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1987-09-01 Interview with Byron Young, September 1, 1987 1987OH129 UKMC 68 00:30:48 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Young, A. Byron, 1939- -- Interviews University of Kentucky. Medical Center -- History University of Kentucky. Dept. of Surgery Vanderbilt University Poor -- Medical care Neurosurgeons Medical education Medicine--Study and teaching Byron Young; interviewee Richard C. Smoot; interviewer 1987OH129_UKMC68_Young 1:|11(13)|29(2)|45(6)|68(6)|85(1)|99(7)|116(2)|133(4)|163(6)|200(3)|219(9)|240(4)|266(6)|280(1)|305(6)|331(11)|344(10)|377(8)|404(1)|417(6)|440(9)|484(5)|517(10)|538(7)|559(2)|583(7)|597(2)|610(3)|624(4)|640(11) audiotrans UKMCoh interview SMOOT: Dr. Young, the last time we were talking we were discussing your experiences in career. Could you give me a complete narrative bringing you to the present, uh, chronologically? Uh-- YOUNG: I spent uh, a uh, year in Korea, which actually was the--one of the most broadening experiences I have had, because I had not traveled outside the United States and had not had a chance to see other, uh, people's culture and uh, countries. And uh, was not very busy there, which was uh, fortunate since I had been busy as a resident. And uh, we traveled throughout uh, uh, Japan and uh Korea, and I learned all about uh, Buddhism and the uh, dynasties in uh, China and Korea, and got an appreciation of other people and their culture; so it was a good experience for us. Then I came back to uh, El Paso and spent another- -oh, ten or eleven months in the Army. I came back here and was in private practice for uh, about five months. SMOOT: Here in Lexington? YOUNG: In Lexington. And uh, after I was here a couple of months, the people at the university talked to me about coming over here rather than being in private practice. And about that time I had decided I felt like I was going to work, uh, every morning. Because all I was doing was seeing--uh, having an office full of patients and operating, and uh, I thought I was just going to work. So I decided to come over here. SMOOT: What year was this? YOUNG: Seventy--see I came back in '73. I think I started in September, and I came here February the 1st of '84. SMOOT: '74? YOUNG: '74. So--September, October, November, December, January--maybe I was six months in private practice, I guess. And uh came over here and uh, have never regretted it. My salary for uh--I made in two months what I was making in six--in a year--in private practice, but that was before the practice plan was changed here. And uh, it was the best decision that I ever made as far as for me. SMOOT: Were you uh, warmly accepted by the physicians in the community when you came back to establish a private practice? YOUNG: Yes. See--then I--when I started my, uh, practice, there were only uh, four other neurosurgeons in town. One of them to--totally affiliated with the Lexington Clinic. And I came with Dr. Angelucci in sort of a loose affiliation. He was getting ready to retire and Dr. Chenault was getting ready to retire. So there was really only one other young neurosurgeon, so everybody--I was--the reason I say I felt like I was going to work. I worked until probably eleven o'clock every night and I was working on Saturdays and Sundays until about three or four. So I just--they needed a neuro--things--times have changed, they needed a neurosurgeon when I came. And so you were just real immediately busy. SMOOT: You were with Dr. Ralph Angelucci? YOUNG: Just--I shared his office. SMOOT: And certainly a strong UK connection. YOUNG: Right. He was--he was on the athletic board--and I'm not sure whether he was on the board of trustees-- SMOOT: Yes. YOUNG: --too or not. I think he was on the board of trustees and the athletic board. And uh, he--uh, after I was there about six--uh, six weeks or two months he had to be operated on, and had an aortic aneurysm--had to be repaired. He went to see--Dr.--New York, and Dr. Spencer operated on him. So I actually took over his practice the whole time he was gone, and had decided I was going to come to UK after they talked to me about coming over. So I waited until he was able to--the--the reason I waited until February the first, I waited until he was able to come back to work and take back over his practice. So I was--had his practice and the one that I was able to establish--both. Just after--we actually didn't practice together, I don't think more than six weeks or two months, because he got sick, and uh, then I came over here. SMOOT: Had he talked to you at any point about the University of Kentucky or your--your coming here and working at the university? YOUNG: Uh, before? No, when I came I was really going into private practice. SMOOT: Okay. YOUNG: And wasn't planning on coming to the university. And uh, the-- Dr. Murrell was leaving. And Dr. Murrell was the second chief of neurosurgery here. And Dr. Murrell decided to leave, so Dr. Blacker, who was going to succeed him as the chief, talked to me about having a private practice, because at that time the university, uh, needed patients. They were going through a transition. Uh, Med--Medicare-- Medicaid came into existence in uh, '66 I believe, and Medicare. When I was in practice in '68--in '73, Medicaid paid fifty dollars if you admitted somebody to the hospital, no matter what you did. Which meant if they had an aneurysm, you got paid fifty dollars. So the university had a good flow of patients because the people in the community would refer patients with Medicaid in other areas, but uh, Medicaid increased their payments to about fifty percent of the usual customary. When that happened, private doctors kept the Medicaid patients. So UK needed--the reason I--they had asked me to come is they actually needed somebody who could--had a practice and could generate a practice, because at that time, all the doctors were on salaries and mainly I think we were taking care of indigent patients and trauma patients, and had not developed uh, a private practice type of referral. So that's--and me being from Kentucky, I think that's--I think that's what my appeal to the depart--the neurosurgery division was. SMOOT: Had you noticed a large number of indigent patients uh, while you were a student here? YOUNG: That's all we had. SMOOT: Okay. YOUNG: The--the hospital uh, I think was founded to take care of indigent patients. And what I have heard, but I don't know if it's true or not, that there was not a billing office when the hospital was started. That the idea was that we would see every patient who wanted to be seen. And what I have been told was that there wasn't any real charges sent out in the beginning--you--you could always--you could check--I think this might be something you want to check with other people. But they soon realized after a few months that the state legislature had not given them that much money to uh, take (laughs) care of everybody that came in, so they started billing and collecting for people. But my understanding was that when--the hospital first started that there was not much in the way of billing and collections, or it was very haphazard. And even in '73, when I was here, my understanding was that the hospital's finances were somewhat chaotic; that they sent the bill, but if you didn't pay, you didn't pay. And if the insurance didn't pay, that's--they didn't pursue--I mean that was--that was it. And uh, there was no limitation on who was admitted, whether they could pay or not, or anything of that sort. And it was basically--uh, I think it was an indigent hospital. It was--we operated on patients if they- -they did not have the equipment to, in other places. But that was a small part of the practice. Mostly I think it was indigent patients. SMOOT: You've identified this period when you arrived back in Lexington and began-- YOUNG: I--I have something for you. Do you live here in town? SMOOT: Yes. YOUNG: Okay. I--uh, this trip we took was for our twenty-fifth wedding anniversary. SMOOT: This is the trip to Finland? YOUNG: Scandinavia. SMOOT: Scandinavia. YOUNG: My wife gave me for an anniversary present all of the newspaper clippings and mementos of trips and things that we had had over the last twenty-five years. SMOOT: Oh, really? YOUNG: And I don't know if you have this or not, but I have the article that was in the Lexington-Herald for the founding of the medical school. SMOOT: Hmm. Very good. YOUNG: Do you have that? SMOOT: I've seen that, but I don't know if I could put my fingers on it. YOUNG: I'll get a copy of it to you. SMOOT: I'd like a copy. YOUNG: Because what it says in there is exactly what I expressed to you that the hospital--they--it was anticipated that within a few years this would be one of the--either top five or top ten medical schools in the country, and that was the--that's what the newspaper said and that's what uh, everybody was think--saying. SMOOT: Okay. I'd like--I'd like a copy. YOUNG: Yeah, I'll get that. Because it is a picture of the pa--of the hospital, and it's not quite finished yet, and it tells about uh, all those things. SMOOT: Now you've--have you kept a scrapbook of uh, your experiences here, or is this just one that you've found? YOUNG: No. No. This is things--no, this is our family. You know, our kids have--these are little things where the kids came home from school and wrote this letter "I love you, mommy." (Smoot laughs) You know, all that kind of--this is just the twenty-five years of being married. SMOOT: Okay. YOUNG: But this is some of the things that Ju--my wife found tucked away in different places. SMOOT: Okay. You came at a transitional period, as you said, he--here with the university when you--when you joined the department here. Were there any other transitions that you could discern, because there were things taking place administratively, uh, from say the late sixties to the early seventies--this period. It--it was a transitional period, but I'm just wondering if--if you saw other things that may have indicated the--the degree of transition taking place? YOUNG: I ca--see I left in '65, (coughs) and didn't come back until '74. So I can't tell you anything about that period. SMOOT: But you can tell me your impressions. The difference-- YOUNG: Right. Okay. Okay, good. Uh, the--I thought the quality of the faculty was lower. It's hard for me to know whether that was a change in my development. SMOOT: Um--hm. YOUNG: Because a medical student would perceive a faculty member differently than another fac--faculty member. Because after all, I had gone through six years of training and two years of experience in the Army, so I would have a different perspective of people. But my general impression was that the quality of the faculty was not as good. SMOOT: Okay. YOUNG: And my general--and I can say this now--my general impression is that the quality of the chairman is not as good as it was when the school was first started. The overall school in many ways is--is much better. But I don't think we probably have that core of people that are--that I thought of at the time, were truly recognized nationally-- SMOOT: Um-hm. YOUNG: --as outstanding. SMOOT: Okay. What about the students? Had their quality been maintained? Uh-- YOUNG: No, I don't think so. But this--you're talking about me being a student-- SMOOT: Well, you were a student here and you feel that--that you were-- YOUNG: The--the siz--I, uh, the first couple of classes were small. SMOOT: Um-hm. YOUNG: So that the pool that we were--and actually the pool that we were selecting from was much larger. Because fewer people are applying for medical school now. Over the years we've--the University of Louisville and the University of Kentucky both have expanded their size. So that, uh, well we only--there was only forty in the first class, and sixty in the second. So that's--I think just from population--and--and the numbers wou--we would be down. But I think probably the overall classes are not as good, because you're taking people--uh, an extra twenty-five or thirty that we would not have been taking then-- SMOOT: Um-hm. YOUNG: --and the numbers of students that are applying na--nationwide is down. SMOOT: Um-hm. YOUNG: I doubt if the quality of the top students has changed any. I think we've just added on an extra number of students at the bottom. The standards have changed uh, a lot, which I think just reflects our society, in that now virtually everyone passes. A B is an average grade. An A is a grade that a lot of people get, and so it's not really distinguishing these very few people. And I think I even mentioned this before to you, that--but that's--I think that's our whole society. SMOOT: Grade inflations is a big problem here-- YOUNG: I think--yeah I was reading that in--in the colle--the school of education at the University of Indiana, the average graduating grade was 3.8 or 3.4 or something, which tells you that, you know, that's--a B was an average grade. But that--and I think there was a greater--uh, students that uh, probably shouldn't pass then did not pass back when I was here. And that--that's a student's perspective. Now there are people who passed that--I think everybody passes. There is a thing of getting everybody--not everybody, but of getting everyone through and--and uh, the standards of grading and the products have probably diminished. SMOOT: You grade people? YOUNG: Yeah. SMOOT: Do you give out A's and B's all the time? YOUNG: We give out higher grades than--we do, because there is more of a uh--yeah, we do. SMOOT: Do they deserve these A's and B's? YOUNG: They do if that's--the-- on a relative grading system they do. SMOOT: A relative grading system. YOUNG: It just depends--I mean if you are assuming that B is average or near average, that--we give them what they deserve in the way we are grading everybody else. If--so we're not really saying anymore an A is this select group, or B--I think B--I think of B as being, uh, average. SMOOT: Um-hm. Okay. Uh, this is a--is this something that has come down from the other offices? Is this something that you have uh, had to begin to determine for yourself? Uh-- YOUNG: No, I think it is society. I mean, this is not a thing from the university, I think this is society. SMOOT: Okay. Do you think that perhaps it would be better to uh, become a little bit more rigorous? YOUNG: Yeah, I think it would be better if we had, you know--say three percent are getting A's, or five percent are getting A's, and ten percent or below that are getting B's, and eighty percent are getting C's, and five percent are getting D's, (Smoot laughs) and five percent are failing or something. SMOOT: Um-hm. But you don't see that happening anytime soon, or do you? YOUNG: Um, actually there is uh--I'll tell you what has changed that I've noticed. There were, when I first came here, the students were insisting they not be graded. SMOOT: Not be graded at all? YOUNG: Not be graded at all--pass or fail. And that uh, the uh, learning of itself should be the big issue, and not testing and all those things. That has--the students don't think that anymore. Students have changed over this last ten or fifteen years. Uh, now uh, grading is expected because everybody has realized if you don't grade people, then they get to applying for internship and residency, you can't separate people and you can't give them the same rec--the recommendation that you want to. Plus uh, people, uh--society it's going through a change, and I think younger people now probably more goal oriented, and if, uh--the Vietnam era of thinking has kind of passed for right now. And uh, students are very inquisitive about what's going to be on the test. "How am I--how am I going to be graded?" So they are--I think the students are thinking more of the way I did when I was in medical school, and not the way--before it was, "We're not taking the test, and we're not going to be graded, and we shouldn't be." SMOOT: Um-hm. YOUNG: The curriculum is changing too, in that we went through an era there where there were a lot of electives, and the students should be able to select what they want to take. But we've switched back now to saying, "We'll just--the faculty will decide what you will take." And there is more, uh--now-- SMOOT: More structure now? YOUNG: Structure and you--fewer electives-- SMOOT: Um-hm. And do you-- YOUNG: --than there was. SMOOT: And do you think that's better? YOUNG: I think it's better. I think the--from--now that I'm on the faculty that (Smoot laughs)-- SMOOT: Faculty--that--that's a tough world. (laughs) YOUNG: Faculty--faculty know more about what uh, needs to be taught and what students should take, than the students do. SMOOT: Sure (both laugh). Uh, there was a philosophy that we talked about I believe last time. The philosophy that Dr. Willard had developed for this Medical Center, and in--in his recruiting he used it uh, in a variety of aspects, because it affected the students too. And it was really influenced a great deal by what was generally termed comprehensive medicine, uh, something that was a, more or less an outgrowth of the 1950's. YOUNG: Right. SMOOT: Uh, a lot of the members of the original team, of the original chairman of the various departments, the Deans, et cetera, were also influenced by that. You saw a lot of that as a student. Did you see very much of that when you returned as a member of the faculty? That-- that sort of philosophy? YOUNG: When you say comprehe--uh yes, and uh, I think that's--I don't happen to agree with that philosophy, but it was kind of prevailing one, uh, when I was here, and I think it's continued up for a time, we had a lot of emphasis placed on uh, um, psychology and--you're---this is what you're getting at? sociology and--and uh, these areas? SMOOT: The totality I believe-- YOUNG: --of the person. SMOOT: Exactly. YOUNG: And seeing the patient in the totality. The thing that I was struck about when I went to Vanderbilt, was that their curriculum was of pathology, and uh, biochemistry, and there was very little of this. SMOOT: Um-hm. YOUNG: The, uh--the uh--I think the wave of that may have passed, whereas that we're more--I think we're deciding now we're more of a scientific discipline and uh, there is a lot to learn in science. At least--and my philosophy may be different than the res--many of the faculty here, but uh, I think our job is to get people so that they know enough about medicine to practice well. And if they--if there is a limited amount of time, we better make certain they have that. And I don't think you can inculcate some of the uh, ethical uh, values in people when they're already twenty-one years old. You can influence them some and their ethics, but uh, I think probably many of those traits are already there and we're not going to have a great influence on them. SMOOT: Um-hm, um-hm. YOUNG: And it's more of a--that we need to select the people that already, as much as we can, have some of those characteristics, and weed out the ones that don't. I think we have a greater responsibility to get rid of people from a medical school that show that they don't have those. SMOOT: Um-hm, YOUNG: And I think you can educate people in ethics to some extent, but uh, I'm not sure that's through--the main purpose of the medical school. SMOOT: Um-hm. YOUNG: And I think, uh, just the changes in our society, economic factors and others, have made doctors look at patients more as people. Because there is more competition for patients, and we have to be nice to people now. To--to have patients, you have to understand them better. So I think probably among some of these other factors, uh, operate more forcefully to make the medical profession change their attitudes, than trying to do it through a-- SMOOT: An academic process, perhaps? YOUNG: The other--yeah, ac--um-hm. SMOOT: Is tha--is tha--is that a fair way of putting it? YOUNG: Yeah, right. Um-hm. SMOOT: Uh, so you would actually ascribe uh, more--even market factors-- YOUNG: Would be, probably-- SMOOT: --and societal factors, uh, in the broadest sense of the word? YOUNG: --right. Being--probably having more influence on the person, than taking a course uh, in sociology or-- SMOOT: Um-hm. YOUNG: --uh, behavioral sciences. SMOOT: Um-hm. YOUNG: Behavioral sciences here have played a very, very strong role in the, uh, medi--medical school and the curriculum. SMOOT: Um-hm. YOUNG: Uh, but I'm not certain how much of an influence they have on the ultimate product that we turn out. SMOOT: Um-hm. Well, let's--let's just look at--at uh--of course, I've-- I've been, uh-- YOUNG: You've been talking to all these people. You just talked to Kurt Deurs--Deuschle, so you'll-- SMOOT: Exactly. YOUNG: A different viewpoint probably. SMOOT: That's right. Uh, were--were you ever involved at all with th-- with uh, Dr. Deuschle, anything as a student? YOUNG: Yeah, Um-hm. I was a student when he was here. SMOOT: Okay. Uh, and did you involve yourself at all with--with community medicine? Uh, with what he was trying to do? YOUNG: Yes, Um-hm. Um-hm. SMOOT: Uh, did you have a clerkship? Did you go out, uh--? YOUNG: Yes, but I went to uh, Ashland and worked at Armco Steel. SMOOT: (laughs) That's not exactly the uh-- YOUNG: And I went to--remember I told you I went to Harvard-- SMOOT: Yes. YOUNG: --for three months. So I had already been from that area, so I didn't want to go back and-- SMOOT: Right. Right. Did you work with Dr. Claycamp at-- YOUNG: Right. Um-hm. SMOOT: --Harvard. Um, well, did you find that--that a valuable experience, uh, in--in terms of your own development, or--or had you already been-- YOUNG: Uh, I'm not--I'm a bad example. Uh, I had uh--well, uh, I had only decided to go become a doctor in my uh, junior year in college. So uh, I had--I lacked one course in having a philosophy major. And I had the minimum courses in uh--uh, I had the minimum pre-med background, so I took a lot of sociology, philosophy, and things in college. And I did--I uh, worked much harder on biochemistry, and physiology, and pathology, than I did those courses. SMOOT: Um-hm. YOUNG: Uh, I'm--maybe they had a greater influence on me than I thought, but I didn't think they were--influenced me that much. SMOOT: Would you describe then the--the overall prevailing philosophy today as--as a scientifically based or a specialized-- YOUNG: I think it--I think it's more scientifically based than it was then; there is less emphasis placed, uh, on that, at least I think there is than there--there was. SMOOT: Do you see, uh, that becoming a trend that will continue into the end of, say the century? Or-- YOUNG: Yeah, I think uh, what uh, medicine will--uh, is starting to recog--or what we have to recognize is that, uh, there has been a lowering of the public's esteem of physicians. SMOOT: Um-hm. YOUNG: But uh, we have achieved that esteem by having some specialized knowledge and performing a real service for society. And that service is being able to heal diseases. So that our efforts ought to be toward--uh, you know scientific measures--and that's why you have the esteem is actually being able to perform a real service for society. We have to be uh, kind to the patients, and uh, make them satisfied with our services, but I think if we put the emphasis on being kind to them, but don't have the scientific background to heal them, that tha--that's probably--we're not going to--we'll have the greater esteem by being able to heal them-- SMOOT: Um-hm. YOUNG: --than providing the social support. SMOOT: Of course, I don't think you would have too much trouble being nice to your patients. YOUNG: No. No. No. Yeah, (Smoot laughs) I hope not. SMOOT: But uh, some--some did for a while-- YOUNG: Right. SMOOT: That was--that was sort of uh-- YOUNG: Yes there's--yes. SMOOT: --acceptable really, wasn't it? YOUNG: Yes, I'll tell you--the, uh--I think that here--and I think that was generally--but I think that was a particular problem with this medical school because when you have, uh, indigent patients, and patients that are just coming to the institution, and you are not trying to build up a practice, and not trying to please any referring doctors, you don't establish--the--I think may--much of the way that medicine was practiced here in that it was an in--it was a house staff hospital. And many of the physicians made rounds once or twice a week to truly supervise the residents. So there was not much contact between the faculty and the patient, which I think is a bad example because, uh, then if you don't have contact with the patients, you really can't teach the residents "How should this--how should you approach this?" And you don't provide a role model for them. That's changed a lot; uh, the--the faculty here are greatly involved with taking care of the patients, and really provide a real role model for them. So I think there was a detachment from the patient with the faculty, and uh, if something--when you are treating indigent patients, you don't go to the same effort to make them happy as you do other patients, or the referring doctors that you are dependent upon. And that's--I think that's just a fact of life--of everything. SMOOT: Okay. How would you describe your department now? Uh, this department--wh-, how it's--how it has developed, how it has grown, where it stands today? YOUNG: I th--the uh--we are uh--it's going through a transition. I think we--we had--uh, oh, we emphasized a great deal of clinical uh, activities and education; and not research. And when the department first started research was a big factor. So I'm a recruiting a different kind of person than we recruited over the last ten years. We are uh, sa--uh, placing a lot of infl--uh, emphasis on research; obtaining funded grants from NIH. We are only trying to, uh, in most areas recruit people who are research oriented and can get research grants. Now that doesn't mean we are going--the clinical part is going to go down, but we're recruiting a different kind of person. So I have recruited a new chief of general surgery from Michigan. And I'm trying to do what uh, Dr. Willard and Dr--what I saw Dr. uh, Eiseman do, and that's recruit the--the youngest, best people from other institutions that would come in and make a big factor for us. I'm recruiting a chief of cardiac surgery. So I called around to the eight or ten best places in the country, and only had people from those places come. And I hope we've--are recruiting a new cardiac surgeon, uh, this week, uh, but I'm recruiting a different kind of person. And we're not recruiting people from uh, our own faculty as much as trying to get more--more of a uh, nationally based faculty from what I perceive as being the best institutions in the United States. So we're--uh, more money is being spent on research and more emphasis placed on that. SMOOT: In the few minutes that we have left, is there anything el--else that you would like to add to the interview that we have not discussed or touched upon, that you feel important to the uh-- YOUNG: Yeah--yeah, I better--better--I, there is no doubt that the medical school--and I better emphasis this, and the hospital--is infinitely better than it was back then. I'm only talking about the core of people that we recruited--comparing with them. The big--uh, that--I feel like there's been two big factors that have--uh, that I--I've told you about that I thought we were up here, kind of went here, and then back up. I think the two big factors that have been the greatest--and had the greatest impact on the school in the last eight or ten years, have been the development of the pract--private practice plan, because it's brought in--brought a lot more money into the university, and it's added incentive and helped our clinical programs because we have a big contingent of private patients. And the hospital has become financially solvent, and in fact is a moneymaker. We had a period about uh, four or five years ago, when the hospital either lost money or broke even. We couldn't buy equipment that we needed to stay at a--at the--uh, better than the community hospitals. In fact they were getting equipment--well, this was back seven or eight years ago, faster than we were. Now the hospital is doing extremely well, so we are able to truly be the tertiary-care hospital, uh, for the state. And so the financial viability of the hospital had to be private patients, and the practice plan which caused that--private patients to--to--to come here. Because there was incentive to the physicians to see patients, has been the big--two big factors I think that have influenced the development of the school. SMOOT: Is there anything else you would like to add Dr. Young? YOUNG: Not that I can think of. SMOOT: Thank you very much for your time. YOUNG: Thank you. [End of Interview.] Dr. Byron Young (Chief of Neurosurgery, Director of Kentucky Neuroscience and Orthopedics Institute, and Johnston-Wright Endowed Chair of Surgery), grew up in Somerset, Kentucky, attended Transylvania University, then enrolled in the second class of the University of Kentucky College of Medicine. In his second interview, Young describes his professional career as a neurosurgeon and working at the University of Kentucky Medical Center. He discusses different perspectives in education, specifically grading in medical education. In addition, Young talks about the changes in approach by the University of Kentucky Medical Center in the twenty five years since its inception. insert here