other health professionals that serve that objective. But it's been a continual, um, sort of tug-of-war, as it is in every Medical Center in the country, in terms of the role and interests of the specialists, which are very necessary in medical education, versus the generalists. SMOOT: Did you find that the philosophy, as it changed, was flexible enough to accept these kinds of changes that were going to take place, or did it have certain features that were inflexible and caused some problems, uh, over the course of the years? BOSOMWORTH: Well, um, I don't think there was any real inflexibility in it. Uh, there was a--a balancing act, uh, which has been a responsibility of the various administrators in this institution--to maintain a reasonable balance between the interests of both sort of segments of--of the academic enterprise and--and also to maintain a balance and an opportunity for the interaction of other health professionals in the arena, not just the physicians, although the physician component has been a--the largest and, to a degree perhaps, more dominant than some of the others. But, uh, uh, there's never been an intense, uh, conflict in that area and--and now, uh, there's a greater recognition than ever of the importance of, uh, the--the original core philosophy that was developed here and it--it's because of the external environment more than the internal environment. But, uh, the forces around us are reshaping the thinking even of the specialists in terms of their role and responsibility towards patients. SMOOT: This philosophy really extended well beyond just an idea and goals and objectives of the personalities. It's actually reflected in the physical plant itself, uh, in, uh, the remuneration agreement that was made with the various faculty members. How were these manifestations of the philosophy, uh, impressed upon you and--and given a broader importance perhaps? Then-- BOSOMWORTH: Well, uh, one of the things that Dr. Willard did was to--uh, in the design of this facility--uh, to recognize the mission, uh, that they had set forward. And that actually was captured by the, uh, uh, the predecessor to the National Institutes of Health and the public health agency and resulted in a publication which became sort of a model for some of the developing medical schools in the United States at that time. Uh, the--the financial practice aspect of the institution was very attractive to me. Uh, I didn't come here to, uh, generate a lot of personal wealth. I came because of the professional opportunity. As a matter of fact, I--I could have stayed at Ohio State and made about 50 percent more than I did when I accepted this position here. Uh, but the concept at that time was, uh, what was called an academic full-time system, in which we essentially provided patient-care services, billed for those services, collected where that was possible and then pooled the resources for the benefit of, uh, the--of the institution and not for the benefit of the individual. And that was a, uh, prevailing mode of practice, uh, in this institution until 1978, but as early as 1965--66 there was a developing tension in the institution with regard to whether, uh, the people who were most responsible for the production of a patient-care revenue should benefit more extensively from it and that actually led, in my view, to a decision of the first chairman of surgery to leave the institution. He was at--he felt very strongly that we should move in the direction of what's known as a geographic full-time system, in which there was greater departmental and individual control of revenue from patient care benefiting the individuals who generated the most, rather than to spread the money, uh, from the haves to the have-nots. And that--that same conflict has existed in med--medical schools throughout the United States. And we have since moved, uh, more in the direction of, uh, of a geographic full-time system. It's had some benefits and it's had some drawbacks, but it--but it's a national trend that we resisted probably four or five years longer than most institutions had resisted in the United States. Uh, I would say by 1975 at least 50 percent had gone from an academic full-time system to a--a geographic, uh, system. And by 1978, when we made the change, we were down in about a 20 percent group, uh, and it was becoming increasingly obvious that we would not be able to recruit or retain faculty without making that kind of a change. SMOOT: Hmm. Could you go into that more specifically, what the benefits of the two systems might be and the--or the pros and cons I suppose would be the easiest way of putting it? BOSOMWORTH: Well, the--the academic full-time system had--had the benefit of creating a pool of money, which could be institutionally managed and applied wherever it was needed as a resource, uh, to the College of Medicine or the College of Dentistry, which were the two colleges that had that kind of a plan. They were the two that had the capability basically of generating revenue. Uh, so it provided institutional flexibility, it provided an opportunity to apply money in the development or a department of community medicine, which we probably--it did--which wasn't much of a revenue-generating department. And we couldn't have financed that department without transferring money that the surgeons made or the anesthesiologists made over into the basic course according to the operating budget. And, uh, so that was a--that was certainly a programmatic benefit. What it lacked was, uh, much of an incentive for the faculty to devote their--their very extensive energies to patient care, or to the development of a patient-care program that attracted patients, uh, who had financial resources. And the system that we operated tended to attract patients without financial resources. So our--our revenue generation in the late seventies, before we made the practice-plan change, was--was I think about five to six million dollars, from professional practice. Once we made the change and it--and the incentives were there for individuals and for departments, about three years later we were at twenty million dollars. So it had a profound, uh, effect upon revenue, but it also causes and did causes--and did cause--a certain change in the priorities of how people used their time. We had a much better balance, uh, uh, in terms of research, teaching and education under the old system, uh, than we did under the changing system. Although it never really got--it never got badly out of balance, but--but if a department chairman wasn't, uh, a strong administrator under the new system and-- and didn't encourage, uh, educational objectives and research objectives, then the natural tendency was--in some units of the Medical Center--uh, to move more to the patient-care side because it represented a--a revenue enhancement opportunity. When we started here, the pay scale was about ten thousand to twenty-five thousand dollars. The department chairmen were paid twenty-five thousand dollars. It was an interesting arrangement. The--we were limited on our base pay, uh, by the governor's salary, which at that time was eighteen thousand, as I recall. So the highest check we could get was eighteen thousand and then the, uh, fund, which was this ac--Academic Enrichment Fund, from which we--where we deposited our professional fee income, made up the difference. And that was how, uh, my salary was twenty-five when I came and--and I was paid eighteen thousand by the state and then the remainder of it was paid by the, uh, Fund for the Advancement of Medical Education and Research. And so that--that, of course, has changed dramatically, and we--we are now continually trying to maintain our balance between, uh, the various, uh, parts of a three- legged stool in--in the academic environment. I think we're doing a pretty good job. We--we had a period of two or three years where I thought we were getting away from the balance. But I think we've gotten back into it again in a much better way, uh, and we've done some things that--that distinguish and assign individuals to specific roles that may be predominantly patient care, or predominately research, or predominately teaching. And we've changed our academic title series. And we can get into that if we want to talk about it some more. But there--the whole variety of incentives are--have been constructed to try to keep the faculty--in the aggregate--aligned with the academic and institutional objectives and missions, although individuals will have specific responsibilities which will be predominant in one area or another. SMOOT: It seems that, uh, perhaps under the academic full-time system as opposed to the geographic full-time system, that the people at the top had a little bit more discretion in terms of how the money was used. Is that correct? BOSOMWORTH: Oh, that's absolutely correct. And that was, uh, part of the debate, uh, that the dean or the vice president, uh, had a--had a much more significant role in the decision making with regard to resource utilization. And the lower you put the resource generation and the resource application in the organization, uh, the less control. You depend upon influencing friends and relatives, uh, in that arrangement rather than really, uh, being in total control of the management, although we have pretty good institutional control here. There are lots of good checks and balances and, uh, it--it's--I think the institution is operated very responsibly. There are, uh, Medical Centers in the United States that are essentially--well, there are two kinds of geographic plans, full-times. There's a full-time geographic plan and an uncontrolled geographic plan, and there are illustrations not far from us of the latter that--where essentially the faculty can practice anywhere. There'll be fifteen to thirty professional service corporations. Neither the dean nor the president, uh, have any idea of how much money is being generated through the professional practice. It's totally outside the management of the institution, and I don't think that--at least for this institution--that's a--a healthy way to proceed. It certainly raises questions of, uh, public accountability in terms of how that money is being used vis-a-vis the tax dollars that come into the institution. And so we have avoided that even though there's been some interest on the part of some faculty in moving in that direction. It--it's not an overriding issue, at least from my perspective, at the present time. SMOOT: Do you think though that that is a superior system in certain circumstances? BOSOMWORTH: Um, what it--what it tends to do is to, uh, create a group of--of academic units which are very entrepreneurial--largely connected by telephone wire. And they--the, uh, capacity to manage a particular program in relation to the institutional objectives happens only really if the department chairman and the faculty in that unit want it to happen. Uh, now, you-- you have very little institutional opportunity to direct and reinforce and to stimulate activities, uh, that may be--from a corporate sense--uh, very desirable, but are contrary to the wishes of an individual operating unit, uh, under that kind of an arrangement. To a degree some of that exists in the geographic full-time system that we and many other institutions have, but there's a much greater collegial relationship. Uh, the other units can be very independent, physically, uh, isolated, uh--located in buildings that are either adjacent to or away from the academic Medical Center- -and so it's a very different, uh, model. There are some very good institutions that operate with that model. Um, and--but they generally have had very long traditions of research, uh, and a commitment on the part of the individuals who are in that, uh, arrangement to supporting research activities as well as their practice activities. Uh, a lot--I guess a lot has to do with the people and their motivation as much as it has to do with the organizational structure. But, uh, but I--from my own perspective, I believe that the organizational structure that we exist in now, and as it is evolving and it's always changing slightly, is the desirable one. SMOOT: We've already touched several times on Dr. Willard-- BOSOMWORTH: Right. SMOOT: --but I wonder if you would tell me a little bit more about him as--as a leader and as an administrator? BOSOMWORTH: Dr. Willard was a, uh, a very, uh, thoughtful, uh, to a degree introspective, uh, person, but a--but a person with vision. Uh, he was a person who sort of grew on you as you worked with him and a person that almost everyone respected. Uh, he was a mentor to many people. What he did here, because of the compensation arrangements, uh, was to recruit a group of faculty and--and faculty leaders who were largely untried. Uh, they were people like myself who appeared to have some potential, but were not proven in--in any sense from an administrative sense. Most of the chairmen had not headed a department, uh, previously. Uh, one of the interesting things that he did was to, uh--and some of the department chairmen followed with this- -was to recruit Markle scholars, who were individuals that the Markle Foundation, which is now no longer in existence, at least not--it's not--if it's in existence it doesn't have this program. They attempted to identify people in their late twenties and early thirties and funded them for a five-year period, uh, to develop their research and educational skills. And it was a highly competitive selection process and we probably had, uh, nine or ten, uh, Markle scholars here in the original group. The department of surgery had five. And, uh, all of them went on to become department chairmen, uh, at other institutions and--well, one stayed here, Ward Griffen was one and he stayed as the chairman here. But, uh, after Dr. Eiseman left. The--the--uh, so that was the kind of faculty that--that he recruited and he had a, uh, uh, uh, good national reputation. Uh, his background was in public health. He--he didn't have a lot of professional experience in the hospital side or in the health care actual delivery side. He knew enough about it and he knew, uh, and he knew enough to find the right kind of people, um, but he wasn't particularly experienced in that. The other thing that I felt--uh, I appreciated about Dr. Willard was that he helped people along in their own career development. He certainly did that with me, and he, uh, he and Dr. Bost, uh, were, uh, what I would call very high-level, uh, green- eyeshade people in the state of Kentucky and in--and nationally. They were, uh, sort of, uh behind-the-scenes helpers in the formulation of public policy. Uh, here in the state of Kentucky they played a central role in the development of the Medicaid program. They were a central role in the development of the Appalachian Regional Hospital system as we now know it. Dr. Bost, uh, uh, spent a year in Washington writing the Medi--the Medicare regulations, which were written in 1965 under Secretary [Robert M.] Ball [Social Security Administration], and, uh, those prevailed until uh just two years ago. So that team--and he had a larger group in the team, but they were the two central figures, uh- -had a very substantial effect at the national and, uh, local and state level. And one of the things that they helped me to do was to see the--what could be done there. And they began to involve me and others in the Medical Center in those activities and as a result I spent, well, I think over twelve years almost in monthly meetings in, uh, health-policy matters here in the state of Kentucky. Uh, we began with the whole regional medical program--the whole health-planning program in the state--uh, many things evolved from that and so his leadership developed others in the institution who have continued to contribute to the development of health programs here in--in the state and, uh, policy at both the national and the state levels. So those were some of the characteristics--I think he was a--a very thoughtful person. He still is. I just got a very nice letter from him the other day and-- uh, about a recent event and, uh, that--that kind of, uh, relationship I think and the kind of warm feelings that many individuals had has persisted over a long period of time, despite the fact that a lot of his, uh, early appointees are now dispersed all over the United States. SMOOT: It seems that he had a real talent for identifying people that were on the go, on the move, the people that had not been proven yet, but he brought themselves in a very clear way. How do you account for that? Is that just a talent that somebody has, that you can identify, uh, people, uh, after a few meetings and--and seeing their CV [curriculum vitae], et cetera. Or is it something, uh, that he-- BOSOMWORTH: Well, he did a lot of searching.--(both laugh)--You remember I talked about the fact that they went through ten or nine--or ten people--just in my own discipline looking for somebody and that--I don't know that it was that difficult in other areas, but, uh, he did a lot of searching. Plus, he had a--he--he was here at a time--it--very few people get an opportunity to be part of the beginning of something and so that attracted, uh, some people and, uh, that I-I think, you know, in my time of administration here I haven't had that opportunity in the same way that he did. The--I had it in my own faculty when I developed the anesthesia department, and--and I--I guess eight or nine of those people went on to become department chairmen. SMOOT: Hmm. BOSOMWORTH: So--but, uh, now we're a much bigger organization. Uh, we are a much, uh, more tiers in the organization. And so, uh, uh, the occupant of this position, although able to have a--a considerable influence on the direction of the institution, is not directly involved in the way that he was. He was the--both the dean and the vice president and so he had both responsibilities and it was--the institution was small enough at that time and the college was small enough that it was manageable. But eventually, uh, he had to make a decision, which he did in the late sixties, uh, that those positions needed to be separated, and so that caused a--a sort of different operating model in the institution. SMOOT: Who else would you cite--you've, uh, you've mentioned Dr. Bost, uh, as a major mover and shaker of the early foundations of this institution. Uh, are there other people that you would point to as particularly influential and important in its development? BOSOMWORTH: Yes. Well, I would say, uh, Ben Eiseman as chief of surgery, uh, Frank Spencer, who he brought here--there were others in the department of surgery, but--and Ben Rush. Uh, probably those three were very influential in that area and very influential with me personally because I interacted with them every day. Uh, Ed Pellegrino, uh, Bill Knisely, the first chairman of, uh, physiology whose name--I think he's now deceased--I'm blocking on his name, but was another person who was a very major, major force in the institution. Uh, the chairman of pediatrics, the--I guess of the medical school people those were--those were probably the principal individuals. Bob Straus and- -uh, was, was a key person--and Kurt Deuschle. Those were really the-- the core of the original planning group. Dick Noback was a key person. He went on to become Dean of Kansas after--after leaving here. Roy Jarecky played a substantial role in the institution in formulating the student recruitment activities and--and the student admissions and- -and had a central role in the leadership and curriculum development in the early phases. Uh, other units, uh--Al Morris was a very key figure, both in the general administration of the Medical Center and obviously in the dental school, uh, and Marcia Dake, who was the dean of nursing. Uh, she had a interesting operating philosophy, which- -which, uh, caused some differences of opinion in--in the institution and, uh, that's another topic. But, uh, the uh, the other person who I would say was very central to program development here in--in public communication was Bob Johnson, and he--he was the first director of--I guess the title would have been public affairs. I'm not sure what his exact title was, but he was, uh, the person who was out on the road all of the time communicating with doctors and with hospitals and with the media and anybody who would listen about what this Medical Center was about. And he also played a substantial role in Frankfort and--and Dr. Willard and--and this administration. At that time, the university operated differently and, uh, the Medical Center administration played a very direct role in budget negotiations in Frankfort and dealt directly with the governor and members of the legislature, and so on. That changed in subsequent administration in the university. Primarily it changed when President [John] Oswald came and he pulled all of that relationship back into a central administration of the University, which was a disappointment to Dr. Willard, but, uh, uh, that was a--I guess, a period of--of the development where there were relatively few individuals, maybe ten or twelve individuals, who really shaped this Medical Center and played a very central role in it. SMOOT: Hmm. BOSOMWORTH: I'm sure I've forgotten somebody or I could think of--but those are the people that come to mind immediately anyway. SMOOT: Tell me a little bit about the developments of the curriculum here. I know this is something that, as you mentioned, Roy Jarecky had- -has worked with extensively, but, uh, you had to work with it as well. BOSOMWORTH: Sure. Um, we all did and--and, uh, uh, Bob Straus over the--over many years has played a key role in curriculum development as well. Uh, he just finished another four-year term in which he led--provided the leadership actually for the last major overhaul of the curriculum in the medical school. Uh, curriculum development--I--I think the innovative parts of curriculum development here in the early years, uh, dealt with the--in the medical school--with the community medicine and behavioral sciences, which were unique, in the dental school, with the integrated curriculum that--that Al Morris and his colleagues, uh, put together which received national attention and it was emulated in many institutions. Basically it was an integration of--of, uh, basic science and clinical experience so that the clinical part of the program began in the very first year of dental education and basic sciences continued on out until the last year, whereas most schools had a traditional two-plus-two kind of an arrangement, basic science followed by clinical education. Uh, the College of Pharmacy, which of course came into the Medical Center after it was originally formed in 1966-67, represented an interesting challenge. That was really my first involvement with, uh, a responsibility outside of my own departmental operations, uh, because I was asked to serve as the chairman for the search committee for the College of Pharmacy and the college was not in the Medical Center. It was a part of the university, but, uh, not organizationally part of the Medical Center. And Dr. Oswald, who--who was then the president, uh, raised the interesting question and posed it in writing to me, uh, when he asked me--I'm sure at Dr. Willard's recommendation--to serve as the chairperson for the search committee for the dean, as to whether the college of pharmacy should be part of the college of business and economics, uh, or part of the Medical Center. And he had some interesting insight into that because pharmacy was at a turning point, uh, as to whether it really was a commercial venture in the distribution of--of drugs and drug products or whether it was a truly professional activity, uh, in which the practitioners contributed to the health care and the benefit of patients, uh, through knowledge that went beyond merely distribution. And so we examined that issue and concluded that there were some opportunities to go beyond that. Uh, Paul Parker, who was a--chief of pharmacy central supply in the hospital from the beginning, played a very central role in that, uh, in that he had started a residency training program for hospital pharmacists with a clinical component. And I actually had gotten involved with him in--in bringing pharmacists into the hospital in the middle sixties, uh, to begin to get them out of the basement and up onto the floors and begin working with the physicians and the patients. And, so we had a precedent, uh, for a new approach to clinical education in pharmacy. And we recruited Dean [Joseph] Swintosky. And he and others came along and with Parker in the scene, uh, and--and he was an established national figure by that time, in clinical educational, uh, that provided the major momentum for our College of Pharmacy in developing clinical education. And--and one of the national distinctions of this college is that it was probably one of the first two or three in the nation to recognize that there was an opportunity and a need and a--and a real potential to make a major shift in pharmaceutical education. And that's been underway for all those years and now I would say we have probably faculty from--who have been graduates of our either residency training program or our college serving as faculty in practically every college of pharmacy in the United States. I think there are over 170 of them in academic positions, so that's it's a--that--that was a--an early, uh, idea that proved to be sound and, uh, marketable and attractive both to students and to, uh, other institutions. So that--that I think is a very significant aspect of that college's activity. [Pause in recording.] BOSOMWORTH: The College of Allied Health came into being in 1966, under Joe Hamburg's leadership. He'd been a faculty member in the College of Medicine. And that--under his leadership, he basically put together and built a very diverse group of disciplines into a college that is called a College of Allied Health. And the innovative approach that he had was to--was to pick up on Dr. Willard's philosophy of team building and to, uh, bring together a faculty who was willing to try to take disparative--disparate--disciplines and mold them into a more cohesive unit, so that the fa--the students and the faculty understood the roles and responsibilities that each had in providing patient care, and therefore could be more tolerant and effective, uh, in terms of how they delivered care when they actually became employed in the future careers. And so he started the extramural rotations, uh, and had what be--eventu--became known as Kentucky May, uh, began as Kentucky January. And that didn't work too well because you sent the students out for a month in January and they got into all kinds of trouble with bad weather-- SMOOT: Um-hm. BOSOMWORTH: --so they changed the time of year--(Smoot laughs)--but the concept didn't change. And it was to put all of these disciplines together, away from the institution, in a community, have them learn about the community, learn about the health care delivery system and learn something about each other. And, uh, as a result of that, it doesn't sound like much, but it was a very advanced step and it developed the national reputation that this College of Allied Health now enjoys and that the present dean certainly is continuing to promulgate. And we are--we are now in that phase in that College, in terms of building the professional credentials of the faculty. Allied Health began, and I was part of the beginning when I first came here in anesthesia. One of the things that was needed, uh, at that time was the development of a group of people who--who could be supportive of patients needing respiratory therapy. Basically there wasn't any respiratory therapy at that point. When I first came we were starting to use respirators in the care of patients and that, uh, there was no one here who knew how to use a respirator, except myself. And we had to put a patient on a respirator--actually it was one of our faculty members, in a automobile accident. He was on for two weeks, and since no one knew how to operate respirators, I slept in the bed next to him for two weeks--(Smoot laughs)--And, uh--but we finally--I--I got a former colleague out of--a corpsman out of the Navy that I had worked with--brought him down here and started a, uh, certificate program, an in-service-training program and gradually got a pool of people. And then we expanded that to a more formal training program and then his credentials weren't adequate to put him in a faculty position, and so he ultimately left and we recruited another person. But the whole Allied Health field over the last twenty-five years has been what I would call a bootstrap operation. You started with a fairly low-level per-- technically trained person--narrowly trained person, who wasn't academically prepared in any sense and we gradually built that up, as--as went on all over the country, uh, until now we are--we are now being able to put people with doctoral degrees into faculty positions in Allied Health. But that's only been in the last four or five years. It's taken twenty-five years to move from essentially taking a high school graduate and teaching them a single skill, to where we are now with very--and so that these people are highly trained technicians who can run open heart machines, can do very complex, uh, uh, life support system management of people who are paralyzed on respirators, who do complex, uh, uh, laboratory diagnoses and all--all sorts of other things. And so it's, uh--it's been a pleasure to see that program develop, and it--I think it's been important to have that program as a free-standing college. That's been a point of contention in many Medical Centers, including to a degree here, whether resources should be put into Allied Health rather than put them into the mainstream of what people generally have viewed as the programs of the Medical Center. I feel that Allied Health would not have developed if it had been subsumed primarily in the College of Medicine, because the priorities would have been different and you couldn't have protected the resources that would have been needed to make these programs functional. Uh, and so I--I--I think that that's been a very unique and--and innovative kind of program. We're now in the same kind of development over in nursing. Uh, we were one of the first in the country to go to a two-plus-two program in nursing, in which graduates of diploma programs and graduates of two-year associate arts programs were admitted to the upper level of nursing in the baccalaureate level and not--and didn't have to take a whole bunch of courses. And we gave credits for a lot of their undergraduate, uh, two-year experience and for their professional experience. And so they could go on and get a baccalaureate degree with advanced, uh, humanities as well as a--a liberal arts education as well as advanced, uh, professional training in nursing. And that program is going on at the present time and--and that was a--an activity that I think caused our College of Nursing to receive national attention. And now that College is beginning to develop a doctoral degree, uh, program with a research emphasis. And the same thing that happened in Allied--is happening in Allied Health, is happening in nursing. We're building our doctoral faculty. Not--now the vast majority of the faculty hold doctoral degrees, and we're looking for faculty who hold research degrees in nursing, not necessarily doctorates in education, which was the early period of faculty preparation for colleges of nursing in--associated with the universities. And I--so I think you'll see a whole new role for nursing faculty in contributing to the ba--body--of knowledge in health care. And, uh, we're very pleased to be one of the seventeen or eighteen institutions in the country now pursuing that line of--of program development. SMOOT: Let me ask you a little bit more about the College of Nursing because, uh, unfortunately a lot of the early developments in that College have--were not documented at that time. I've-- BOSOMWORTH: Hmm. SMOOT: --talked with people who were involved with the College of Nursing during those early years and they say we simply didn't have time-- BOSOMWORTH: Yeah. SMOOT: --to sit down and write articles and--and, uh, get the word out, although lots of people were coming in from other institutions to observe what was going on at the University of Kentucky College of Nursing. Now I understand that, uh, they were experimenting with curriculum development over there in--in a-- BOSOMWORTH: Right. SMOOT: --in a broad sense and were using a model that had been developed by--I think it was--uh, one of the assistant deans while she had worked at Columbia-- BOSOMWORTH: Right. SMOOT: --Teachers College at Columbia. BOSOMWORTH: Um-hm. SMOOT: Could you tell me a little bit in detail about that? Because it was the first publicly supported baccalaureate program, first of all, in Kentucky in nursing. We, uh, had other baccalaureate programs, mostly though diploma degrees were--were being granted. BOSOMWORTH: Right. SMOOT: I'd like to know a little bit more about that curriculum because I think this is a very important development that has not been fully documented. BOSOMWORTH: Well, you probably could get the details of the curriculum better from some of the early nursing faculty than you could get it from me. I can give you my perceptions of what went on. What they decided to do, instead of dividing nursing up into the--to traditional disciplines that were more related to the disciplines of medicine, they decided to put--build a curriculum that, uh, was around human needs and, uh, they looked at, uh, parent-child--the parenting process and the--and the--and the relationship between the parent and the child and the disease processes and the things that were critical to the maintenance of--of health as opposed necessarily to the treatment of illness. Now, they were committed to both, but the emphasis which was the unique aspect of their emphasis was--and a developing philosophy which is now widespread among nurses nationally--was the recognition that nurses played a role in the management of the patient's environment, and whether that was in the maintenance of health or in the treatment of disease and illness, and so that would be I think the unique aspect of it, but they looked at--at human sexuality was another aspect of their curriculum. Uh, they looked at human behavior and growth and development, uh, and they actually organized the courses around these general topics, rather than a course, uh, in basic nursing one or a course in, uh, uh, physiology or pharmacology. These--those things were all incorporated into the curriculum around these topical, functional areas that were focused on human needs. And, uh, that I would say was the unique part of that curriculum, and the thing that got a fair amount of attention. Uh, I think the difficulty with nursing--it has taken them a long time--I'm not--not just talking about our college, but nursing nationally, but it was true in our college--is that what was lost in the transition from the diploma program was that in the diploma programs the teachers were practitioners, and when we went to baccalaureate nursing education and most of the faculty were, uh, people with doctors--doctoral degrees in education, many of faculty had never been practitioners, or they'd been practitioners many years before and had very limited professional practice, uh, at this part of their career development, find--so they became what I--I--probably-- viewed by my nursing colleagues as a disparaging comment, but as window lookers. They were people looking through the windows at what happened in the patient-care scene; they weren't in there doing it as a part of teaching. Now that's--that's, uh, over simplification and to a degree a misrepresentation because they did do some hands-on kinds of activities, but they set up learning labs, uh, and then they would supervise students in a patient-care setting. But they--they didn't have a responsibility for the patient care. They weren't on--on stream in the way physicians, dentists and pharmacists are--as they are providing care, they're also teaching. And--and I think it's critical to the nurse or to any practitioner who's teaching, in order to maintain their academic skills--that they need to maintain their professional skills. And I--I've felt that nursing made a serious error over the last twenty years as it moved to--to do something that I would also call--which I guess would be contested by my nursing colleagues- -professionalizing the profession. They were trying to, uh, get the image of the profession elevated and not, uh, a sort of subservient to the medical profession--which I think was a useful goal. I--I don't object to that. I think it was appropriate. Uh, they were looking for a collegial rather than a subservient relationship, and I think they're pretty much beginning to achieve that now. But the interesting thing is that--and I'm very pleased to see this in our own college now--uh, they decided that it's important to get back into practice. And so the nurses and faculties have begun to do it by first, aligning themselves in practice, but outside the teaching. They do it on nights or weekends or in the summer, in order to maintain their practice. But they didn't--they didn't link the practice with the teaching. And now we are very strongly encouraging our faculty--particularly the younger faculty who feel more comfortable with this, uh, instead of teaching the theories of nursing to-- to--to demonstrate and apply the theories of nursing to problem-solving situations in the actual care of patients, uh, whether they be sick or well. And so I'm--that--that I think is going to be the next generation of the kind of contribution that we and a few other colleges of nursing in the country are going to be able to make and it's going to be a very central thrust of future curriculum development and future faculty approaches to education, which will be a fairly radical change. Uh, it will take a lot of the education, uh, directly into the patient care setting, uh, dealing with the patient problem directly and assuming a professional responsibility for the patient, rather than as observers and--and documenters of what's happening, uh, while others are providing the care. SMOOT: So something was lost--in summary--something was lost, uh, in the transition from the diploma to the baccalaureate degree program and in particular that loss was found in the hands-on experience that nurses were receiving. BOSOMWORTH: And the assuming--and the assumption of a personal / professional responsibility for the patient, right, and--and therefore the loss, I think, reflected itself in, uh, the professional competence of, uh, faculty, not their knowledge. Uh, I think faculty had been able to maintain their knowledge through their research and their, uh, reading and that kind of thing, and through observation. But, uh, it's- -it's one thing to drop out of surgery for five years and then walk back into the operating room and be able to do open heart surgery, you know. It's just not possible. And, uh, so that kind of, uh, relationship, I think, is important and I'm glad to see being reestablished. SMOOT: You mentioned earlier that, uh, Dean Dake had an interesting operating philosophy. Could you tell me a little bit more about that? BOSOMWORTH: Yes, I think it was linked to this, uh, whole concept of trying to build professional stature. The nursing faculty here and in many other institutions, uh, was very insular, very introspective in its, uh, uh--and didn't want to get outside its walls. Uh, they wanted to be able to teach everything. Uh, I can remember volunteering to teach certain aspects of pre-anesthetic preparation and, uh, premedication and some pharmacology related to anesthetics. I--I think I was one of two faculty in the medical school that ever was permitted to teach in the College of Nursing. And, uh, uh, so they--they felt, I think, that we didn't understand, uh, the--the nursing philosophy and that we couldn't, uh, communicate properly. And, that always bothered me. And I think there were lost opportunities because there were people who were interested in contributing to the education of nurses, and we certainly did it once they got into practice. Uh, I--I devoted a lot of my time to teaching nursing or, uh, or nursing personnel in the recovery room and in the operating room, how to do an awful lot of things that they never learned in--in nursing school. So that--that- -that's now disappearing, and we're getting a, uh, um, more collegial interactive and it's--and it--in all the colleges fortunately. Phar- -the College of Pharmacy teaches pharmacology now in the College of Nursing and, uh, there are substantial roles for other faculty that- -that interact in the nursing program. Uh, that was what I--that was basic reference. (coughs) SMOOT: Are there any other specific innovations or developments that you would point to in the College of Nursing, uh, as having particular importance to the institution, to the development of nursing generally, initially education curriculum? BOSOMWORTH: (coughs)--Well, there've been, uh, individual areas. I wouldn't say, uh that--I mean there've been a group of faculty who've made some major contributions in the neurosurgical area. Uh, one of the faculty members particularly is nationally recognized for her contribution in the role of nurses in analyzing and documenting the mental status of patients subject to trauma, who--who are neurosurgical patients and neurosurgical nursing, neurosurgical assessment. Uh, but I--I--I--I can't point to anything, uh, really unique, uh, that- -that, uh, is sort of, you know, copied nationwide as--as this--this curriculum being focused as a model, uh, nationally. I think one of the things that--that's good that's happening in nursing and our faculty is active par--actively participating in it. And I think it demonstrates sort of graduation from this twenty-year period of professionalizing the profession to getting back to being concerned about the content of nursing and that, uh, nationally nursing is now gone back to doing a thorough assessment of competencies of nurses. What should nurses need to know? What technical skills, what intellectual competencies, uh, should they have in order to carry out the responsibilities of a professional nurse? And our college is actively involved in that. There's a national survey going on and I--I think that that's going to be very healthy and from that will flow major curriculum changes in my opinion. But we're two to five years from seeing those fully developed in the colleges, and I--I hope our college will be actively involved in it. SMOOT: Let me turn now to the College of Dentistry and we've already touched upon it somewhat, certainly mentioning Al Morris and the, uh, development of the diagonal curriculum as they called it-- BOSOMWORTH: Right. SMOOT: --in the College of Dentistry and you may want to expand upon, uh, your comments on the diagonal curriculum, but I'm looking also for other innovations that were taking place in the College of Dentistry at UK as it was developing over the years. BOSOMWORTH: Well, I don't know that I could add a lot more to--to the diagonal curriculum. They--the idea basically was to integrate basic sciences and clinical all the way along and gradually increase the clinical and gradually diminish the basic sciences, but never eliminate them, because they recognized that the lifetime competence of a dentist and--and the life--lifetime competence of all health professionals is tied to continued, uh, education related to basic sciences. Uh, it also made--their intention was to make the basic sciences more relevant. You tend in--in--to get into a situation--I can remember when I was a first-year medical student taking biochemistry, you know, and sitting there thinking, why am I learning all this complex esoteric material? Is it ever going to be used in medicine? Well, that kind of a curriculum that--that was developed here in dentistry attempts to relate the, uh, particular exercise in the--in the basic sciences to the clinical activity that that knowledge would be applied to and so that was really the unique, uh--and--and it also, uh--because clinical activity was developed early in the curriculum, it represented a motivator for students. You didn't sit there and wait for two years wondering what it was going to be like to talk to your first patient. Um, and so those were, I think, valuable, uh, aspects of that. Another thing that was developed in--in dentistry--(coughs)-- which Dr. Michael Romano really pioneered here and went way beyond dentistry was, uh, the whole approach to the use of television in--in medical education. You know we' re now in the computer era, but at that point we were--we--we were leaders nationally in the--in the use of audiovisuals in, uh--in clinical education, which started in dentistry, but rapidly expanded to all phases of the Medical Center. And that led to the development of one of the stronger units in the United States of, uh, of, uh, audiovisual wha--which then expanded on to, uh, the, uh, development of the unit intended to improve the competence of faculty. One of the difficulties in the health professions is that most of us are--have never had any, uh, guidance or experience, prior to being appointed to a faculty, in--in teaching, you know, have any idea about what, you know, the methodology or anything else. And, uh, so you sort of arrive here on day one--I went to a lecture the other day of a new faculty member who was giving his first lecture on the first of July, having been appointed the same day. And he got up and started to give his lecture and he had no idea about how to organize it or how to--how to--how to lay out what he intended in terms of objectives in the beginning and summarize at the end. And he ran over by forty-five minutes, and--and, you know, all of the mistakes you could conceive of he made. And it--and it wasn't because he wanted to make the mistakes. It's because he didn't have the background. And so that--this particular unit that we established here in the Medical Center joined with the audiovisual, uh, with the electronics unit, with the, uh, mec--with the, uh, engineering unit in the Medical Center, and that was a pretty substantial financial commitment that both Dr. Willard and I made to, uh, supporting faculty development in the institution. And part of it was on soft money--a lot of it was on soft money--which is now gone. But, uh--and it--so that that's an area that, uh, I think we were nationally recognized for. Many publications came out of that, uh, about the approaches that were taken here. So that was, uh, I think, another unique thing and it started in the College of Dentistry. SMOOT: How about the College of Medicine, uh, would you like to expand upon some of the innovations taking place there? We've touched that, uh, you had specialized departments, uh--a Department of Community, uh, Medicine, a Department of Behavioral Sciences. Uh, these were unique, were they not-- BOSOMWORTH: Right. SMOOT: --in the United States? Uh, would you like to expand upon those or perhaps point to other innovations, perhaps taking place in research among members of the faculty, uh, in the, uh, College of Medicine? BOSOMWORTH: The--(Smoot coughs)--the--those two departments were unique; they're now copied by practically every medical school in the United States in one way or another. Uh, the role of behavioral science here was basically, uh, to begin to teach, uh, students, uh, the techniques of interview, uh, the techniques of analysis of a patients problems, and it--it matured to the point of beginning to tackle human behavior modification, a--which was a shared responsibility between the department of psychiatry and behavioral sciences. And I--I would say that it's now more into the latter, although it still has a responsibility for the former in terms of teaching basic skills and of communication in dealing with patients. It had some responsibility with regard to ethical standards, uh, and that aspect of the education program, which was fairly unique. And it's an area that, by the way, that I think is going to see a major resurgence in the next ten years--and one of our program priorities here at--university wide--but particularly in the Medical Center. I hope we'll be able to find the resources for it for further development. Uh, community medicine was, uh, unique in that it--we had five faculty out in the field who were full-time faculty of the University of Kentucky, but physically distributed, much like, uh, extension agents in Ag [agriculture]. Uh, they played a role in public service to the areas that they were physically located in. They were supervisors of students out in the field--(Smoot coughs)--They took students into a particular community and they would look at a community-based problem, whether it was sewers or water purification or garbage collection or--and try to trace it back to its origins and then end up, uh, with a report to the community about what could be done to improve that particular problem. So those were the early innovative, uh, kinds of things and--but the--but the programs were essentially departmentally based. Dr. Willard had an early try at trying to put together a program for handicapped children, which was multidisciplinary. And the faculty weren't ready for that, uh, they weren't, uh--they--and the--and the reward system wasn't there and I don't think the higher administration of the institution understood it very well. But it would have required, uh, the College of Education, behavioral science, psychiatry, neurology, pediatrics, rehabilitation, uh, educational rehab services--a whole variety of disciplines--legal services and so on--all coming together. And actually they had proposed a building to be built, but, uh, for a variety of reasons they just--the readiness wasn't there and it--and on--on the part of a lot of people, and so it didn't happen. And I think one of the things that's been, uh--probably the most important contribution that we've been able to make in more recent years has been to build an environment and to build an incentive system, uh, and some- -both physical environment and professional--that encourages people to get out on limbs, outside of their own departments and to work together in a collective sense. And we started doing that, oh, eight or ten years ago, but it really didn't begin to take hold until six or seven years ago. But we've--it's solidly in place here in the Medical Center and that has now permitted us to move in the development of Centers of Excellence. And that's what Dr. Willard had in mind when he was trying to do this handicapped rehab program, uh, you know, twenty years ago. But people were afraid to get out of their own bailiwick, and be- -they--and there was some good reason for that because if somebody went out on this limb and left the department of A and did 90 percent of their work outside of the department, when it came time for promotion and--and increment in compensation and other rewards--people say well, I don't know what he's doing, he's out there doing something, not helping us. And so that--that kind of conflict, which existed in mo- -practically every Medical Center in the country, in every university generally, actually, uh, is something that we have worked on very hard, and I think we now have a very excellent environment here to--to deal with that. And when you look at the Centers of Excellence that are in place or are developing, uh, there is no way that we could be getting the funding in aging that we're getting now if we didn't have the support and a group of risk takers who were willing to get out and, uh, uh--and go beyond the comforts of their own departmental disciplines. Actually I--I believe that--that the departmental structure, although a strength of the institution, is its greatest barrier to progress, and it represents a--a--a opportunity for passive-aggressive behavior, uh, that prohibits--or can prohibit, uh, multidisciplinary institutional development--program development. And that's one of the things that I felt that I was able to recognize fairly early in my career, uh, and--and I've worked continuously at trying to do something about it. And I think it pays off to the extent that we're finding colleagues now who are stepping outside these walls and, uh, uh, two of our colleges operate without departmental structures and it--it's proven to be--I would say the best example of that is the College of Pharmacy. And they--they--they, shift every three or four years and they--if they need--see a new need they--they stop the division of B and create a division of C and realign the whole thing. And that goes on every--it gets a little upsetting to some of the players, but, uh, uh, on the other hand, the mission of the institution and of the college is--has been very definitely enhanced and they've made very rapid progress. When you think, in a twenty-year period, we essentially had eleven faculty and twelve faculty in the College of Pharmacy--it was exclusively undergraduate, no research, uh, uh--to where it is today. It would not have been possible, in my view, uh, if we'd had, uh, twelve little departments, uh, in place in the College of Pharmacy, uh, controlled under a process that--that--that is essentially the case in the departmental structure of this and many other universities. And--and that concept we've tried to extend now to--to not necessarily do away with the departmental structure, I don't--I don't think any administrator probably could survive that--(both laugh)--mass effort- -but I don't think it's necessary, if--if people have an attitude that- -and an understanding--that everyone will be more successful if they can work together. And I think where we have over time, uh, generated that and--and now there's natural leadership involving--evolving with-- inside the institution in that direction, so-- SMOOT: Since we've been on the topic of, uh, the medical college, I also would like to ask you about the development of--of your own department. Uh, you were the first chairman of anesthesiology-- BOSOMWORTH: Right. SMOOT: --and I would like to hear a little bit about the development of that particular department within the structure of the whole college. BOSOMWORTH: Well, it was--it was, as I said earlier, an interesting, an interesting opportunity. It was, uh--I came, I guess because of my age, feeling confident that I could do it. Uh, uh, when I look back at it, I'm surprised that I was able to do it, but, uh, I was fortunate, uh, in having the opportunity to recruit two or three people in the very beginning who were--actually s--all of them were older than I was, uh, and who were in their mid-careers, uh, and who came here and made very solid, uh, contributions. They each had a subdiscipline that was--that built the core. And so--while the first six months I was here by myself, and I practically lived in the hospital for six months, 'cause we were operating every day and every night, and I had two nurse anesthetists, and we met ourselves coming and going, and I was--I hardly ever got out of the building. But, uh, I was also, during that period of time, able to recruit and, by the end of six months, I had two faculty and, by the end of a year, I think I had four or five. And, uh, so that--I came in March--we opened the hospital two weeks later and, on the first of July, I took my first resident, who actually was one of the most outstanding residents we ever had here--his name was Jan Hasbrook. He's now--unfortunately has a very serious, uh, chronic disease and he's not able to practice or teach anymore. But that led to, uh, the recruitment eventually of thirteen faculty members, and, uh, we built a good program with a good research base. We had good extramural funding, both from, uh, indus--the drug industry and from the National Institutes of Health. Uh, we had good residents. I took primarily American residents, uh, there was in--nationally, at that time in anesthesia, probably 45 percent of the residents were foreign. I only took three in ten years, and they all did very well. One's a department chairman now at Louisville. He had his, uh, advanced degree in pharmacology here before he came into the residency program. Another had a doctorate degree in anatomy. And, uh, so they've all done very well, but--and the--the-- we've never had a problem in filling our residency program and that was a problem at that time. It's no longer a problem in anesthesia, 'cause the compensation and other--the field has changed since then, but, uh, the basic, uh, program that we built was, uh--was a good quality--we were almost immediately accredited for the residency training. We had a required rotation of three weeks for all of the medical students, which was part of the--my negotiation about coming here. I eventually decided that it wasn't necessary to have a mandatory rotation, so we went to an elective rotation, but longer, in the senior year of, uh--of I think it was eight weeks. And I had 60 to 70 percent of a class, uh, taking that on an elective basis. Not just me, but because of the rest of the faculty. So in a very rapid period of time we--we had achieved a good national reputation. By 1970, I personally had moved up in the field. I had been elected as vice president of the American Society of Anesthesiologists and was in line to become the president-elect when I, uh, was offered the position of, uh, vice president of the Medical Center, and I had to remove myself from that because of--had a massive time commitment to it. But, uh--and then an interesting thing happened, uh, the--when--when I left the department as--as the senior administrator, I had actually been straddling the fence from 1967--I- -because I--I--Dr. Willard asked me to become the first associate dean for clinical affairs in the hospital, and during that period of time, uh, the hospital director resigned, and so I had a year as the acting hospital director. And, uh, I was still trying to be the chairman of the Department of Anesthesia. It worked pretty well, but I put in an awful lot of hours every day trying to do it. And I--so I recognized that I either had to go back full time to being the chairman of anesthesia or go on in a--my own, uh, career--in another direction. So I had actually looked at a couple of, uh, deanships and been offered one and, uh--at other institutions. And at that point, Dr. Willard had decided to step down and--and the president put together a search committee of, uh, of the five deans and--and four days later I was the vice president--(both laugh)--of the university. And that was a little different than they do things now. But the, uh, department then got into some difficulty in that--it started with the fact that one of the members of the department, Dan Wingard, uh, w--had been put forward by the search committee for my replacement as the principal candidate. And he was not acceptable to the dean--uh, Dr. William Jordan at that point--which was unfortunate because that caused a very negative feeling. The department was solidly behind Dan being the chairman and, uh, so there was a--a very negative feeling. Dan ultimately left within about a year and became chairman at Nebraska, and, uh, uh, four or five of the key senior faculty that I originally had recruited left, and so things got to a pretty low state. Then they appointed uh, uh, a chairman, and that worked for about two years. And, uh, uh, then I sort of got an emergency call from the dean, would I come back and help them?--(laughs)--So in 1974, while I was still vice president, I went back for a five-month period and served as the chairman of the department, because they were getting to the point where it was about to collapse and they couldn't support the anesthesia patient-care requirements to keep the surgery operating. And so I did that. And then they recruited, uh, Dr. Mark Rauven, who became the chairman, from the University of Florida--who was a very brilliant person and a, uh--and a superb research person. And he did well for about a three- year period, but unbeknownst to everybody, he had, uh, severe juvenile diabetes, and, uh, he developed a number of disabilities, the most serious of which was that he became blind. And, uh, that essentially eliminated him in terms of being able to continue to function in his capacity as chairman. He couldn't work in the operating room and so that was tragic. He subsequently died from the disease. And then, uh, Dr. Ballard Wright became the chairman and there was some difficulty relating to, uh, his appointment, primarily misunderstanding about the use of--the receipt and use of funds within the institution. And, uh, uh--so we've had a series of appointments and not--things not working too well, which has been a disappointment to me frankly, because, uh- -although the department has done reasonably well and they've continued to train residents and they've gotten good residents fortunately and-- and--but it certainly has had its ups and downs. Uh, and we're back at a point right now where we have an acting chairman who's a young, uh, fellow with, uh, Dr. [William] Witt--who actually I think is doing a very excellent job, and the department, uh, seems reasonably calm and stable under his leadership and so we'll see what happens next. But, uh, I'm hopeful that, uh--that that department will continue to grow. [Pause in recording.] SMOOT: I think you've already touched upon the, um, major developments in the, uh, College of Allied Health Professions. Uh, I don't know if there is anything you want to add there? BOSOMWORTH: Well, I would say that, uh, in Allied Health the next major thrust is, uh, the, uh, development of faculty competence at the doctoral level and development of some research capability. Um, the research in Allied Health has largely been observations, uh, of--of a particular patient-care problem or situation, very little research contributing in, uh, a fundamental way. We're now beginning to assemble a faculty who I think can make that kind of contribution, if you look at physical therapy, we've got three doctoral faculty in there who have training that is--is very important to the field and--and in the field of kinetics, or the study of human motion and they're actively involved with the bioengineering faculty now in--in some very interesting research, as well as the faculty from, uh, physiolo--or--from physiology and, um, uh, phys--or, uh--health and physical education. Uh, and some similar activities are going to be taking place in med tech, we're bringing on a new PhD faculty. Well, he's not--he's a middle-aged person, but he's--he's well funded at the Federal level from NIH funds. And we're going to begin I think, to retool the whole field of medical technology. That field has progressed to the point where you mostly put in materials and push buttons. You don't do the--all of the original chemical analyses; it's all automated now. So we need a new generation of people who will understand the technology, understand computers, understand, the engineering of these equipment--of this kind of equipment--and then beyond that, uh, uh, understand the new kinds of laboratory tests--tests for AIDS [Acquired Immune Deficiency Syndrome], all of the immune, uh, uh, testing that's going to be done relating to organ transplantation and all of those things--and so we're--we'll be developing a whole new generation of--of people who will graduate from those programs. But in order to do that we have to have a faculty with a knowledge base and a research base that--that can move beyond where we were just even five years ago. And so there's an urgency to making that transition, um, because if we don't make it we'll be preparing people that--at a--sort of an anachronism, you know. Uh, the faculty recognizes that, and the dean recognizes it, and so they're moving ahead to-- strengthen that. And that's going on all over the college, and so I guess that's an important aspect of what'll be happening. It- -it produces some tension within the faculty, particularly those of the master's level faculty who have--sort of see handwriting on the wall. They've got to upgrade their skills and--and get advanced degrees, uh, because over time--we--we don't contemplate term--terminating anybody, but over time as we replace we're definitely moving in that direction. SMOOT: You had already mentioned that you were directly involved with the recruitment of the new dean of the College of Pharmacy, Dr. Swintosky. BOSOMWORTH: Right. SMOOT: I have heard different stories on the status--shall we say--of the College of Pharmacy as it was geared within the profession of pharmacy- -prior to his coming. Now certainly since Dr. Swintosky has been here, I've heard very good reports on--even ranking the College of Pharmacy- -and I know this is always a rather arbitrary sort of thing and I don't know where these rankings are actually coming from--even ranking the College of Pharmacy here within the top five at certain points-- BOSOMWORTH: Right. SMOOT: --of colleges of pharmacy within the United States. Could you tell me a little bit about the college, because you had to do some studies I'm sure-- BOSOMWORTH: Yes. SMOOT: --uh, prior to his arrival and what he has done to upgrade that particular college? BOSOMWORTH: I think that the College of Pharmacy, under Dean [Earl P.] Slone, was a college which was highly respected in the state or Kentucky. It was, uh, uh, strongly supported by the practitioners, it met the, uh, industry's needs at that point in terms of, uh, retail pharmacy. Uh, uh, so it--it was a program that met the expectations of the state of Kentucky, but it was not a program, uh, that was at the forefront of research or program innovation at the national level. And I don't fault, uh, Dean Slone for that because I--he didn't have the resources. Uh, uh, Dr. Willard, and then I did subsequently, made a substantial commitment to bring resources into that college. Even though it's not a big college, it's a lot bigger than it was when they started--or when the dean started. Uh, and they've done a lot to help themselves with resource development. They were--they were for a long time constrained by their physical facilities, and, uh, they very likely before much longer are going to be constrained again. I wish we could have built a building twice the size. But, uh, at any rate, uh, uh--the col--two things happened in the college. We--we built a very strong, uh, research faculty and Dean Swintosky--although he'd had prior academic experience, I believe at Temple [University]--came from industry. He'd been at, uh, Smith, Kline and French in Philadelphia for ten years and was a section head in one of their major research programs in--in--in industry. Now, he was still a--he was still a faculty member in two, I think, colleges of pharmacy in Philadelphia and--but his principal responsibility was in the industry. So, when he came here he recruited, uh, at least half of the new faculty from industry. And so that faculty had a different orientation than people who have spent their entire career in academic world. They were willing to be directed. Uh, they--they understood the power structure of an--of an industrial model as compose--compared--to the newer structure of an academic model and that was Dr. Swintosky's style, to manage pretty much in the way of industry. It caused some controversy, but it was--I think you'd have to say on balance that he was effective in--in--in that and that the faculty he brought here were willing to function in that model. Uh, he--he did establish the--the--breakdown the departmental structure, uh, and he, uh, created divisions. Uh, it was a very centrally controlled administration in the college, and that persists to this day--to a degree--to the consternation of some of the faculty. Uh, and it may well be time for some change in that--in that model. I suspect, uh--Dr. Swintosky has just announced his intention to resign as dean, he's at that retirement age in terms of the University of Kentucky, having reached age sixty-five, although I think he will stay on the faculty. So we'll be very shortly searching for a new dean and I suspect that we'll see some change in--in operating philosophy with a new dean, but at any rate--the research faculty developed very strongly. They had--they had close ties with industry, which are maintained to this date. They are--they were and continue to be consultants to the industry--valued consultants--and they--their principal skill was not in the formulation of new products--which is a--a--an attribute that the faculty in some other colleges have. It was in the manufacturing of, uh, products and in the dosage forms of products, uh, that they--the majority of the faculty had their principal skills, and that was one of the reasons that they were--their competencies were of great interest to the industry. And--and a--a reason why--at least on a per capita basis--I suspect our College of Pharmacy has the highest level of industrial funding of any college, uh, faculty in the United States. They also have an excellent, uh, Federal funding as well, but--and then the other element of the program, uh, was--and the leadership, as I have eluded to earlier, really came from Paul Parker in the development of the clinical aspect. He had that program in place in the hospital and that was basically a vision of Dick Wittrup, who is a person I forgot to mention early in the--he was a central figure in--in--uh, in the formulation of the hospital and, uh, he supported Paul Parker. I used to kid Paul Parker, I'd say we ought to call this the Paul Parker Hospital Pharmacy and put that out on the front--(laughs)--'cause it was a dominant part of what happened in the hospital. And he and his colleagues developed the, uh, unit-dose system, which was a nationally copied system, uh, which materially improved the safety of drug administration. It was a system in which, instead of dispensing from the basement of the building and sending up bulk supplies which were then measured out by a whole variety of people and administered by another group of people to the patients, that the pharmacists track the drugs, each patient had a drawer and each patient had a--four sections in the drawer and all the medications were put in so that it minimi--it drastically reduces drug error. And it became a--a widely recognized and endorsed, uh, method of drug administration and was adopted nationwide and it was a- -a--one of the leading contributions of the College of Pharmacy and the hospital to, uh, drug management in an institution. Now it's used in nursing homes and, uh, even in-home health care situations. Well, so that--that--the unit dose and, um, the clinical training of pharmacists beyond the baccalaureate degree--that led to the early development of the Pharm. D. degree, and so we were one of the pioneers in that. And I actually became involved in that movement in the run--nin-- early seventies, uh, not because I had a connection with pharmacy so much as we were doing it here and through our national organization of my counterparts, we began to study the issues related to pharmacy and I--I got involved in it and have been ever since. That--that--those two kinds of contributions, aligned with the research, really brought the national distinction and the-- and the very high proportion of our Pharm. D. graduates and our residency training graduates who went on to academic institutions with responsibilities either in administration or faculty responsibilities are the key, uh, elements of why we have the national recognition that we have. SMOOT: Um-hm. Having now touched upon all these various colleges, um, I want to step back and ask you about the relationships that were established, uh, between Dr. Willard, who was of course one of the deans at the time-- BOSOMWORTH: Right. SMOOT: --with the other deans of the colleges. And of course at first it was only himself as dean of medicine, then the College of Dentistry and then the College of Nursing and it was expanded later, uh, with pharmacy and, uh, Allied Health didn't actually become a college until 1970, was it? BOSOMWORTH: Sixty-seven, I think. SMOOT: Sixty--I thought it was-- BOSOMWORTH: If I-- SMOOT: --school then and then became a-- BOSOMWORTH: Oh, all right, yes--but it was a discrete unit. SMOOT: Yes. BOSOMWORTH: That's correct, yeah. SMOOT: Um-hm. How about those relationships, uh, could you tell me a little bit about that? BOSOMWORTH: Well, he recruited all those people and, uh, so, uh, I never sensed that there was a relationship problem. SMOOT: Um-hm. BOSOMWORTH: Uh, they were, uh, very supportive of him and they were supportive of his-- his objectives. Uh, he was protective of their interests. He didn't let the College of Medicine dominate, uh, to the extent that--even though he had the dual responsibility of dean and vice president, he managed to keep his hat straight and, uh, separate his responsibility as dean from his responsibility as vice president. And I never sensed a negative, uh, reaction. Now, I wasn't in the room, you know, at that point--(laughs)--with all of the discussions, but my--my sense about it is that--that that relationship was good. Actually when the separation was made, uh, there was a--the appointment of the first dean, uh, the, compatibility between that--Dr. Jordan and Dr. Eme--and Dr. Willard--was, uh, a little less--uh, the right term--but less, uh, effective--or supportive--than the previous arrangement. Uh, I think that's changed again now. You know, I think the relationships are all different again now, and that--partially due to the people, but, uh--but partially because of the size of the institution. Back at that point I doubt that we had in the aggregate more than 180 or a 190 faculty and, you know, we're 470 and probably then I would imagine we had less than 1,500 employees total; we now have over 4,000. So you've got a different, you know, a different animal here. But, uh, uh, I--I felt that there's been a--generally though--a good collegial relationship among the deans during his administration and during my period of responsibility. Uh, there are of course tensions, uh, uh, that--but that's what this system is about. I think it's healthy, frankly, to have some of that and to have the hospital, uh, uh, in the position that it's in. Uh, there's always a tension between the hospital and the medical school and, uh, wh-that needs to be resolved and to be resolved constructively. But we've had a remarkable stability in the dean structure here, compared to many institutions. You know, we've had relative--we've had--what? Three deans of medicine. Uh, we've had two deans of Allied Health. We've had three deans of nursing, uh, three deans--well, we're on our fourth dean--about to be on our fourth dean--in dentistry, two in pharmacy- -over a twenty-five-year period. So it--it's been--compared to many other institutions--a very compatible group of people, a very stable administrative structure. SMOOT: Um-hm. How would you describe the quality of the students? You've already alluded to that somewhat by citing certain outstanding students, but the overall quality of the students within the various colleges of the Medical Center? BOSOMWORTH: It's variable. Uh, we have, uh, when the medical school began, uh, we had a group of students who we probably now wouldn't admit, uh, in terms of academic credentials, not intellectual capability, but in--when we first started here, uh, the students particularly from rural Kentucky were woefully prepared and they were, uh--and they were not competitive on any national standard of examination. Uh, if we would have had to apply the national standards, uh, uh, in the first class--I think we had thirty-five students and now some of those are really outstanding people, but they just were--their--even their grade school education, their--their family backgrounds and their high school and college preparation were--were very inadequate. And so we had to do a lot of support and remedial work, which normally you shouldn't have to do in a medical school. Uh, well, that's changed, of course. We're--we still have a long way to go in Kentucky--(laughs)--in that regard, but, uh, it's changed. Uh, and if you took our student body and looked at the medical school class that matriculates, it would compare very favorably to the national average. We wouldn't be up in the top. I mean we have some of the very top students, but, uh, we wouldn't be up in the very top of--of--of some of the institutions in the country that--particularly the private institutions that--that have traditionally ext--attracted, you know, the top 8 or 10 percent of the applicant pool. Uh, but we-- we are getting very good Kentucky applicants and that's been the case in dentistry as well. Uh, there's some interesting--nursing has always done fairly well. Uh, Allied Health has been up and down in--in its, uh, units, although there's one very interesting exception in Allied Health and that's physical therapy. Uh, the qualifications--it's very competitive to get into, and the qualifications of the--academic qualifications--of the students entering physical therapy could readily be matched against the medical school. Almost any physical therapy student, in terms of their academic qualifications could successfully get into medical school, which has always interested me. They--the grade point average of the entering class in physical therapy routinely fluctuates between 3.3 and 3.5. Uh, uh, and that's their first--after their first two years of pre - professional education, so they're--and we--we've got, uh--pharmacy has had a--traditionally has had a good group of students. The thing that changed--which has been fortunate I think--is that--'cause we probably wouldn't have much of a pool if it hadn't happened--is we've had a significant increase in the number of women interested in health professions. They've traditionally been interested in nursing and to a degree, Allied Health. Now, we're beginning to get some male applicants in nursing, but we need a lot more. And the medical school class is 35 percent now. Pharmacy has moved up to 50 percent women. So there's been a--those kinds of changes in the student population have taken place, but I--I--I think generally we've got a quality student body, uh, which we can feel fairly comfortable with, particularly in comparison with a lot of state institutions and--and a certain group of private institutions too. SMOOT: Um-hm. I believe we've already talked this; I suppose I'm asking you to summarize with this question, but how have changes in knowledge and technology made these curricular changes necessary over the years within various colleges? BOSOMWORTH: Well, I think it's an ax--axiom now in health care that we're down to 50 percent of what you've learned in the previous seven years will not be applicable in the next seven. So having completed a course of work in dentistry or medicine or nursing, uh, if you drop out for a five to seven year period and don't pay attention to what's going on in the field, you'd be in very serious trouble, because half of what you encounter when you go back, nobody will have talked to you about or you won't have learned about and that keeps getting narrower--that gap. So, uh, and the technology is just unbelievable. In the--I--I've been--well, in active practice of medicine since I left my residency program--uh, I'm less involved in it now obviously, but--but since 1958--and, uh, I just was attending at six-thirty this morning a lecture over in the anesthesia department and, uh, listening to the whole review of technology applied to monitoring patient care. Uh, back when I was beginning in my career, wh--the only thing that was available were a blood pressure cuff, a stethoscope on the chest and an EKG [electrocardiograph] machine. And now we've got mass spectrometry, we can tell at any given time how much anesthetic is going into the patient, how much is coming out, what the carbon dioxide is, uh, what the oxygen is, what the effective function of the heart is, what the brain waves are doing, uh, whether the muscles are contracting under an anesthetic, uh, muscle relaxant. Uh, you know, there are twenty different devices available now, most of which didn't exist twenty years ago and most of which have gone through four or five generations in the last ten years. So--and that applies to every field in medicine. So that there--there's a terrific expansion of the technology and a terrific dependence on the technology. And that's one of the, uh, things that we've got to guard against is it's very easy to start looking at the machines, rather than the patient. Or it's better--you begin to talk to the machines rather than the patient and that's a--that's a very important thing that, uh, faculty have to remember and that our students have to remember. So the--the changes that have--been--are phenomenal and they're just going to accelerate, and we're going to have to bring the computer into our--the central part of our teaching and learning processes. And we'll see some very, I think, dramatic approaches to teaching, which will begin to develop over the next-- they're starting right now--and they'll begin, uh, rapidly escalating. You know, the aviation industry has had the link trainer for years. Why we've never done that in medicine is really beyond me. Uh, we--we--we ought to be able to adapt, and we are beginning to adapt that kind of technology to learning and so that we're not out there trying to begin the initial stages of teaching with the patient directly, but we--in teaching problem solving through the use of some of this technology. And so those are some of the things that I think, uh, that are important to look forward to in the future. SMOOT: (coughs)--We haven't really talked much about the development of the University hospital. Could you tell me a little bit about the development there, because you were coming here just as that was beginning-- BOSOMWORTH: Opening. SMOOT: --opening? BOSOMWORTH: Well, um, as I said earlier, we began with I think--thirty- five faculty--clinical faculty--when--at the time the hospital opened. We gradually opened the various wards of the hospital. And we were concerned about the development of a referral practice, but the patients kept coming faster than we had a capacity to deal with them it seemed like. And, so we did not have a problem in terms of patient volume in relation to the student body. Uh, wh--as the hospital has grown, the programs have grown, they've become more complex and sub specialized. Uh, we've maintained a very central role though inpatient care in the state of Kentucky. If you look at the complexity of services, uh, we provide more, uh, services, uh--the last analysis of that I saw is that we were providing twenty-six specialized services beyond what you would call routine hospital services and the closest one to us in the state is twenty-one and then the next one down is eighteen and then the next group is down at fourteen or fifteen and those are the bigger hospitals in Kentucky, so--including the University of Louisville--so we--we have--we have done a lot of very specialized things and we continue to do that. Our--I mean, our reproductive medicine program that Dr. Emery Wilson operates is another example. Our--our whole contemplated approach to organ transplantation and bowel transplantation and pancreas transplantation. So we keep trying to stay on the forefront of the development of these kinds of very specialized services. Basically because we've got skills in people and--and at least so far, the resources to finance the technology that goes with this, but it creates a very interesting problem for us, because the more specialized that we get, uh, the less relevant it is to undergraduate medical education or--and to other kinds of education. Uh, you need--the majority of undergraduate medical education ought to be general in nature, and we are increasingly in the hospital setting, specialized. So we've got to look to new opportunities for the base for undergraduate medical and nursing and some other kinds of education. And--and then as these people mature and get int--and need to have special education, we're going to provide those opportunities for them, but we've got a--a discrepancy between what we're doing in the hospital and how relevant that is to the undergraduate level of--of all the health professional education activities. So we're looking to new ventures--HMO [health maintenance organizations] development, PPOs [preferred provider organizations], uh, the, uh, relationships with private community hospitals and community fac--practitioners, uh, satellite clinics and all kinds of different arrangements that will broaden our base in order to maintain a patient population that supports both our teaching and our research objectives. SMOOT: Uh-hm. I noted recently that you were involved with a, uh, commission at the Southern Regional Education Board. BOSOMWORTH: Right. SMOOT: I'm looking at a copy of the article that was put in the Chronicle of Higher Education, "States are urged to consider sale of hospitals and push for changes in medical curricula." Uh, I was wondering about this because I--if I'm not mistaken, the University of Louisville has some sort of arrangement like this, do they not-- BOSOMWORTH: Right. SMOOT: --where they have--Humana has come in and actually, uh, uh, administers their hospital, is that correct? BOSOMWORTH: Right. SMOOT: Is that something that you see in the future of the university hospital here? BOSOMWORTH: No. Actually I'm--I've--I--I had the misfortune of missing the last meeting. I would have been violently opposed to that position. Uh, the--as a matter of fact, I wrote the directors-- (laughs)--saying that I was appalled that they had taken that position, and then I--I've been called upon now to explain that to some of my colleagues around the country. Uh, I think in some selected situations there is a basis for the sale of a University hospital, but when you get behind it, what you normally find is some kind of catastrophe that forced it, uh, not--not a deliberate prospective selection of a variety of options that would be available to an institution. In the case of Louisville, it was a response to Governor [John Y.] Brown saying, I'm going to sell the hospital, and so they decided that if that was, uh, fait accompli, rather than let that happen, they would make, uh, an arrangement with Humana to manage the hospital. They actually had been negotiating with Norton Children's [Hospital], uh, uh, and for that relationship prior to Humana. Uh, I don't think we're going to see the sale of a lot of hospitals. Uh, I--I think it would be a mistake, uh, because, uh, the corporate objective, particularly of the for-profit corporations is not health care or research--or education or research- -it is health care and it is health care with a black bottom line. So that--they--I'm not--they're not incompatible and they may work in selected situations, but--just two years ago the, uh, for-profits were talking about acquiring fifteen to twenty university hospitals. Now they're not talking about it at all. And, uh, there are really only two principal teaching hospitals that have been acquired so far, one is Creighton and the other is Humana. Uh, a third is being managed out in California. Tulane, uh, in, uh, Louisiana, had that relationship, but stopped it two years ago. Uh, so I don't see that--any real momentum in that. There is some momentum in the separation of university hospitals into separate either for-profit or not-for-profit entities, but essentially still controlled by the university. The--if you look at the board structure in these situations, uh, uh, West Virginia, um, Florida, um, Mississippi, North Carolina, uh, Oklahoma, they have set up independent corporations and they've largely done it primarily because of restricted policies within the state. Uh, Florida started because of personnel policies, it--very interesting story about why Florida did it, it w--I mean, one of the key elements, they--they were trying to get a--their dietitians--dietary aides--new uniforms, so that they would look better in the hospital environment--they were trying to cater to improving their financial complexion of their patient population--and, uh, that decision had to go all the way to the governor's office. And that's how Florida works, there's a five-man commission that makes a decision on all of higher education and all the health care facilities that are state owned and operated. And--although there was more to it than that obviously, uh, the--the bureaucracy was such that--that the University of Florida teaching hospital couldn't operate. They were having trouble figuring out how to finance their hospital renewal, and so they--they spun off this corporation, with the support of the state government and the legislature. Although if you look at it carefully, um, the president of this freestanding corporation is the president of the University of Florida and the board are interlocking with the University of Florida. It--it's--it's technically and legally a--a freestanding corporation, but for all intents and purposes, it's an affiliated corporation of the University of Florida and that's the case with many of the others. So, uh, Arizona is in the same model. I--I do not anticipate that we will do that, at least not in the foreseeable future. Our next step here, uh--we're moving towards the creation of an affiliated corporation, uh, like the athlete's association, or, uh, I guess that would be the closest, uh, analogy--so that's it's a part of the University of Kentucky. But it's standing out there by itself, and it's financially independent. Uh, and that has a certain attractiveness to the board of trustees and too, I'm sure, the central administration of the university. 'Cause if it's out there on its own bottom, it isn't putting the history department or the English department at risk if--if somehow the hospital goes belly-up and needs five million dollars to make its operating budget. So that's been one of the factors of getting some separation. The other has been an enhancement to the operating flexibility. You know, can a--can a university easily decide to make an investment in an HMO and use two million dollars of its money in a joint venture to develop an HMO. Well, we're right in the midst of testing that issue right now here. But, uh, uh, so there are operating considerations that may lead to some related corporate status, but I seriously doubt that it will lead--in very few instances- -to independent, for-profit owned by the chains. Now, I think we will have relationships with those kinds of corporations and HMOs and in PPOs. Uh, and affiliated hospital relationships we will have. We have one with Charter [Ridge], the psychiatric chain, which is very, uh, productive for us and works very well and--but it's a very small piece of the program. We don't--and if Charter went out of business we could still survive or if somebody else bought it and they didn't want us any more we could still survive. SMOOT: Uh-hm. I noted that one of the original points made in the development of the philosophy for the Medical Center, was the care provided to indigents. And this is a problem that, uh, hospitals across the nation have had to deal with. I know you've had to deal with it in ways-- BOSOMWORTH: Right. SMOOT: --that, uh, have brought some particularly bad press at some points. I wonder if you might tell me a little bit about that original statement, and how indigents have been treated at the University of Kentucky hospital and what you've had to do to change those, uh, uh, policies and et cetera--a little bit about that. BOSOMWORTH: Actually, there's a difference between the public perception and the, uh, legislative documentation of the mission of the institution. Uh, I think it's correct to say that Governor Chandler and others, uh, made a case for this institution based upon the quality of health care in rural Kentucky and the need to have trained health practitioners in the state. And as a part of that, uh, that the institution could and would provide care to people whose financial resources limited their access to care. But if you look at the, uh, language that created this institution, there is recognition of a role for the provision of indigent care, but it was very carefully constructed to avoid, uh, putting this institution as the primary provider of indigent care for the state of Kentucky. They deliberately avoided, uh, making that representation. Now, a lot of people wanted us to be that and a lot of hospitals and doctors wanted us to be that because it relieved them of a burden. Uh, and in fact we--when--when I first came, they--the--the, uh, state appropriation to the hospital was 84 percent of the hospital's operating budget and now it's 7 percent of the hospital's operating budget. It's essentially the same, I think it was about four million dollars at, uh, when we opened, and it's gone from four million to seven and a half million in twenty-five years. So, uh, the state's commitment to the support of the hospital in behalf of the patient-care program. If they'd intended to so do something about financing indigent care at the University hospital, we wouldn't have seen the pattern that we have. Now, there's st--there's been an expectation that we do it and--and we got on a collision course on--with the money, uh, back about 1980. It really was a turning point for the institution. Uh, we got down to less than a hundred and fifty thousand dollars of fund balance that was available to acquire equipment and--we could hardly buy light bulbs because we were shifting all of the revenue that we were deriving in excess of--that we were getting from paying patients--over to cover the burden of the indigent care population that was not being reimbursed to us. And so, I was a central part of that, I knew exactly what I was doing, uh, that--that, we had to make a decision, that we had to change the policy and get this to be--not a UK problem--but a pubic problem. And so we--we instituted--with some agony--uh, through the council of supervisors a policy that caused us to set a goal to limit the number of patients who could not pay for care. And that forced the problem out into the public arena and it--it did create a negative, uh, reaction in the press and on the part of our--some of our colleagues here in the community who began finding themselves having to take care of these patients. And we began to say to referring hospitals and to practitioners in the--throughout the state that traditionally had sent us patients that, uh, we would accept your patient if you were prepared to declare that either you personally or members of your medical staff at your hospital or your hospital were not competent to care for the patient. And that was a fairly tough line, but it--it had the desired effect of getting the attention of a lot of people. But we were also getting enough of a backlash that I realized that if we just stopped there, uh, that we couldn't tolerate--(laughs)--the--the difficulties that would be created. And so that led us to create the--this commission--which we were authorized to do under our original charter- -you can go back and look at--one of our assigned responsibilities was to, uh, examine on behalf of the state, public policy issues. And so that was created and we were very fortunate that Brereton Jones, when he became a member of the Council of Supervisors, started questioning this policy. And so I turned to him and said, well, can you help us? And so he said he would assume the chairmanship of, uh--of that committee, which subsequently became known as the Health Care Access Committee. And that led to the governor's commission in Frankfort that looked at the whole issue or health care access. I served as a member of that; there were forty--thirty-eight people. Uh, Dr.--Mr. Jones chaired that committee and many of their recommendations were adopted. We've still got a long way to go in financing indigent care in Kentucky, but, uh, that step proved fortuitous in terms of broadening the understanding to say it wasn't just a UK problem, it really was a state of Kentucky problem, which was our objective from the beginning. And as a result, uh, we've had, uh, considerable success in improving the financial position of the hospital. We're still taking care of a lot of indigent patients, 30 percent of our patients are on Medicaid, about 5 percent of our patients are totally uncompensated. [End of interview.] Dr. Peter Bosomworth, the chairman of the Department of Anesthesiology at the University of Kentucky, discusses his initial interest in the structure of the Medical Center. Bosomworth outlines the different new development in curriculum over the years at UK and the unique advances in some programs. He also discusses his personal career, profiles incoming students at the medical school, and the development of the university hospital. insert here