American Academy of Physician Assistants Oral History Project
Interview with William Stanhope
conducted on May 28, 1998, by Brien Williams
telephone interview
BW: Okay. This is an interview with Mr. William Stanhope, former President of the American
Academy of Physician Assistants. He is currently the Director of the Healthcare
Leadership Program at Quinnipiac College in Hamden, Connecticut. It is the 28th of
May, 1998. This interview is being conducted by telephone. Dr. Stanhope . . .
WS:
Oops, Mr., Mr.
BW: I'm sorry. Mr. Stanhope is in his home.
WS:
In his swimming trunks. [Chuckles]
BW: In his swimming trunks, all right. [Chuckles] And the interviewer is Brien Williams and
I'm in Washington, D.C.
Okay. The first question I wanted to ask you was a little bit about your background prior
to becoming involved in the PA program at Duke--sort of where you began and what you
were doing at the time you gravitated toward this profession.
WS:
I had been a surgical technician in the Army. Got out of the Army at age 22 and had two
and one-half years of college under my belt, when I read about the Duke PA program in
William Stanhope Interview, May 28, 1998
2
1966. At that time the medical schools in this country had a policy of blatant age
discrimination and, in fact, only four schools in the country would accept an application
from a person over the age of twenty-six. That would have clearly left me out of the
running. When the Duke program came up, I was working in a small community
hospital emergency room as sort of a glorified orderly on the weekends.
One of the physicians that I had been working with doing some PA-like things in his
private practice had heard Stead, the founder of the PA program at Duke, speak. He came
back and told me that he thought this would just be a wonderful thing, because I was
screwed on the basis of age from pursuing my dream of going to medical school. And so
I applied in 1966, was interviewed, and started school at Duke in 1967.
BW: Your family background: Were there doctors in your family?
WS:
No, there were not. Well, a long, long time ago but none that I had ever known.
Interestingly enough, my grandfather had been trained as a dentist in Boston but had some
catastrophic illness, became deaf and, because he couldn’t communicate, had to give up his
practice.
BW: And at the time you were going to high school and such, were you living in Massachusetts,
or where are you from?
William Stanhope Interview, May 28, 1998
WS:
3
Yes, I was in Massachusetts. My father was a career Naval officer, but we happened to be
living in Massachusetts all through my high school years.
BW: And then you went into military service.
WS:
Yes.
BW: Which branch did you say?
WS:
I went into the Army.
BW: And you became a . . .
WS:
Surgical technician. I actually did that, not out of any altruistic compulsion but rather for
very selfish reasons. [Chuckles] A good friend of mine, one of my high school buddies,
who was a year ahead of me, was an Army surgical technician at Walter Reed. He told me
that it was probably the best duty in the Army. You almost always, always slept between
clean sheets. Army hospitals draw rations and a half, and the chances of working with
attractive young nurses were very high. So, as a young [chuckles] 18-year-old, it covered
all three important needs: It provided extra food, not sleeping in the mud, and the
opportunity to work with young nurses.
William Stanhope Interview, May 28, 1998
4
BW: [Chuckles]
WS:
And once I got in and learned the job, I found out that I just couldn't wait to go to work
every day. Just really absolutely loved it and, in fact, liked it so much that I didn't worry
much about the extra rations.
BW: Where were you stationed?
WS:
I was stationed at Fort Dix, New Jersey, after being at Fort Sam Houston for training. For
the last six months of active duty I was stationed at the U.S. Army General Hospital in
Landstuhl, Germany.
BW: And this would have been circa what years?
WS:
Ah, 1961 to 1964--just before the big buildup in Vietnam. In fact, I had tried to go to
Vietnam in 1962, when we were first putting medical advisers and the first U.S. Army
hospital in the country--I worked a lot with the Chief of Surgery as his surgical assistant in
the operating room, and he refused to sign my release to get me over to Saigon.
BW: And what was attractive about going to Saigon for you at that point?
William Stanhope Interview, May 28, 1998
WS:
5
Adventure. Adventure. My godfather was the U.S. naval attache in Saigon at that time,
and he had written to my Dad and told him how well he was living. He was really having
a pretty good time and going tiger hunting and lived in a big villa. I just absolutely knew
that if I got over there, Big Jim would take care of me, even though I was in a different
branch of the service and an enlisted man. You have to remember in 1962 and 1963, we
still pretended that we only had advisers over there.
BW: Right.
WS:
The field hospital that went from Walter Reed, in fact, was an advisory hospital and they
were pretty much engaged in trying to train their Vietnamese counterparts.
BW: And, describe the kind of activities you did in your role as the technician.
WS:
As a surgical technician?
BW: Yes.
WS:
Well, there were basically three sets of duties, oh, probably four sets of duties. The
Army's pretty well self-contained, so the least attractive set of duties was the sort of, I guess
you'd call it housekeeping stuff. We, of course, kept the operating room clean and ready
to go; we took care of our own instruments, in terms of making sure they were sharp and
William Stanhope Interview, May 28, 1998
6
properly maintained, and all of that kind of stuff. We did our own packs-- things that are
all now disposable, we had to do ourselves. We would make some of our own sponges,
and put up our own gloves, and all that kind of stuff. Then in the operating room we
would alternate between working as a scrub nurse and working as a circulating nurse
(they're the civilian analogues). And then a couple, three of the surgeons were training me
to work as a first assistant. The Chief of Surgery was a general and a thoracic
surgeon--and, on occasion, I would help him on the general and thoracic cases as his first
assistant. I also worked a lot with the Ear, Nose, and Throat surgeon and functioned
almost exclusively as his assistant when he needed a second pair of hands. So, we did
everything--everything from cut up our own sponges and wash and repackage our gloves to
make our own linen packs to first-assist on major cases to mop the floors.
BW: And how would you characterize the relationships that you had with the surgeons at that
point?
WS:
Most of the fellows were quite willing to teach and were very patient teachers. They were
just delightful to work with. It was not, in any way, shape, or form, the typical military
sort of relationship. I mean, the docs were all officers, but they weren't jerks about it.
They didn't remind you every thirty seconds, "Hey, I'm an officer and a gentleman, and
you're just a peasant." I mean, they weren't like that at all. They were delightful guys to
work with.
William Stanhope Interview, May 28, 1998
7
BW: And the kind of training you had before you started doing this kind of service, what was
that like?
WS:
Everybody had to go to the basic corpsman school, where you learned how to be a combat
corpsman, and then I went on and went through the operating room specialist school. I
can't remember how long it was. Let's see, I went in June, finished training in January.
Probably a three-month course, in how to be a surgical technician, where they taught us
more anatomy and more about the kind of operations that were done, why they were done,
and how to work in the operating room, and hammered into us the principles of aseptic
technique.
BW: So, basically that was your training for this kind of service?
WS:
Yes, yes.
BW: And did you feel . . .
WS:
Before that I had been trained as a juvenile delinquent.
BW: So, you came to the end of your service. Was that a two-year stint?
WS:
Three-year hitch.
William Stanhope Interview, May 28, 1998
8
BW: A three-year hitch. And then you separated.
WS:
Yes.
BW: And this is . . . Take me through those steps again, which eventually led to . . .
WS:
Well, let's see. I got out in 1964 and went to college. I had a wife and a child by the time
I separated, and after I got out of the Army, about ten months later, my younger son was
born. Worked in several different jobs. Worked as an orderly in the county poor-home
which had sort of a nursing component to it. Worked in an organo-metallic chemistry
research and development lab. Worked for a florist. And worked in a small community
hospital emergency room. . . . I worked about between 50 and 60 hours a week and went
to school full-time. What I would do was, I worked three to four shifts on the weekend in
the small community hospital emergency room, and then worked for the florist in between
times. For about a year and a half, I worked after school, afternoons, at this chemical
research and development outfit, and worked in the hospital on the weekends and delivered
flowers in between.
BW: That's remarkable! And where . . .
William Stanhope Interview, May 28, 1998
WS:
9
[Laughs] Hunger. Hunger and hungry children are sort of a pretty compelling, a pretty
compelling . . .
BW: Incentive.
WS:
Incentive. And there were times, there were times that were really pretty tough. There
were a couple of times when we got to the end of the month and had to go a couple of days
before we could put much more than baby formula on the table for the kids.
BW: And where was this all taking place?
WS:
This was in Massachusetts. It had just developed the community college system in
Massachusetts and, quite frankly, my academic performance in high school had been such
that no self-respecting senior college in the state--or probably anywhere in New England,
for that matter--would have said more than hello to me.
BW: So, this was a period of time when you were going through, probably, some changes in
your attitude toward things, and so forth. Is that correct?
WS:
Well, actually my attitude really changed in the Army. I discovered how much I really
enjoyed working in medicine. I mean, I really enjoyed it. I would as often as not hang
around on my own time, helping guys with the cases that they were doing, or hanging out
William Stanhope Interview, May 28, 1998
10
in the operating room lounge, bugging the surgeons to teach me stuff while they were
waiting to get their cases started. Actually I started taking some college courses when I
was in the Army. The local college had night classes on base and stuff. So, I realized: (a)
That, you know, being a delinquent didn't cut it as a young adult; and (b) I really just loved
what I was doing. I mean, I really had a passion for it. It was the first time in my life that
I had ever discovered I had a passion for anything besides whisky and women.
BW: So, did you get an AA degree at a community college?
WS:
Yes, I got an AA degree at the community college. The way things sort of worked out, I
ended up with almost three full years of school at the community college, because I
dropped out for a semester, thinking I wanted to start a book store, and gave that up after
the semester and returned to school full-time.
BW: Which school was this?
WS:
It was Northern Essex Community College, one of the Massachusetts community college
system's schools. And I did pretty well there, actually. I really did pretty well in school,
had pretty good grades.
Working in the small community hospital emergency room with the four to five physicians
led to me working pretty closely with a couple of them, particularly the youngest physician
William Stanhope Interview, May 28, 1998
11
on the staff, who believed in the concept of trained assistants long before Stead had
anybody, or before he had heard of Stead's programs. When I had time, I would swing by
his office and do some technical things in the office for him. I'd do some of the basic lab
work in the office and would go to the nursing homes and make sort of cursory rounds for
him in the nursing homes. He took care of people a lot at home, and so I'd swing by their
home between classes, if they were in the neighborhood, and look after them and take their
vital signs and make sure they were taking their medicines the way he told them to take
their medicines. He's the fellow that had gone off and heard Stead talk and came back and
said, "This is what you need to do."
BW: So, that was your next move, then?
WS:
When I interviewed at Duke--the options I had in my mind were, I could try whatever this
new thing was. It sounded pretty cool. Wasn't sure what it was, but it sounded like it
would be a lot of fun. I could go to, God forbid, nursing school, and then into anesthesia,
or go to Amherst. Amherst College had developed a relationship with our community
college, and there was the opportunity for us to transfer to Amherst. At the time I was
thinking that if I can't do medicine, then I'm going to be a history professor. Fortunately I
got into Duke. Certainly got saved from being a nurse anesthetist, and maybe fortunately
saved from being a history professor.
BW: Now, this mentor of yours in the hospital, can you just give me his name and the hospital he
was associated with?
William Stanhope Interview, May 28, 1998
WS:
12
Yes. It's Dr. Robert Papaioanou.
BW: And he was associated with which . . .
WS:
Amesbury Community Hospital. It's long since been closed. In Amesbury,
Massachusetts.
BW: Okay. Now, in reading background for these interviews, several people have mentioned
how medical corpsmen coming out of Vietnam would come back to the States and the only
options . . .
WS:
I'll tell you a great story about that.
BW: All right.
WS:
The Army had a system called proficiency pay. If they had a technical specialty that didn't
have enough manpower, they created a system of proficiency pay as a recruiting
inducement. There were two levels of pay: thirty dollars a month or sixty dollars a month.
There was always a shortage of operating room technicians. To get proficiency pay, first
of all, you had to be in a specialty that was under-staffed, and I was. Then you had to take
William Stanhope Interview, May 28, 1998
13
a comprehensive Army-wide written exam, and you had to score in the top 10 percent
Army-wide, and I did.
So, I was drawing proficiency pay, and being in the top 10 percent of your specialty
Army-wide was kind of a big deal. I had gotten promoted to E-5 in a year and ten months,
which was an incredibly accelerated set of promotions. And, as I said, I had been
first-assisting people in the operating room when I was eighteen and nineteen years old--on
major chest and belly cases.
And when I went to the largest Army hospital in Europe, I was responsible for the ER shift
at night. There would be no physician there, and if a wreck came in, why, we did what we
could while we rounded up the surgeons to come up and do their stuff. If there was a
typical set of pay-day/night brawls and the guys came in with cuts, bumps, and lumps, we'd
take care of them without calling the surgeons. The surgeons had made it clear that they
would teach us how to sew up these wounds, but they did so with the understanding that
we'd never call them unless there was something we just simply, absolutely, positively
could not handle.
So, I had been doing all this for the past three years, running the emergency room, closing
up all kinds of wicked lacerations. (God really does look out for fools and drunks.) The
corpsmen were the fools, and the drunks were the people that we practiced on. In
retrospect, I closed wounds that today would probably give me the shivers thinking about
closing, just because I didn't know any better.
William Stanhope Interview, May 28, 1998
14
The day I got home from the Army, the headline of the local paper was that they were
going to close half the operating rooms in my hometown hospital, because they didn't have
any nurses to work in the OR. So I called up the Chief Nurse and introduced myself and
told her that I was a pretty damned good surgical technician. I could hear her puff herself
up over the phone. She informed me in no uncertain terms that, not only didn't the
hospital have technicians but they didn't believe in technicians, and it would be over her
absolutely cold-dead body that they would ever allow a technician in the operating room.
However, if I had nothing else to do with my delinquent self, I could come and work as an
orderly, cleaning bed pans, for ninety cents an hour. I thanked her very much and went on
about my merry way.
BW: [Chuckles]
WS:
And, as I said, this was at a time when I had been helping the Army surgeons with major
chest and belly cases, in addition to being the scrub nurse or the circulating nurse for any
major surgical cases.
BW: And I would gather that your situation was not a particularly unique one.
WS:
Absolutely. Absolutely not. The nursing community just never missed a chance to slip it
to the ex-corpsmen, if they were working as orderlies.
William Stanhope Interview, May 28, 1998
15
BW: Do you have any sense of what happened to the medical technicians from World War II?
What they were doing by this time?
WS:
Well, the guys from World War II had been, of course, pretty well assimilated. A lot of
them went on to become physicians. I have, in fact, worked with a number of physicians
who had been corpsmen during World War II. In fact, my second boss as a PA had been a
Navy corpsman during World War II and had been with the Navy supporting the Army
operations in the Italian campaign, on a troop ship, as a Navy corpsman. He was pretty
tuned in to--he was terrifically tuned in to--what the corpsmen could do.
And a number of other physicians that I've worked with over my career have been, have
told me that they were corpsmen. They had the original GI Bill, which was really a pretty
good piece of change, and they went to medical school. Some of the World War II
corpsmen ended up as nurse anesthetists, and some of them ended up, you know, back
being cattle ranchers and farmers and teachers and engineers and anything else.
The same sort of thing pretty much happened from Korea, although I think there was more
of an assimilation from some of the Korean guys into some interesting technical jobs.
One of my classmates at Duke is a guy named Al Bibby, who's a character in his own right.
He had been a Navy corpsman with the Marines in Korea, and had also been an operating
room technician. When he was discharged, he went back home to Boston to work for a
William Stanhope Interview, May 28, 1998
16
fellow named Francis Moore, who was the Chairman of Surgery at Harvard and the
Physician-in-Chief at the Brigham. Al ended up in Dr. Moore's lab as his senior
technician in the surgical lab. He did all of the animal transplants for the original Boston
kidney transplant team, which was the team that did all of the original work with transplant
surgery in the United States. So, my classmate had done all of that highly technical and
very skilled animal work.
There were a lot of guys that were doing things like that. From Korea on, because we kept
the draft, there were a lot of guys that would be corpsmen and then could never get to use
that information, because the civilian sector didn't have a place for it. And if there was a
place, the nurses would just absolutely screw you every chance they got.
BW: Tell me again why you felt barred from going into medical school yourself?
WS:
Because at the time all of the medical schools but four in the United States had a published
policy that they would not accept an application from a person who would be over
twenty-six at the time they started med school. And that didn't go away until the civil
rights laws.
BW: So, you got your AA at Northern Essex, and then you went into the program at Duke.
William Stanhope Interview, May 28, 1998
WS:
17
Right. Then I did Duke, and had gotten to know and work a lot with Dr. Estes, because I
was the spokesman for the class. I was the class president or leader at the time, and
Dr. Estes was our program director. So I would meet very frequently with Dr. Estes to
talk about program issues and ideas that we had about how to help make the school better
and stronger, and stuff like that.
When it came time to look around and decide what I was going to do at graduation, Dr. Hu
Meyers at Alderson-Broaddus had started a PA program. It was the first PA program to
actually offer a baccalaureate degree. They offered me what we would today call a
teaching fellowship. The deal was, if I went up there and served as a role model for Hu's
first class and taught and took a couple of theology courses, an ethics course, and a couple
of other liberal arts courses, then at the end of my year of fellowship I would earn a
baccalaureate degree. So, I did. I went there and took the liberal arts courses and began
my teaching career at Alderson-Broaddus.
As that year was drawing to a close, some folks from the University of Oklahoma had
stopped by Duke and had expressed a very strong desire to start a program. They were
pretty progressive, because they said they wanted to start a program with a PA as the
program director, which at that time was absolutely unheard of: The notion that one of us
would direct a program was really, to many people, sort of just not in their lexicon. One of
my classmates had looked at the position and encourage me to apply. Dr. Estes supported
William Stanhope Interview, May 28, 1998
18
me in that application, I went out for a couple of interviews, and ended up going to the
University of Oklahoma.
BW: And that would have been in what year?
WS:
1970.
BW: And you became the program director there?
WS:
Yes. I was actually the first PA in the country to be a program director, which was
interesting in and of itself. When I would go to some of the early meetings, where people
were talking about PAs, and they would look at my name tag and they would always ask
me, "Where's the real director?" meaning "Where's the doctor?"
BW: Let's back up a little bit here now. You were a member of, I guess, the second or third
class.
WS:
I was a member of Duke’s third class.
BW: The third class.
William Stanhope Interview, May 28, 1998
WS:
19
The first class started with four guys and about half-way through one of the guys dropped
out, went off to become a missionary. So, there were only three guys in the first class.
Then there were, I guess, about eight or ten guys in the second class full-time, and several
people who were working as technicians at Duke in various capacities went through the
program on a part-time basis and then sort of finished mid-cycle.
BW: And how many were in your class?
WS:
I think we started with ten or twelve guys. One guy got in a little trouble and dropped out.
BW: And it sounds like these were all men. Is that right?
WS:
All men.
BW: Why was that?
WS:
Well, there were very, very few women corpsmen at the time. I mean, there were some.
Certainly were. They were in the Army WACs and the Navy WAVES, there were very
few of them, and I guess they hadn't applied. It wasn't until the fourth class that they took
their first woman, who was a wonderful person named Joyce Nichols, who had been an
LPN at Duke for a long time. And then they took somebody else, another wonderful
William Stanhope Interview, May 28, 1998
20
young woman named Clare Vanderbilt, in the fifth class. Clare had been at Duke since
she was sixteen, as a medical records clerk and then librarian, a medical records librarian.
[End Side A, Tape 1]
[Begin Side B, Tape 1]
BW: . . . whether everyone in these early PA programs, it was just assumed they had this military
background.
WS:
Yes. And, interestingly enough, the guy who was the administrator for the program was a
fellow named James Mau. Jim had been in and, in fact, was in the Reserves as a Navy
fighter pilot, and his preference was for Navy corpsmen. So in my class there were only a
couple of guys who had been either in the Army or Air Force as medical technicians;
everybody else had been a Navy corpsman. All of the Navy guys were qualified for
independent duty, which meant they were the only medical person on a small ship, like a
destroyer escort or smaller, or submarines. So basically as an independent duty corpsman,
they were the public health and preventive medicine officer, and the doctor, and the nurse,
and the dentist, and the optometrist, all rolled up into one.
BW: Talk to me a little bit about just what it was like being at Duke, in the program.
William Stanhope Interview, May 28, 1998
WS:
21
It was like riding on a rocket ship. [Chuckles] I had absolutely no idea what Duke was
like. I was from the North, from New England, and if you heard of medical schools, you
heard about Harvard, you heard about Tufts, or if you were from up in the sort of upper-tier
New England states--New Hampshire and Vermont and northern Maine--you might hear
about the University of Vermont's Medical School, but never had heard about Duke, and
had no idea that it was such a really high-powered place. Nor did I have any appreciation
for just how carefully selected the resident doctors were at Duke.
At that time, and I think it's still true, if you want to do a residency at Duke, you've got to be
in the top 10 percent of your graduating class from medical school or you're not going to be
accepted into the residency.
But . . . we were the same age as the interns. When I arrived at Duke, I was exactly the
same age as all of the guys who were in their internship year and had no appreciation for
just how really smart these guys were and always felt it was pretty easy to stand
shoulder-to-shoulder right next to them, because they certainly knew a hell of a lot more
basic science than we did, but we had, in many instances, a lot more clinical experience.
And I had a lot more actual operating room experience as a surgical assistant than any of
the guys in their first, second, and probably third year of surgical residency at Duke. I
mean, I had first-assisted on more big cases than the guys--any of the guys--had done by
the time they were in their second or third year of surgery training at Duke.
William Stanhope Interview, May 28, 1998
22
So there was a lot of practical give-and-take. They were real giving and real willing to
teach us whatever they could and we could certainly exchange some of that teaching for
work, because we knew how to do all of the things that an intern had to do.
BW: And the times when you were interacting with the interns was during practicums, or during
classes, or both?
WS:
During practicums. It was basically set up so that the first year was pretty much
classroom, nine or ten months of classroom work, and then the remaining fourteen months
were clinical practicums, where we were on the floors. And, interestingly enough,
because of our experience and because of the classes we had, which were very
pragmatically oriented classes, we were to a person way ahead of the medical students, in
terms of being able to do practical things on the floor. If the oral quizzing got really
heavy, why, eventually the medical student would pull ahead of us, because they had had
some excellent, excellent basic science which we didn’t have.
When it came time to really taking care of patients and all of the bedside quizzes about
diseases and medicines and practical things, it would be fifteen or twenty minutes into a
quiz before the medical students could pull ahead of us. Most of the time people gave up
by that time and just assumed that for some reason we were able to stay at or ahead of the
medical students. And for the lazy interns--we could certainly out-perform the lazy
interns, which made it very easy, because people were really willing to give us teaching
William Stanhope Interview, May 28, 1998
23
time, because they realized that if they slowed down and taught--if the residents slowed
down and taught us--why, we'd more than make up for it by doing some of the just
grunt-and-sweat stuff that you have to do, like drawing bloods, you know--just the basic,
basic things that you have to do in an internship or a residency program.
BW: And where were the nurses in this mix?
WS:
Well, they weren't real happy. And every once in a while, on each of the floors, when
we'd come by, the nurses would give us a little hassle. But one of the things the program
did for us was they put us in long white coats. Duke was at the time a very hierarchical
place--and a long white coat implied that you were either a fellow or you were a member of
the attending staff, that you weren't an intern and you weren't a junior resident. The
residents, of course, knew who we were, but in many instances the nurses didn't know who
we were. Their assumption was that we were either fellows or very young-looking junior
attendings, and they never, they didn't trifle with us as much as they did with some of the
guys that came a little later, when the new Director put the guys in short coats with a
distinctive program patch.
Every once in a while the nurses would try and be unpleasant, but the hospital was big
enough, and there were enough people in flux, that we could pretty well ignore them.
Plus, we had a couple of nurses who worked for the program who did some of the teaching
William Stanhope Interview, May 28, 1998
24
and, in retrospect, were doing some down field blocking for us, keeping a lot of their
colleagues out of the way.
Another thing that people don't appreciate is that in the 1950s and 1960s, the physician in
the American hospital truly was an all-powerful figure--to the extent where the nurses
would stand up when the senior doctors would come on the floor and, in fact, would not
only stand up but would actually offer them their seat. And Stead was the Physician in
Chief at Duke University Hospitals and just wielded incredible power--power that you
couldn't find replicated in any hospital that I know of, any place in the country today. I
mean, absolute, damned near absolute power, and my hunch is that it had been made pretty
clear that there would be some tolerance of chatter but not a lot.
BW: You mean chatter from nurses?
WS:
Yes, chatter from nurses. I mean, every once in a while they'd really try and bust your
chops, and they would out-and-out refuse to do something. We had all been around long
enough and knew how to play the game well enough that we could turn around and get the
physician to go tell them to sit in the corner and be quiet. I mean, that's a game we learned
in the Army. The nurses were always, always trying to bust our chops in the operating
room. They hated it and just would go ballistic when the surgeons would ask us to be their
surgical assistant--because it meant ultimately that she (the scrub nurse) would be doing
what we asked instead of our doing what she told us to do. You have no idea how berserk
William Stanhope Interview, May 28, 1998
25
they'd get. When they got real nasty, we'd just turn around and set it up so that they'd tell
us to do something when the docs had just told us to do something else, and basically we'd
turn to the docs and they'd crush them like a bug. So, we knew how to play the games and,
if we had to, we carried those over to our experiences at Duke.
BW: And who was teaching the courses at Duke?
WS:
Really senior members of the Department of Medicine were our primary teachers, and
there was a nurse that did some teaching for us. She taught us how to read EKGs and
that's pretty much what I remember their input being. Ours was the last class that they had
nurses teaching, because, as corpsmen, we balked at nursing involvement in our physician
assistant program.
BW: Yes. Let's just take that as a tangent just for a moment here, because that was one of the
questions that I had, reading the material, was why the nurses were not seeing that this was
an opportunity that they ought to be taking, to step up to this . . .
WS:
Well, I think you need to ask Dr. Stead this, and I think you ought to make . . . I assume
you've got a pencil and a piece of paper handy.
BW: Oh, yes.
William Stanhope Interview, May 28, 1998
WS:
26
I really think you ought to ask
Dr. Stead this. The story
is--and I've never asked to
confirm this--but the story
that I have, my understanding
is that when Stead originally
decided that his attendings at
Duke needed help with people
who were going to be
permanent and who were not
going to roll in and out every
year or three years, he had his
attending staff train four
nurses, on an experimental
basis, very informally. Just
basically hitched up four
nurses with four of his
attending staff, and my
understanding was that the
instructions sort of were,
"Let's find out what their
limits of learn-ability are."
William Stanhope Interview, May 28, 1998
27
And there weren't any,
because there's nothing that a
smart young person can't
learn. And he wanted to
formalize that. Stead went to
the powers-that-be in nursing,
both academic nursing and
the nursing service at Duke,
and because they basically
were wrapped up in the
struggle for professional
autonomy that American
nursing was grappling with at
the time, and told him to take
a long walk off a short bridge.
At that point in time Dr. Stead commissioned Dr. Andrew Wallace to put a study together
to figure out what the manpower alternatives were.
There are some real interesting stories, some folk myth and there's always some folk
reality, and the myth and the reality aren't necessarily the same. Now, the myth has grown
William Stanhope Interview, May 28, 1998
28
that the PA program at Duke grew out of this overwhelming concern for how to provide
manpower to the rural areas, and there's no question that that was part of the concern. But
the other part of the concern was how to find manpower that could work with the
physicians at the burgeoning interface between technology and medicine.
Duke had a very big renal dialysis program and kidney transplant program, and at the time,
in the early 1960s, all of that dialysis equipment and machinery was damned near
home-built. It wasn't quite, but it was just one generation above being home-built and
jerry-rigged. And when you're pumping blood out of a major artery, and pumping it back
into a major vein, if something goes wrong with the pump, you're going to have a lot of
problems. So they needed technicians who could keep the equipment working.
Also Duke, at the time, had the largest hyperbaric medicine research program in the world.
That is a diving program, where you basically take the patient into a big tank and take him
down to four or five atmospheres of pressure and pump in oxygen. The thought was that if
you gave cancer victims their chemotherapy and then put them in an oxygen-rich,
high-pressure environment, it's going to speed up the metabolism of the cell and that's
going to increase the attractiveness of the cell to the chemotherapeutic agent, and you'll get
a better cure. Well, if you're at four atmospheres, you can't just open the chamber door
and walk next door. There were decompression times and tables.
Both mechanical and
medical skills were needed to provide medical/nursing care to the patients in these
hyperbaric chambers while they were down at four or five atmospheres.
William Stanhope Interview, May 28, 1998
29
Duke also had a huge program in cardiac catheterization--Stead is one of the real pioneers
of cardiac catheterization and he had a huge lab program. Well, they didn't have enough
nurses to take care of the patients in the cardiac catheter lab, and the nurses didn't want to
acquire the technical information and the technical skills to invent the couplings and
connectors and technology as they were going along. So there were corpsmen that were
working in those areas, and Dr. Wallace, a young cardiologist, was looking for ways to
stabilize manpower in the cardiac cath program, and was working as a consultant at
Bethesda Naval Hospital at the time where the cath lab was run strictly by corpsmen.
There were no nurses at all in the Navy cath lab.
So in his report he saw the creation of a PA as a way to help deal with the technical
manpower that the evolving healthcare system would need, and the technicians to make all
of these doo-dahs and gee-hahs work. So, we were all trained, as much in technology as
we were in anything else. We actually had courses--which have subsequently long since
been dropped--for example, in medical electronics, because they wanted us to know
something about both the design and how to trouble-shoot some of the electronic
monitoring equipment, for example.
And we had courses in computer technology. Keep in mind, this is 1967 and 1968 and
1969--way before there were desktop computers. We had courses in computer
technology, because they recognized that computers were pretty important in the research
William Stanhope Interview, May 28, 1998
30
projects and they wanted somebody who would learn how to be comfortable with them and
ultimately how to write code and how to fix the damned things. And so we had as much
training in that sort of very high-tech stuff as we did in the primary-care kind of stuff that
subsequently came later. From 1970-1974 Duke experimented with specialty tracks--the
most notable being the training of former X-ray technicians as PAs in radiology.
The training changed in 1972 and 1973, with the first Health Manpower Act, which
pumped money into the PA programs, which is when Duke began to change their
curriculum away from the technology and specialty tracks and more into the primary-care.
My generation of PAs were as well trained in technology as we were in primary-care
family medicine.
BW: Who was the driving force in the development of the curriculum at Duke?
WS:
Well, I think it was probably actually put together initially by Stead, Wallace, and a couple
or three of Stead's senior attending staff. When I arrived, Dr. Harvey Estes had been
appointed as the Medical Director and he was a cardiologist. At the time I was there, he
was just beginning to make his transition from cardiology to community medicine. He
became chairman of the Department of Family Practice and Community Medicine, but it
was Community Medicine when I was there, and then acquired the appellation of Family
Medicine after I left.
William Stanhope Interview, May 28, 1998
31
Shortly before we left, actually about half-way through our training, they hired a young
Family Practitioner right out of the Air Force, named D. Robert Howard, who became the
Medical Director. Drs. Estes and Howard subsequently did a lot of the work that led to the
national institutionalization of PAs. They did a lot of the work on the accreditation and
certification issues and put in the efforts that had to be done to societally legitimize us, and
that was done by a combination of Harvey Estes and Bob Howard.
BW: Now, by the third year of the program at Duke, I would imagine that most of the corpsmen
that were coming out of the military were hearing about this program and being attracted to
it. Would that be right?
WS:
Yes. And if your next question is, "What was the applicant pool like," I never went back
and checked. But by the time we were, you know, our senior year, there were a very, very
large number of applicants per seat.
We had a very interesting project, where the nurses had gotten crossways with both
the Chief of Surgery and the Chief of Medicine over staffing some units, and both the
Chief of Medicine and the Chief of Surgery established their own wards that were taken
away from the Department of Nursing and put under the control of either Medicine or
Surgery, and those wards were run by the corpsmen-candidates to the PA program. And,
in fact, the surgical model lasted for, gosh, it lasted well into the late 1970s, probably
1978 or 1979, before they shut that down.
William Stanhope Interview, May 28, 1998
32
So it went like eight or nine years, where they ran the floor completely with PA program
applicants supervised by a PA from the second class. The deal was, if you came and
worked for a year on this unit and worked out really well, that you were pretty well
guaranteed a seat in the subsequent class. That was real crafty. They had people who
really paid attention and would do whatever it took to get noticed in a positive way by
people who might influence their application to the Duke program, to the PA program.
They ran a couple of floors and, in fact, did so well that it was only after some apparently
really Herculean battles by the Nursing Service at Duke did the units get rolled back to the
Department of Nursing, because the attendings and residents so liked having patients on
this corpsmen-driven ward.
The guys would do anything it took to take care of the patients, because they knew that the
better patient care they provided, the more likely they were to be noticed, and that meant
they were more likely to be given one of the coveted spots in the program. So, if they
called a resident to tell them that somebody was sick, absolutely everything that could have
possibly been done for that patient would have been done by the time they called the
resident, which is not the case on the other floors. So, patients got better care and the
residents loved it, and the attendings loved it, and the program liked it, because it gave
them a way to look at everybody before they took them.
BW: Now, at the end of the eight or nine years, what conditions had changed to . . .
William Stanhope Interview, May 28, 1998
WS:
33
I don't know, because I wasn't there. I'm sure it was just pure institutional give-and-take
politics.
BW: Talk to me a little bit about the ambiance of being at Duke for the period of time that you
were. What was it like?
WS:
At some level it was a real blast, because everybody there had this notion that it was a
teaching institution and that, by God, they would teach. If you wanted to know
something, all you had to do was ask. No matter how complicated the question was, or
how complex the problem was, they would keep going until they could find somebody that
would really help you understand what the problem was. So, if an intern didn't know the
answer, he'd find a resident, and if the resident didn't know the answer, together we'd find a
fellow, and if the fellow didn't know the answer, we'd catch one of the attendings and
would find out either there was a known answer or it was something that people didn't have
an answer for.
It was a place that really was teaching-friendly. The institution has imbedded in the
culture of the Medical School that first and foremost its purpose was to train and educate
people, and patient care and research came second and third. So, from that point of view it
was a wonderful place to be, from the training point of view.
William Stanhope Interview, May 28, 1998
34
Now, from a sort of a what-are-we-going-to-do-with-the-rest-of-our-lives place, it was
pretty depressing, because we were the class that really began to get a lot of attention.
There had been a lot of publicity, a lot of publicity. The lay press just went wild with this
notion of finding a positive use of military corpsmen. It was at a time in this country
where there was a sudden awareness that old Dr. Welby, who had been the black-bagcarrying family doc whose life had been interrupted by World War II and come back home
to care for middle America, was getting old and retiring, and there wasn't a young
Dr. Marcus Welby coming to take his place.
And so there was this huge, huge outpouring of public sentiment about what these fellows
could do--wasn't it great that the kids could go in the Army and come out and have
something useful to do. This is in the early 1970s, when they began to talk about PAs
going into rural practice with old Doctor, you know, old Dr. Smith, who was just barely
away from his horse and buggy--that these young fellows would be coming to town to
work with old Dr. Smith. And people really loved it.
So the lay press was just really hot, and we were getting a lot of attention. It was like
living in a goldfish bowl. I mean, every day there'd be somebody else in the back of our
classroom who'd be looking at us and asking us the same damned questions: "What did
you do before you came here? How does it feel to be a pioneer? What do you want to do
with the rest of your life?"
William Stanhope Interview, May 28, 1998
35
Well, at the time, there weren't laws that specifically accommodated what we were coming
to know as physicians' assistants. Many states had laws that said a physician could
delegate tasks to anybody that he wanted to, and that was his prerogative. But what kind
of tasks could be delegated wasn't defined and issues of money weren't defined, and
Nursing was beginning to poise and posture, you know, about how they didn't like this
idea.
There was a period in time when I certainly became kind of depressed and I would guess
that if we could have tapped into the recollections of my classmates, they would tell you
that at some level they were depressed, because we were convinced that we were stuck in
North Carolina for the rest of our lives, because there weren't laws in other states, and it
didn't look like we'd be able to go any place. So, we had that to contend with: the notion
of thinking that we were having just an absolutely wonderful time and we were learning all
kinds of great stuff and, in fact, there was nothing these guys wouldn't teach us, and that
was just exciting beyond belief.
But at the same time we had all these people coming to the back of our classroom asking us
all of these questions, and a lot of them were fairly negative people, you know, that were
there because they were curious about it and they were there because they were damned
sure that this was a terrible idea and could never work. They wanted to come and get
affirmation for the fact that we were all high school drop-outs, which was part of the rumor
from the nursing community, that we were all high school drop-outs and practically
delinquent sociopaths. And people would come to the classroom and actually come in
William Stanhope Interview, May 28, 1998
36
with those kinds of expectations, that they were going to see a group of guys that all went to
the Marine Corps because the judge said either go to the Marine Corps or go to jail.
It was a wonderful intellectual experience, but from a living experience, we were thinking,
"Holy smokes, what are we going to do about laws in other places, and I want to go back to
New England, and, oh my God, you know, I'll never be able to go home and do this,
because there just doesn't seem to be any way to do it." And that's ultimately why we
formed the Academy, because we wanted to have a voice in how things were evolving.
Are you there, or did I put you to sleep?
BW: No, no, no. [Laughs] Part of my job is not to talk a lot or interrupt you, so that's why
...
WS:
You're good at it.
BW: Well, thank you. [Laughs] When you're meeting and doing an interview like this
face-to-face, why, I give you a lot of support through non-verbal, but it's hard to do on the
telephone. [Laughs]
WS:
I just wanted to make sure I hadn't put you to sleep.
William Stanhope Interview, May 28, 1998
37
BW: No, not at all. Not at all! Were your wife and child (or children, by this point) with you
there?
WS:
Absolutely, absolutely. Yes, they sure were. We were living on the GI Bill plus a
stipend of two hundred bucks a month. In fact, Duke gave us a stipend which was exactly
what they paid the interns, two hundred dollars a month, and all you could eat from the
dining room. When we first got to Durham, we lived out in the country in what's now
Research Triangle Park, which is, if you know the area at all, half-way between Raleigh
and Durham. We lived in this old place that had probably been built right at the turn of the
century, heated with a kerosene space heater.
[End Side B, Tape 1]
[Begin Side A, Tape 2]
WS:
My kids were two and four when we started there and four and six when we left, and it was
their first exposure to day-care. So, they were sick with every bug that was known to
anybody in the state of North Carolina. So my wife was usually home taking care of one
of the sick babies and I was working.
In addition, about half-way through our first year there was this tussle that I alluded to a
few moments ago between the Chief of Medicine and the Department of Nursing, and the
William Stanhope Interview, May 28, 1998
38
Chief of Surgery and the Department of Nursing. What they did was they hired a bunch of
us from our class to provide nursing care nights and weekends on a couple of the wards.
My class was the group that sort of broke into that idea that you didn't have to be a nurse to
run a floor with thirty or forty patients on it; you could do it with people who were or who
had been corpsmen.
So two nights a week I worked 11:00 to 7:00 in the role of a nurse with one of my other
classmates. We'd take having the narcotics keys and being sort of the de facto boss, and
the next night the other one would. So, we did that two nights a week. To make a little
more money, drew blood every morning at 5:00. So, one of us would slip away from our
ward, and one of us would cover thirty patients for an hour while the other one dropped out
to draw blood.
I worked almost the whole time I was in the program. And it was tough. It was really
tough on my family, because I'd work two nights a week and then, depending on which
clinical experience I was on, I'd be on-call and would stay in the hospital one or two
nights a week. When it was in season, there was a night for striper fishing. There'd be
weeks where we'd be in the hospital four nights a week and up on the New River one
night a week striper fishing, and then the rest of the time was for the family.
BW: Anything else along the lines of ambiance of being at Duke? What about having fun?
William Stanhope Interview, May 28, 1998
WS:
39
Yes, we had fun. You know, we were all young guys, we were all, how old were we,
twenty-four, twenty-five, twenty-six. Al Bibby was the old man in our class; he was
probably thirty-three or thirty-four. We all came from the very common experience of the
military. We were all the products of middle-class America, and we were sort of the
10 or 15 percent of kids in the 1960s who were always sort of on the edge of being in
trouble, but not really.
Most of the kids in subsequent classes were in the draft from Vietnam. Most of the kids
that I trained, in my first four years in Oklahoma, were kids who had gone into the service
to be corpsmen because they were getting drafted and realized that if they volunteered as a
corpsman they might have a better life than if they were drafted as an infantryman. The
reason they were drafted is because they often partied their way out of college. They had
then gone in the service, matured overnight, and realized that there was more to do with
your life than drinking whisky and chasing wild women.
We had some absolutely wonderful times, because our class was really pretty cohesive.
We set it up so that whoever got the lowest grades in the quiz, for example, had to buy the
beer for everybody else. And about once a month we'd keep tabs and collect, and get a
half a keg of beer. Now, a half a keg of beer for eight to ten guys was a lot of beer. We'd
usually spend the better part of one whole weekend trying to drink a keg of beer, and we
had a pretty good time.
William Stanhope Interview, May 28, 1998
40
Another thing we did that was a lot of fun was deciding to form the Academy. We did that
in the spring of 1968. I was its first president. There were lots of activities that were
involved in trying to get an organization up and going and get the few people that were
around to make the contributions they needed to make. So that occupied a lot of
recreational time, too, and I really view that--I didn't know it at the time, but in looking
back--that was sort of a recreational experience for a number of us, where we spent a lot of
our time and energy trying to make the Academy something that could grow.
BW: And the impetus for the Academy was?
WS:
The impetus for the Academy was both the number of articles that were beginning to
appear here and there, both in the lay press and in the professional press, about this
character named "physician assistant," and people had all these different views of how we
should be and what we should be and what we should know. And there were people who
held the belief that there were things we shouldn't know, and that was actually a prevalent
belief in the 1960s that a lot of physicians had, that nurses had, too--that you could know
too much, and that if you knew too much, you wouldn't know your place.
Duke was such a wonderful place that the notion there was, well, let's see what the limits of
learning are for these guys. And when we would hear people talk about thinking about
putting limits on what we could learn or what we could do, we realized that there had to be
a unified voice that we could carry to the table. So instead of being talked about in the
William Stanhope Interview, May 28, 1998
41
third person, which was happening all the time, we would be at the table and people would
be talking to us in the first person. And we were just absolutely determined that we would
have our place at the table, that you would not be able to talk about us in the third person,
and you would not be able to make decisions that would affect my ability to do things to
take care of people. You would not be able to say, Well, I decree that PAs can't do a
lumbar puncture, or can't put in a central line, or can't put in a chest tube, or can't work in
the emergency room, or can't do this or that, without having had an awful lot of pretty
serious dialogue with one of us who were taking an exactly opposite point of view.
BW: Now, is this in reaction to conditions at Duke, or what you perceived as being likely to
occur outside of Duke?
WS:
No. It wasn't really . . . Now there were some issues at Duke, they had more to do with
how we thought the program ought to look. So, there was a little impetus at Duke, in
terms of thinking about things that we really wanted the program to do to change. But
most of it was in response to external forces.
If you remember, I said there were always people who were in the back of the classroom.
I mean, without exaggeration, I don't think a week passed that we didn't have some
delegation from some place or some person from some place sitting in the back of our
class, sort of watching the goldfish swim by.
At the breaks we would talk to these people
and, as I said, a lot of them would, they would all start with the same inane questions, and
then move on and either be really pro the concept or it would be clear to us that they were
William Stanhope Interview, May 28, 1998
42
really anti the concept. They were there to see just what this dangerous new person was
being trained to do so they could make sure that that didn't happen in their state or
community or whatever. About three-quarters of the people were positive, and about a
quarter of the people were negative. We were beginning to see stuff creeping up, letters to
editor and occasional articles here and there coming out, talking about this new thing called
a PA.
We, the group of us, were just absolutely determined that folks would not be able to talk
about us in the third person. If you were going to talk about us and you were going to
decide who we were and what we could do, then you, by God, were going to have to do it to
our face and not as some anonymous somebody-or-other making these decisions without
ever having met us and without ever having worked with us and seeing what kinds of
things we could do.
BW: So as a beginning organization, I could see how you would organize yourselves internally.
But what was your interface, then, with forces beyond the organization?
WS:
Well, as soon as we were organized, we immediately began to let the administration of the
program know that we expected to have a place at the table when the decisions were being
made about what the education would be standardized to look like and what the roles and
functions would look like. And if there was going to be discussion about legislation, then,
by God, there was going to be one of us present. And if there was going to be discussion
William Stanhope Interview, May 28, 1998
43
about standardizing the training, then, there damn well ought to be people who had been
through the training present at whatever level, state or local, state or nation, where those
discussions were taking place. And very early on, I mean right from the initial moments
of incorporation, it was clearly our intent that we would be the voice that was dealing with
organized medicine and talking about who PAs were and what they could do.
BW: Did you see this at first as exclusively a Duke/North Carolina kind of thing, or were you
already . . .
WS:
Well, the MEDEX program had started in Seattle by the time we organized, or there was
rumor that it was getting ready to start, and Hu Meyers, who started the PA program at
Alderson-Broaddus, had announced that he was starting the program and folks at Emory
were going to start a program. As soon as we heard of another program actually starting,
we immediately did everything we could to contact the students who were at that program
and say, "Hi. This is who we are and this is what we want to do and we need your help."
Now, interestingly enough, the people at the MEDEX program in Seattle thought about
their training model as a very different education model. Although nobody will talk about
it today, the fact of the matter is there was actually some intellectual antagonism and the
people in Seattle would never pass our letters on to the students so that we could
correspond directly. It was actually a couple or three years before we had real contact
with the PA students in Seattle.
William Stanhope Interview, May 28, 1998
44
And as soon as I met Hu Meyers, we went right up to West Virginia and met with the
students in their first year and convinced them that, by God, it was in their best interests to
join this fledgling academy of physician assistants and support us as students.
BW: Are you talking about going up there, to West Virginia?
WS:
Yes, and the roads between Durham, North Carolina, and Philippi, West Virginia, were
just two-lane miseries in the late 1960s. It was an awful drive which took about eight
hours. There were no expressways at all; it was all two-lane road.
BW: Describe just a little bit the dissemination of the concept of the physician's assistant,
because you're talking now about it. Was this a spontaneous outgrowth in Seattle, or a
spontaneous one in West Virginia, and things were going on in Colorado and so on and so
forth?
WS:
I think it was actually spontaneous. Henry Silver, the pediatrician in Colorado that started
the child health associate program, which is a PA training model that focuses just on the
specialty of pediatrics. Silver, in the early 1960s, had become interested in the public
schools as a tremendous public health vehicle, and realized that there were lots of health
issues that the children were bringing to school that were going unrecognized. He worked
with some people at the Colorado University Nursing School to train nurses specifically in
school-health issues, and he realized that that was really working well and, again, went to
William Stanhope Interview, May 28, 1998
45
the nurses and said, "Listen, there are terrible pediatric problems in this country,
ambulatory pediatric problems: Kids are without immunizations and blah, blah, blah."
And Nursing picked up the pediatric nurse practitioner model out of Silver's desire to train
people for the public school system, and then they promptly threw him out. As soon as
they got it started, they said, "Dr. Silver, we don't need doctors to tell us how to take care of
children, and thank you very much for the ride and don't come back."
So Silver then decided that he would create something analogous to Stead's PA program,
only he would do it focusing just in pediatrics, and he would do it with a little bit different
model. Dr. Richard Smith was in Seattle, with a background in public health. He was
very aware of the health needs of two subsets of our population: the inner city poor and
the rural poor. And Dr. Smith had worked with some Navy corpsmen some place along
the line and realized that if he gave these guys a little training, they could do a lot to help
the family docs in the inner cities and the rural areas. The Smith model developed
spontaneously.
And then, if you were to look back, you would find bits and pieces in the literature, that
people in diabetes were thinking about training PAs just to manage the diabetic patient, and
people at the Cleveland Clinic were training PAs just to assist in the operating room, and
the urologists were saying, “You know, our endoscopic instruments are complex and
complicated, and wouldn't it be nice if we had somebody who was a technician who could
take care of the instruments and help us in the operating room when we needed help?”
William Stanhope Interview, May 28, 1998
46
So, there was talk of somebody trained just in urology, somebody trained just in
orthopedics, and just in anesthesia, and all these sorts of things. Every time we'd hear
about one of these programs starting up, we would immediately try and contact the
program to contact the students to let them know that there were others like them some
place in the country who were really struggling to bring our voice to the table.
BW: Did you all have a problem with the degree of specialization that was taking place, or was
that just fine?
WS:
[Sighs] Some people did and some people didn't. I've never viewed that as a problem.
Now, if you go back and look at the historic literature, there was a piece that was published
by the National Academy of Sciences, either 1969 or 1970. The National Academy of
Sciences was the umbrella organization that eventually spun off something we now know
as the Institute of Medicine. Stead was very active in the National Academy of Sciences,
as were many of his senior clinicians. In 1968 and 1969 and 1970, as all of these different
sorts of models were being talked about in the lay press and were talked about in the
professional press and were talked about at organizational meetings--it become clear that
there was a potential for this to just become the perfect metaphor for the Tower of Babel. I
mean, everybody talking about all different sorts of models, training models, and
utilization models with no standardization..
William Stanhope Interview, May 28, 1998
47
Stead convinced the National Academy of Sciences to come up with a position paper, and
that position paper laid out three different kinds of PAs and they used a nomenclature
system that was, in retrospect, unfortunate. They had people who were Type A PAs, Type
B PAs, and Type C PAs. Of course, being the products of a hierarchical society, the
people who were labeled Bs and Cs didn't like that and did everything they could to undo
that recommendation. Coming from Duke we were, of course, the stereotypical type A, so
some of my colleagues thought that was just absolutely perfect and right on.
I kind of thought, actually, that it was divisive, and didn't like it, and took a very strong
position very early on that we, the PAs, had to recognize that we had more in common than
not, that there were more similarities than dis-similarities in our goals, and that the
Academy needed to work hard to be the voice of anybody who had been formally trained as
PAs. The other issue that was happening, that has completely slipped everybody's mind
right now, is that many, many, many, many physicians--particularly physicians in the rural
parts of America--had somebody that they had trained as their assistant. Bob Papaioanou,
the fellow that I mentioned that encouraged me to go to Duke, was in reality training me to
be his assistant and, had Stead not come along, there's a reasonable chance that I might
have worked for Bob for five or six or seven years as his assistant, having been informally
trained. Every time I learned something, every time Bob taught me something, he
immediately put that training into action. So, if he taught me something about geriatrics,
he then had me doing more nursing home visits. If he taught me something about how to
William Stanhope Interview, May 28, 1998
48
look at EKGs, he immediately had me using that information. And had Duke not come
along, I might have been one of those informally trained assistants.
So there was this huge cadre of people who had been informally trained, and there was
suddenly a question of how to include them in this lexicon. And as there was beginning to
become a clamoring in the legislative bodies as to how to deal with this issue, how to deal
with allowing physicians to have formally trained assistants work for them, one of the
things that was always a sticking point in the early legislation was, How are you going to
accommodate Eddie So-and-So, who has worked for old Doc Smith for lo, fifty years, or
you know--I'm making it up, but--who has worked for Doc Smith for twenty years and is a
faithful and loyal assistant who really does carry the water when the Doc is out of town?
And that was problematic.
So one of the issues that we had to face as an organization was how to deal with the people
who were informally trained, in addition to trying to decide how we would deal with the
people who were formally trained but had come out of a specialty program like the Silver
child health associate program, who were "the Type B PAs," and how we would deal with
the people who were coming out of Dick Smith's MEDEX program in Seattle, who were
recognized as the Type C PAs.
BW: How did you resolve the informally trained assistant situation?
William Stanhope Interview, May 28, 1998
WS:
49
We just kind of marched on; while for the moment it was a very real problem, the position
that we took was, it's a time-limited phenomenon. The issue sort of came to a head in
1973, when the first national exam was offered. There were ways that people who were
informally trained could sit for that examination. What we said was, if you were
informally trained and you sat and passed that examination, then you could join the club.
If you were informally trained, took the exam and didn't pass it, you couldn't join the club.
If you were formally trained, you could join the club whether or not you passed the
examination. And that's how we dealt with it. We recognized that it was a time-limited
phenomenon, that sooner or later we would run out of people who were informally trained
who had passed the examination and that there would never be very many of them to begin
with, so if they can pass the test, bring them into the club and just forget about it and march
on. Don't perseverate on it. That was sort of the position that a group of us took. It was
thankfully the position that prevailed.
BW: Now, you've covered the place at the table matter and this one about informally trained
assistants. What were some of the other issues that you addressed in the early days?
WS:
Well, one of the issues that was very problematic was that there was a lot of opposition to
our organizing. There were people at Duke who were unhappy that we were organizing.
As I got to know some of the people who were active within organized medicine, both at
the state level in North Carolina and West Virginia and Oklahoma, and in Chicago at the
AMA--there was a lot of concern about our organizing. Remember, the 1960s were very
William Stanhope Interview, May 28, 1998
50
conservative times in the United States. We were coming out of a period of political
conservatism.
One of the things that people were continually cautioning us about was, “Don't become like
a union.” “Don't unionize.” “Don't organize to unionize.” “Be careful how you present
the voice that you want to have.” “Don't let people perceive you as being pro-union, or
they will crush you like a bug and, in doing so, they'll pretty well ameliorate or crush the
PA movement.” So, there was a lot of that. There was a lot of concern that we would
organize and become unionist or, even worse, that we would be uppity and not know our
place.
And, in fact, there was a lot of discussion--all the time there was discussion about place and
where our place was in the medical hierarchy, and where our place was in terms of what we
could either do or what privileges we were seeking, what we were seeking to do. There
would be physicians who would basically want to bring a PA into their lives as equal
partners, there would be physicians who wanted to make certain that we were respectful of
our place, and there would be discussions from both sides.
In fact, at my first job in West Virginia, one of the first role socialization issues that I
confronted came up because I had the temerity to sit at the dining room table in the
hospital/clinic cafeteria reserved for doctors. I actually sat at the doctors' table and talked
to the doctors during lunch time! The administrator of the clinic and a couple of the
William Stanhope Interview, May 28, 1998
51
nurses went out of their way to tell me that I was really transgressing place and had
committed heinous social faux pas by sitting at the dining room table with the physicians.
These were the same physicians that I had been in the operating room with all morning
long, standing directly across the table from them, helping them do whatever operation
they were doing and, in a couple of instances, Meyers actually had me do the operation and
he assisted me. So, having been in the operating room, repairing a hernia or pinning a hip,
I had no tolerance for the notion that I couldn’t sit with the physicians at lunch.
There were lots and lots of discussions in the early days about place. Some sophisticated
cultural anthropologist would talk about role and socialization, but I prefer to just talk
about place, because I think it's a little more graphic. And that's really what people were
talking about was: Know your place. You can't sit with the docs. You're not a
physician. Don't be uppity. Know your place. Don't try and act like somebody who can
sit on the front porch. I sort of use the back porch or the back of the bus analogy. It was
okay for us to, using the metaphor of the old Southern domestic, it was okay for us to wet
nurse the children, i.e., it was okay for us to stay up all night taking care of really sick
people, but by God it wasn't okay for us to sit on the front porch with the master and enjoy
a mint julep.
BW: For the record, did you change your behavior, or did you continue to . . .?
William Stanhope Interview, May 28, 1998
WS:
I didn't change my behavior.
52
My basic approach was: Listen, I tell you what. When
Dr. Meyers tells me that I can't sit at the table and have lunch with him, I'll no longer have
lunch with him. What I didn't tell them was if he told me that, I'm out of here. But I just
said to them, “You know, I acknowledge what you're saying, however I don't accept it, and
when Dr. Meyers tells me that I can't sit with him at lunch, I won't sit with him any more,
and until then I'm going to sit wherever I God damn well please." No, I never changed my
behavior and viewed the acquiescence to that sort of place as untenable, intolerable, and
not acceptable.
[End Side A, Tape 2]
[Begin Side B, Tape 2]
BW: Okay. Just back up to where you started talking about the three other organizations.
WS:
Sure. There were three other organizations that popped up between 1969 and 1971, and
the presence of those organizations made it possible for organized medicine and everybody
else to keep us from having a place at the table. And the way they did that, particularly the
AMA, was say, “We would give anything to have PA representation at all of these
meetings. However, we're not sure who speaks for the PA community, and since we're
not sure, we're not going to have anybody at the table.” So, we then had to deal with these
other organizations.
William Stanhope Interview, May 28, 1998
53
One of them was backed by the AFL-CIO. As I started to say before we flipped the tape,
there was in the Maritime Service, and there still is, I suppose, something called the purser
pharmacist mate. This is an officer in the Maritime Service who was the purser, who
basically looks after the cargo and all of the monetary transactions of the vessel, and also
takes care of anybody who gets sick. Any merchantman who gets sick while the vessel is
at sea is the responsibility of the purser pharmacist mate. The training program for them,
as well as the medical facilities for them, were based at the old Staten Island Public Health
Service Hospital, which was responsible for providing care for the merchant
fleet--basically for anybody in the Maritime Services who was north of, probably north of
Philadelphia, all the way up into the North Sea and over to England. So if somebody got
sick, the purser pharmacist mate would get on the radio and talk to a physician at Staten
Island, at the Public Health Service Hospital, and they would tell them how to take care of
them.
Well, the purser pharmacist mate community decided that they would start a program just
to train more purser pharmacist mates, and that was started at the U.S. Public Health
Service in Staten Island. They had already been up and going. I mean, they had been
training people since World War II for this role, the purser pharmacist mate role. When
the PA business came, they converted those guys, the Maritime union still called them
purser pharmacist mates, but the people at the Staten Island Hospital, who were responsible
for training them, began to call them PAs, and the AFL-CIO subset which was controlled
William Stanhope Interview, May 28, 1998
54
by the pursers and the purser pharmacist mates decided that they would lay claim to being
the voice for PAs.
We recognized that we couldn't tolerate that for two reasons. First of all, we weren't at
their table and, secondly, we absolutely couldn't let them become the voice, because they
were controlled by a union and organized medicine had made it very clear in private
conversations that there was no way they would ever deal with a union.
Then there was an organization that was formed by people who had trained at the
Cleveland Clinic program, and then there was another organization that was purely
proprietary. Anybody who wanted to call themselves a PA could write to this character
down in Florida and send him a check with a letter saying that you worked with a doctor in
any kind of setting and, without any sort of training or credential check, why, he'd send you
back a plaque you could put on your wall. In fact, we actually had one of the guys' dogs
join his organization, just to make a point.
So, we had to find a way to ignore the purser pharmacist mates, a way to discredit this guy
who was running a purely proprietary organization in Florida, and a way to convince the
folks from the Cleveland Clinic that they needed to merge with us. So, by 1972 we had
had a bunch of meetings with the Maritime guys. I stand six feet and when I'm not quite as
fat as I am right now, I usually weigh about 210 pounds, and I felt like a midget when I
would go talk to those guys. I mean, I had to look up to everybody in the room. They
William Stanhope Interview, May 28, 1998
55
were all six feet five inches, huge, burly guys. We just decided we wouldn't deal with
them. We just ignored them. Whenever we were asked, we just said, "Listen, they're
backed by the AFL-CIO and we're not really interested in becoming unionized. It's not
our role to unionize the profession."
So that took care of them. People pretty quickly realized that Paul Palice, down in
Florida, was a person without much character or credit. And for the group from Ohio,
who were also people who had been formally trained, we basically met with them in 1972
and said, "Listen, you guys are really in a wonderful position. You tell us what it's going
to take, and we'll do it. If you want a seat on the Board of Directors, or a couple seats on
the Board of Directors, you can have them. Whatever it is you want, you can have, as long
as you'll throw in with us. And once you come in under our umbrella, then we truly will
have just one voice." And that happened. We convinced them to fold in with us.
From 1972 on, we--the American Academy of PAs--have been the voice of the profession.
It actually took, in retrospect, a bit of struggle to get to that position.
BW: What about legal issues?
WS:
Duke was very much in the fore of dealing with the legal issues. Duke has a Law School
that's every bit as good as its Medical School. And they had some really pretty good legal
minds, a fellow named Clark Havinghurst being one of them, who identified Nathan
William Stanhope Interview, May 28, 1998
56
Hershey from the University of Pittsburgh being another. They ran a couple of
conferences, 1968, 1969, and 1970, where they really explored developing model
legislation that would be the way to handle the right-to-practice issues which we were
facing.
BW: So the AAPA was not dealing directly with that. Is that what you're saying?
WS:
Well, members were. One of our early members who was, in fact, a classmate of mine
named Carl Fasser, stayed on the Duke faculty and was the PA that was working for Bob
Howard and Harvey Estes as they were dealing with these issues. Carl was our voice on
those issues.
BW: Now, account for me, you took a leadership position, I gather. I mean, you were the first
president, you were leading the movement to create the Academy? Would that be correct?
WS:
Absolutely.
BW: Right. And why were you the one out in front?
WS:
I don't know. I mean, I really don't know. I don't mean to be abrupt or flippant. There
were an awful lot of guys, particularly in my class, who are real leaders and have real
leadership potential. My class, the third class, was the first class of PAs at Duke to really
William Stanhope Interview, May 28, 1998
57
organize itself as a class with the realization that if we wanted to effect change in how the
program was going, that the only way we could do that was to speak with one voice. As
the class got organized, the other fellows who were potential leaders and who are very
much real leaders in their own right, were probably smarter than I was, in retrospect,
decided to sort of drop back a half a step and let me sort of stand in front and take some of
the hits. I have classmates, three in particular, who also went on to become presidents of
the Academy and very much leaders of the profession in the early days.
BW: Because you worked as a group, it wasn't a hierarchical type of thing at the beginning. Is
that correct?
WS:
Well, we needed somebody who would address programmatic issues on a regular basis and
who was not intimidated, and that was me. And so, I guess it just sort of evolved from my
position of leadership in the class to being the person who was the first president.
There was actually a fellow, Richard Soheebe, who graduated by the time we had
incorporated, who was everybody's version of a leader. Dick, in retrospect, really should
have been the first president of the Academy, but he had just left Duke to go into private
practice, in Durham, and wanted to put all of his energies into making his position in this
private practice work. And so, when it came time to decide who was going to be the first
president of the Academy, Dick couldn't do it because he had joined this practice, so it fell
to me.
William Stanhope Interview, May 28, 1998
58
BW: So, describe your tenure as president.
WS:
Well, we met on a pretty regular basis. The first part of the tenure was taken up in just
doing basic, basic, basic organizational things, like making certain that the bylaws were
flexible enough that they would both allow and foster virtually unlimited growth, and
doing all of the sort of things that you have to do to get any club started: Making sure that
we had letterhead and we had an address, and we were developing issues that we would
come to be one voice about, and trying to decide how we would respond to various issues.
Dr. Estes was our mentor in all of those endeavors. He loaned us the six hundred dollars
we needed as the fee for the lawyer and the fees to the State of North Carolina to
incorporate. Had it not been for Dr. Estes it would have taken us longer to get the
Academy up and going, because it would have taken us longer to accumulate six hundred
bucks. He, as a Department Chairman, came up with a loan of six hundred dollars so we
could incorporate.
So, we were dealing with internal organizational things. At the same time we recognized
that we could not let organized medicine think that we were trying to work outside of their
spheres of influence. What we did was as soon as we incorporated, we set up some liaison
positions and Dr. Estes found somebody from the North Carolina Medical Association who
would meet with us as an advisor. The advice that we were always seeking was, what can
we do to establish relationships with organized medicine, what can we do to maintain a
William Stanhope Interview, May 28, 1998
59
positive relationship with organized medicine, what can we do to overcome the negativity
that a lot of vocal members of organized medicine had and directed towards us.
There were a lot of people who did not think the idea of a formally trained physician
assistant was a good idea. They were the people who would talk incessantly about place,
for example, and they really thought it was a very bad idea for medicine to teach someone
other than a physician how to take a history or to let somebody other than a physician
examine a patient, actually do all of the elements of the exam, not just the vital signs, which
the nurses had always done, but really teach about different heart sounds and how to make
a diagnosis of all of these different disorders. There were people that didn't like that. So,
we were seeking advice and counsel from proponents within organized medicine as to how
to overcome some of that negativity.
At the same time, we had to learn a lot of things. We realized, as it became clear that there
was going to be some sort of structure put to the issue of who becomes a PA and what the
training programs are going to be like, we wanted to have a voice in that process. We
recognized that in order to have an effective voice, we had to learn what the process was
and how it was governed and what the laws were about accreditation. If we were going to
have a reasonable voice in the practice acts--what PAs could and couldn't do in
practice--we had to learn something of the law behind state regulatory agencies and how
the practice laws were written and passed. Very early on, starting in 1970 and 1971, we
William Stanhope Interview, May 28, 1998
60
began to clamor that the physicians we worked for should receive reimbursement for our
services.
By 1972 we were meeting with people from the U.S. Senate Finance Committee. We
realized that to talk to the committee staffers about Medicare and Medicaid coverage, and
Medicare and Medicaid reimbursement, we had to learn a lot about the Medicaid laws and
the Medicare laws, and we had to learn a lot about the Senate Finance Committee, and we
had to learn about the role of staff on the Senate Finance Committee. The Interstate and
Foreign Commerce Committee was the one on the House side which dealt with all of the
health legislation. They have a health subcommittee and we had to learn who those
players were and what they were doing.
So we were busy learning all of those things so that we could represent the Academy
externally and we could continue to insist that we would be involved in the accreditation
process, and we would be involved in the examination process. We would be involved in
speaking to state legislative bodies about who we were and what we could offer to the
people of the state when the state legislative bodies were thinking about practice laws. So
the people who were active in the Academy in its earliest days were continually
challenged, to learn about a lot of things we had never even thought of or never been
exposed to, and we realized that if we didn't learn those things, we would not be able to be
effective and responsible spokespeople for our emerging profession.
William Stanhope Interview, May 28, 1998
61
BW: How were you able to balance those activities with fostering your own careers?
WS:
Well, most of the people who were the activists all ended up in academic centers. One of
my classmates, a fellow named Tom Godkins--who went on to be also twice the president
of the Academy and once the president of the Association of PA programs--went to the
Mayo Clinic right out of PA school, and then joined me at Oklahoma about a year later.
Another of my classmates, a fellow named Roger Whittaker--who also went on to serve as
president of the Academy--went to work for Western Electric in occupational medicine,
and I recruited Roger away from Western Electric after a year, and he came down to work
for me. Then the third classmate, a fellow named Carl Fasser, stayed at Duke for about a
year and a half and then was recruited down to Baylor College of Medicine by a fellow
named MacIntosh, who had been Chief of Cardiology at Duke, to start the PA program at
Baylor.
So by 1971, three of us, and by 1972 four of us, were anchored at academic centers that
were really pretty supportive and pretty permissive. And there was a guy in the class
ahead of me named Paul Moson, who ended up coming to Yale in 1970, late 1970, early
1971, to start the Yale PA program. Paul also had the support of his institution, since they
were starting a program.
What we did basically was we took the position intellectually that since the school is
starting a program, anything that has anything to do with PAs is a legitimate expense and is
William Stanhope Interview, May 28, 1998
62
of legitimate concern to the PA program director and his colleagues. So we were using
secretaries that the University provided to support the training activities, we were using
those secretaries in any PA activity, which included the Academy. And if we had grant
funds to support the training program, we again took the philosophical position that
anything we did to further the PA program was an appropriate expense under the grant,
since the purpose of the grant was to train PAs. Basically with those very, very liberal
interpretations of the use of resources, we did whatever we thought needed to be done to
build a stronger profession.
BW: When was it that you felt that the profession sort of moved beyond what you might call a
kind of state of siege on a number of fronts: The nurses, the AMA, so on and so forth.
When did the plane come out of the clouds and into the clear?
WS:
Well, even today I don't think we're flying in absolutely perfectly calm skies. I mean,
there's always been some turbulence. Some of it has been clear air turbulence and some of
it's been turbulence to the point of challenging--if you want to use flying as a metaphor--of
trying to put a fast mover down on the deck of an aircraft carrier in the middle of a blizzard
in the North Atlantic, when visibility is zero-zero and the wind's about fifty miles an hour
across the bow. And we still have, on occasions, that kind of weather. We haven't had
that really miserable North Atlantic storm-like circumstances except for bits and pieces,
since probably 1975, 1976, and 1980, 1981.
William Stanhope Interview, May 28, 1998
63
Actually, by 1978, all of the structural elements that are today recognized by the young
graduates were in place for us. There were laws in most of the states. They were
primitive laws at the time, but nonetheless there were practice acts in most of the states.
Probably thirty-five out of the fifty states had some sort of certification of PA activities
embedded in the practice act by 1978. Most of the first- and second-generation training
programs had been established by then. The Academy was very well established and
absolutely recognized as the only voice of the PA community. There was a nationally
recognized examination and there were nationally recognized standards for the programs
that defined PA education.
Now the time that I was actually the most worried was in 1980-81 with what was called the
GMENAC Report, which was the Graduate Medical Education’s National Advisory
Committee Report. In late 1978 and 1979 they had a series of meetings and came out
publicly stating that at the turn of the century we were going to have too many physicians.
The committee recommended national manpower activities which would cut back on the
number of physicians that were being trained. They also recommended a need to stop
funding PA and nurse practitioner programs. The amount of federal funds that were
flowing to the PA programs damn near stopped. We came within a breath of, came within
one absolutely unexpected, totally unforeseen, fortuitous meeting from being, unfunded by
the Health Manpower Training Act. That meeting took place between Dr. William
Wilson, the Associate Director of the Utah Medix Program, and Dr. Davis Summall, who
was a congressional staffer.
William Stanhope Interview, May 28, 1998
64
A lot of the programs that had been weak siblings closed down in the 1978, 1979-1982
period, and a lot of classes got programs scaled way back in the number of people that they
were taking. They cut the numbers of students that they were taking in by 30 to
50 percent. That was a very tough time for us. It was a very tough time for the
profession. It was probably the scariest time. That is what I would have called
absolutely clear air turbulence, because when you were looking around, everything looked
fine, and all of a sudden bang, the bottom dropped out and--to use the airplane metaphor
again--you fell about fifteen hundred feet in a second. That was a very bad time for the
profession, I think, and something that took us a long time to recover from.
BW: Who would be an authority to speak, I know you are, but I mean who sort of lived through
that . . .
WS:
Harvey Estes would, I think, be an authority. Dr. Estes. You're going to just absolutely
love interviewing him. First of all, he is the quintessential, absolute gentleman. He is
wonderful. He's a scholar and a gentleman, and really has a very, very broad sense of all
of these events and a good sense of, sort of, the PA profession and its evolution and its
place in the history and evolution of American medicine.
BW: I'd like your take on the 1980 issue. Was it that the government projections were wrong,
or how did you find lift again?
William Stanhope Interview, May 28, 1998
WS:
65
Well, I don't think the government projections were wrong. I think, from a social and
social-anthropological point of view, we do have too many, and certainly from the position
of a health economist, we certainly have too many physicians in this country. We don't
have, in my view, anywhere near enough PAs. That sounds a bit ludicrous, but I would
say you need to back up and understand the principle, Adam Smith's principle, of labor,
you know, the division of labor. Smith used the metaphor of the manufactory of a
common pin.
Medicine has never really taken to and organized itself around the concept of the team
delivery of healthcare, based upon a true division of labor. In such a system that we would
seek production from the most competent, least cost kind of person, and put the most
expensive person to doing only those things that the most expensive person can do. The
person whose labor costs us the most will absolutely not be allowed to do things that can be
delegated safely and properly to other people. We've never done that, from an
organizational point of view.
We have in the military. We do it pretty efficiently and effectively, particularly in the
Army, to a lesser extent in the Air Force, and to a much lesser extent in the Navy. But the
Army has done it really quite well, the Air Force medium well, the Navy not very well at
all; some hospitals within the VA reasonably well, and some of the HMOs reasonably well,
in terms of this division of labor.
William Stanhope Interview, May 28, 1998
66
If we really divided labor properly, we'd have far fewer physicians and a lot, lot more PAs.
Some elements of the managed care community, I think, are beginning to recognize
that--so that we're beginning to see a demand for fewer docs and more PAs, because they're
so much cheaper.
BW: Going back to your tenure as president, you were at Oklahoma during that whole period?
WS:
No, I was at Duke, well, let's see. . . We started in 1968, in the spring of 1968. So, from
the spring of 1968 to the summer of 1969 I was at Duke, as the president, and basically we
were struggling to reach out, and struggling to contact the people in West Virginia and the
people at Washington, and the people at Denver. Then I moved to Alderson-Broaddus. I
was at Alderson-Broaddus from the summer of 1969 until the summer of 1970--just about
a year at Alderson-Broaddus. I finished up my term as president, as I recollect, just before
I moved to Oklahoma to take over and start, or start and grow, the PA program at
Oklahoma. I was out of office for a year. So I served two terms as president; I succeeded
myself as president. Then what I did was I doubled back as secretary and served as
secretary for two years.
BW: Immediately following?
WS:
No, I took a year off. I was out of it for a year.
William Stanhope Interview, May 28, 1998
67
BW: So when Godkins was president, you were secretary.
WS:
Let's see.
BW: 1971, 1972?
WS:
That's about right, actually. I was secretary when Godkins was president. The big issue
at the time was whether or not the Academy would be an inclusive organization . . .
[End Side B, Tape 2]
[Begin Side A, Tape 3]
WS:
There were two very divergent philosophies that cropped up by 1970. One was a group of
people, including Bob Howard--who was at that time the Director of the Duke
program--who very much wanted to see the Academy only represent those people who
were from the "Type A schools." And there was a group of us, myself included, who took
the position that A, B, C, or whatever, we needed to have numbers to have strength. We
needed to represent everybody because we needed the numbers, we needed the money that
the numbers would generate, and we needed the strength that the numbers would generate.
And, in fact, it was a very divisive period. Godkins representing the inclusive, McQueary
on the Duke faculty representing the exclusive, went head-to-head and Godkins lost.
William Stanhope Interview, May 28, 1998
68
So a guy named John McQueary took over from me and basically kept the Academy at
Duke and ran the Academy out of the Duke program, basically with a position that we
would only represent the Type A PAs. In the meantime, Godkins was at the Mayo Clinic
(and we knew that he was going to come to work for me in Oklahoma). A fellow named
John Braun, who was from the class ahead of us, had decided that he was going to run for
president. He basically had the philosophy that McQueary had, that the Academy would
only represent the Type A people. We knew that Godkins couldn't get elected against
Braun, because of his views of the Academy representing the larger number.
Braun worked for the government. At the time he was at the National Institutes of Health,
working in the office that was beginning to fund the PA programs. The manpower law
had passed and money was about to begin flowing to the PA programs. We recognized
that if the question were raised and phrased properly, that Braun would be in a position of
conflict of interest and would not be able to finish out his term as president.
Godkins ran as vice president and as soon as we could into Braun's term, we formally got
the question raised of a conflict of interest. The answer came back as we expected. Yes,
there was a conflict of interest and Braun had to step down. Godkins moved from the vice
president position, which had been not contested, to now all of a sudden being the president
and getting the Academy really to sort of change its focus from an internal focus to much
more of an external focus.
William Stanhope Interview, May 28, 1998
69
I had run as secretary, because I was determined that we would change the direction of the
Academy and take it from an inward-looking to an outward-looking organization. I was
also determined that I would get the question asked of whether or not there was a conflict
of interest for the seated president, so that the vice president could then take over and do
what we thought needed to be done. So we engineered that palace coup and Godkins
actually ended up serving out three-quarters of Braun's presidency.
BW: In a nutshell, what was the conflict of interest?
WS:
That they were going to be funding all these programs, that he worked for the office in the
government that was going to be funding all these programs and at the same time he was
sitting as the president of the Academy which was in a position to benefit indirectly,
because so many of the members of his Board of Directors ran the programs that would be
funded.
BW: Yes. Okay.
WS:
It was one of those things that, sort of, you know, if you say it you believe it. Who knows
if there really was a conflict of interest, but we managed to get the question asked and
answered in such a way that the person we were asking sort of had to say, "Yeah, gee, it
does sound like a conflict of interest to me."
William Stanhope Interview, May 28, 1998
70
BW: Would you briefly review your career from Oklahoma on?
WS:
Yes. I went to Oklahoma in 1970. Started out actually in a faculty track as a clinical
instructor, which was the lowest possible academic rank. By 1978 I had been promoted a
couple of times. Ended up with the rank of associate professor with tenure.
In 1977 I applied for the Institute of Medicine's Robert Wood Johnson Health Policy
Fellowship. Won a place in the fellowship. They chose six mid-career faculty members
from medical schools around the country. I went to Washington as an Institute of
Medicine health policy fellow in 1978, and did that for a year.
During my fellowship, because of my interest and belief that we would ultimately have a
federalized health delivery system, I ended up working in the arena of military medical
care, because one of my classmates had the corner on the Senate Healthcare Committee,
and I didn't want to go on the House side, because it was so disorganized. So I went to
work for a very strong Republican named Robin Baird, who was from Tennessee. He was
the ranking minority member on one of the Armed Services subcommittees and hired me
basically in his office as a fellow to work on the issue of military medicine and to help
Robin--and ultimately the Congress--understand the issues confronting the military
healthcare system.
William Stanhope Interview, May 28, 1998
71
Finished that up. Went back to Oklahoma. Actually wanted to stay in Washington, but
my divorce had been finalized during my fellowship year, and I had custody of the
children. The deal was that I had to agree to return to Oklahoma if I was to retain custody,
or stay outside of Oklahoma and surrender custody. There was no way I was going to do
that.
So I returned to Oklahoma. Went back to the program as the program director, replicated
the health policy fellowship out of the School of Public Health at Oklahoma, and managed
to run several students, both medical and PA students and public health students, through
sort of a mini-health policy fellowship focused on state health issues. That sort of fell
apart when we had a new Dean at the School of Public Health who buckled under some
political pressure from the Director of the State Health Department, who didn't like the fact
that we had given a state senator a very bright doctoral candidate from the School of Public
Health, whose background was in finance and auditing. This kid had gone to work for the
state senator, who was distrustful of the Health Department. [Chuckles] The Director of
the State Health Department went to the Dean and said, "If you don't pull this student,
you'll never again have another student placement occurring any place in the public health
system in the State of Oklahoma." The Dean buckled under the pressure of the bluff and
shut the program down.
I had replicated the health policy program, was doing some other things. After Reagan
became elected, ended up as a potential candidate for a position in the Pentagon as
William Stanhope Interview, May 28, 1998
72
Principle Deputy Assistant Secretary of Defense for Health Affairs. Was all set to move
to Washington right after Reagan's inaugural, but that fell apart because Carlucci, who had
headed up the transition team, had a disagreement with Weinberger and many of Carlucci’s
recommendations were discarded.
So, I stayed at Oklahoma for a couple more years. We had a new Department Chairman
come in, and a new Medical School Dean come in, and it wasn't the environment for me
any more, so I left. I left the program, left the University, and went to work for a
rehabilitation institute for a year. Unbeknownst to us, the owners--which was Hospital
Corporation of America at the time--had decided that this rehab institute would be their
major tax loss. So, although they recruited some really great people--a group of us, three
physicians and myself, had left the University at the same time and we were pretty excited
about developing this wonderful multidisciplinary rehabilitation program--the HCA
wanted to take it as a tax loss. So that never worked out.
Ultimately I ended up making the decision that I would probably leave teaching full-time
and go into clinical practice full-time. So, to do that, I decided that I needed to put myself
back in a trainee situation, to catch up on some of the stuff that I hadn't been paying
attention to clinically, and did a year as a PA surgical resident, at Montefiore, in the Bronx,
in New York.
BW: Which school?
William Stanhope Interview, May 28, 1998
WS:
73
Montefiore Hospital, the teaching hospital of the Albert Einstein College of Medicine.
They had a program there that a number of years ago the Chairman of Surgery had taken
positions that he had for MD interns and converted those positions to being positions for
PAs. You got paid exactly what the surgical interns got paid, and you did everything that
a surgical intern did. The difference was you weren't an MD--and that was the only
difference was the two-letter initial after somebody's name--but the workload was exactly
the same.
So I did that for a year. Finished that experience, which was interesting only because I did
it at 42 and I was [chuckles] working with kids. The other interns were 26 and 27, and
here I was 42. So the hours were kind of tough. The work certainly wasn't tough, but the
hours were kind of tough.
Then when I finished that, concurrently as I was finishing, there was an outbreak of an
antibiotic-resistant Staph infection in the cardiac surgery patients. They felt it was
coming from the operating room. So the hospital decided they wanted to hire somebody
who knew something about operating rooms and something about surgery, who could deal
with the problem, regardless of who was responsible--somebody who could go
head-to-head with the Chief of Surgery or Chief of Anesthesia or the Chief Nurse. They
decided that I was the one that would come in and clean up the operating room. So I did
William Stanhope Interview, May 28, 1998
74
that for about eight months. Basically ran the operating room, as sort of a cross between a
good cop and a Gestapo officer.
Then I ended up, through a set of sort of fortuitous experiences, taking over the Harlem
Hospital PA program, which was one of three PA programs in the country devoted to
training minority students, and those from under-represented populations to be PAs. I did
that for three years. While I was doing that, I was living in Bangor, Maine, and
commuting every week to the hospital. I stayed at Harlem three nights a week and stayed
in Bangor four nights a week.
That got kind of old, so I left that and went to work for myself in Bangor as a freelance
surgical assistant, moon-lighting in the ERs in northern Maine. That lasted for a year.
The person who took my place at Harlem didn't work out at all, so just about a year after I
left, the people at Harlem convinced me to go back to Harlem as the program director. I
did that for another three and one-half years, which had me be the director of the Harlem
PA program for a total of seven years. That was a real blast! Suddenly being a minority
person in an institution like Harlem and being responsible for recruiting and training
under-represented populations in the profession was a wonderful experience. I think that's
probably the second highlight of my career, the first being my health policy fellowship.
The privileges of being at Harlem and working with the wonderful young people I worked
with there was just an incredible experience.
William Stanhope Interview, May 28, 1998
75
In some ways it was the toughest job I ever had, because of the culture of race and racism at
the institutions I was working with. I worked with people from Columbia, which is not a
minority population-friendly institution, and the people at City College, many who could
be characterized as limousine liberals, and then Harlem Hospital itself, which is a pretty
tough environment. So I did that. That was a great set of experiences in many, many
ways.
Then I got recruited from Harlem back to Montefiore to start a Spine Service for the
Department of Neurosurgery. I did that for about two and one-half years. The
Department began to fall apart, both for internal and external reasons. I could see that the
entire complex of the Department of Neurosurgery was going to be changing very shortly
and I surmised that the Chairman would be ultimately dismissed, which he was.
So I left there and got recruited to Quinnipiac College to start the Healthcare Leadership
program. Got it up and started. The president of the College suddenly woke up one
morning and realized that I had expanded the scope of that program beyond his original
vision and would ultimately, if left unmolested, would have ultimately been competing
very heavily with his College of Business, which was running a program in health
administration. The President, I think, realized that we were on our way to pulling all of
the health practitioners out of the College of Business and under the umbrella of this
program, so he decided to close the program.
William Stanhope Interview, May 28, 1998
76
At the end of June I am unemployed. My wife, who has been running the PA program
here, as the program director, has just taken a new job as a program director in Oakland,
California. So I'm managing the house and getting ready to trek west, as an unemployed
significant other.
BW: [Chuckles] Wow! That's interesting.
WS:
Yes. Let me tell you, it's actually weird as hell, because I have never, ever looked for a
job. I mean, Dr. Estes was my mentor at Duke and he's the one that directed me to West
Virginia, and then ultimately recommended and directed me to Oklahoma. I guess I
looked for a job when I competed for the fellowship. The fellowship was a very
competitive process, but that was a volitional competition. Montefiore asked me to
handle the operating room, the President of Montefiore asked me to handle the operating
room. The Chairman of Neurosurgery asked me to join him to start the Spine Program.
The people at Harlem asked me to come to the Harlem program to run it. Now all of a
sudden I'm back to what the 25-year-olds are experiencing: I'm looking for a job in an
interesting market.
[End Side A, Tape 3]