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1986-08-06 Interview with Peter P. Bosomworth, August 6, 1986 1986OH199 UKMC 56 01:28:07 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Bosomworth, Peter P., 1930- -- Interviews University of Kentucky. Medical Center -- History Area Health Education Centers Program University of Kentucky. Professional Education Preparation Program Peter P. Bosomworth; interviewee Richard C. Smoot; interviewer 1986OH199_UKMC56_Bosomworth 1:|12(12)|24(8)|35(4)|48(3)|60(4)|73(4)|85(10)|97(5)|109(9)|122(10)|139(4)|151(10)|163(10)|176(3)|187(3)|198(9)|212(12)|228(2)|241(6)|257(2)|276(4)|288(6)|303(9)|316(5)|327(6)|343(6)|357(2)|368(11)|380(7)|393(1)|409(2)|421(5)|430(9)|440(12)|457(7)|468(6)|482(7)|494(1)|505(1)|521(2)|537(4)|549(13)|563(6)|580(12)|595(5)|606(11)|615(6)|625(10)|638(7)|649(11)|663(2)|676(5)|685(13)|696(6)|707(10)|718(14)|733(5)|744(10)|755(6)|765(10)|780(9)|809(6)|829(9)|842(8)|854(3)|868(9)|881(2)|892(5)|902(9)|916(5)|928(12)|941(10)|958(8)|971(5)|990(2)|1001(12)|1012(6)|1025(12)|1038(12)|1050(8)|1062(5)|1075(10)|1088(8)|1102(2)|1113(3)|1126(4)|1138(5) audiotrans UKMCoh interview SMOOT: Dr. Bosomworth, the last time we were talking about the Medical Center, we had discussed the various, uh, colleges within the institution, we had talked about the hospital and indigent care. Uh, I recall indigent care as being our last question from the previous interview. I wonder now if we might turn to a discussion of the University of Kentucky Medical Center as a functioning institution in the broad sense of the term. How has the University of Kentucky Medical Center impacted on the state, impacted upon medical education, uh, medical practice generally, health care, uh, throughout the state of Kentucky and elsewhere? BOSOMWORTH: The best way to examine that question is to look back at the mission, uh, which has been fairly constant in the terms of its description since the be--beginning of the Medical Center and that focuses us then directly on our education, our research, and our service responsibilities. And so I'd like to look at it in a broad sense from those perspectives. Uh, the--the educational impact I think has been very substantial. Uh, as I previously indicated, we're--we're currently--have enrolled about two thousand students, uh, of all sorts, who--who function, uh, in a learning capacity here, but hopefully go on to, uh, practice their--their area of expertise in--in the commonwealth of Kentucky. And to that regard we've had, uh, outstanding success and modest success in terms of retention of students in--in the state of Kentucky. We've had outstanding success and retention in, uh, pharmacy, in allied health, uh, to a somewhat lesser extent in dentistry, but still significant. We are right at or slightly below the national average for retention, of uh, physicians in comparison to, uh, physicians who are trained in other states. A recent study from the Southern Regional Education Board showed us to be pretty much in the middle of that group. The strategies that we've attempted to initiate that have been focused on retention have included the development of the Area Health Education System, which is a decentralized educational program intended to provide clinical opportunities for students away from the campus, but also intended to influence students to look at areas of need--and hopefully to target those areas for prof--future professional practice. Uh, another strategy has been the professional- -or the PEP program--which is the Professional Educational Program, uh, intended to identify early--before admission--students, who would be good candidates for the health professions, who we might attract and retain in Kentucky. And we're not far enough along to get the full impact of that on medicine and dentistry, but it appears to be a--a very desirable program because it's bringing students who are disadvantaged or minority students into the institution. That program is complimented by the HCOP program--the Health Career Opportunity Program--uh, that uh, is directly focused on minorities and to a lesser degree on disadvantaged students. Without those two programs, I believe that, uh, we would not be doing as well as we are. I know we wouldn't in allied health and pharmacy, uh, and--and to a degree in the nursing program. Um, the difficulty in the medical program has been one of--of, uh, retaining students in Kentucky for their residency-training program. Uh, there's a very high correlation betwe- -in--in terms of retention of the student, if the student is enrolled in medical school, stays in Kentucky for the residency training program. About 80 percent of those students remain in the state of Kentucky for their professional practice. And so when a student leaves the state and takes residency training elsewhere--and a lot of ours go into the southeast, particularly North and South Carolina, to a degree Florida, lesser degree Georgia. Uh, a lot of those students remain in those locations and practice there because they identify practice locations. They--they--they get to know practitioners who are their mentors and the--we have a hard time getting those students back to Kentucky. However, the other side of that coin is that we get an influx of--of physicians into Kentucky who--particularly physicians who train with us at the postgraduate level here, who are--have had their undergraduate medical education in another state. So I think on balance, uh, we are serving our mission, uh, even though we'd like to retain more Kentucky residents. And we hopefully have some strategies in place that will help us to do that. But I think on balance, uh, we are a positive--a very positive im--impact--in terms of the health professional manpower needs of the state of Kentucky, and we have successfully, uh, met that portion of our mission. The service aspect of our mission, of course, extends to patient care and--and goes, uh, to a, uh, very broad spectrum of services. We have a highly specialized faculty here who are capable of offering many services not available in other locations in the state or even in this region of the country. So we attract a lot of patients. Indeed every year we get patients from every county in Kentucky, although our patients are primarily concentrated in central, southeast, east, uh, sections of the state--the natural refer- -referral pattern for this area of the state. We are admitting, uh, uh, seventeen to eighteen thousand patients a year and the inpatient side, uh, in the aggregate--including our emergency room patients--we're seeing almost two hundred thousand outpatients. We had a transient dip in the number of outpatient visits, but that's climbed back up again. And so our patient population at the present time is very stable. Uh, our occupancy in the hospital is high compared to other hospitals in the region and indeed in the state. We're substantially above the state average in occupancy. And so we have a very solid base of patient care, which renders a great service to Kentucky, but it also is the fundamental aspect of our clinical education program. I think that the quality of our patient-care program is good and in some areas it--it's outstanding. The concern we have in the patient care is the environment that we're in--the changing environment--that relates to the development of new healthcare delivery systems and a competitive environment that we find ourselves in. So far we've been competing fairly well, but we realize that we have to have a larger role in these competing systems and in the developing HMOs and the preferred provider organizations--(coughs)--in order to, uh, maintain a patient population and possibly to further develop it. So we are actively engaged in pursuing our options in those areas. In the research area, we've had, uh, reasonably good success in certain sectors of the Medical Center, but not uniform in every college. We are comparable in every college to many other, uh, medical centers in the country, but, uh, we have not had a high volume of research dollars in nursing or allied health and to a degree, uh, less than we would like to have in dentistry. We've done extremely well with our research program development, particularly the basic aspects of the research program development in both medicine and dentistry, particularly in recent years and I think that has-- is--is achieving national recognition. And the quality of our faculty are such that they are successful in competing for funds under a peer- review system. Uh, we are increasingly competitive in the industrial arena for funds and grants and contracts that are of mutual interest to us in a research perspective but have potential for uh, development in--in private enterprise. Uh, so our opportunities have been good in expanding. Uh, in terms of creative productivity of our faculty, uh, in the--not in the basic research, but in the academic area--where-- some very innovative things have been done in the Medical Center, uh, we've stood up well in that--with unusual aspects of our curriculum development, uh, uh, very innovative educational programs, some of which have attracted national attention and substantial extramural funding, uh, which has brought distinction to the institution. So once again, on balance I think in looking overall, I think we've done well in terms of meeting the public expectations that Kentucky had when it created this Medical Center, uh, in dealing with the manpower aspects particularly, with the service aspects, uh, and increasingly in terms of our research productivity. I don't know that--that Kentucky government generally had high expectations in the beginning for a--a--a strong, broadly based research program. And we've had to do a lot of that, uh, sort of on our own steam, through extramural funding and support rather than mainstream, uh, funding from the state of Kentucky, but that's not different from lots of other state institutions. SMOOT: Let me ask you this follow-up question on what we've just discussed. You're familiar with Lewis and Sheps', The Sick Citadel? BOSOMOWORTH: Yes. SMOOT: Okay. They were talking, among many other things, uh, about the emphases that certain institutions give to these three aspects, this includes uh, educational research and patient-care aspects of each Medical Center as--as a group. Could you rate or, uh, place in some sort of order for me, the, uh, emphasis given to each one? Is educational, uh, consideration--are educational considerations given the priority or research considerations given the priority or patient care? Uh-- BOSOMWORTH: That's varied from college to college, it's not--uh, I guess I could give a average impression of the overall Medical Center, but I--but it would be more appropriate, uh, to probably look at it on a college-by-college basis. Uh, I would say that, uh, uh, education and leadership in education was, uh, and has been for many years a--a prominent goal in the College of Dentistry and one that--that in fact has been achieved and their curriculum has been copied by a number of other institutions around the country. Um, education has been a, uh, prominent--has played a very prominent part of the overall time and effort of the faculty in both allied health and nursing. Uh, allied health probably with more national distinction, uh, in terms of--of some innovations, the extramural program, the Kentucky January Project and things of that sort that achieved, uh, national distinction. In addition to that, our--our--our allied health program was one of the first academic Medical Center based allied health colleges in the country, so it--it got in on the ground floor. The leadership in that college quickly established national reputation and they--they continue to have that. And they--they've played a very prominent role in the preparation of teachers, uh, in allied health, and that's brought them distinction in that area. Allied health is now working to strengthen its research mission and beginning to change its faculty. It essentially had up until the last four years--three years-- technical-based faculty. It's now--over 45 percent of its faculty are doctorally trained, many with postdoctoral experience and so we're going to see a different balance in our College of Allied Health, which I think is appropriate in an academic Medical Center. The, uh, College of Pharmacy, uh, when it became part of the Medical Center, was essentially an undergraduate, purely education program, with a small faculty and a good reputation in Kentucky, but without national distinction. That has changed dramatically in the intervening period of approximately twenty years, with the addition of a number of very distinguished research faculty and the--and the major development--in fact the leadership role--in the development of what's now become known as clinical pharmacy in the United States. So pharmacy has had a heavy involvement in--in providing leadership in the development of a new phase of clinical practice in pharmacy, and it's had a very prominent national role with its research program. So the--so the educational thrust and a--and a basic redirection of, uh, pharmacy practice, uh, were very central and continue to be very central in the College of Phar--of Pharmacy. So I would--I would give them high marks on both of those, uh, counts. The College of Medicine has, uh, had a--a--some individual, very innovative programs and we've talked about some of those previously and I won't go back into them, but and--and has achieved, uh, distinction as a result of that educational effort. Uh, it--it has come along quite well with its research program and once we made a decision to begin to specialize and concentrate our efforts in selected areas which--and these selected areas have extended beyond, uh, research, but that are fundamentally based in research, uh, such as our aging and cancer and other programs, which we've already talked about. Those are beginning to attract, uh, uh, national attention and just bring distinction to the institution, which over a fairly long period of time, uh, may well significantly elevate, uh, the national image of the institution generally and of the College of Medicine specifically. And that's one of our goals, in addition to obviously making contributions, uh, to patient care and research and new knowledge. Um, what have I forgotten? Have I forgotten an academic unit? I don't think I have. SMOOT: I don't think you have. BOSOMWORTH: So, uh, if you were looking at our overall stature in higher education in the academic medical centers of this country, you--you could go to almost any campus, any--any nationally based research university with a Medical Center campus and talk to the leadership of those institutions and they would know something about the University of Kentucky Medical Center. If you--if you went to national leadership and tried to evaluate overall where we stood, uh, we would probably range probably collectively in the middle third of--of the, uh, national academic health science centers, but with some elements of our program up at the very top, in the top 10 percent. So that's how I would evaluate that. SMOOT: Um-hm. Is it one of your goals to bring Kentucky into that top third? Is that a--is that a realistic goal, uh, if so? BOSOMWORTH: I think it's possible, uh, in--but it would take a major additional infusion of resources and it's a matter of, uh, a combination of institutional priorities and statewide priorities. Uh, we haven't yet reached the level of funding here in the state of Kentucky for the Medical Center where we're--we're still at about 92 percent of the average, and so we're--you know, we're not even at the average. I think if we could get to the average we could--we could excel in terms of our competitive position at the national level, uh, not necessarily up in the top 5 percent in every unit, but--but we could do a lot better than we're doing now if we had additional resources in the way of a physical plant. We have--still have limitations in our research facilities in terms of availability of physical plant to carry out those opportunities that would present to us if we had the space. And we have our limitations in the number of personnel. We have a relatively small faculty. Our--our medical school faculty for instance, in compare--in size in comparison to Harvard is--uh, is one-tenth the size of the Harvard faculty. So you--you--you know, there's a matter of--of--of both quality and sheer numbers of people who are out there doing work and doing distinguished things which add a mass that--that uh, you can't achieve when you're a middle-sized, uh, kind of institution. So we have to look at our comparisons of--of benchmark institutions that are in our immediate area or--or are comparable and I think we're doing quite well in comparison to those kinds of institutions. SMOOT: For example, the University of North Carolina at Chapel Hill or the University of Florida or Duke University, perhaps--uh, Tennessee, Ohio State-- BOSOMWORTH: Ohio State, West Virginia, Arkansas, uh, In--Indiana, Illinois, those are the, uh, benchmark institutions that we look at. And we s--we fall, uh, somewhere in the middle. Uh, I wouldn't put us in the lower half, but I--I'd put us in--very competitive in that group. There are some distinguished institutions in the southeast obviously. And, uh, in terms of, uh, financial support and probably, uh, national distinction--uh, of the public institutions--uh, uh, North Carolina probably stands out as being well funded, uh, and uh, uh, very competitive in many different fronts at the national level. SMOOT: Um-hm. And this brings to mind that about the same time this institution was being developed, uh, the University of Florida was developing its Medical Center-- BOSOMWORTH: Right. SMOOT: --as well as West Virginia University. Uh, have they been comparable you--you would say then or have they? BOSOMWORTH: I would say that the University of Kentucky, and the University of Florida are very comparable. They've had a little better support for facilities development than we've been able to garner here in Kentucky, but we're catching up with them. Uh, they made a big spurt four years ago on their hospital facilities. And we're just catching up with that right now. Um, West Virginia has--has struggled in its financing. Um, West Virginia is trying to support four medical schools, and, uh--we think we've got too many here maybe in Kentucky with two--but, uh, they've got essentially four medical schools that are operating in West Virginia and that's been quite a burden for them to--to carry. Uh, Mississippi has been struggling with the financing of its Medical Center. Arkansas has had, uh, a--has had financial problems, but they've had some, interesting uh, programs that have attracted national attention. And so it--it's a combination of adequate resources--but good leadership and high-quality faculty. And uh can't lay either success or failure totally on the numbers game of either not enough money or not enough people, uh, but both of those things--absent both of those things, you have a big hill to climb. SMOOT: You may recall from, uh, The Sick Citadel, which I cited earlier, um, one of the problems that they were pointing to was the fact that not enough time is being given to the actual teaching of physicians who are going to go out and practice. Uh, I was wondering if you might--having that in mind--tell me a little bit about the success rate of Medical Center graduates, starting with the College of Medicine in particular, since that was what they address more specifically in the book, but carrying it over to all of the other colleges--the success rate of the graduates of this institution. BOSOMWORTH: It depends what criteria I guess you want to apply to success. Uh, we have an extraordinarily high percentage of our graduates who are employed, uh, and those that aren't employed have chosen not to be employed, for the most part. Very few of our graduates are leaving the field and doing something else totally different. Um, we--we have, uh, in--in medicine, uh, where all of our graduates go on to some kind of postgraduate training, we do have a formal feedback system. And our graduates are very, uh, competitive in getting outstanding residency programs, both here and nationwide. And we get very good feedback that they are--they are very well- trained clinically, that they are very competent at that stage of their career in comparison to graduates of other schools. So that's one indicator, I guess, of our--of our success. We don't--we don't really have information on--on the financial success of our graduates or, uh, some other indicators that you might apply. Uh, we have--a, uh, a number of our graduates are going into, uh, academic practice, which some people would say was good and some people would say, you're depriving, you know, some of your best, uh, people from entering or for--encouraging them not to enter pr--private practice of medicine. But, uh, our College of Pharmacy probably has--has more--I think there are 145 graduates of our College of Pharmacy who are faculty members in colleges of pharmacy in the United States now--in the clinical area particularly. And, uh, so that would in--from my perspective would be a measure of success although there's 145 people that are mostly not practicing in the state of Kentucky. Um, I think we're at about the national average for, uh, uh, graduates from the medical, uh, school going into, uh, academic practice, but we've got some very distinguished, uh, people, considering the young age of our graduates. I just read the other day that, uh, one of our graduates is now the chairman of the Department of Anesthesiology at Yale--and he was one of my former students--which makes me very proud of that. And, uh, uh, so I think we've had our--made our contribution to the academic side of health care in--in many different uh, disciplines, not just medicine or pharmacy, but, uh, we--we've had, uh, people go on to distinguish themselves in that area. SMOOT: Well, isn't that one of the--isn't that really one of the, uh, goals that you would have to set for yourself, is to replenish the supply of educators? BOSOMWORTH: Well, we would hope that people generally would understand that. I-- educators understand it--(Smoot laughs)--and, uh, whether people who are taxpayers understand that, uh, most people do not appreciate the value of making an investment in research and development as a necessary portion of the hea--expenditure in health care in order to preserve the quality and enhance the quality of American health care. And we're seeing that demonstrated almost daily with these people wanting to squeeze out educational costs out of the reimbursement for health care services, but, uh, it's critical to the maintenance of a quality health care delivery system in this country. SMOOT: What do you think has been the impact of the Medical Center and its various personnel and those people who have been educated here? What has been their impact on medical practice, standards and competition within Kentucky? BOSOMWORTH: From the--at least the information that is available to me, I--I would say that, uh, they, uh, have distinguished themselves in terms of the quality of medical care that they're rendering here in Kentucky. Many of them have gone into underserved areas, uh, many of them have--have brought the latest technology in--into the field and they're pretty conscientious about maintaining their own continuing professional education. We--we see a lot of them coming back here for specific continuing education activities, and we go out into the field to provide them that kind of service. We average nine thousand people a year here at the Medical Center in continuing education. So it's a sizable enterprise for us, and I think that all contributes to quality assurance. The--there's a lot more that can and will be done, uh, with quality assurance. I think we're just beginning to scratch the surface. Uh, in another five years, I--I believe that you'll be able- -the average person in the--in the public, uh, sector who wants to try to figure out where is the best place to get medical care of a certain source, will have data available, uh, that can be readily referenced about mortality, morbidity, um, uh, frequency of liability, uh, uh, misadventures that take place. All of the things which are known inside medical institutions but are not generally known in the public sector, and I think, uh, we'll see some systems involved that will begin to deal with that. I think, uh, we'll see, uh, the evolution of a system of protocols--linked to computers--that will, uh, guide, uh, the basic elements of medical practice and--and if--if a health professional chooses to deviate from that protocol, uh, they'll have to justify it. And we only have that in very limited ways right now, such as in cancer care and more related to research activities, but I think something of that sort is going to come in quality assurance. We've really just scratched the surface on--in that regard. I think we've got, uh, good quality, but there's a wide variation. And there's a certain proportion of pract--practitioners who do not practice with good quality, usually for reasons that are extraneous to their original competence, usually related to, uh, drugs and alc--abuse of drugs and alcohol and--or psychiatric problems. And once again, we're--we're I think probably prodded by external forces. The health professions are gradually beginning to address that and to pay attention to the fact that a profession really has a responsibility to police its own profession. And if it doesn't, uh, somebody else is going to do it for 'em and, uh, so that's, uh--we're not there yet, but we're making progress with that and--and I--I think, uh, uh, the public--the end result will be, uh, in the public interest. SMOOT: Um-hm. Let me follow up on that. I don't mean to get too--get carried with this, but, uh, this is a big issue that faces the people in the United States. You know we're worried about equity and in health care, we're worried about major problems in insurance--liability insurance, malpractice and et cetera-- BOSOMWORTH: Right. SMOOT: --um, and part of that is the profession's, uh, desire to police itself. With the public's perception--and I think rightly so in many ways, I'm expressing my own opinion here--uh, that the profession has not done a very good job of policing itself. Uh, do you foresee a major, new, uh, resurgence of government intervention in health care from--from this new angle rather than say, from the earlier intervention when it was funding everything, uh, where that has slowed down, now with this--this regulatory, uh--this sort of regulatory, um, process coming into play. Do you think this is something that's going to take place in the future? BOSOMWORTH: Well, I think one of the--one--there're not many good things about medical liability crisis problems, but one of the good things about it is--(laughs)--that it's forcing the medical profession and the health professions generally, uh, to deal with uh, the quality of care. Uh, as much as we would like to lay the blame of the crisis on all kinds of other people, the--the core of the medical liability crisis is malpractice. Uh, now, it gets com--complicated by, uh, things that happen in which the outcome is not good, but in which there is no malpractice. And--and that is complicating this. And that needs to get properly extracted, uh, so that when there is a misadventure which is not based on negligence, but for which there was no reasonable method of preventing a bad outcome, those kinds of things should not be part of the general perspective, uh, that either the public or the courts have with regard to competence. Um, and--but that still leaves us with a s--hard core of--of actions or failure to act, uh, that, uh, results in an adverse effect to the patient. And as we improve our risk management, because there's a very great incentive now to do that because of the economic consequences to institutions and to individual practitioners, that probably will be a more powerful influence on reducing, uh, the reducible adverse, uh, effects, uh, on patient--of health care--services that are rendered to them by practitioners--than any, uh, government intervention is likely to ever do. Uh, the government interventions that have been in place to date, thr--in terms of quality control, have been focused primarily on their economic interest, uh, and haven't really gotten narrowed down to quality. Um, that's why I think if you, uh, could develop a protocol system that required people to justify their deviation from the standard of care, and you had, uh, good quality control, uh, in place and you had good risk management, which means careful education and--and elimination of practitioners from opportunities to practice--controlling their scope of their practice if they can't, uh, function in the full areas that they're supposed to, getting them into therapy if they need it, for your psychiatric, drug abuse or alcohol problems--are all fundamental aspects that, uh, I hope the profession can continue to expand its responsibility in conjunction with other components of the health care delivery system. And that would be my preference in terms of how this problem should be tackled. SMOOT: It's my understanding that there's actually no nationally coordinated effort in terms of dealing with this problem. It's really regulated by the states, is it not? BOSOMWORTH: Uh, well, licensure is regulated by the states. Um, uh, they'll--reimbursement mechanisms can certainly be brought to bear and linked to quality control, uh, which could have, whi--which through the national Medicare, Medicaid and other government insurance programs--VA, all of those things could be, uh, used as, uh, leverage points on quality control. But, uh, uh, the--the fundamental--the core of quality control at the present time rests in hospitals, in county medical societies, in state medical associations, and the licensure board. And the licensure board is really dependent either on patients providing information or, uh, health professionals providing information or nurses about nurses or physicians about physicians or what have you. And there are weak links in that system. Uh, but it's getting better and, uh, here in Kentucky now we have a very effective, um, uh, substance abuse and, uh, effort, uh, in both nursing and in, uh, uh, medicine. And the Medical Center happens to be actively involved in supporting both of those programs, in fact they started the one in nursing. SMOOT: I've already touched, uh, on one of the major problems I'm sure you have to deal with in--as a medical educator and administrator in terms of malpractice. What are the problems--major problems--uh, on a national level or, uh, on a state and local level have you had to deal with? We've also touched on indigent care, so I wouldn't really--I don't think that we need to go into that again, unless you feel that you need to add something to what we have previously discussed. But what other major problems have you had to deal with as a medical educator and administrator, uh, in--in Kentucky at the university? BOSOMWORTH: You're talking generically about problems? SMOOT: Yes sir. BOSOMWORTH: Um, I have to sort of give my philosophy about problems. I--I look at problems as opportunities, and I look at--uh, at, uh, uh, the old saying I guess, about a cup of water that's half empty. I always view it as half full. And so problems represent a--an opportunity, uh, to, uh, gain uh, public attention and institutional attention if they deserve a broad institutional response. It--it's- -it's very rare that you can manage change in an organization, without the presence of some tension in the organization. And I uh, must admit that I've been a party to going outside the institution and working with public officials to sometimes generate the tension through public policy, in order to come back and get the changes managed with inside the institution. Uh, but the--(coughs)--the--the problems basically, uh, that have turned into opportunities for us have been the problems of maldistribution, uh, of health professionals here in the state of Kentucky. And it's a severe problem, but probably the most stimulating problem that led to creation of this institution. Uh, the problem of adequate support, uh, for the hospital, uh, we went through a period of time when there was, um--it was not--we weren't certain whether we could keep the hospital open. Uh, we got down to a reserve of operating the hospital of less than a hundred thousand dollars, and we couldn't buy equipment. That was a--that was the problem that stimulated us to get into the indigent care issue and that ended up--as we've talked previously--with some fairly interesting and I think innovative things happening as a result of that. SMOOT: May I ask you a question about the relationship of the University Hospital in terms of the budget to the inst--to the university as an institution in the broad sense? Is the budget of the university hospital part of the university's overall operating budget? BOSOMWORTH: Yes, it is, uh, but it's now, uh, identified as a separate line item. Uh, it's not a line item in the sense that some states have total rigidity about movement of funds from one entity to another. But it is separately negotiated, it's separately identified in the formula, uh, for funding in higher education and, uh, we're moving in a direction that'll probably make it even more separate, if we change the corporate structure of the hospital into an affiliated corporation, which is what we're working on right at the moment. SMOOT: Would that be ad--wouldn't that be advantageous to the university as a whole, in terms of, uh, receiving funds from the state for the, uh, development of the rest of the institution? BOSOMWORTH: Well, it has a, uh, advantage to the rest of the institution in that it protects them from a liability in the event that we couldn't make our budget in the hospital. If we were an affiliated corporation it would be different than if we were where--where we are now. Uh, fortunately in--we only had one year--that was back in ninet--just before I was involved in my present responsibilities, but I was involved with the hospital at the time and that was 1967--when the hospital's expenditures exceeded its--all its--all sources of revenue and the university had to come to its rescue--about seven hundred thousand dollars which was quite a bit of money at that time. Uh, ever since then we have--we have always been on the right side of the ledger as far as the hospital is concerned, and the recent years we've been uh, very solidly based financially in the hospital. But anyway, that problem has been a--uh, uh, one that will continue for us and that's--that's the thing now that's stimulating us to look at these new delivery systems. Uh, the problems that relate to, uh, undergraduate uh, medical education, there's a whole new--we didn't--we talked about that earlier, but we didn't really get into it, of the changes that I think are going to take place in the nature of undergraduate medical education--the--the matter of introducing, uh, new technology, simulation, uh, teaching problem solving, which we haven't done very well collectively in this country, yet--yet--the--the physicians particularly--but nearly all health professionals are daily involved in problem solving and we don't teach those skills in the way that I think they can be taught. Uh, an--and so we're going to see changes in--in that area too. Those are just a few of the problems, the research problems, the--the major issue of uh, the aging population, uh, that's--the--the problem of nutrition in this country. Those have all been things that we've looked at when we tried to sort out our priorities for future program development because when you sit in this kind of a seat, you--you've got to look--uh, if you're going to develop ten centers of excellence, we won't hit on every one of them, but we will--we--if we're going to do that, it takes, uh, five to ten years of--of lead time and program development, facility development, resource development. And if you've missed the target and failed to pick the areas that are--are most likely to be significant over a very long period of time, you're going to run out of fi--financial support and the state will lose interest in it and the federal government will lose interest in it. And--and we have--we're highly dependent on those sources. So I--I--I think we have tried to look at regional problems, statewide problems and national issues as a basis for our prioritizing program development here. [Pause in Recording] SMOOT: Do you think that these Centers for Excellence have the potential to, as we discussed earlier, to bring Kentucky into that top third of medical centers within the United States over that ten year period that you spoke of? BOSOMWORTH: Uh, absolutely, yes, I do. Uh, I don't want to say which ones out of the ten at this point. I--I--I feel--I mean I can speculate about that to a degree, uh, because some are more developed than the other and some are getting national attention now. Uh, you know, our aging program certainly is up--I'd put it in the top five in the country. Uh, we're--we're consistently competitive, uh, in federal funding, uh, and--and all of the top institutions are in there ge--trying to get the same money and they're funding any--anywhere from five to seven centers and we are consistently, uh, in that group. Uh, we're increasingly competitive in cancer. We've got to develop a bigger base there. That will come as our facilities come along. I think we will be competitive in the pharmaceutical sciences area and that will continue to bring distinction in that area. A very big area for us that--that's going to take a lot of development is nutrition. That's a university wide program, uh, it should involve ag, it should involve the Medical Center, home ec, uh, possibly chemistry, some other elements of the university. And we're just--uh, we--we've had trouble building a cohesive team in that area. Uh, it's--it's--with a new dean in home ec and some other changes that have taken place, I can see where we're going to make progress now. And I--I feel that uh, just like aging, nutrition will be a long-term increasingly important uh, area, uh, for national support and national focus. We've just scratched the surface on that because it's so fundamental to the--to the preservation of health and, uh, I think the American public will begin in--as it already has, to increase its focus on--on behavioral modification, including nutrition. Another area that's--that's in its, uh, teenage level, I guess, here in Kentucky is the area of, uh, preventive medicine and occupational health, particularly occupational health. The--that's an area that most corporations, particularly the middle-sized corporations, the--the--with five hundred to five employees, have no idea about and have no concept about their liability with regard to employee health. And it's a very rapidly growing area of, uh, legal interest. And I think that's justifiable. I--there's an awful lot of things happening in the workplace that deserve attention with regard to their impact of the health of the employees working in those places. You can get a--probably shouldn't get into this here in Kentucky--but you can get a sense of that by going into a tobacco manufacturing plant. I had--did that not long ago and af--by the time I had walked through the plant, I--my heart rate was 130--and I was just walking at a leisurely pace, and it was due to the absorption of nicotine, uh, in the air and in the dust, uh, that was generated in that particular plant. The employees had developed a tolerance to it, but a person, like myself, who had never been exposed to it--and I don't smoke--walking through that area, and it just reminded me once again, uh, that, uh, there's an important health problem--(laughs)- -that exists there that needs attention. And, uh, we're heavily into it now with the mining industry, uh, here in Kentucky. They've become uh, quite prospective and very forthright about that with our--we've got mobile, uh, occupational health care services now at the mine head and that--we are just about to launch into a major joint venture with a private corporation uh, to bring occupational health services to Kentucky's middle--sized, uh, corporations, which I think will be a--a good service to the corporations and a good venture for us to be engaged in. So that's an area that I think, uh, will--will come along. I'm hopeful that we can do something in uh, oral biology, uh, and that's another goal that I think is important for us to address and we have some competence in it. A big area is the whole area of biotechnology. Again, it's an area that requires university wide coordination because there are--it's a multi-discipline--well, all of these things are multi-discipline area and--but this one is--uh, involves, uh, uh, the bioengineering, it involves uh, membrane science from the Lexington campus, it involves the mathematical and computational sciences, it involves ag and then the basic sciences here in the Medical Center, particularly in pharmacy and--and in medicine, with, uh, uh, biochemistry probably being at the core of all that. But it has terrific potential for the manufacturing of new products, uh, uh, through the use of genetic engineering and, uh, uh, that's where I think Kentucky could get into the high-tech business. I don't see us getting into another silicon valley here in Kentucky, but--but in this area we've got competence and we can build something. And I'm hopeful with the funding that's come in this last, uh, budget that we'll be able to put a program together that will make it--once again, it'll take several years, but we're prepared to devote the vacated pharmacy building to the development of a biotech center and, uh, that's a--a major goal for quite a few people here now on the campus. SMOOT: From what you have just told me, there's going to be a considerable amount of expansion here, so I would like to ask you a question that you hear so often, lately, and it's a cyclical problem apparently. Is there a surplus of health care professionals-- physicians usually is the group that is--is focused on--but is there a surplus? Do we have too many--[beeping sound]--uh, health care professionals--physicians in particular, but health care professionals generally--being produced in the United States right now? Um, I know that part of the problem is distribution, uh, but I've seen figures, uh, saying, somewhere between 1990 and the year 2000, we'll have anywhere from seventy thousand to a hundred-fifty thousand too many practitioners--physicians I believe that was the specific reference I saw there. Uh, how is the Medical Center here going to react to, uh, those types of, uh, problems? BOSOMWORTH: I used to be, uh, a strong advocate of governmentally controlled health manpower policy and the longer I've worked in it, the more convinced I've become that a public policy in controlling the numbers, uh, of people who enter a particular health profession, whether it's nursing or medicine or dentistry or what have you, is--uh, doesn't get the job done. The people who originally set the policy have--if you go back--and I've studied it--back to the 1963, when the Bing Commission, which--established by President Kennedy, he set a goal--that commission did, uh--for health manpower--[microphone interference]--in the uh, health professions that, uh, wo--if--if followed to the letter, would have led this country to go from about seven thousand entering students per year to eleven thousand five hundred. But something happened between that period and the full implementation of the policy, and the full implementation of the policy led to the stimulation of enrollment increases, instead of eleven thousand five hundred to seventeen thousand. And so we've had a--more than a ten year period of--of exceeding that goal by a very substantial amount. If the original policy had been adhered to, uh, we wouldn't be far off the mark, except what's changed in the interim is these changing delivery systems which the Kennedy administration didn't anticipate, but--at any rate, if you look at what does regulate, uh, the enrollment most effectively, it's student demand. And you can go back and look at the public policy applied to teacher education or education in engineering and what really finally gets the thing straightened out is the interest of students. And they are pretty quick to realize when the employment opportunities are diminishing and we've seen that in dentistry with a profound drop in the applicant pool. Now, it's beginning to come back a little bit, but we've gone from sixty-five hundred dentists en--entering--or--or dental students entering--I think seven--eight years ago, now down to about forty-six- -forty-seven hundred, so we've closed almost one-third of the dental entry spots--(laughs)--in this country in less than a ten-year period. Uh, and that's largely been related to uh, institutional initiative, not federal initiative or state initiative. And it's largely been related to the fact that the applicant pool wasn't there to sustain a class size that was previously authorized. We're beginning to see that in medicine. We haven't seen it to the same degree. And there's another piece of this equation that I think needs to be put into a perspective, and that is that there are not a lot of people in the public sector clamoring to reduce enrollments. It's--it's generally the pressure arises--when it arises--from the professionals themselves through, uh, what I would have to say is--is to a degree a vested self-interest and, um, in terms of preserving a certain level of income. When we went out with the dental school issue here a year ago, most of the public at-large could care less whether we overproduced dentists, particularly there were out there--were some people saying that, uh, that was the thing to do in order to drive down costs--and they may be right. Uh, competition is beginning to control costs, if not to diminish them. And so I--I am not sure that a federal policy on manpower, uh, has ever proven to be effective in achieving its original public objective. I--I cannot cite a single case where it brought it out at the right level. We either have overreacted or under reacted to what was required. So that's my general response to that. SMOOT: And you think it's going to be pretty much, uh, the same story then, uh-- BOSOMWORTH: Oh, I don't think the people who want to set manpower policy will go away, uh, but I'm not sure that they'll have the same impact. Now, if--if it gets outside of the professional arena, and people other than health professionals are the primary stimulus for setting manpower, then it probably will have some effect. But if, uh, the--if public agencies are reacting to the pleas of health professionals, uh, that can be countered, uh, by different kinds of public interest perspectives than those of the individual health professionals, well I--I don't think that manpower policy per se, is the--is going to be the basic strategy that controls the size of institutions. We got into this discussion just--this time talking about size, to a degree, and one--one of the things that--that will be a problem for us is to separate from--the number of students from the operating budget of the institution. Uh, we--higher education traditionally has been tied to someone wanting to take the total operating budget of a m--of a university or a medical center or a college and divide it by the number of students, rather than looking at what it expects of that college from a programmatic point of view. When we add uh, Centers of Excellence in aging or cancer or, uh, biotechnology, or some of these other areas that I've been mentioning, that's not going to generate massive amounts of students. It will generate some and mostly at the graduate levels. And those people will be needed, uh, as future, uh, developers of their particular fields and disciplines. S--so the program has to be understood independent of the student production and--and to a degree has got to be judged on the basis of its merits for serving a research purpose, a product of--producing new products or producing new services or--or--that are for the public good. And if we continue to get ourselves tied up in very simplistic ratio analysis, which is based on students and dollars, then we'll never get from here to there in s--terms of these programs and that's why I--I believe that universities, while--while depending upon formulas to give the decision makers a general sense of ballpark--of where the funding ought to be- -the decisions ought to ultimately be tied to what's reasonable, which is the formula approach, but what's uh, desirable and appropriate from a programmatic point of view. And universities have trouble trying to, uh, uh, keep both of those perspectives before the decision makers and I think it's critical that the programmatic elements--and we've had some interesting debates inside the university about that over the years. But I have personally maintained a long-time position that programmatic representation is important, uh, to securing expansion of public support. It's hard for a legislator to go back to his constituent and say, "I funded the formula." It's much easier to go back to his constituent and say, "I did something about neonatal care at the University of Kentucky Hospital." SMOOT: Well, these policy makers that are going to change things--this-- this is the General Assembly and the governor's office and-- BOSOMWORTH: And the Council on Higher Education and the--for us--the, uh, uh, Department of Human Resources-- SMOOT: Um-hm. BOSOMWORTH: --and all those people. SMOOT: How much of your time is spent dealing with--with these people, with these, uh, governmental, uh, agencies and institutions? BOSOMWORTH: It varies, uh, depending on where we are in the biennium, but I would say it's b--it fluctuates between 20 and 25 percent of my time is devoted to, uh, outside--what I call--outside constituencies. SMOOT: Um-hm. And this has been something that you have discussed-- this--this programmatic approach, uh, has been-- BOSOMWORTH: Right. SMOOT: --something that you have discussed at length no doubt with--with all these various, uh, groups. BOSOMWORTH: Yes, uh, most of the program support that we've gotten has come as a result of doing that. SMOOT: Yes. BOSOMWORTH: Uh, the pharmaceutical sciences was--I think--got attention because of that, uh, the cancer program got funding because of that, the PEP program got funding because of that, the Area Health Education System got funded because of that kind of an approach. Uh, most of the incremental things that have happened here--the president did a superb job in doing that generally this last time around with the, uh, area-- the Centers of Excellence that were put forward by the university-- SMOOT: Um-hm. BOSOMWORTH: --uh, that got uh, political and public attention. SMOOT: Um-hm. BOSOMWORTH: We haven't institutionally in prior years maybe done that as extensively as we have in the last couple of years and I think that, uh, we've all recognized that, uh, we need to do more. Just because we're the University of Kentucky doesn't necessarily mean that we're going to get the public support that we could justify and deserve without a significant commitment to this kind of--of communication on the outside of the institution. SMOOT: Um-hm. Do you feel that the institution--at least in terms of your own interaction with the legislature and, uh, uh, the people on the Council of Higher Education, et cetera, that the University of Kentucky has a--a good image and a good rapport with all of these various people--these institutions and governmental agencies, et cetera? BOSOMWORTH: There's a point in time if you'd carried on a survey, uh, they would've felt that they were--they were being recognized through opportunity to participate in various university activities, uh, particularly the public kind of events, uh, but that they were to a degree, uh, getting some skillful neglect. Uh, I think that that has changed very substantially in recent years and that, uh, we've been doing a better and better job at that and we've come to recognize the importance of regular and frequent communication with those people. And, uh, there's still a lot more to be done and the continuing fostering of that relationship, uh, is--and I think will be--an important part of the presidential selection process for a new president of the university. Uh, President Singletary has encouraged, uh, consideration of that element and I--I--a number of other people, including myself, in discussions with individuals connected with the search process have done that. So I think there's a--there's a much higher level of awareness on the part of the board of trustees, uh, the advocate group for higher education generally, and, uh, the university faculty and administration of the need to, uh, cultivate these kind of relationships. Uh, as a basis for continuing to get quality support for the institution. SMOOT: You've worked with Dr. Singletary for quite some time. Uh, tell me a little bit about that relationship, uh, professionally. How have you, uh, worked with him uh, as a--when he was vice president, then chancellor and he--his presidency? BOSOMWORTH: I--I feel that--uh, uh, I was in the beginning part of my administrative career--not in my present role, but as an associate dean and then linked to the hospital--when President Oswald was here. And during that period of time, uh, he--he re-consolidated all of the resources of the institution back into the office of the president. And that was a somewhat painful period for the Medical Center, I think probably for lots of areas of the university--although I wasn't enough involved to un--understand or have a feeling for all of that, it--it did some very good things and it made some very needed changes in the institution, particularly in terms of quality control on faculty, and some other things and programs that were--were needed. Uh, but it was a tough time for the institution and that was followed by all of the--the unrest on the campus. And so when President Singletary came, he came, uh, in a--in a very, uh, difficult period of time, where the prior administration had not fully anticipated all of the constraints- -we were in a sort of the golden era of resources in the late sixties- -and a lot of commitments had been made, uh, including commitments to the Medical Center. And commitments had been made, for instance, to build a new College of Pharmacy in the year before--(laughs)--President Singletary came. And, uh, so he arrived on the campus at the time of this turmoil and that was linked to a reduction of interest in supporting higher education, because the people couldn't understand all this commotion. Why were these things happening on campus? If they couldn't keep it under control, why should we support it? And uh, so he had to deal with all of that. I think he did a very excellent job of sort of calming the waters, uh, beginning to restore public trust in the institution. Uh, not that we ever seriously lost it, but I think higher education lost it generally. And, uh, having to start with, uh, a budgetary situation which was substantially different than it had been just the three or four short years previously. And that meant retrenchment. And we had a long period of time of--of difficult financial resource development in the institution. We--we'd go through a whole biennium without any real incremental support and then it might be another one we'd get something. And so we made--we made progress, but we never really caught up to where we should have been for a full-fledged research institution. And we're still not there, but we're closer now than we've been since I've been involved. So that's, you know, I--I think that that progress and the strategy for the development of that is directly attributable to the president of the university, and--and he--he is--is a man who is, uh, an excellent analyst of--of the issues and of the strategies and the alternatives. He is not--he's very careful about his commitments, I think partially- -(laughs)--based upon the experience that he had when he saw that he came here and there were sixty different commitments out and there was no money to--to make the commitments come into being in any short period of time. And so he--he's a person--from my perspective at least--who wants to operate, when he makes a commitment, at about the 95 percent confidence level that he's going to be able to deliver, which means that, uh, we don't get out there very often with high-risk ventures, uh, in which you're, going to lose 40 or 50 percent of what you're proposing to do and there are some people who criticize that. On the other hand, he's been able to deliver on what he's committed to, uh, in every instance at least that I have had any direction- -direct dealing--with him on--on that kind of thing. That's meant we've been conservative in what we've proposed and in what we've uh, achieved. And maybe if collectively we had been, uh, more risk taking and uh, less conservative in our approach uh, we might have gotten more, but we might have produced a disaster here. We've had a very conservative fiscal policy. We've had a conservative tenure policy. Uh, we haven't over-committed ourselves in terms of expanding faculty when we could have expanded them on soft money. Uh, and so we've never had a crisis of the--even though we've had to take budgetary cuts, because of the conservative fiscal policies that we've had here. But tha--the other side of that coin is you might have been able to have done something more with a--with a different approach to risk taking. But my--my personal philosophy is, uh, uh, aligned with his or I wouldn't have worked this long in the institution. And he's been very fair with us. He has, uh, dealt with our priorities. He's worked carefully with us. He's been extremely supportive of the programs that we've developed, and the priorities that we've developed, and he's been very--there was a point in time when he had Medical Center buildings at the top of the priority list for several years here, in terms of new facilities. And so we've had our turn at--at, uh, getting those kind of resources, uh, and the u--rest of the university had to sit and wait. We've had to do some of that, too, over the years, but, uh--so there's been a fairness and an evenness, uh, in how he's dealt with his senior administrators--at least certainly from my perspective. And I think my colleagues share that view too. So, uh, I've enjoyed working with him. I think, uh, he's made a, uh, long-term contribution to the institution. He has, uh, brought stability to the institution. We've had some good success with private fund raising--beyond our expectations. And he's played a very important role in that, uh, and, so I--those are my general appraisals, I guess. He's uh--he's--he's a man who is also, uh, nationally known. I--everywhere I go in higher education, uh, ev--everybody that I encounter at--at my own level or above in higher education knows Otis Singletary. SMOOT: So you would reject the rather pejorative statements that often are thrown about, such as, he's just been a caretaker and he's allowed the--(coughs)--flagship institution of the state, which is the catch phrase that's always thrown about-- BOSOMWORTH: Yes. SMOOT: --uh--the--to, uh, lose funds, to uh, not maintain itself in terms of its uh, competition within the state, uh, with other institutions of higher learning, uh, that uh, he has been a man that has been overly preoccupied with sports, uh--you would reject these types of, uh, things, would you not? BOSOMWORTH: Yes. I--I--I think, uh, the--the president's decision- making process is a rather private process. And so people think that-- uh, and because he's conservative and he doesn't get out--uh, uh, saying that he's going to do something until he's worked the territory--uh, uh, people have a view to say, well, he's not doing anything. That is not correct. I mean, every--almost every moment that I'm in contact with him--in a social situation or a formal institutional setting or a cabinet meeting or with the faculty--he's always working on his objectives. Uh, he just isn't necessarily, uh, very visible with those until he's--until he's got a level of confidence that he can achieve them. Uh, any person has, uh, you know, I--is--can be subject to certain criticisms about their priorities and--and, uh, so I suppose that the detractors that--that want to take that kind of an approach with the president, uh, are entitled to do it. But my--my overall assessment is that, uh, he's been good for the institution and that, uh, a lot of good things have happened here. SMOOT: Um-hm. Well, I recall--(coughs)--a lot of those people who had been naysayers in terms of his abilities as president were quietened, uh--(coughs)--with the campaign, I suppose I could call it-- BOSOMWORTH: Yes. SMOOT: --that he waged, uh, about a year ago when he felt that there was a definite, clear threat to the future of this institution-- BOSOMWORTH: Correct. SMOOT: --and went out and garnered support from alumni and friends of the institution statewide, uh, to insure the future of this institution would be positive. Uh, you participated somewhat in that, did you not? BOSOMWORTH: Yeah, I was extensively involved in that. I--I would say that, uh, it would have been desirable probably to have--have done something of that sort, um, either two or four years sooner. Whether it would have made any difference or not, I--I don't know, because wh- -two and four years sooner--we've discussed this extensively--uh, uh, we were just reaching the public awareness that education was important. And it was absolutely clear that you couldn't push higher education in front of primary and secondary education and that if we were going to get cohesive support for education, we had to get behind the primary and secondary education. And so if he would have gone out two or four years earlier, uh, we might have won that battle, but we might also have lost the war--(laughs)--And, uh, so I think the strategy was correct, um, but even so, we might have done some things that would have given us more visibility on the outside, at an earlier date than we did. I think that there was, uh--we had a lot of debate inside the administration about whether to do that at an earlier time. And, uh, the feeling was that, uh, they had good lines of communication that weren't very visible or public and that they were doing as much as they could. And you can only second-guess that by running an experiment that can't be run. Uh, so--uh, but there--there certainly was a lot of discussion about the timing of and the extent of how visible and public and how--what--whether we attempted to mobilize our supporters. And what we found out there, I guess, is what's surprising to some, but it wasn't to me, is that there's an army out there that just needed a little guidance about how to help us and, uh, that, uh, there's a lot more that can be done to capitalize on that. SMOOT: You've already touched on the relationships of the Medical Center and of yourself in particular to, uh, the state, to the president of this institution. I'd like to turn now to the other major state institution, the University of Louisville. And for years, even prior to the opening of the, uh, Medical Center at the University of Kentucky, there existed at least in, uh, popular perception a good deal of tension between the two institutions. I wonder if you could tell me about the relationship between the University of Kentucky's Medical Center, in particular, and the health care facilities and educational facilities at the University of Louisville. BOSOMWORTH: Well, of course I wasn't around at the--at the inception. And you've done some very in-depth interviews about those tensions in the creation of the medical school and I won't attempt to, uh, re-address that. Um, the environment, when I came here in 1962, wasn't--uh, there was no high level of awareness of tension between the two institutions. Louisville was a private institution--city financed, uh, admittedly in fairly de--dire financial circumstances, sort of holding the fort. And we were an institution, uh, building and developing. And so we didn't view ourselves as in competition. They were not dedicated to in-state student admissions, their marketplace was national. I remember I--as a student in Ohio--uh, many of years before that, applied to the University of Louisville. I chose not to go there, but--but, uh, it was a school that had some national recognition, primarily because it had been around a hundred years. And so there wasn't any real tension then. And--and I actually was involved in the beginning communications between the two institutions, when Dr. Willard involved me in a committee, uh, that was related to the Council on Higher Education in the late sixties and that was--that was merely a coordinating relationship because the Council had no, uh, oversight over the University of Louisville until it came into the state system. And it came in at a very desperate point in its career, for the Medical Center and for the university with the old general hospital, and the, uh, uh, uh, their--(coughs)--they'd consumed all of their endowment. They were about to go broke. And, uh, uh, that of course cr--started the creation of the tension because of the diversion of funds in new money that was necessary in order to salvage the University of Louisville and keep it afloat. And we--we went--the University of Kentucky went from about a 60 percent share of the state general fund appropriation over an eight- or ten-year period, down to about 41 percent. We're gradually coming back up now, but, uh, uh--and that, had a lot to do with, uh--with--instead of--they essentially brought two new colleges into the system and didn't--and didn't really expand the pie. They just sort of re-divided the pie and so that slowed the growth of the University of Kentucky. And that directly coincided with the financial problems that President Singletary had in the early part of his administration here. Uh, so that was the sort of background for the tension, uh, but it--but it--in terms of the relationship of the leadership in the health sciences between the two institutions, we always had, uh, good communication and we met regularly. Uh, by nine--shortly after Louisville came in, the Council on Higher Education created a health sciences advisory committee and had, uh, three Council members on it, two of whom subsequently became chairmen of the Council on Higher Education. So they had a very in-depth insight as to what was going on at the two institutions. And a lot of the early decisions were made--and they were pretty good decisions--made in that committee about resource allocation, joint program development between the two institutions, uh, the approach that Louisville was going to take with regard to its, uh, renewal of its teaching hospital. I was--actually was a part of the advocacy of getting support for them to do that--uh, testified in a couple of different situations to that effect. What happened there, though, was that other forces intervened. And there was some rather poor planning that took place, which hurt a lot of us, including UK, because they went in first with an idea they could renew the Louisville hospital at twelve million dollars, then it got to be thirty-three million dollars, then it got to be forty-seven million dollars, and they finally let the contract and it was eighty-eight million dollars. And so that--that drew--that was the biggest project ever undertaken in the state of Kentucky with public monies for a uh--a institution of higher education. And so we were sitting over here trying to get a five-million-dollar project approved and a seven-million-dollar project approved, and it just--it slowed down the state's capacity to respond to all of those things. And--and so that was a source of, uh, tension between the two institutions--and not helpful in terms of that period of the relationship, because it had started off well and we were in agreement about scope and support, and they were supporting certain things that were important to us, and we them. And then it got out of control in terms of the cost, and that--that did cause some difficulties. Um, and there were some people that intervened in that, uh, that that were outside of our control, as to how that all got decided. Um, one of the unfortunate things, from my perspective, had made--history may change that, but Louisville was very close, uh, to using its funds to build a facility directly adjacent to the Norton Children's Hospital. And I had worked with, uh--with the director of Norton Children's and with Dr. Boyer at U of L and this committee to try to foster that because they could have done a beautiful job with their forty-three million dollars with that approach--of integrating the facility into the Norton Children's rather than building a free- standing facility. And then that, uh, concept broke down and, uh, uh, that put them back trying to build an independent facility and that--that got the money thing off the track. But af--after that era, uh, we then got sort of a new, uh, definition of the role and power of the, uh, Council on Higher Education and the--and a new executive director. And they reconstituted the committee structure and, from my perspective at least, unfortunately took Council member participation out of any consideration of the health sciences--subsumed the health sciences into the academic affairs committee of the Council on Higher Education but without any representation from the health sciences. So that complicated our input into that whole process. Uh, the presidents then committed a--to a creation of a coordinating committee of the- -between the two institutions, which is now in its eleventh year of operation. It has a council staff person who sits in on the meetings, but it's a creature of the two universities. And we have just recently put together a summary document of all of the accomplishments of that uh, organization, which are quite substantial. Uh, we--we've touched on many different issues that, uh, range from, uh, faculty issues, house staff compensation, priorities for program development, uh, search for new, uh, chairmen in which both institutions have participated, uh, various analysis of the budget cuts, the whole dental cooperative, uh, planning process came up through that route, uh, the development of the PEP program, the development of the, uh--a joint effort in the Area Health Education System, a joint, uh, research-- federally funded research project or--or program that's going--extends over seven years came out of the process. So it's one of those uh, best kept secrets kind of things, I guess, that people keep assuming that just because we're seventy-five miles apart, we don't talk to one another and work with one another. You're never going to get rid of some competition, and that I think is actually healthy. Uh, what we need to do is try to avoid, uh, direct duplication and where duplication is appropriate, to have it complimentary. And that's what we've been trying to do in the cancer program and to a degree in the aging program, although their aging, uh, research activities at the present time are very limited. But there's enough problems relating to aging and cancer to go around to more than one institution and--and that's true of many of the things that we're likely to get into. So, uh, the--the reason this thing works is because the alternatives to it not working are fairly severe to both institutions. [End of interview.] In his second interview, Dr. Peter Bosomworth, chairman of the Department of Anesthesiology at the University of Kentucky, evaluates the University of Kentucky Medical Center and compares it to other institutions. He discussess broad problems and issues in the national healthcare delivery system and also discusses the university's specific goals and developmental programs. insert here