1

                           DR. NEIL C A M A N

                         Dr. Fitzhugh Mullan,
                              Interviewer


Mullan:    It's the 26th of June, 1996, and I'm in the office of

Dr. Neil Calman.    We're on 16th Street in New York City in the
Institute for Urban Family Health.      We'll hear more about that.
I wanted to ask Neil to start by telling me a little bit about
where he grew up and what his youth was like.        There's a big
question.


Calman:    There's a big question.    I was born in New York City,

the oldest of three and then later of five kids, meaning that my
parents had two more children after I was out of the house,
already at college.
       My family moved to New Jersey when I was about four years
old.


Mullan:    When were you born?



Calman:     1949. About a year after we moved to New Jersey (1953),

my father was drafted into the Army.      So    I spent two years in
Virginia on an Army base when I was six and seven years old.           And
then moved back to New Jersey where I eventually graduated from
high school.


Mullan:     In New York, where did you live?
                                                                    2

Calman:   In Washington Heights.



Mullan:   And in New Jersey?



Calman:   In New Jersey, about fifteen minutes across the George

Washington Bridge in Glen Rock.


Mullan:   What did your folks do?



Calman:   My dad's an oral surgeon and took over his dad's

practice who was also an oral surgeon in Washington Heights. My
dad just retired last year.    But he worked there through the
whole transition of that community from mostly a Jewish immigrant
community to now mostly a minority immigrant community, and
stayed in that community the whole time, in the same office.


Mullan:    What about college?



Calman:    I went to college, I went to the University of Chicago

for four years and really loved being in Chicago.     I wanted to
stay there, but couldn't because I was involved in too many
political things in college.     They didn't want me there.


Mullan:   Had you been political before college? What kind of

expectations did your parents give you?
                                                                     3

Calman:   I guess all of my political stuff came from my

grandfather, whose plaque is over there.   My grandpa Maurice
Samuel Calman was a socialist alderman in the city of New York.
Basically, he was an incredibly political person.    He grew up as
a socialist with all of those ideals and everything.    He was an
attorney.   He was an alderman, which people have told me is sort
of the equivalent of what New York's City Council now is.       In
those days, it used to be called the Board of Aldermen.    My
grandfather was also a dentist and a    lawyer.   He had a degree in
agriculture, and he was a three-letter athlete in college.      He
was just one of these all-around incredible human beings and
probably the most influential person in terms of what inspired me
through the years.    He led a very decent life but was always
involved in, inquiries about the bigger picture of what was going
on about everything.   He had a philosophy about everything in the
world that went on.    Nothing just existed as an event.   It always
existed in some context of me having to understand what kind of
world it was that we lived in that allowed this thing to happen.

so,



Mullan:   You knew him?



Calman:   Oh, yes, I knew him very well.   In fact, he died when I

was in my second year of college.    It was a very, very difficult
time for me.   It was really the only major psychological crisis I
had in my life.   It took me a long time to sort out what it was
about, but after he died, it was like there was this huge anchor
                                                                      4

that just got lifted.     It was very, very difficult for me because
I really hadn't realized what a big influence he was on my life.
He was just somebody who lived out his ideals.    His notebook was
filled with stories.     Interestingly, he was arrested a number of
times during the time he was an alderman.     One of his arrests was
for a fake coal crisis that he lived through?     In the twenties
there were huge stock piles of coal and stuff all in outlying
parts of New York City that were being stockpiled by the
companies to drive up prices.    As a result, they were going
through a brutal winter where people in tenements, couldn't get
coal.     He went around and photographed all of these stockpiles of
coal and led this huge protest march in New York.     I mean, that's
just the kind of guy he was.


Mullan:    Did he or your dad or anyone else in your family push
you into dentistry or medicine?


Calman:    Not that I really recall.   My dad seduced me into it,

but he didn't push me into it.    My dad was associated with a
small hospital, which has now been torn down, called Jewish
Memorial Hospital, which was in Washington Heights.     It was a
hospital that took care of all poor people by the time I knew it.
But there was a docctor there named Harry Wallerstein, who was an
oncologist-hematologist. He ran a small research laboratory with
funds that were donated from somebody whose daughter had died of
leukemia that he had taken care of.     It was called the Marsha
Slater Research Laboratory.
                                                                      5

      I don't think that it produced any major, significant work,
but it was responsible for more leadership people going into
medicine than anything else.   Because he ran this program where
any of the staff of the hospital could recommend their children
to come and work in the research laboratory for the summer.      He
literally closed the lab in the summer to run his student program
which he funded completely out of the research monies that he
used to get.   There were always seven, eight, or nine daughters
and sons of people that worked in the hospital that he would run
this research program for in the summer.     It was completely done
on his own inspiration and good will.
      I started going when I was fourteen.   My dad hooked me up
with this program.    I was always interested in science, but my
dad hooked me up with this program when I was fourteen years old.
So   I went there and basically washed beakers and glassware for
the first summer.    The second summer, I got to handle the mice
and inject mice with stuff and do things.    By the time I was
eighteen, which was my senior year, I was the second-in-command
of the student programs.    I was teaching all the younger kids
that were coming up what to do.
      But I'm still in contact with some of the people who were
there.   One of the people is the head of cardiology in a big
Philadelphia hospital.   Another one is the head of OB/GYN in
another place.    I think they were kids who were ambitious as
kids, but also had this opportunity to connect with something
that was very real.    I mean, he would set up a set of
experiments, and we'd spend the first week having to learn
                                                                      6

about--I was probably the only fourteen-year-old in the country
that knew the entire Krebs cycle and every aspect of purine and
pyrinidne metabolism.    I couldn't even tell you about it now, but
I knew every transchemical transformation and everything that
went on, because we had to learn it.    He would force us to learn
the basic science behind the research that we were doing.      We'd

sit in lectures, sometime for hours and hours.


Mullan:    Were religious values part of your upbringing?


Calman:    My mother's father was a cantor, but they were more

cultural Jewish values than they were religious Jewish values.
You know, my grandfather was of the, again, sort of the socialist
Jewish tradition where the most important thing was whether
somebody was Jewish or not.    He knew everybody that was either
half Jewish, quarter Jewish, or an eighth Jewish.    You know,
every entertainer, every everybody.     That was just part of his
values.    But I didn't grow up in a religious Jewish family.


Mullan: By    the time you got to college, you were politically

engaged.    Tell me a bit about that.   Where did that come from?


Calman :     The thing that made me want to go to the University of

Chicago, which was my first choice of schools, was a L i f e
magazine article that ran probably in 1965 or '66, that basically

was about all of the political activity that was going on in the
University of Chicago, about politics, about the school and the
                                                                          7

student body forcing the school to deal with issues in the

community.     It was Black Panther time and everything was going on
in Chicago, Chicago, Chicago.       I said, "Wow, that's the place I
want to be."      So   there was obviously some attraction to this
level of political involvement.       That's my first recollection of
having any kind of real political thought or interest.          It was
probably my junior year of high school.
     One of my babysitters down the block was in graduate school
at the University of Chicago and kept coming home talking about
how exploding it was of a mental experience to go out to this
place and be part of all these things that were going on.          It
just sounded to me like I had to be there.       So    there wasn't any
question at all about where I was going to go to school or what I
wanted to do.


Mullan:   In terms of the University of Chicago, you arrived there

in what year?


Calman:   1967.



Mullan:   Tell me about it.



Calman:   Well, the other major thing about the University of

Chicago is that it's very       big on liberal arts.    Robert Maynard
Hutchings was the founder of liberal arts education.         He was the
first person that really espoused the idea that people shouldn't
go to school to learn what they were going to do in their trade,
                                                                      8

but to go to get a broad education as a human being.    That was
perfect for my eclectic interests.    I took literature and poetry
and music and everything.     I just figured this was perfect.   I
was doing plenty of science in my summer work and everything
else.    This was just like a perfect opportunity for me to kind of
go to a school that was the way I was.
        So I took courses in archeology and did all kinds of great
things.    You could take courses in any division of the school no
matter where you went, no matter what you were doing as a
"major."    You weren't even allowed to have a major until halfway
through your third year.     So it was just a great a great

educational environment.
     But somewhere along, I guess it was along the lines of the
first year I went to school, I got a part-time job working in a
research institute at school.    There was also a group of students
that were beginning to get together there over student issues, a
lot of which had to do with how the school was responding to
political issues that were going around in Chicago at the time.
        I just got very interested in the social issues that were
being talked about in a variety of different places around campus
and everything, and how the school was responding, and what role
students had.     There were lots of incidences of violence on the
campus, a lot of rapes that were going on the campus and things
like that.     It was like a white island on the South Side of
Chicago.    According to the school, it was kind of like a white
island which was being invaded by the people around it.       There
was no integration of the school at all into the community, the
                                                                     9

school played no role in the community, and the community, I
think, was responding.     It was like it was a foreign body; it was
walling it off and invading it.    And I think a lot of people felt
like there was different vision of the school that was needed.
People started talking about it, and although I didn't know
anything about it, but I became very interested in it.
     There were actions by students to design courses that were
more socially responsible.    Some of the teachers who were talking
about involving students more in the design of course work and
curriculum were being systematically persecuted by the school and
not given tenure.    That was what was going on all over the
country at the time.    Then the Vietnam War, of course,   started
bringing other protests to the campus.
     I guess the major issue, around my second year of college,
in the middle of my second year of college, there was a sit-in in
the Administration Building.    The issue was around the firing of
one of the teachers who'd been a really outspoken political
figure on campus, a woman teacher, and the issues around students
wanting a voice in the curriculum committees, various places
around the school.     There was no voice at all of students
anywhere in education.     I guess there probably wasn't in any
other place in the country at the time either.
     So I was involved in the sit-in in the Administration

Building, and I got suspended.    The sentences that people got
ranged from being expelled from school to being suspended for
anywhere up to two years.    The sentence depended upon what
                                                                         10

happened in the hearings that the school set up after the sit-in
was over.


Mullan:     This is all administratively within the school?



Calman: Yes, all within the school.      So   at the hearing, I

basically discussed how people needed to be true to the their
values, and that when there are things going on that you believed
in, that you were forced to act.      Because I showed up for the
hearing and went through their process, which a lot of people
just refused to do, I ended up with being suspended for two
quarters.     One of them was the summer and one of them was the
spring.     So I ended up out of school for about six months.



Mullan:     The cops weren't involved?


Calman: The school dealt with this without the police.         They held

hearings for students at the law school.        There were about thirty

students who decided not to show up at all for their h e a r i n g s ,
and they were all expelled from school, and a number of them
joined the Weather Underground.      A number of leaders of the
Weather Underground came from that group of people who were
expelled from the school.     It was a hot time in Chicago.


Mullan:     And through the summer of '68, I guess, you weren't

there then?     During the convention?
                                                                       11

Calman:    I was home.   Thank goodness.



Mullan:    But the environment, nonetheless, was highly charged?



Calman:    Very highly charged.   So I went back to school, but
during the time that I was out, I went home to New York.     I was
trying to figure out how to salvage this six months so that I
wouldn't get totally off track.    What I did was, go back to the
research lab, and I talked to Harry Wallerstein.     I said, "I need
a job for six months."
     So he said, "Fine," you know, after he gave me a little

lecture about how stupid I'd been, he gave me a job.     It was very
interesting, because somebody in their lab had left, one of the
full-time research people.     I went home, and I designed an
experiment I wanted to do based upon the research I had done in
the prior years.     I came in with a proposal for an experiment
that was related to what the lab was doing, but something that I
was very     interested in, independently, and he approved it.    He
spent about $10,000 for special equipment and supplies that they
needed to do my experiment because Dr. Wallenstein really
believed in it.
     I designed it to run over the period of time that I was
going to be out of school.     We published four papers off of it--
all of us.     It really turned out to be the only reason I believe
that I got into medical school, because I applied to sixteen
schools, and on my transcript was all this stuff about my
                                                                    12

political activity in college, and nobody wanted to touch it.      I
only got two interviews out of sixteen applications.
     I really consider that I got into medical school on a
complete quirk.    The person that interviewed me was somebody who
had actually read one of the research papers that I had
published, and he was doing research in an area that was very
similar to mine.


Mullan:   What was the area?   What was the paper?



Calman:   I was studying how cancer cells became resistant to

chemotherapeutic agents over time, and the changes that were
going on in them.    People were just beginning to look at things
related to the immunology of cancer.    What I showed is that if
you immunized mice against cancer cells that you injected into
them, you could actually immunize them so they wouldn't get the
cancer.   Which was no big deal; people knew they could do that.
But what I did was I took the cancer cells after they had become
resistant to one of the chemotherapeutic agents and showed that
even though the immunized mice were totally immune to the basic
leukemia virus that we were giving them, that they had no immune
recognition at all of the same virus after it had become drug-
resistant.   So that while you were killing the cells with
chemotherapy, the cancer cells, those that were growing up had a
different antigenic structure, and they were no longer recognized
as being "foreign" so you were hurting the mice's own immune
                                                                       13

response to its cancer while you were helping them by reducing
the tumor load with chemotherapy.
        It was a very interesting thing, and many years later, they
began to understand that you could actually map the antigen on
the cell surface, and that people began to map the cell changes
that went on as cells became drug-resistant.     So   that you could
actually prove that the antigen structure changed.
        So it was really fascinating to me, and I was deeply into
this.     I mean, I was putting sixty, seventy hours a week into the
research lab.     I was coming in on Saturdays and Sundays and I was

totally engrossed in this project.
        So it turned out that I got into Rutgers--one of sixteen

medical schools to which I applied--for three reasons.      One was
that there were two professors at Rutgers at the time who were
really furious that the student body was looking very
homogeneous, and that they were systematically eliminating people
who were interested in political issues related to health care.
The admissions committee allowed them to make recommendations for
a few slots.     I was one of the people they picked for that.
Secondly, I got lucky, because I was assigned a doctor who
interviewed me who knew about the research that I was doing and
was interested in it.     Thirdly, it also turned out that the same
interviewer became very interested looking at my college
transcript about courses that I had taken in archeology.      One of
the courses that I had taken was the archeology of the Dead Sea
Scroll-s, which one of the few things you could take without
knowing another language, either Egyptian or something else, in
                                                                        14

archeology.      It turned out that his father was on the team of

people that discovered and translated the Dead Sea Scrolls.        So

it was just one of those lucky things.        His father had written
one of the books that I had read in this coursef and we talked
about that for half the time and my research for the other half
of the time.     So I was lucky, because that was the only school I

was admitted to.


Mullan:   What did you major in Chicago?



Calman:   Well, a few things, but I ended up in microbiology
because I got credit for all of the research that I had done.


Mullan:   And did you graduate on time again?



Calman:   Yesf I doubled up my courses in a couple of my quarters

and graduated with the rest of my class--even graduated with
"Special Honors" because of my research       .

Mullan:   But the transcript actually had on it some evidence that

you been suspended?


Calman:   Yes.    I tried but was never able to get the school to

edit it off.     It's probably still there.


Mullan:   What did it say?
                                                                        15

Calman:   It said--



Mullan:   "Scarlet letter.''



Calman:   I can't remember, but it was clear enough that it said I

was suspended for disciplinary action or something like that, for

two quarters.    They never took it off the transcript.     They
decided that they were going to have people carry that with them
for life.


Mullan:   Was the war an important factor in your mind?



Calman:     It was very important.    It created the entire atmosphere

around college campuses at that time.       As you know, it was the
major element of real personal insecurity that people like me,
who grew up in white, middle-class life had ever experienced. As
I perceive it now and look back on it, it was the only real
threat that I had experienced in my life.       I mean, we had never
been under attack as a country or anything like that.       But it was
like the only real threat, the threat that you're going to end up
going and fighting in this war that was totally ludicrous and
that nobody believed in or anything.        It was just something we
just lived with.
     I was eligible during the years of the draft lottery, you
know. My number was 219.       So   I watched it each month the draft
data came out, to see what number they were going to get up to
and where things were at.      But I was clear I wasn't going.     I
                                                                        16

never really had to face what I was going to do, but it was clear
to me that there was no way I was going into the Army or going to
war.


Mullan:    So, you went on to Rutgers?



Calman:    So, I went on to Rutgers.



Mullan:    The year being 1971?



Calman: Yes, I finished my work at University of Chicago.       I

worked in the research lab there at LaRabda (phonetic) Institute
all the way through college until right before I graduated.         Then
I went to Rutgers.
       As I viewed medicine at the time, I still thought that I was
probably going to go into medical research.       I wasn't sure.    I

mean, I really went to medical school to become a researcher.
That's what I was into.    I totally believed that people with
scientific minds had a responsibility to try to solve these big
medical problems that people faced.      This thought helped me to
connect my sense of social responsibility with the fact that I
was spending all this time in a lab.      I knew I had been
successful in research and was being told by people that were
mentoring me that I had a real skill for this and that it was
something I should cherish.       I was told   I had "golden hands. I
had been offered a fellowship at the University of Chicago in
research, because that didn't have to go through the same
                                                                  17

admission process as for medical school but my research mentor
told me I should become an M.D. to maximize my options to do both
laboratory and clinical research.
    When I landed in medical school, I quickly connected with
about half a dozen people who were very socially aware, much more
socially aware of issues in medicine than I had been.    At the
time my politics wasn't well connected to my medicine.    I was
involved in University of Chicago and political activities, but
it wasn't at all connected to medicine.    I guess what happened is
that clinical practice allowed me to integrate two parts of my
life which had been totally disconnected.   Spending hours and
hours in a research laboratory and my political interests helping
people and society and other things like that were very much
there.
     There was a group, (I can't even remember the name of it)
but it got formed when I was at Rutgers--of about six or seven
medical students. We used to meet every week or two to discuss
political issues around medicine.


Mullan:   People in your class?



Calman:   Yes, this was in my class.   My recollection is that

people were very critical of my research interests.     That it was
viewed like being a radiologist.    That if you were political and
you were in medicine that you needed to be taking care of people

out in the community not doing research.
                                                                         18

     There was a pediatric faculty member that ran a community

clinic, a free clinic, called NABE.


Mullan:   The guy?


Calman:   No, the clinic.     I don't even remember what it stood

for--the Neighborhood Health Clinic or something like that.         It
was run by him and students.


Mullan:   How do you spell NABE?


Calman:   N-A-B-E, I think.       I don't remember.   He was a

physician, and he brought students from the medical school there
in the evenings to learn how to take blood pressures and to do

other things like that.     So,   I went there.     All my friends, the
people who were in this group, all went there and so I went
there.    That was my first real clinical      experience.


Mullan:    First year.



Calman:    Yes, my first year of medical school.


Mullan:    Did you like it?



Calman:     I liked it after my first day.     My first day I was

incredibly frustrated because I spent a whole night there being
totally unable to take a blood pressure.          It seemed I I could
                                                                      19

just not learn how to take a blood pressure.     It was just
impossible.     I couldn't hear it.   I thought there was something
wrong with me.     Finally, at the end of the night one of my
colleagues figured out that I had one of those reversible
stethoscopes and nobody had bothered to teach me that it clicked
on and that I was listening to the wrong side of it.


Mullan:     Did you start a research program or were you involved

with any researchers at Rutgers?


Calman:   No, not at all.   My research ended at that point.    I

really didn't do anything with laboratory research from that
point on.     During my first year of medical school, I worked in
this neighborhood clinic for a while, and then I started to get
interested in what health care was about and became part of this
study group that was learning about the health care system and
health care issues and political issues around health care.
     At the time, I was really a follower.      There were a lot of

people there who were a lot more sophisticated about this stuff
than I was.     I knew that I was interested and hung on and read
the study readings and showed up at the meetings and found that I
was really interested in it.     But I was not a leader.   I had all
I could do to hang on to the academics of medical school during
my first two years.


Mullan:   Was it tough?
                                                                            20

Calman:    Oh, it was very tough.     For me, it was very tough.    I

mean, I've never been somebody who was incredibly good at
memorization.    Everything to me always had to be connected to
logic or something that I could understand. And there's just no
logic to the majority of things that you learn in the first few
years of medical school.     Memorizing the names of bones and veins
and nerves was absolute torture for me.


Mullan:    Was it better once you got into the clinics?



Calman:    Oh, yes, it was fabulous.     I was flying high.   But my

first two years of medical school were at Rutgers.       I was dying
in Piscataway, New Jersey.        [chuckles] Having come from Chicago,
I   felt I was in a wasteland.      Rutgers was just beginning to
establish itself as a four year school, and they were taking only
a third of the class on, I believe, into the four year program.
So, most of us were being encouraged to look for places outside
if we didn't want to stay in New Jersey, and I was just dying to
get out.    So, a recruiter, whors now actually the president and

chief executive of Rush Medical College, came to Rutgers to
interview a bunch of students that were interested.       I was wanted

to go back to Chicago.     So--



Mullan:    Who was this?



Calman:    Leo Hennikoff, and 1 / 1 1 never forget his interview.       I

took on a passion for going to Rush his interview.       Dr. Hennikoff
                                                                       21

is a pediatric cardiologist. He sat down, and he took two or
three clinical problems that were clearly beyond what a second
year medical student should know anything about and reasoned them
through with me for a couple of hours.     That's what I remember
about the interview.
     I remember one of them was about a person with aortic
insufficiency. He was talking about what happens to the blood
pressure.     What would happen to the blood pressure with the blood
running out the aorta in two directions instead of one.      We
discussed the EKG, the part of the EKG representing the atrium,
and what one would expect the EKG change to be over time as the
person's heart enlarged.     He went through this clinical problem
with this incredibly logical way of thinking that totally clicked
into the way my own mind thinks.     I was so enamored by that way
of thinking.     I was sure I wanted to go to that school.
     And Rush turned out to be exactly like that was an
absolutely phenomenal two year clinical experience. I've never
experienced anything like that afterwards. Just incredible
clinical training for two years; brilliant, thoughtful educators
and clinicians.


Mullan:     Did you find a group of politically simpatico people?


Calman:     Oh, yes, and I almost got thrown out of Rush, too.    It

is one of my claims to fame.     I've been thrown out of everywhere
I've been.    My closest friend from Rutgers and I went to Rush

together.    His name is Bobby Cohen.   You know Bob?
                                                                         22

Mullan:     I did his oral history.



Calman:     Did you really?


Mullan:     This story sounded familiar.     Yeah.    Keep going.



Calman:     That's interesting.    So,   Bob and I   were roommates in

medical school.       We were in this group called Concerned Medical
Students at Rush which       started a year before we were at Rush by
a group of people who I hear are still in Chicago, mostly at Cook
County     and other places.   We were involved in many      activities.
Again, I was mostly a follower there.


Mullan:     Talk about Rush and your experience there.      There was a

simpatico group who was politically active.          This was Co-Student
Health Organization.      That was no longer on the scene?


Calman:     The group I was in was called Concerned Rush Medical

Students.


Mullan:    The SAMA/AMSA didn't appeal to you?


Calman:     I don't   remember any contact with them.     All I remember

is this group, and what we did.       Marge Cohen, who's Bob's sister,
was also very active in that group.        There were a few other
people.    Gordon "Gordy" Schiff, Marge's boyfriend (later
husband)    from Chicago and a few other people who were there and
                                                                     23

from whom I learned a lot.   They were more widely read than I was
in terms of political issues related to medicine.    But I was very
much in tune with the things that were going on there.    I was
very interested in their work.    They did this fabulous paper on
the pharmaceutical industry that people were circulating ten
years after it was out of date.    They just did great work.   But I
had a harder job with the academics than they did.
     Then I got really involved in the politics there because it
was at a time when Rush had James Campbell as president then.
Campbell had a plan which divided up the whole city into
districts all of which figured into a master plan for health care
in Chicago.    My recollection is that it was a plan that showed
great disfavor to poor inner-city communities and which segmented
the population so everybody who couldn't afford to pay was going
to end up at Cook County Hospital rather than Rush.     It was a
great for Rush but many thought not for Chicago.     Rush would take
over all the private care that was going to be given in a hundred
mile radius.    We got very involved in opposing that politically.
Commenting on it and understanding it.    There were some people at
Chicago at the time who were very savvy about all of the health
systems issues in Chicago.    We were learning from them about what
those issues were.
     This was a major turning point for me at Rush though.     I
found myself in the middle of this huge dispute which eventually
ended up causing me some problems in school.    I was on my OB-Gyn
rotation.   Rush then had segregated OB-Gyn services.    There was
floor at Rush which was largely for paying insured patients, and
                                                                  24

a floor for the poor patients from the community.    They were
staffed differently.   They had different nursing models and
different staffing levels.   All the same types of things that
just last year they were blasting Mount Sinai in New York for was
going on twenty years ago at Rush.
     There was a Doctor there who was doing experiments on black
women who were getting caesarian sections where they would
anesthetize the woman and then start taking arterial blood
samples, measuring oxygen content from various sites after they
were under anesthesia--drawing blood from the radial artery, the
uterine artery and the umbilical cord--the way I remember it.
This was all done before the baby was delivered..
     We had learned that the idea when you do a C-section is to
put the mother under anesthesia, and deliver the baby as quickly
as possible so the baby doesn't come out sedated.    But for these
poor mothers who were being experimented on they open the
abdominal incision, and then they wouldn't deliver the baby.
They would just start drawing arterial bloods from the uterine
artery and from the radial artery and from all different places.
That would go for minutes and minutes and minutes.
     So it occurred to me that this is probably dangerous because

we had learned that the idea was to deliver the baby as quickly
as possible.   I became concerned, and I asked the chairman of OB
what was going on and then discovered by asking one of the women
that was involved in this that nobody had ever gotten her consent
or done anything to advise her that she would be participating in
these experiments.
                                                                      25

     The Department of OB refused to do anything about it.      I and
one of the other students went and Xeroxed a whole bunch of their
medical records and showed there were no consents in the medical
records and showed that the delivery times after induction of
anesthesia were eight and ten and twelve minutes where they
should have been two or three minutes.     And then went back to the
OB director and said, "Look, this is ridiculous.      People aren't
even being asked if they want this done or anything, and there
were no consents in the chart or anything."     And they refused to
change this stuff.    So,   we took it to the newspapers which was
probably not the smartest thing to do when you're a third year
medical student.
     There was a black newspaper in Chicago that really picked up
on the story and put it on the front page.      The other Chicago
newspapers picked it up and ran articles about Rush University's
illegal experiments on black women, and that they were done
without consent.


Mullan:   What happened to you?



Calman:   I don't remember exactly, but I know I was in deep

trouble for quite a while in Chicago.     Eventually, they set up
their first human experimentation committee at the school in
response to this.    We were asked to participate in the committee.


Mullan:   The students?
                                                                     26

Calman:   Yes, specifically, this one other student and myself who

were involved in bringing this issue to light.


Mullan:   Did you get thrown out all the way or suspended?



Calman:    I don't think I was suspended, actually.    I don't really

even remember the details of what went on.     But I remember being
up to my ears in hot water for quite a while in relationship to
the deans and the other people that were there.     You know, of
course, it was very difficult for them to do anything to us,
because it was a real public issue where they were totally in the
wrong.    They were smart in not wanting to complicate that by
throwing out the very students that exposed it.     But inside the
school, it was clear that we had crossed the line in terms of
what people should do in such circumstances.     But we had
documented every meeting we had had with the people that we had
gone to first to try to do things inside the school, and nobody
paid any attention to us.    So   we were pretty much on the side of
right.
     Then at the same time, Bob and Marge and the other groups
were really going full-scale on a lot of other issues.        There was
wide spread dumping of patients to Cook County across the street,
This group, the Concerned Students group, was working on lots of
different issues simultaneously within the school.


Mullan:   We're at mid-seventies now?
                                                                        27

Calman:    This was '73, ' 7 4 ,   '75.



Mullan:    What was your thinking about what you wanted to do?         Did

the notion of generalism become an issue?


Calman:     I've been plagued by being kind of a dabbler my whole

life.     I played seven different musical instruments, none of them
terrifically well, and still do.          You know, liberal arts
education, I mean, that's been kind of my style. My style has
always been not to spend huge amount of time in one focused area,
but to keep a very broad vision of things.
        I did fabulously well in my third year.      Every rotation I
was in, the faculty would try to recruit me to that specialty.
The chairman of pediatrics took me out to dinner and said, "You'd
make a fabulous pediatrician."        The chairman of psychiatry
offered me a job which I kept for a while working in the Psych
Department, taking care of patients.         The chairman of surgery
said I had golden hands.


Mullan:    OB probably--



Calman:    No, OB wasn't one of my strong suits.        I loved
everything that I did.       I really couldn't figure out what I would
do as a specialty. My recollection of this is a little foggy,
but the events aren't. Somewhere around the end of my third year,
when I had to start thinking about residencies, I found out about
                                                                       28

family practice.     It was definitely   not through the school.
There was not a single family physician at Rush at the time.
        I wanted to find out about this specialty and I had heard
about Jorge Prieto, who was over at Cook County doing something
in family practice, and I went over and talked to him.        He was
telling me about this new specialty.      This was probably ' 7 3 .   And
family practice only started as a specialty a few years before
that.     I mean, it was really a new specialty.


[Begin Tape 1, Side Bl


Mullan:      This is side two of tape one, Neil Calman, the 26th of

June.


Calman:     So there really were not any family physicians to get

attached to.     I went to the dean, and I said, ''1 want to learn
about this new specialty called family practice."
        He said, 'Well,   you're going to have to find something,
somewhere to do it, because we don't-have it.       I don't even know
anything about it. "
        I think it was at a point where people weren't even
discouraging about it because it didn't really exist.        Nobody was
a GP anymore.     The Dean hooked me up with a narcoleptic
psychiatrist who was my psych preceptor, who had done six or
seven years of general practice down-state Illinois before coming
back and doing a psych residency, and they made him my advisor,
unofficially.     He said, "You know, this is great.     General
                                                                         29

practice is where it's at, you know.        It's fabulous."   He said,
"After seven years of this, I could retire.''       He said, 1'   burned
myself to the bone, and I can retire."
     He was seeing sixty, seventy people a day in his office.          He
was the only doctor for miles around.        He had literally made
enough money in seven or eight years to almost retire, but he was
working seven days a week, twelve hours a day.        He semi-retired
and became a psychiatrist, which was not exactly a profession
befitting somebody who was narcoleptic, because he constantly
fell asleep in the middle of his therapy sessions.        It really was
one of my funniest experiences in medicine.        He kept insisting
that he wasn't asleep, but the medical students would run the
whole session, because he would        be totally asleep, snoring in
the chair.   In the end we'd go, "Doctor!"
     And he'd say, "Yes, I'm paying attention to you.         You did a
fabulous job.     Didn't he?"   And   he would turn to the patient.      It
was very weird.     [Laughter] But, anyway, this was the guy who
helped me understand what general practice was all about.

     Then one day, in the back of the New England Journal, there

was an advertisement that had been placed by the United Farm
Workers Health Clinics by a family doctor there who was

interested in getting another doctor to come and do a locum

tenens.   He had been working there for years and years without a
break; in Delano, California.         I said, "Ooh, this sounds
interesting."
                                                                    30

     So I called him up and I said, \\I'm interested in coming out

there.    Is there any opportunity for me to come and to work there
as a student?"
     He said, 'Well,   it's run by the United Farm Workers, and you
have to go through their headquarters before you could come
here. "
     And I said, "What do you mean?"
     'Well,   you have to go and meet with Caesar Chavez, and you
have to be indoctrinated into the Union first.    Then after that,
you can come and work in the center.    We'd love to have you.     It
would be a great help to me, I mean, even though you are only a
medical student, it's better than nothing.    And I have no help
out here. "
     So I went to the dean, and I said, "Look, I want to take a

few months off, and I want to do this."     I guess it was the
spring of my third year.
     He said, "Well, if this is really what you want to do,it's
fine ."
     So   I took off two months.   Got in my car, drove out to
California, went to a place called La Paz, which is where the
headquarters for the United Farm Workers Union was, and got my
union indoctrination.    Then went out to Delano, California, where
I lived in the emergency room, on the emergency room cot for two

months in this clinic.
     That, I think, was actually the single most important thing
that ever happened to me in my career in medicine because there
were so many things I learned there, not things about medicine so
                                                                     31

much, but the medical world has this view which, I think, we all
have become victim to, and even me, over time more and more, that
you can't do anything unless you're a specialist in it.
      We were taking care of people who had no access to the
general health care system.     None of them had health insurance.
You either went to the health clinic and got whatever you could
get done, or you got nothing.     I mean, it was that or home care
or zero.    If you were brought in by ambulance to Bakersfield,
which was thirty-five miles away, you could be seen as an
emergency patient, but were unlikely to be admitted.     If there
were any questions about your immigration status, forget it.
Everybody knew that going to Bakersfield to the public hospital
was a direct route to possible deportation.


Mullan:    How did that experience play itself out?



Calman: The doctor that I was working with had been there for a

while and he had a large number of books in a small room and he
did everything by the books.     He had learned over the years.


Mullan:    Did he count himself a family physician?



Calman:    Yes, but I don't recall what his training was.   I know

he wasn't boarded because there was no such thing at the time we
had trained.    He was a general practitioner, but he was a young

guy
                                                                      32

Mullan:      Do you remember his name?



Calman:      No, but I have it at home in my journal.   We did

everything.      We did all our own lab work.   Really nobody could
pay for a laboratory.      I mean, we did CBCs in the office, and we
did urine analysis.      We did vaginal smears, and we did all our
own lab work.      We did all our own X-rays.   At the time, every
hypertensive patient had to have an IVP.        That was the standard.
We did IVPs in the office.      I mean, I learned to do IVPs.    I was
a great X-ray technician.      I did probably did five, six, seven,
eight X-rays a day.      Probably did at least two, three IVPs a
week.     We did complex suturing.   I'm talking about farm wounds,
things that were just brutal.      You know, he would suture in
layers and do everything. We set fractures and did casting.          We
delivered probably twenty babies during the time that I was
there, including a molar pregnancy which I'd never seen before or
since.
        He had this whole group of liberal-minded, caring, specialty
people who made themselves available to him free of charge all
the time by telephone.      So we did a lot of telephone

consultations with people all over the state and, in some cases,
outside the state who just were sympathetic to the farm workers'
cause and who would talk about cases with us over the phone.
        So   the take-home lessons from that place were, number one, I
developed this enormous sense of confidence that people could do
more than what you saw people in sub-specialty areas doing in
medicine.       The other thing was that the people in the union there
                                                                         33

that ran the clinic were enormously political.        The clinic closed

for half a day every day.        We all went out marching.   The whole
clinic staff had to go out on a weekly march.        There was a weekly
march through some town or through some grape fields where
everybody was required to go.        The clinic was closed   except for
somebody who sat in the emergency room, one of the nurses.
     But we went out, and I've got pictures of myself carrying
the United Farm Workers' flags and banners from the clinic, and
all the little farm towns around where people would cheer the
clinic staff on.      It was very much an understanding that the
health care we were rendering existed within this political
context.    I mean, they were one and the same.
     In fact, in my journal, which I read a couple of years ago,
and which covers the time that I was out there, is impressive in
its description of how much I believed at the time that you
couldn't separate the way people felt about their work and their
jobs and their family from their health care.        It was just like
they were one and the same.        The clinic was right there.   The
people lived in the community.


Mullan:     This was 1 9 7 4 ?



Calman:    Yes.



Mullan:    And this was towards the end of your junior year?
                                                                      34

Calman:   Yes.    So then I headed back to Chicago knowing "This is

what I want to do.     I want to be a family doctor."
     On my way, I had one more week left, and I left the clinic a
week early.      I made a bunch of phone calls right from Delano to
arrange to visit some of the California family practice
residencies on my way out.      I took a swoop through Northern
California, and I went to the family practice residency in
Sacramento and in San Francisco.
That's where I ran into Bob Massad for the first time.      It was
in San Francisco and we ran through just what family practice was
about.    I looked at the San Francisco program, and I looked at
Jorge's program.      Then I went to Montefiore, and I fell in love
with Frankie Seigel, who was one of the people I told you about.
She was a woman family physician with forty years of experience
in family practice in the Bronx, a person who had gone back to be
the residency director at Montefiore.      I really got inspired
politically by a couple of the faculty people there--Margie Gold,
who is still there as a faculty member at Montefiore, and people
who really tuned in to where I was at in terms of the connection
between my politics and what I wanted to do in primary care.
     So I went to Montefiore really because I wanted to be

trained under this incredible woman who had been doing family
practice for years in the Bronx.
     So   although I knew I wanted to be in family practice, I knew
I couldn't live in the farm lands.       So the only three programs I

applied to were San Francisco General, Montefiore, and Cook
County.   Monte became my first choice because I wanted to come
                                                                       35

back to New York and because Margie Gold, who was a faculty
person there, and Frankie Seigel were just people I connected
with instantly.


Mullan:    And the Montefiore social medicine program, family

practice residency was relatively new then?


Calman:    Yes, I think I was either in the third year of the

program.


Mullan:     How many incoming interns were there?


Calman:    It could have been six or eight.



Mullan:     Tell me about the Montefiore experience. What was it

like?


Calman:    Well, it was strange, actually.     I think that the few
critical things that happened to my at Montefiore were, number
one, my exposure to Jo Boufford, who I learned much from and from
whom I got my first real taste of administration.       It was amazing
watching her struggle to stay on t o p of this program of crazy-
minded radical doctors, all of whom were moving in lots of
different directions at the same time.       She was going through a
transition at the time which I've used as a model in my own mind
about leadership stuff, which was being in a program where there
were a lot of very independent-minded people and being able to
                                                                     36

allow those people enough flexibility to allow the program to
grow, because that's really what the richness of the program was
all these people, but still being very clear that she was in
charge of the program, and that there needed to be certain
established values and limits set to where things go.     She really
struggled with that through the whole time I was there through
lots of public meetings and many one-on-one discussions.


Mullan:    Her role, at that point, was what?



Calman:    She was director of the social medicine program.   At one

very seminal point, which I refer to a lot now as a leader of an
organization, she got up in front of the group and said, "You
know what?"      She said, "This is a program where we share a lot of
responsibility and decision-making, but the world out there holds
me accountable for every single thing that goes on in this
program.    So   when I have the authority out there to a curriculum
committee and when there are other committees, they report to m.
Nobody cares outside this program that there's a curriculum
committee and that you screwed up and the family practice
curriculum doesn't meet the R.R.C. requirements.      They hold me
accountable for that.      The hospital holds me accountable for the
fact that everybody shows up at their rotations on time."
     It's been a very helpful model for me because I refer back
to that frequently as a model of distributive decision-making
without ever abdicating your responsibility for being in charge.
I remember that one community meeting where that happened.      It
                                                                     37

was like a "buck stops here" kind of meeting where she finally
came to grips, in tears, with the fact that she had to run the
program, and that she couldn't any longer allow certain things to
go on because the world was holding her accountable.
     I've used that a lot of times because I think that all of us
who have leadership positions in organizations are faced with
wanting to bring in super creative, independently-minded people
because that's the only way that organizations can grow and
flourish, but still being able to keep enough ties to them to
make sure that things don't go off in directions that aren't
consistent with the mission or that actually even invade what the
mission of the organization really is or should be.


Mullan:   Say a quick word about the residency program, just for

the record.   How is it special?


Calman:   I think it was special in the cohort of people it

attracted in its self-perpetuating nature of bringing people who
were very independent-minded, socially committed people in
medicine, and allowing them enough opportunities within their
residency to pursue some of that.   So that when they came out
after three years, instead of going into a traditional system
where that gets beat out of you, and where you come out like
processed cheese, you actually have an opportunity to explore
that part of your being and allow it to grow and develop.     So I

came out my third year, I was ready, me and three other people
there, my partner Marna Sternbach and Pat H. G. Bloom, who became
                                                                     38

good friends of mine.   We started a health center as third-year
residents.    Our social medicine project was to start a health
center.   We never, ever worked there, but it started.   It got
built up and it was growing.    It's up in the northeast Bronx' and
it's still thriving.


Mullan:    What is it called?


Calman:   Ronald Frazier Health Center.   It was an interesting

project, and it was my first real community health center
experience.
     So   I think that's what the residency was.   The bad part is
that Montefiore Hospital is just the absolute worst environment
for the program.    To this day, the program exists as a fourth-
class citizen within that institution.    The family practice
attendings still don't have admitting privileges to the hospital

except for the family practice floor, you know.    You can't admit
to another bed in that hospital if you're a family physician.
And that problem has    always existed.   It was something that
drove me crazy while I was there.    I just hated the feeling of
being second-class' perceived of that way within a larger
institution.    I think that influenced a lot of what I did
afterwards, too.    But the camaraderie of the people that were
there and the people that I met there, I mean, there's probably
not another group like that anywhere in the country.
                                                                          39

Mullan:     As you proceeded through that and looked to the future,

what did you think about doing and then what did you do?


Calman:     Well, I discovered a few things about myself at the

time.     One was I discovered I had a great administrative mind.         I
was the chief resident there, and I loved organizing things.          I

have always been an organizer.       I loved organizing things.   I
shared the chief residency there with two other people in the
year.     I became aware of the fact that I had some administrative
skills, that I liked setting agendas for meetings and taking
minutes and writing policies and procedures.        I kind of had a
head for that stuff.
        But I was thrown out of residency, too, for about two weeks.
[Laughter]     By Dave Kindig, who was the president for a brief
period of time in his history, he served as president of
Montefiore.       I don't know how brief it was.   It was probably only
a year or two, maybe even less.       I don't know, but in between
Martin Cherkasky      and Spike Foreman, there was a very short Dave
Kindig era.


Mullan:     Cherkasky was still there.      Dave was the president or

director and Cherkasky was the--


Calman:    CEO?    Is that what happened?



Mullan:     He wasn't called CEO then, but it was, anyway, Dave was

there.
                                                                        40

Calman:     Yeah.    There was a big 1199 strike, and within the

Residency Program in Social Medicine a group of people who were
not on critical rotations organized to support the 1199 strike.
Most of us were on dermatology and other kinds of rotations that
were not essential.       It was one of the first real struggles that
1199 had.     It was a very bitter strike.    It was in 1976, July of
'76.    I think July 7th through 17th.     It was a ten-day strike.
       Those of us who didn't have to go into the hospital went out
on the picket line in support of 1199 and refused to go to our
elected rotations and everything.       The hospital basically said,
"You don't show up, you're out."       And some of our faculty members
did, too.
       That event dominated my life for about a year afterwards,
because we were all fired.       Then the CIR [unclear] came in and
got us our jobs back.       The National Labor Relations Board came in
and supported the faculty people that were fired.       Then there was
a sympathy strike of other residents in the hospital, about
thirty or forty of them, who went out on strike to support our
being fired.        We and our firing became "the cause" instead of
just people supporting the 1199 cause.        That was kind of weird.


Mullan:      How many were fired?


Calman: About a dozen, I believe.       Eventually, the Hospital was

forced, to take us back as residents.        I can't even remember what
the details were.        The National Labor Relations Board, like a
year or more afterwards, forced them to reinstate all of the
                                                                     41

faculty people with back-pay and public postings that the
Hospital had done wrong.      It turned out that there were laws
protecting people that supported other people who were on strike
which the hospital conveniently ignored, but ended up paying for
afterwards.


Mullan:     How long were you out, and did it affect the length of

your residency?


Calman:    It didn't affect the length of my residency, and I can't
remember why.     I think I skipped a vacation month or something
like that to make up for the time that I was out.     I don't
remember much else about it.     I guess we were out about a month
overall.


Mullan:    Which year of your residency was this?



Calman:    End of my first.



Mullan:     So as things developed beyond politics, what were you

thinking about?


Calman:    Do you mean in terms of career stuff?



Mullan:    Yes.
                                                                   42

Calman:   Well, I don't know.   I was very much torn when I

graduated residency.    I really didn't know what I was going to
do.   I knew I wanted a combined administrative and clinical job.
I started feeling these development parts of me, having had this

experience, even though it was a disastrous experience, setting
up this community health center.
      The four of us, as I mentioned before,   got together.   Some
community folks in the Northeast Bronx had been trying to get
federal funding for Ronald Frazier Health Center for a long time.
In fact, I think I even met with you.   My recollection was during
that time, we came down and met with you.    This would have been,
I think, in ' 7 8 .


Mullan:     You were at the National Health Service Corps?


Calman:   Yes, and we were trying to get money from the Corps, and

we were trying to get money from the Bureau of Community Health
Services.    We met with you and somebody else who I can't remember
in Washington and got a very sympathetic ear, because we were
planning on going into a transitional community. We were in a
community which was not listed on the number one worst, needy
communities--it wasn't the South Bronx.     It was the North Bronx,
but it was a community that's now almost 100 percent minority,
but was in transition at the time and had no services, no health
services, no primary care services. Nobody was doing outreach or
any kind of public programming.
                                                                       43

     But it was my first experience working with a community-
based organization, a real community-based organization, not one
that was coming out of the hospital or some outreach program.          We
were working with people from the community that were building up
this health center.     We outran them.    We were incredibly self-
assured and incredibly aggressive.        The only thing was we forgot
to include them in everything that we were doing. S o we were
running around.     We got them federal funding when they had been
trying for years.     And got them National Health Service Corps
positions when they had been trying for years.       We were very,
very successful. We just forgot to include them in this whole
thing.   We had all the plans.     We rewrote their grant.    We did
everything.
     It was just one of these real lessons that you kind of never
forget in your life that sort of no matter how smart you are and
how fast you run, when you're in a collaboration, the
collaboration moves at the pace of the slowest partner in the
collaboration, not the fastest partner.
     In fact, there were a lot of things that we were planning
that ended up in struggles with the community.       What happened at
the end was the community leader said, 'Thank       you very much.
You've done a great job, but I don't think we want this program
the way you've designed it."
     We had designed it.     We knew that the only way to keep
doctors in the community was if they were involved in faculty
positions.    So   we had arranged for all of us to be part-time
preceptors back at Montefiore while we were going out to work in
                                                                      44

this community site.    We were right but the community didn't want
resident doctors.     They wanted real doctors out at this site.
They didn't want medical students out at these sites, you know.
They wanted a real practice in the community, and we just we
weren't smart enough to figure out how to really sell it.      So it
was a really blown out' horrible experience.      They threw us out.
They basically said, "Look, you either do it our way or leave."
     We said, "You know, but we're the ones who got you all the
funding and did everything."
     And they said, "And we're deeply appreciative for all that
help that you have given us' but you've got to understand, we
started this project.    And even though we readily admit that it
wouldn't have gotten where it is without you guys and what you've
done, that still doesn't mean that we've given up our control
over the project .
     So we left.     We all just said \\NOway.   We're not going to
be part of this.''
     And the woman there that ran the program made a lot of
mistakes.   She brought in some guy who was a real well-known bad
guy in medicine to be the medical director and to sit over us'
and that was sort of the way they got rid of us.      They brought in
this guy who had had his license sanctioned and everything else.
He was going to be the medical director, but he was an OB/GYN who
had delivered her kids.     She figured that was all the credentials
he needed to be the medical director. Anyway, it was a long,
bitter struggle. At the end we left.
                                                                     45

Mullan:    What did you do?



Calman:    I went and worked with New York Medical College for two

and half years running a center in East Harlem.    It was actually
on the border of Yorkville and East Harlem.    We had Yorkville
patients and East Harlem patients.    It was a really, really
interesting practice.    We had people were poor and uninsured, and
we had people who had million-dollar-plus incomes all coming to
care in the same place.    I inherited this practice.
     Administratively it was a disaster, but it was such a small,
little laboratory that you could practically do anything and it
would be fine.    I mean, we saw, total, each of the providers saw
six patients or seven patients a day, spent like an hour on them.
The guy that was the head of the place was a behavioral science
person who believed that the more time you spent with people, the
better they would get.    So there was just no pressure on

productivity at all.     It was being supported by the medical
school where their finances were not a major issue.     It was
called the Center for Comprehensive Health Practice. After a few
months the medical director there left.     I was picked to be the
medical director, which I was happy to do.     I was just three
months out of residency, and I was the medical director of this
place.    But I had learned about teams at the Social Medicine
Residency Program.
     I used to run back to speak to Jo Boufford every couple of
months and say, "Okay, here's my list of questions, you know."
How do you get so and so to work with so and so? And this
                                                                     46

person's doing a great job, but they don't come to work on time.

I mean, from the most mundane to everything, and she was
wonderful even though I had been a pain in the neck to her while
a resident.


Mullan:     What sense did you have about family medicine in the

city?     Did you have a sense of being a pioneer?


Calman: Definitely.    My admitting privileges were at Metropolitan

Hospital.     I got privileges in medicine, peds and OB/GYN, and did
deliveries at Metropolitan Hospital.      I was the only family
physician that ever got privileges there.      I worked through every
one of the departments and got privileges.      In fact, at one
point, I just remembered a couple of weeks ago, that I actually
wrote a residency application to get a family practice residency
started at Metropolitan Hospital.     It never got off the ground,
but it was just because I didn't stay there long enough to do it.


     At the same time I was there, there was a residency program
starting up that was affiliated with New York Medical College at
Kingston Hospital     two hours north on the thruway, up in central
New York.     I asked if I could get involved in that because I was
the only family doctor in the whole center, and I was feeling a
little isolated socially from what family medicine was about.
They needed preceptors up there.     So   I made arrangements, and
every Friday, I drove two hours up to Kingston for two years.
                                                                    47

Every Friday I drove up there, and I got involved in the start-up
of the residency training program in Kingston.
    But the most important part of that activity for me was
working so closely with the head of the Kingston program, David
Mesches,   a very entrepreneurial family doc who had merged his
private practice with those of a few other family docs and set up
this family practice network up in Kingston in the mid-Hudson
area, started a department and started a residency program.    He
was bringing medical students up from New York Medical College
two hours away to do a rotation up there.   He'd set up this
organization called the Mid-Hudson Consortium for the Development
of Family Practice.
     I was totally enthralled by the idea that he had set up this
separate corporation. He had gone from being an employee of a
hospital to having this independent consortium of family practice
people.    Then he was going back and negotiating relationships
with the hospitals as an independent entity.     I thought, "Wow,
this is so cool, you know.   This is a great idea."
     It was in my head that there was something that at some
point seemed right for New York City an independent group of
family practice people should somehow get together and really
take leadership around family practice in New York City.     I think
the most incredible thing about it was that being more
independent, he could do all this family practice development and
hospitals were dying to attach themselves to him because of what
he was doing, even though the hospitals themselves would never
                                                                          48

want to do anything in family practice.      I thought, "Wow, this is
just perfect for New York City."
     So I left the Center for Comprehensive Health, and I went to

become the founding medical director of Soundview Health Center,
which was in the southeast Bronx.


Mullan:   What year are we at now?



Calman:   1981.     I became the medical director of Soundview Health

Center.


Mullan:   What sort of health center was it?


Calman:   It was a 3 3 0 funded community health center.     An   Urban

Health Initiative Project, I think It was called.          It was a
great place.      The man who was the director there, Pedro Espada,
was a community resident who was a social worker and is now a
state senator in New York, was a very brilliant guy, again, very
entrepreneurial and had a lot of ideas about what he wanted to do
in the community about different kinds of community services and
other things that he wanted to put together as a vision.          He did
a great job.      He really put together a lot of stuff.
     Because he had larger personal political aspirations, he
gave me sort of carte blanche to set up the health center to deal
with the medical and administrative systems and everything.           That
was my first foray into being almost like a CEO.      I mean, I could
still turn to him.      He was   a very good decision-maker, and I
                                                                       49

could still turn to him when I felt like I was over my head in
terms of making decisions.    But I put together the finance
department.   I put together the billing department.      I wrote
computer programs for billing and for other things and set up the
clinical models and did the charting systems and did everything.


Mullan:   How big an operation was it?


Calman:   Well, when I left there, there were eight family

physicians and two family nurse practitioners.


Mullan: All family physicians?



Calman: Yes, it was interesting. At the Center for Comprehensive

Health, I was the only family physician.     There was a
pediatrician and an internist and a nurse practitioner.       I felt
that I was a great model having a family doc at the helm because
they have the broadest vision and then having people in different
primary care specialties.     That's sort of what Montefiore was
like, too, RPSM   .   So I figured this is great model.

     So I got to Soundview, and I was, of course, the first
family doc.   I met another family doc who was coming there
through the Corps, and then there were two of us.      It came time
to hire the third person.     So I said, "NOW let's get an internist
and a pediatrician."
     There was a third family doctor I brought in, Joe Halbach
who is now the residency director at Yonkers family practice
                                                                       50

residency.   He said, "You know what?     Why do we need an internist

and pediatrician? Why don't we just keep hiring family docs?"
     And   I said, I
                   '   don't know, Joe.     You know, I just always
assumed I was going to do this like the other place.''
     He said, 'Well,    I know somebody who is really interested in
coming here as another family doc, you know.       Why don't we bring
her on, and then there will be four of us.        Then we can decide
after that whether we want to hire an internist or pediatrician."
     So to make a long story short, we never did hire an
internist or pediatrician.     It just kept growing, and we kept
bringing in more and more family docs.        Interestingly, there
weren't that many places in New York at the time where family
docs could go and work and get full admitting privileges,
including privileges to do OB.


We had developed a relationship with Bronx Lebanon Hospital
Center because there was a vice president of clinical affairs
there at the time who was a visionary, as was the president of
the hospital, Fred Silverman.     They decided at the time that they
needed to reach out to community-based health care centers and
start to bring them in to become parts of the hospital, really to
gain some loyalty and to gain some admissions and specialty
referrals.
     So he brought us in, and he said, "You want to start a
Department of Family Practice?     Fine."
     So I went up there as the medical director of Soundview and
started a Department of Family Practice at Bronx Lebanon.        It was
                                                                       51

the only department that had a voluntary director because I
wasn't paid at all through the hospital.      I was the director, but
I was on full-time payroll at Soundview Health Center.
     But it started a division, and we negotiated OB privileges
and pediatric privileges and internal medicine privileges.         I
shouldn't say negotiated.       The president of the hospital and Ira
Lubell, who was the V.P., put these people together and said,
"You will grant these people privileges.      This is exactly the
kind of health care that we need to be doing, and they're doing a

great job."
     And every place I went, they said, "Oh, yeah, yeah, family
practice.     It's terrific."    Years later, I found out how much
strong-arming had been done in the background of this
relationship.
     So   we're right at the end of the pre-natal period for the
Institute, which came out of a combination of my work at
Soundview, where I had this large family practice group together,
and where we were all talking about what we wanted to do.         One of

the things we all talked about was how we needed to get into
training because we thought we were sitting in this fabulous
health center that was just a great place to bring students and
residents.    We were looking for some long-term way of maintaining
the interest of the docs that were coming into this practice.
The first three or four of us were pretty committed, but we were
now hitting number six, seven, and eight.       "You know what?   We
don't want to keep recruiting docs.      We want people who are going
                                                                     52

to be here for a really long time.    To do that, we need   to get
into developing training programs."
     So   from our group of doctors, who were the only family
physicians on the staff at Bronx Lebanon, we were rotating and
doing service in the hospital as family physicians and had a very
big service that we were running.     From that we wrote a residency
application to start a residency program.    The inpatient training
was going to be at Bronx Lebanon, and the outpatient training was
going to be at the Soundview Health Center.     That was going to be
the family practice center.
     We did a construction plan to do some minor renovations to
the health center and to do everything else.    We needed to start
the residency.     This was my number two experience in outrunning
the community.    The application got funded.   We received federal
funds for a faculty development program in family practice to
teach us all to be faculty people.    We hired a faculty
development director who's still working with us to this day, Jim
Deary, who had his doctorate in education and in organizational
development.
     I had brought a family nurse practitioner, Yvonne Eisner,
with me, who worked with me at New York Medical College.     She
then came to Soundview Health Center to work with us as well.


Mullan:    What about the Soundview Community ethnically,

economically, and geographically?     It is in the South Bronx, you
said?
                                                                       53

Calman:     Southeast Bronx, yes.    It was an all Spanish and black

community, but probably one cut above what things were like in
the Deep South Bronx.     It had basically been a landfill area, so
most of the housing was newer.      There were still a few private
homes down in the peninsula.     It's kind of a peninsula in the
Bronx.
        So we wrote the residency applications and got funding.
It's very interesting, but we got a residency training grant and
a faculty development grant from the feds.     We got accredited for
this residency program which was supposed to start in July of
1986.     The community board and Pedro Espada, who was the
executive director, again felt that we had gotten too far off
track, that this sort of very excited leadership group of docs
who are really committed to what they wanted to do and everything
had just gotten way off track.      In fact, when they looked at the
vision of their community health center being turned into a
training center and whatever, all they could see was that this
wasn't what they had all had in mind when they started it.
     So we found ourselves staring down the throat of a brand-new
residency program that we were recruiting residents for already
that had no family practice center site because Soundview refused
to do the kind of work that needed to be done to have this
happen.    So the hospital became the recipient of this gift, a new
department and residency, completely grant funded.       Fortunately
they were absolutely enthralled about this.     Bronx Lebanon heard
about this and said, "You know what?     We're there."
     I said, "What do you mean?"
                                                                       54

     They said, "Here.    Take this floor."   They handed over a
floor.    They cleaned out a floor, their ambulatory care center
that was like 8,000 square feet, practically overnight.      They
just moved everybody off the floor.     They said, "Here, Neil,
you're the chairman of the department.     Run this floor, and you
can run your residency right here.''
     So   we took the hundred-and-something thousand dollars that
Soundview was going to get to renovate, and we put it into this
floor, wrote up the grant revisions and had them approved.        We
had just had a major change of plans.     This was a freestanding
ambulatory care center that the hospital had, and we renovated
that instead.    It was an the old Department of Health building.
And we ran the residency program there for four years.      Almost
the entire staff of family docs that were at Soundview came and
became the core staff of the new residency training program on
site.


Mullan:     What happened to Soundview?


Calman:    They restaffed.   We left as they filled the jobs, we

left one by one.    First, I think only two of us left and then a
year later, two more people left.      It kind of lost its spirit
because the heart had been cut out.     You know, this is why we a l l
went here.    This is what we were a l l there for.   It was an
incredible group of people.
                                                                   55

     Four of us, Yvonne Eisner, who's a family nurse

practitioner, Eric Walsh, who's a family doctor, myself and James
Deary founded the Institute.


Mullan:    What was the idea behind that?



Calman:   Well, again, sort of looking back at it, I think it was

really modeled after the Mid-Hudson Consortium concept.    The idea
was to set up an independent corporation.   We did it just about
the time we made the transition over to Bronx Lebanon so that we
would not be employees of Bronx Lebanon Hospital.   So none of us
ever worked for Bronx Lebanon.   To this day, there's never been a
family physician employee of Bronx Lebanon. All of us worked for
this separate corporation and we said to the hospital, "If you
want the residency, that's fine.   But we want the residency to be
run by the Institute, and the hospital can contract with the
Institute around running the residency and hiring the faculty."
     Again sometimes there's real visionary people who help
things happen.   The visionary people in this equation were two or
three of the leadership people at Bronx.


Mullan:    This is tape two, side A, continuing with Neil Calman.



Calman:   So Fred Silverman, who was the president, Miguel

Fuentes, who was then the vice president, who now is the
president of Bronx Lebanon, and Ira Lubell, the Vice President
for Educational Affairs,   saw that this was an opportunity to get
                                                                     56

hooked up with a group of entrepreneurial family docs who were
going to do good things and the hospital was not at all into
controlling this piece.    They said, "If you folks have gotten
this far as you've gotten so far, we support that.    Do it.     We'll
give you the space."
     I said, 'Look,    I'm going to make a proposal, a no-lose
proposal for the Hospital."    This is what eventually sold them.
We've used the same format a few other times since.    We said,
"Tell us what budget you used to operate this ambulatory care
center before we came.    Give us your last year's budget and     pay
that to the Institute in twelve monthly installments. We will
come in, put in a primary care model, create your first model for
continuity of care between outpatient and inpatient by
hospitalizing and caring for our own patients."    These were all
things that were very new concepts ten years ago--for people in a
community health practice to be doing inpatient work and taking
care of people in the ICU.
     We said, "We'll do that.    We'll run your residency program,
get it accredited, and increase the productivity of the center by
20 percent.    If we fail to meet any of those criteria, you can

cancel the contract in one year."
     So   they gave us a contract.   It was $872,000, divided into
twelve installments. We created a budget to pay for the staff
and pay f o r the family docs and the nurse practitioners and the
support people and staff the whole place up.    That was the
Institute's first real major contract.
                                                                       57

Mullan:     Tell me a little more about what went in to Institute

thinking.    Surely, you could have gone into Bronx Lebanon and
simply joined the staff and built a Bronx Lebanon-focused
activity.    But, presumably, you had a bigger concept cooking
there and the Institute was a vehicle for it.       Was that so?


Calman:     There was a combination of a personal issue and a
professional philosophy.       The personal issue was that Soundview
had been my third attempt at working for somebody else, and I
think at that point I realized that I need too much independence
personally and professionally.        I work very, very fast and move
too fast for the majority of people that I could ever work for.
I really saw at that point that I had two choices in my life.
One was to continue to be frustrated working for people who
didn't move as fast as I did.       The other was to start my own
company.      This was really what was going on in my head.


Mullan:      So, this was, in essence, your own company?



Calman:     Yes, definitely.     The four of us became the board but

it was always clear that I would be the boss..


Mullan:      This was a not-for-profit?



Calman:     Right.   I think that if it weren't   for my social

commitment I would have gone out and started a group practice
that probably would have twelve branches right now be in suburban
                                                                          58

communities. Thatrs just me--a developer.         I'm a developer and
that's what I love to do.       But because of the way things were, I
said, 'You    know what?    You could do this."   So what I really did
on the professional side, I described this as a hybrid between a
community health center and a private group practice.          For years,
I've described it that way when people said, "What the hell is
this stupid thing?"        I said, "It's a hybrid, extracting the best
from both."     And the way I would explain it is that from the
community health center model I took a sense of real mission and
purpose that we were there to take care of people who hadn't
gotten care before, but I was absolutely sure that the way
community health centers employed physicians was wrong and didn't
work.     It was years later that the National Health Service Corps
and everybody else started to develop a consciousness about the
fact that doctors had a real role in health centers and elevated
medical directors to report to the boards and lots of other
important things.
        In the 7 0 ' s and 8 0 ' s in community health centers, doctors
were just employees.       They were treated just like clerks in the
health center movement, you know.        I was just absolutely sure
that was a bankrupt idea, and there was clearly no way I was
going to have anything more to do with this after my three
experiences. And yet it seemed to me that what I was saying by
saying that at that point in time was that you had to give up
your political commitment to taking care of uninsured people or

taking care of poor people because there was no way you could
open a private group practice and make it work financially. So I
                                                                         59

was convinced that we were going to create an organization that
was going to sit right on that line and capture the best of both
worlds.       That was the original vision and purpose of what we did,
to bring in a professionally run organization that could build on
the entrepreneurial spirit of smart people that wanted to come in
and develop programs and give them lots of freedom and
flexibility to do that, and not have to be accountable to some
outside group of people that were saying, "NO, don't do this.
That's not the way we want it."
        So   a l o t of this just had to do with me saying, "Nobody's
tying me down anymore.       I'm not going to do this again."       First
Ronald Frasier Health Center, then the Center for Comprehensive
Health, and finally Soundview Health Center.        Three job
experiences and I was at the end of my rope.


Mullan:       Tell me about Bronx Lebanon.    How did it develop?

Where did it go?


Calman:      Well, what happened was that Jim Deary, Yvonne Eisner,

Eric Walsh, and myself became the four founding members of the
Institute.      We got some good legal counsel and said, "You know
what?    Not only are we going to be the four members, but we're
going to be the board of directors."
     We had no qualms about not being a community-based or
community-controlled       organization.   We made no qualms about not
having a community board.       We were the board of directors of the
non-profit and the first four employees of the non-profit, which
                                                                            60

is perfectly legal as long as you don't use it for your own
purposes and make a sham out of the fact that it's a non-profit.
           So   we set our salaries according to what to what people were
making in similar positions in the community that we investigated
and had a lot of really good, sound legal advice from very smart
people in New York who said, "There's no reason you can't start
out like this.          Just do this and make it what you want to make
it.   'I




           So   we had a non-profit.   It was tax exempt.   It had
charitable purpose.          We were the board.    We were the directors.
We were making the contracts with everybody. About, I guess, two
months after the Bronx Lebanon program was born, the board of the
Sidney Hillman Health Center was going bankrupt.            There was a big
employee trust fund that had been used for health care purposes
for years and it had almost been depleted.
           The Amalgamated Clothing and Textile Workers Union ran a
40,000 square foot health center on 16th Street in Manchester,

exclusively to service its numbers.           It was supported by a trust
fund which was losing a million dollars a year funding the
center.          There was three and half million left in a trust fund
that had fifteen million in it just six years before.              The reason
they were losing all this money is that they had thirty specialty
physicians there and no primary care.             The specialists would come
in.        The union members could come there for free.      The
specialists would come in and they would say, "Ah, you need a
vein stripping."          They would then refer them out to their private
office.          All the patients had was catastrophic coverage which
                                                                      61

paid for surgery.   So   practically every person that walked in the
door here ended up in some surgical room somewhere or getting
some procedures that were unnecessary.     Not o n l y did the
specialists do that, but.they charged the Trust Fund $100 an hour
to come here on site and do this stuff.
    When we came in and looked at the charts, we were so
appalled.   It was just the most atrocious health care system that
anybody could have ever imagined.     What happened was we called an
independent auditor in and found 78 percent of all of the
services that had been done in the prior year were medically
unnecessary.   We were asked to come in to bid on this.      We bid
against St. Vincent's Hospital, Beth Israel, St. Luke' s,
Roosevelt, two private doctors' groups, and some big employee
health outfit that was in here.
     I came in, and I brought three family docs down with me and
we said, "Look, we looked at your records."      We did a patient
origin study and we printed it up on maps and stuff for them and
said and we figured out this whole thing.      I said, "What you need
here is to get rid of thirty-two specialties, to close your
specialty centers."      We gave them a budget for the operation, and
we gave them the exactly the same proposal we'd given the Bronx-
Lebanon Hospital six months before.     We said, "For one year, give
us what you lost, just the amount of money that was lost as an
operating budget.     Then after that, you don't have to pay us
another nickel.   We can make this place completely financially
solvent."   And we had a proposal to do that.
                                                                   62

    We actually broke even two months earlier than we expected.

We closed down four of the six floors of the building.     We fired
all the specialty people.   We set up a panel of outside
specialists we could trust.   We brought four family docs in to
run the center.   There were only 30,000 visits a year going on in
the whole building.   We brought in four family docs.    We took
something like two hundred people off of weekly allergy shots,
some of whom had been getting them for twenty years.     I mean, it
was the most--nobody complained.   The patients were so relieved.
We thought there was going to be an uproar with the patients.
The patients said, "You mean I don't need these shots anymore?
Oh, God, doctor, I can't thank you enough!"   It was an amazing
transition.
     We brought in this group of family docs, and we closed down
most of the building.   We met all of our financial projections.
I think we lost only $600,000 the first year we were in operation

and then broke even in year two.   All they did was pay us a very
small fee for service for the patients they did, and we opened up
to the community and started doing work with Medicaid.     We
developed HMO contracts and a lot of other stuff.   The building

filled up in five years, refilled with community patients of all
kinds.   We now have probably fifteen different programs that run
out of the building that have all been developed for HIV
patients, for the homeless, and for many other kinds of patients.
We are continuously writing grants and developing other programs
here, student programs and all kinds of training programs as
well.
                                                                        63

Mullan:        How did the union feel about that?



Calman:    Well, the union's almost gone.    They were on their way

out back then, and the leadership knew that.        Most the clothing
is imported now.       The men's apparel industry is almost dead in
Lower Manhattan.      When we came in, there were more than 15,000
members and 100 shops.      Two years ago, there were 6 shops and
4,000 members.      Now I think there's only two shops left.
     We still supply care to whatever the union members are that
are left, and to union retirees and people who had been laid off
from the union.      We provide them all care.   I mean it's our
roots.    So   we still take very special care of the clients that
come in from the union.


Mullan:        What happened to the fund?



Calman:    The fund is still there somewhere in a bank account.       We

guaranteed them that after the first year, they'd never have to
touch the trust fund again.      And they never did.   We actually
entered into a sort of illegal managed care contract with them.
We told them that no matter what volume of services we provided,
that we would never charge them more than what the interest was
on the trust fund.      It was good, because those were the years
when the interest rates were high, and they were making a lot of
money.    So   we got three, four hundred thousand dollars a year

from the trust fund.      By the time the interest rates had fallen
                                                                    64

and there was only a hundred thousand dollars coming in off the
trust fund interest, the membership had dropped in the union.
     So, again, we benefitted from a number of speculations I
made, but they were speculations based upon good data.      I mean, I
had graphed the membership of the union going back ten years, and
it was headed on a straight linear decline, and they knew it, and
we knew it.   We had set up a financial arrangement where the same
dollars were going to buy less and less over the years, but we
had anticipated the membership was going to drop, and it did.
     So, when Sidney Hillman and Bronx Lebanon, we ended up with

two huge projects almost instantly when the Institute started.
Actually, three.   We had a faculty development program for which
we had gotten a grant from the federal government.
     What happened with the faculty development program was we
put together this fabulous program bringing in consultants from
all over the country to teach our core group of faculty, all of
whom were good community-oriented family docs, but none of whom
had done any teaching or really knew how to teach.      We set up
this great group of consultants, we put together this proposal,
and the feds funded it.   As we were negotiating with them,
because we never just write grants, you know.   We've    always gone
down and talked to people and tried to figure out how and what we
wanted to do and matched this with the grant program.      As we
were down there talking to somebody, I have no recollection of
who was, they said, "You know, if you're going to do this in New
York, it's really a waste just to do this for your own ten
faculty people.    Why don't you offer it to the other family
                                                                  65

practice residency programs while you're bringing in all these
national consultants."
     I said, "HOW are we going to be the faculty development
program center for New York City?   We don't even have our
residency yet. "
     They said, "Look, you can administer it.
     I said, "Yeah, but we're going to be the only faculty
development program in the country that's never actually run a
residency, and we're going to be the ones teaching everybody how
to be faculty?"
     So   Jim Deary, who had this background in organizational
development and in education, said, "Hey, I'll run it."   He said,
"You know, that's right up my alley."
     So   he ran it, and it got funded consistently for twelve
years until they eliminated the family practice funding last year
for faculty development.   We were continuously funded for twelve
years.


Mullan:   How many people have you trained?



Calman:    I think he's tracked about 140 people that have come

through our year-long training program since the beginning of it.
We train about ten to twelve a year.


Mullan:     It's a year long?



Calman:    It's a year long.
                                                                       66

Mullan:     You do it part-time?




C    alman:      You do it part-time while you're on your job.

     attend ten workshops, ten full-day workshops which you have
to be given release time for by your employer.      You do
                                                                 You




videotaping and videotape reviews of your precepting abilities.
You do an administrative project and a research project with some
staff people that we have.      You prepare some seminars that you
have to give at a few different residency training sites, to

perfect some talks that you give and learn how to use            aids
to best advantage.      It's really been oriented more towards junior
faculty.    Now we have a track.    The last funding cycle we did a
track called the Continuing Education Track, which was for people
who'd been in our program before, who were still in the New York
area and are now more senior faculty and administrative folks.
We have now started to do advanced faculty development stuff
around organizational development, some advanced organizational
development concepts and budgeting and some topics on managed
care and things like that.


Mullan:     So   what happened next?


Calman:    Jim Deary.    Big, big issue related to having that guy on

because he was the organizational development training
professional with us.       He's just this very incredible, stable
person who you looked to and you say, "Wow, he could teach me."
You know?     He's great.
                                                                     67

     Yvonne Eisner, who was on, basically kept beating us up
about nurse practitioner training and why were we doing all this
stuff with physicians.   She was on the board.    We developed our
whole collaborative practice model around her image of how
physicians and nurse practitioners should work together, which
was very different than what was popular in the educational
culture at the time that we started in the eighties, you know.
She was really a maverick and has been a half-time clinician and
half-time promoting nurse practice in our Institute, but that's
what really got us into collaborative practice.     I think then we
became known for being a very good and friendly place for NPs to
come both to learn and to practice.
     Two other key people have been pivotal.     Bruce Soloway, who
became the medical director of the Family Practice Center up in
the Bronx and Red Shiller, who became the director of this campus
and is now the Beth Israel Chairman but who works for the
Institute.


Mullan:   Chairman of the Family Practice at Beth Israel?



Calman:   Right, but he works in the Institute.    The year after we

came to 16th Street, we made a proposal to Beth Israel to do
exactly the same thing that we had done at Bronx Lebanon, to set
up a residency at our 16th Street and start another community-
based residency.   We offered to do the whole thing, but they
said, "Thanks, but no thanks."
                                                                       68

     Then two years later, we sent them another letter, and I
went over there and actually met with some senior people,
including the president of the hospital.     They said, "You know
what?     There's no way family practice would be accepted."
     Then when the Medicaid managed care thing started to hit, I
said, \\Youknow what?     This is really the hook for B.I.     We've
got to go back there and say, 'We will be the Medicaid managed
care people for you.     You can do Medicaid managed care, and werll
do the risk-sharing stuff.     We'll do the risk stuff out in the
community in our site.     This will be an opportunity for you to
get involved in opening this site.'"
     They said, "WOW, we've got to talk to those people."
     Next thing we knew, they had awoke to discover all this
stuff that we'd been talking about for years.     Departments and
correspondence and plans and everything.     We had rooms full of
vice presidents, finance, everything.     Everybody wanted to do
family practice instantly.     They wanted to be the first family
practice residency in Manhattan, which they were.     You know, they
were like feeding us money and resources to make this development
happen fast.     It was like an instant transformation.


Mullan:     What year?



Calman:     I guess '91, '92. S o that became our second big

hospital contract, a hospital contract with Beth Israel to run
their family practice department and residency and to supply the
director for their department.
                                                                       69

Mullan:     How many residents in your program?



Calman:    Bronx Lebanon has 30, and Beth Israel has 2 4 .   A total

of 54.


Mullan:     That was '92.



Calman:    Yeah.   Then the next big breakthrough for the Institute

was hiring Maxine Golub.    Maxine is an MPH, and she was the head
of the Bronx Committee for the Community's Health, which was a
consortium of all the Bronx community health centers.        We were
doing some training for them about telephone medicine, and hooked
into Maxine, who had a long and varied history in public health
and health services development.     She'd worked on lead screening.
It was like an instant connection between Jim Deary and myself
and her.    We were doing this training. It was like the day we
both left there, he and I looked at each other and said, "Some
day we are all going to work together."
     I guess about a year later, the Bronx Committee folded, and
she came to work for the Institute.     She really had this vision
of how community organizations could link up with health
providers and form these health centers in the community that
were not really community health centers.      I mean, they weren't
run and developed by community boards.      It was like an instant
match with this plan that I had originally thought of in '86,
which was how we were going to combine these two pieces.        She
said, "Look, they don't want to run it.     Health care's too
                                                                   70

complicated right now.    No lay community leaders or social
workers are going to come up and figure out, learn the managed
care contracting business, learn all the issues related to labor
relations and all these other issues that were hot, hot issues in
health care, and write a new 330 application to get federal money
to start a health center."    I mean, it was a dead model from
everybody' s view.
     So we said, "Well, we have a potentially perfect answer.

Let's just collaborate with committees and committee agencies
that need health service."    We'd had these great successes and
collaborations with the hospitals and said, "Let's just agree
that these are going to be collaborations, that we're going to
take two agencies and bring them together on an almost equal
status and see if they can't collaborate to do a health project."
     But our first attempt got blown out.    We were in a community
working with a community organization, had done the architectural
planning, the community board there decided that it was

potentially              that the Institution, mostly led by Jewish
people was going to be connected to this organization that was
led by a group of Catholic priests who were very concerned that
if we counseled anybody about birth control or abortion or
anything like that, that their principles would be violated.      The
next thing we knew, the project went to a Catholic organization
to run.   This was a total violation of process.   We had answered
an RFP.   We had the highest ratings on the RFP.   We knew this
from certain people we knew on the inside who were very unhappy
with the decision.
                                                                        71

        I was very discouraged.   This is just another example of how

you can just get sidetracked.      I was really ready to quit.    She
said, "You know what?    Let's not quit so soon.      Let's just be a
little bit more sure about who our partners are when we go into
this and make sure that everything's on the table.''
        So our next experiences were successful. We were able to

open a whole bunch of centers in fairly quick succession over a
couple of years.    Maxine brought together a lot of funding from
Robert Wood Johnson Foundation and many other foundations. We
also were fortunate to find A1 and Gail Engleberg and Carol
Who both gave us and Beth-Israel one million dollars cash to
support the development of family practice.


Mullan:      This is to establish?


Calman:     To establish the department of family practice.      One

gave a million dollars to Beth Israel and the Institute. He gave
$450,000 more to build one of our health centers.       He just gave
us another half a million dollar loan, interest-free loan, to
start our managed care company.      So   he's been right behind us,
sort of boosting us along.


Mullan:     Let me just get an inventory of where the Institute's
at in terms of beyond Beth Israel, Bronx Lebanon, and the Hillman
site.     Your other operations, just kind of a summary.
                                                                    72

Calman:   Okay.    The whole project, two academic training sites

for residents, the Phillips Family Practice and the Bronx Lebanon
Family Practice Center.     We have three large five- to six-
practitioner practices: Parkchester Family Practice, the Mount
Hope Family Practice, and the Sidney Hillman Family Practice.       We
have four small two- to three-provider practices: Times Square
Family Practice, Crotona Park Family Practice, and M.D.B. Family
Practice, the East 13th Street Family Practice.     Then we have
eight part-time sites which cater to the needs of the homeless
population only, that are run in soup kitchens and churches and
shelters.    Our   total staff is sixty-five family practice people:
family physicians, family nurse practitioners, and three mid-
wives, 57 family practice residents and 200 administrative,
nursing and support staff.


Mullan:     What you've done starting in ' 8 6 or thereabout it seems

to me is you have, as you described, created an intermediate form
between the publicly funded health center and the privately
funded private group practice.    You have explored and implemented
various permutations of that hybrid form, using family practice
as the principal agent of service delivery, by family physicians
and family nurse practitioners.    Have you reached the limits of
what that can do in an urban area, or have you just begun to make
things work?   And at what point do you cease to become an
idealistic intermediate form and became instead, a business
operation whose ethos begins to shift toward the more standard
commercial activity?
                                                                      73

Calman:   Well, I think it comes down to different things.     I

think we are a business.    I don't think you can have a $17
million-a-year operation with three hundred-plus employees and
not be a business.   In fact, what people expect of you is to be
incredibly efficient in relationship to the business part of what
you do, almost to the point of having the administrative part of
the organization be invisible. What a doctor in a practice wants
is the most efficient purchasing operation in existence.      They
want to be able to pick up a phone or have their nurse pick up a
phone, figure out what they need, order it, and have it
delivered.   They don't want to know anything about what goes on
in between, who you bid it to, how long it took you to pay the
bills or anything else.    So   my philosophy about the business end
of the administration is that it should be completely invisible
to the people on the front end.     We're never totally successful
at that, but that's the goal.      The administrative piece should be
completely invisible.
     I think we've been very good at it.      I don't think that we
have the same level of bureaucracy that people complain about
when they work in other kind of environments.      That's really

critical.
      The second difference between what we do and what others do
is who our clientele is.    I think to the extent that at some
point all people will be insured, which I think will happen in
the future, the real difference in organization is going to be
how people define health and what the work is.
                                                                       74

        And also how true you stay to your commitment of who are you
really out there to take care of.       We have had a number of
opportunities brought to us by commercial HMOs to operate
networks and primary care sites that cater totally to a
commercially insured population.       We had one deal where a huge
group operated by one of the HMOs was going out of business, and
we could have taken the practice over lock, stock' and barrel--a
program with six or seven thousand insured people that was making
a considerable profit.      We turned it down because it wasn't
consistent with our mission.
     We've turned down a number of other things.      We've   turned
down collaborations with organizations that we didn't feel were
serious about their mission in terms of wanting us to work with
them.     We've   turned down a lot of opportunities because they just
didn't seem right or didn't seem like the right organizational
personality match.
     We try to do what keeps us true to our purpose.      We have a
lot of liberal-minded people who came to work in the organization

because of the mission.      As much as I've become entrepreneurial

in trying to develop and do new things, they don't let me stray
very far from why they came here.      You know, they say, "Hey'
listen.     I didn't come here to become part of the biggest HMO in
New York, you know.      I came here because I wanted to take care of
this particular group of people."
     In one of our practices, I was worried about the finances,
and we allowed a commercial HMO to start marketing to bring in a
mix of patients into the practice.      It soon became the dominate
                                                                      75

payor in the practice.      The medical director said, "Look, we're
not here to take care of these kind of patients.      You know, this
isn' t why we came here."
     I went, "Whoops.    Yeah, you're right.    That's not what we're
supposed to be doing."      And we shut off the stream to commercial
HMOs, and we started to do some outreach to some community

organizations. We shifted the payor mix back to where people
wanted to see it.


Mullan:    Speaking of underserved,     you've got insured

underserved, as in Medicaid, and you have uninsured underserved,
as in non-Medicaid.     You have uninsured uninsurable as in
undocumented, etc.    How do you define your mission, and what
happens when uninsured people get insurance? Is that still part
of your mission?


Calman:   We don't define our mission around insurance.      We define

it around people who have difficulty negotiating or accessing the
current health care system in New York City.      Some of the people

are well insured, but that just still doesn't give them access to
decent health care.     So we've had special programs for HIV, not

because there's nowhere for people to go, but there are very few
places in New York City where you can go if you have AIDS or HIV,
where you become part of a delivery system that doesn't have AIDS
written on the door or HIV written on the door.      So we have a

totally integrated delivery systems for the care of HIV.       We have

hundreds and hundreds of people with HIV at our sites, but
                                                                     76

they're sitting with everybody else being taken care of by the
same providers, with a very complicated network of backups.     We
have two or three people who are real AIDS experts that work with
the Institute, one who's published a lot, and one who works half-
time in the state setting policy for AIDS care for the state.
Both work for the Institute.   These folks are in the background
of all of us who take care of people with HIV/AIDS, but all of
those patients are cared for in our general settings.   So   that's
a different kind of availability than people have in a lot of
other places in New York right now.
    And our homeless network.    A lot of those people are on
Medicaid, or we can collect some reimbursement from the federal
government for their care, but they don't have anywhere to go
expect emergency rooms.   I mean, if it weren't for our network,
there's not a care system out there for those folks.    So   it's not
really dependent on insurance.
     We also do all of the care for the home-bound with the
Visiting Nurse Service in New York.   We have a group of people
that go out to take care of people who are truly home-bound,
which means they live in places where they cannot get in and out'
even with assistance, even with ambulance transportation, they
cannot get in and out of their apartments.   There's about forty
such people each in the Bronx and Manhattan that the Visiting
Nurse Service cares for' and we deliver primary care to them at
their homes.   A small population, but that's the kind of special
work that we've been able to attach ourselves to and the kind of
special programs that we do.
                                                                          77

        So   I think our mission is defined by our being
"ghostbusters" of a         sort.   If you need primary care and you have
a population that's tough to serve, that's the kind of folks that
we like to try to figure out health care delivery models for.
        We have an ex-offenders program in the Bronx' where this
group of folks came to us and said, "You know what?          We have all
these people that are coming out of prison.          They have positive
PPDs.     Many have been recently diagnosed as HIV-positive.       They
have all kinds of other kinds of medical problems and nobody
wants to take care of them because nobody wants them in their
settings."       So   we worked out this collaboration with a group of
folks who do a lot of social service support for ex-offenders
when they're released from prison, to get their medical records
transferred over.


Mullan:        Let me explore the other axis.     One axis which you've

done eloquently, you've done superbly with and eloquently in
defining, having to do with your "ghostbusters" mission, the
other is the application of family medicine to those problems in
an environment where family medicine heretofore didn't exist or
at least didn't flourish, realizing it's over a period where the
paradigm is changing.         Tell me about that and what you think the
potential is.


Calman:       I have been accused of being a flag-waving family

physician, which is something I accept.          1'11 bet we have the
largest primary care organization in the country that's
                                                                     78

exclusively family practice.    I mean, we have not a single
internist or pediatrician that works for us, and it is based upon
a singular philosophy that if somebody were to start from scratch
and wipe out the home health care delivery system in the United
States, what they would create is a front line that looks a lot
like family practice and a back line comprised of sub-
specialists, and that the role for the primary care internist or
pediatrician would not exist.
     The evidence for that is that with the exception of some
developmental issues in pediatrics, family physicians do not
generally refer to general internists or general pediatricians.
They refer to internist sub-specialists and pediatric sub-
specialists.
     I think the front line training for family physicians is
absolutely superb in the way that it is done in terms of the
breadth of training.   People do all this work in GYN and
dermatology and ENT and the other issues which comprise the top
one hundred reasons why people need to get health care.     It's a
philosophy that's oriented around doing as much as you can with
people and keeping them out of the hospital.    I think,
philosophically, it's really oriented around the fact that people
are basically healthy and that these things that are happening to
folks are things that need to be worked through.
     It's really much more of a health-oriented training model.
It's very hard to explain to folks who have gone through training
in other kinds of settings, how different philosophically it is.
I think pediatricians understand it a lot more because I think
                                                                   79

the philosophy looks a lot more like pediatrics, but internal
medicine is as different from family practice as night is from
day in terms of just the paradigm of how doctors view people as
people instead of patients.   I think in terms of the transition
to managed care, there's just no question that family practice is
going to be much more closely a model for how things are going to
need to be continued than other primary care models.


Mullan:    Is the receptivity to that sort of transition, which,
to be sure, is higher throughout the system than was it was some
time ago, is it in the urban setting, New York setting, growing?
How do you characterize the environment, the receptivity to
family medicine as a movement in urban areas in general, New York
in particular?


Calman:   Well, I think that the medical establishment deludes

itself by thinking they control this.    Patient demand controls
it.   We've said all along that the evidence that this would
predominate as a model is the fact that when you open one of
these family practice centers, that in fourteen months it's
filled to capacity, and we don't have a single brochure published
advertising any of our clinical sites.   By the time we get around
to publishing our brochure and figuring out who the providers
are, it's already filled to capacity.    I just was laughing
because today I got a memo from somebody saying, "I'm helping to
write a brochure for the Mount Hope Family Practice."   Two days
ago I was looking at their statistics, and they're operating at
                                                                     80

75 percent of capacity, and I'm thinking, okay, it's going to
take them a month to write it, a month to edit it, a month to
print it, and by the time they are done, there's not going to be
anybody they can give it out to because they're already filled.
     So I think that patients basically are responding.     The HMOs
put the booklets out.    They list the family docs' the internists,
the pediatricians.     I don't know how the internists or
pediatricians are doing, but the family docs are closing their
panels.    They just don't have capacity anymore.   And I don't
think the major draw of family practice is that the whole family
gets to see the same doctor.     In my own personal experience,
that's the advertised piece, but I don't think that's the major
draw.     I think the major draw of family practice is that people
can get a lot more of the things that are wrong with them taken
care of in one place than they can when they got to an
internist's office.    Second, there's just a general philosophy
that people are healthy, that people are in a general state of
good health--and sometimes get sick.     Family physicians are

trained to be advocates for them and be with them through their
illness.    That is part of family practice education in a way that
I think goes beyond what exists in internal medicine.
     So I don't think internal medicine is going to disappear,
but when you keep hearing about everybody talk about developing
the "generic primary care specialty" and you look at what they're
talking about and it looks exactly like family practice, you
realize that we're on the right track.    I've never been worried
about recognition issues, because we can get hospital privileges
                                                                      81

almost anywhere nowadays because the hospitals have floors that

are half empty.    When we applied to Beth Israel Hospital in the
late eighties, they said, 'Look,   you can have privileges in
pediatrics and in OB/GYN, but not in internal medicine."      And we
couldn't figure out what was going on.     It took us months to
figure this out.    Well, it turned out all the medicine floors
were full, and the pediatric and OB/GYN floors weren't.       So that
determined how they viewed family practice and our credentials.
We were saying, 'You   don't understand.   We do two years in
medicine and only a year in Peds and OB combined.    Why would you

offer us privileges?"
     'Well,   that's just what the chairpeople want to do."
     But it turned out it had all to do with hospital beds.      So

now that everybody's got hospital beds empty everywhere, they're
family physicians' best friends, you know.     I don't think that
there's any question that economics drive people's judgments
about quality and all the rest of this stuff more than anything
else does.


Mullan:    What about the relationship and the futures, respective

futures, of the nurse practitioner and the family physician?


Calman:   Well, I think that nurse practitioners and PAS and

midwives are going to have an enormous new role in a managed
care-dominant health system.    People are talking about being
concerned that the physician glut has eliminated the need for
these "physician extenders," but I think that folks who say this
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are ignoring two important issues. Number one, the majority of
people in medicine don't like doing what midwives and nurse
practitioners, in particular, love to do, which is taking care of
healthy people, doing a lot of preventive care and education.     I
think that in the transition to managed care where primary care
providers are now at risk for bad health outcomes, that we will
all be moving in a direction of depending a lot more on people
doing really solid self-care education and health education.      I
know we're moving that way in our own organization.
     I think that PAS and nurse practitioners are going to look a
lot less like mini-doctors, which is   what happened in the
eighties where they did almost the same thing that doctors did,
except maybe didn't go quite so far.    I think that people are
going to start, especially in nurse practice and midwifery, to
rely on them a lot to do a lot of preventive and educational
interventions that physicians are horrible at, aren't trained
for, don't like to do, and no matter how many of them get thrown
onto the market, are still not goinq to do.


Mullan:    And the competition between them, you think will be

re1axed?


Calman:    I think they're going to find that there's a niche, that

there's a real niche now for these providers.    It was hard to
define the niche when they were "physician extenders", when you
look at health manpower statistics and the fact that you couldn't
produce enough doctors, so you were going to create all these
                                                                  83

other kinds of health professionals.   I think that that's just

not going to be the drive. The drive is going to be that people

are recognizing the fact that doctors are just horrible at doing
asthma education.   Nurse practitioners are much better at sitting

down with people and teaching them how to use metered dose
inhalers and teaching them how to monitor their peak flows and
how to adjust their medications and to use the nebulizers.    I
mean, doctors just don't sit with people for forty-five minutes
and do that kind of stuff.   But that's going to make the critical

difference as to whether or not somebody goes into an emergency
room or gets hospitalized.
     Now that the financial incentives are shifting, I think the

places that you see the most sophisticated use of nurse
practitioners and midwives are in the really sophisticated
managed care delivery systems where people realize that doctors
just aren't going to do that, and yet that's what the critical

prevention-driven outcomes are going to improve.    I think a whole

new model of team practice is going to develop around these
issues that we've been paying a lot of lip service to over time,
but is now going to become a very significant part of our managed
care system.   And we're doing that within the Institute in a
number of important care areas.


Mullan:   What is your view of managed care?



Calman:   I think it's like nuclear energy.    It can be a most

constructive or a most destructive force, and it always remains a
                                                                     84

little bit dangerous.   That's the analogy I use frequently in
talking to people about it.    On the constructive side, it's the
first time we've ever had a financing mechanism that truly
supports prevention, that recognizes that keeping people healthy
is actually in an organization's financial interest as well in
their philosophical interest.     The entire financing system before
was designed around illness and sickness.     The sicker and iller
and the more you did to people, the more money people made.    I
think that redesigning a system with the totally opposite
incentives has more good attached to it than bad, more potential
payoff than problem.
     Having said that, I think that we totally redesigned a
system that the American public doesn't understand.    That's where
the real danger in managed care lies.    Another analogy I use is
it's as if you all of a sudden had some pre-paid insurance for
your car and you now drove into the garage and the garage
mechanic, instead of saying, "Gee, you need a new fan belt," or a
new muffler or whatever, said, "Oh, don't worry about the noise.
Don't worry about the clanking.    I know your tires look a little

bald, but they'll last another couple of hundred miles, and just
come back and see me in a couple of months."    And the clanking
gets worse and the noise gets worse or whatever, but there's
really no incentive in place for them to change anything or do

it, because the fan belt price and the tires price and everything
comes out of their pocket.    There's nothing else that I'm

familiar with in American civilization that functions with that
kind of reverse financial incentive.
                                                                          85

        In America we are all familiar with being s o l d something
that we don't need, and that's the way the old health care system
was.     When the doctor said, 'You     need an MRI.   It's going to cost
you $300."
        "Wait a second.    What do you mean?"    People were into that
already because it's the same way everything else is being sold
in America, which is they try to sell you a product and you pay
money to buy it.       Now we have the only example in American
culture for where the entire system is turned on its head.         I
don't think that 99 percent of the people in America have a clue
what kind of a financing system supports managed care, and that,
in fact, the "garage" they now go to has a financial incentive
not to provide the care.         I think it's dangerous until people
really understand this, as the safety in all these things is
always the consumer.       So   I think the big danger in managed care
is we still have a totally uneducated population of people who

don't understand what the financial incentives are about managed
care.

        So   even though I'm a big supporter of managed care, I'm glad
that the newspapers keep running all this horrible stuff, because
that's the only thing that's informing people about what the
potential dangers are.      And even though the transition is going
to take place and everything's going to happen, what you're going
to end up with on the other side is a public that's skeptical
about it in a healthy way and says, "Wait a second.         What do you
mean I don't need a dermatologist?        I read in the paper that you
guys get paid more if you don't send me to the specialist."
                                                                    86

     So   I think that public education that's going on through the
media is going to create some protective mechanism which will be
helpful in terms of helping the public be protected about some of
the managed care things that are going on.     But ultimately, I

think it's a much better financing system.     If you look at the
top ten things that managed care companies think you should do
for people in order to save money, and the top ten things that
family doctors think you should do to people to be humanistic,
they'd be the same list of things: keep them out of the hospital;
keep them in the hospital for a short of period of time as you
want; use tried and true, less expensive medications instead of
new designer drugs.    These are all the things that I believe in
from the point of view of philosophically the way I practice and
its the same values that managed care supports.


Mullan:     Where is the Institute headed?



Calman:     I don't know.   We have a new committee that I just

started called Institute 2000.     We are doing long-range strategic
planning, like looking out ten years to try to look at this
question.     I can tell you what my own very personal vision is,
with the understanding that that's not what's going to end up
being the vision, because the vision is going to have to be
created by a large number of leadership people who are all very
independent-minded and have a lot of ideas of their own, and
somewhere we'll end up with some sort of a vision about this.
                                                                         87

    But I believe that there are certain things that are part of
our future, and the more quickly we can get there, the happier
we're all going to be.       One of them is a completely computerized
information system, including computerized medical records.          I
think that is absolutely in our future.       Having said that a
couple a months ago, it's almost daily that something comes up
that we all go, "Wow, all right.       We need that."   Last week we
were talking about the fact that our different centers are
opening on different evenings.       It was something like, "This is
ridiculous. A patient calls up at eight o'clock at night.          We
have seven centers in the Bronx.        If the one that they go to
isn't open on Tuesday night, why can't we see them in another one
of our centers?    Whoops.     No medical record."
     We want to start a big education and recall program around a
particular drug.    A new finding comes out that there's a problem
with a particular medication interaction. We bring together our
twelve medical directors and say, "What are we going to do to
find out who's on this drug?"       Whoops.   There's no way we can
possibly do that.    We have no data system that knows how many
patients in our practice are on this drug.
    Or we want to make sure everybody that's got a particular
condition, everybody with diabetes and renal failure, is on a
particular medication.       We're going through this stuff, and we're
realizing there's just no way without a computerized medical
record system.     That's number one.
    Number two is, I think we're going to have our own managed
care company.    We have it already for Medicaid.       I think we're
                                                                       88

going to try to figure out how all these special-needs
populations, HIV people, homeless people and others fit into
managed care.     The same way the last ten years we've been trying
to figure out how they fit into primary care.    Our next goal, the
next place where we're going to have a big role is figuring out
how they fit into managed care.     Because they're all going to end
up in managed care somewhere, and they are the most vulnerable
potential people in a managed care transition.
        I would like us to have a citywide network of sites.   I
would like to have somewhere between six and ten sites in each of
the boroughs, supported by the most sophisticated MIS system, and
in the communities right now that are the absolute neediest.       I
think that a lot of the people that are doing community health
care out there right now are not going to survive, because
there's just no way that people are going to be able to survive
with the lack of sophistication that a lot of the community
health providers have.     They're going to be either eaten alive or
they're just going to disintegrate due to the effects of managed
care and capitation issues.


Mullan:      What about private practitioners?



Calman:     Some will fall victim to the transition to managed care.

Some private practitioners, some community health centers, you
know.     Unless there's just a huge increase in subsidies that are
going to go to them to support them through this period, I think
that you're going to find that as Medicaid gets transitioned to
                                                                        89

managed care, you already see the commercials and a lot of other
people really clamoring for Medicaid patients.      They're going to
have choice.     What that's going to leave is a very small
population of uninsured people, small in comparison to the rest
of the state.     I t ' s still not going to be insignificant. But
who's going to survive taking care of only uninsured people?         So

there's going to be a new model that's going to need to develop.
    My prediction is that the [President Bill] Clinton plan fell
apart because it meant that people would have to go into the old
health care system.     Once you gave them their red, white and blue
health security card' they were going to be in the old expensive
health care system.     But now we have a Medicaid managed care

delivery system where you can buy care for $1,300 per life per
year.    So   you now have a system into which you can try to
transition larger and larger numbers of uninsured people.       And as

the subsidies start to fall apart for the public hospitals and
community health centers, I think that you're going to see an
insurance mechanism come to support the people who are uninsured,
because it's going to ultimately be at a price that's no greater,
and probably less, than what we are currently supporting to
preserve the so-called "safety-net" institutions.      So   I believe
we are successful at what we're doing, we have great sites, we
have great providers.      I think that we should be continuing to
grow our network so that this scenario can play out.
        In my vision of how I would know my life was successful
would be to know that in New York City, that in a large number of

very, very poor communities where people would have been dropped
                                                                     90

off the medical     scene with the demise of other parts of the
health care system, that we will have centers for people to go
that are going to take care of everybody, and they'll get the
kind of care there that's probably as good if not better than
what people get on Fifth Avenue.    They'll have sophisticated MIS
systems, they'll have recall systems, they'll have prevention.
They'll be able to be called back if a medication that they're on
turns out to have newly discovered side effects.     It's not going
to be the same models of care that people know now as the old
community health care network or "safety-net."
     While I support this transition,     I also think that it's
moving too slowly towards its ultimate goal.     What I believe is
that if we do this right, at least in certain model places, we're
going to end up with a truly first-class system of care with all
the technological and staffing and other advances, serving the
people who need it the most.     I believe that the financing is
going to be there to do that, and that we'll be prepared to be
able to say, "Hey, we can do that, take care of those uninsured
folks for this price if you attach some insurance to them and put
them into this kind of delivery system."


Mullan:      Is there anything that you'd like add in the way of

comments?    You've covered an enormous amount of ground,
personally and professional as well.    What makes you happiest
about your work in both your work today and what you've done over
the years?
                                                                     91

Calman:    I really enjoy being somebody who can do good and do

well at the same time, and to watch other doctors and to watch
other administrative people come in and really do the same thing.
It really thrills me that Bruce Soloway came to us straight of
residency in '86 and never left, and he's been working his way up
through the system as medical director, associate department
director, and now runs the residency, too.     Many people, really
talented, bright people, have given their professional careers to
the Institute and see it as a place that they want to stay for a
long time.    The longevity of employment of people in our
organization is incredible.     It thrills me that they have
opportunities to explore and do the things that they want to do
with their own professional careers.     This organization and me
personally, get credit for a lot of stuff done by smart,
motivated staff.     If not for Maxine Gollub, we wouldn't have the
kind of community collaborations that I get a lot of credit for
but that come from her vision that she brought to the
organization.    I think that's the way it's been for everything.
All of the programs that we have come out of ideas that get grown
from other people.     I think what we've got to do is we got to get
the entrepreneurial folks out there to start to connect more with
public service kinds of things.
       For some reason, and I don't really understand what it is
yet,    I have a feeling that I ' m going to understand it more in a
year or two, there still seems to be this schism in the world
between the people who are the public health types for whom
                                                                          92

growing and developing and being entrepreneurial is a horrible
thing that you have to feel guilty about all of the time.
     Even in New York, there are half a dozen of us now, people
like me who are out there building and growing and doing stuff,
not for a huge sense of personal financial gain.         I think there's
twenty jobs that I could take right now where I would get paid a
lot more that I get paid now.         The entrepreneurial part of it is
the personal satisfaction,          the development piece, and that's
why I'm encouraging the people in Boston.         The greatest thing we
could do is give these people freedom and sayl ' G o out there and
do it.    Don't lose sight of that stuff, but just go out there and
build primary care in the nearest areas.         I guess that's what I
think is going to connect us eventually with work in other parts
of the community..

     It's one of the things that the current administration, I
think, is forcing people to do more, too, saying, "We're not
going to just keep subsidizing things the old way.           You really
need to go out and do this stuff in a new way."         So   I see that as
an encouraging part of the future as long as enough people pop up
to do this kind of work.      So,   that's it.


Mullan:    Thank you, Neil.



Calman:   Thank you.



[End of interview]
                                                                                          93

                                                     Index


Amalgamated Clothing and Textile Workers Union                        44,      46

Beth Israel Hospital 49, 50, 52, 58
Boufford, Jo 27
Bronx Committee for the Community's Health 50
Bronx Lebanon Family Practice Center 52
Bronx Lebanon Hospital 37-41, 43, 45, 46, 49, 50
Center for Comprehensive Health Practice                      33,   36,   43
Chavez, Cesar 22
Clinton, Bill    63
Cohen, Bob 2 0
Cohen, Marge 2 0
Deary, Jim     38,      40,    43,    47,          48,   50

East Village Family Practice 52
Eisner, Yvonne 38, 40, 43, 48
Espada, Pedro 35, 3 9
Foreman, Spike 2 9
Fuentes, Miguel 4 1
Golub, Maxine         50,     51,    65
Gould, Margie         26

Hallbach, Joe       36
HMOs   45,   53,   57
Hutchings, Robert Maynard                      6

Institute 2000 (Committee) 62
Institute for Urban Family Health (New York)                        1, 38, 40,      46,
             53-55,      60,    62,       65

Jewish Memorial Hospital                   3

Kindig, Dave       29

Life magazine 5
Lubell, Ira 37, 4 1
M.D.B. Family Practice 52
Managed Care 57, 59-61, 63
Marsha Slater Research Laboratory 3
Massad, Bob 2 5
Medicaid 45, 49, 54, 55, 63
Mesches, Dan 34
Metropolitan Hospital (New York) 34
Mid-Hudson Consortium for the Development of Family Practice
             35,   40
                                                                        94

Montefiore Hospital (New York) 26, 28, 29, 32, 36, 43, 49
     1 1 9 9 strike 29, 30
Mount Hope Family Practice 52, 57
Nachebloom, Pat 28
New York Medical College 33, 34, 38
Nurse Practitioners 48, 58, 59
Park Chester Family Practice    52
Phillips Family Practice 52
Cretona Park Family Practice    52
Prieto, Jorge 2 1
Primary Care 26, 31, 36, 41,    44,   53,   55-59,     63

Resident Program of Social Medicine (RPSM) 2 9
Robert Wood Johnson Foundation 5 1
Ronald Frazier Health Center (Bronx, New York)               28,   31
Rush Medical College 15, 1 6 , 2 1
Rutgers University 1 0
Seigel, Frankie 2 6
Shakasky, Martin 2 9
Shiller, Red 49
Silverman, Fred 37, 4 1
Soloway, Bruce 49, 65
Soundview Health Center (New York)      35,   37-40,        43
Sternbach, Marna 28
Sydney Herman Family Practice 52
Sydney Herman Health Center 4 4
Times Square Family Practice 52
University of Chicago 2, 5-7,    10
     Weather Underground 8
Urban Health Initiative 35
Visiting Nurse Service   55

Wallerstein, Harry 3, 4, 8
Walsh, Eric 40, 43
Weather Underground (University of Chicago)            8