Georgetown forum; RMP: Master plan for medicine

Our MP masterplan for medicine. The topic of the eleven hundred and fifty eight consecutive broadcast of the Georgetown University radio forum. Another in a series of educational and informative programs from Washington D.C. The Georgetown forum was founded in 1946. This is Wallace Fanning speaking to you by transcription from the Raymond Rice studio on the campus of Georgetown University historic Jesuit seat of learning in the nation's capital. Today's discussion will be our MP The master plan for medicine. Our panel consists of medical doctors they are Dr. William S. McCune president of the D.C. medical society and the grantee of the Metropolitan Washington regional medical program Dr. John S. Rose dean of the Georgetown University School of Medicine and Dr. Arthur Wentz program coordinator of the Metropolitan Washington reet regional medical program. It's fact that 70 percent of all

Americans die from heart disease cancers stroke and related diseases. It's also a fact that during the last few decades medical science has made amazing advances in those fields. The problem is how to organize the nation's health resources to bring those advances to the greatest number of patients. In October 1965 President Johnson signed into law a far sighted and comprehensive plan to establish regional medical programs across our country to combat these killers by means of grants. The program aims at improving patient care through research continuing education and training. It also seeks to develop better methods of exchanging knowledge among all sectors of the medical profession. Private physicians medical school officials hospital administrators public health officials and voluntary health agencies the regional medical programs are in a sense funded cooperation with

improved patient care as the goal. Today the Georgetown University forum has invited three physicians involved in the metropolitan Washington Regional Medical Program. We ask them to give us a progress report on this very young program which might well become the nation's master plan for medicine. And we're going to begin by asking Dr. McEwen to tell us how this all came about. Mr. Fanning in 1065 at the president's White House conference on the nation's health it was pointed out as you just noted that 70 percent of all deaths in America occur from heart cancer or stroke. Therefore it seemed best that the efforts of the nation's doctors and medical facilities be aimed toward improving health care in these three categories. The next question which arose was to how this could best be facilitated. It was felt that for it to all come

from the federal government and directly to individual physicians might not be wise or effective and therefore it was decided. That certain regions of the nation should be chosen and that these regions should set up their own programs called the regional medical programs. The region regions vary depending upon the population upon the facilities available in different areas and upon the needs in different areas. For example in the west three states Nevada Utah and Colorado combined together and have one program in the District of Columbia. We have a unique situation because we have one city which occupies a relatively small geographical area but we have surrounding population concentrations in Arlington and in Montgomery County Prince George's County there for our own region is a city which includes surrounding metropolitan areas in two different

states Virginia and Maryland the District of Columbia Medical Society has been chosen as a grantee or the leader of this particular program because we have three medical schools in this area and the Medical Society has members from not only these medical skills but from the surrounding counties. Mark McKinnon one of the best ways I think to measure. Something new is measured against that which has been before it. Now how well. How would you explain what this regional medical plan does as opposed to what we've had up till now. What improvements does it offer up to the present time before other major medical programs began. Each individual area each medical school in each state medical society. Each local health department work more or less on its own with information available. Now when the whole region is involved the various parts of the region

combine together they correspond with each other. They train each other and the whole area can be trained more efficiently. Doctor doctor once. I think it might be of interest to identify how in this particular metropolitan region the organization has emerged responding to the opportunities afforded by this legislation the medical and paramedical community identifying themselves and volunteer in cooperation selected and their own region in the light of existing medical patterns and patterns of treatment and probably in the light requirements that could be readily identified. The identity of the recipient of the granting

funds from the federal program. Was selected after due consideration and is a representative body of the medical community. Directed by a program group representing the five county medical societies as well as out of the District of Columbia and being administered by the District of Columbia Medical Society. The structure is supported by an advisory group which has the maximum authority in the direction of the regional program and is comprised of medical and paramedical and consumer constituents representing any of the health agencies who have expressed an interest in participating in the implementation of a regional medical program in the metropolitan Washington area.

Dr. Rose medical schools have played of course important roles in regional medical programs. One of the key words in regional medical programs is cooperation and as you've said this is in a sense funded cooperation here in Washington and in other cities where there are more than one medical school. There has always been cooperation. I might say that here in Washington there are as you know three medical schools. Those of Howard University George Washington University and Georgetown university deans of these three schools meet regularly. We regularly consult with each other about our city hospital about the Veterans Administration Hospital about medical educational problems in general the regional medical programs have brought us closer together and

and have led us to closer cooperation with many of the other health health agencies of the area in some regions the medical school or a group of medical schools acting cooperatively have been. Grantee that is the agency which receives federal funds and administers them. This region is extremely complex as has been pointed out by Dr. McCune and I might say that the three medical schools find it quite easy to work with with the Medical Society of the District of Columbia and the other agencies through the organization that we that we have here. I think our principal role is innovative and developing new methods of cooperative activity new methods of continuing education that is to bring new advances in medicine

the latest techniques and concepts to the attention of practicing physicians so that the patients of this region the citizens of this region receive the very finest and the latest in in medical care. And I think the private practicing physicians of the region are our key elements in this and and and Dr. McEwen as a practicing surgeon as well as President of the Medical Society of the District of Columbia and certainly have some comments about the role of the practicing physician in. R n t what I trow that I think perhaps the first pride which a practicing physician would take in a program of this kind to be a sudden realization that there's been an improvement in the hospital care of his patients.

For example we have now a grant which will have to do with him proving the training of personnel working in Korea. That is her case centers. If he has a patient who has had an acute coronary occlusion then this patient is placed in a coronary care unit he will find that the training of the personnel would have been considerably improved as a result of this program. He would also perhaps take an interest in the fact that there may be something that he is interested in and in this way he can initiate a request for a grant himself and as he becomes interested he can interest other people in the possibility of increasing education and increasing research. What are you three of. Positions are very close to this program and I and your listeners are not. And I wonder at the risk of oversimplifying if you could tell us first of

all when the president signed this signed into law this plan for regional medical programs back in October of 1965. Three years ago. Did that establish a a sort of a central fund that the idea was their money made available to regional medical programs. What is it. Yes the funding was defined at the time that the legislation was discussed. And so that the planning phases the regional medical programs were provided for by and in the language of the law right now. Where did the planning actually take place to take place within the Department of Health Education and Welfare or with a mayor where to me as a physician the subtlety of this legislation rests in the identification first of a national need and the. Response to this need being left in the hands of the regions to

identify their own needs and implement programs with this objective of improved health care to their own devices that will accommodate the BQ guarantees of their own particular region on how to doctor some three years later after the lawless after it was signed into law. We have a very young District of Columbia Metropolitan Area program. Was it left up to you people in this region to apply for for help in this or is it. Is there some organization at the top that is actively working to to coordinate the individual regional plans. This is a purely voluntary participation with groups of. Medical plan and Medical Communities identifying how they best felt they can respond and take advantage of the opportunities afforded by this legislation.

And Dr. O. Mr. Fanning I think you're expressing some of the points that some of the some of the concern that many of us had when the program first began many of us wondered how a community as complex as the as Washington D.C. and its environs could possibly develop the kind of cooperative thinking that would be required to develop a regional program. But I ventured really I came about Dr. winces predecessor as program coordinator was Dr. Thomas W. Mattingly a prominent physician of this area and he deserves much of the credit for getting this program off the ground. It's complex because there is a jurisdiction like the District of Columbia which has the equivalent of a state health department and a state medical society. We're surrounded by counties of Virginia and Maryland which have their own medical societies and health departments. We have as we've said three medical

schools we have regional medical programs developing in Baltimore and in Richmond and some of the surrounding counties of the district. That at least in part they are they belong to those regional medical programs. It has been possible to develop these cooperative activities because everybody is doing it voluntarily and and working in the region that they feel they belong to. In other parts of the country it has certainly been much easier to take a state for example like Kansas or Missouri. These are geographic regions. They have they are so they are one state. It has been possible in in those areas for cooperation to develop a much greater rate. Yet the program here is working and every program in the country is different. As Dr. winces said each

program is designed to serve specifically the needs of its own region. All of the health planning the various programs for bringing new knowledge to physicians in these areas. Which ultimately is what being brings better patient care to the citizens. Are these are arranged now through the regional medical programs. I think we should stress that one of the very difficult problems in modern medicine is the problem of a practicing physician keeping up with all of the things that are going on in medicine. New drugs new new concepts of disease new new developments in basic medical sciences and certainly one of the most important goals of the regional medical programs will be to develop the techniques that will make bring new methods of learning to physicians as part of their regular daily routine.

What might these be. Do you have any idea or can you project. Here in our own region there are and there are new techniques under development for which funds will be applied for through the Washington regional medical program. For for example for bringing some of the regular teaching conferences for example the cardiology program at Georgetown University Hospital for bringing tapes of these conferences which occur once a week into the into a television circuit which will be then available to every practicing physician. This requires a great deal of money and and requires outside funding such as the regional medical programs can provide. There is there. Of course there are many techniques for conducting conferences in

various community hospitals which can be sponsored by the medical schools the faculties of the schools can and can participate in the regular programs of the community hospitals. We have new programs developing whereby teams from the medical schools will visit the various community hospitals of the area and bring new techniques of diagnosis and treatment to the attention of the physicians who are using those hospitals. We have new registries and record keeping methods which will provide us with a better indication of what kinds of continuing education physicians will need. What kind of. New ideas about medical care that must be brought to their attention. One of our programs is called the stroke surveillance

program and this is a stroke registry. It is beginning at our hospital where a biostatistician is reviewing the records and will spread to the other hospitals in the region and all patients who have had a stroke. Their records will be and allies and and stored by modern computer techniques and an analysis of each one of these cases will provide information as to what new techniques our practicing physicians ought to have brought to their attention. Some additional methodologies which may be afforded the opportunity to evolve through these programs are those in the actual care of patients and models being formulated and hopefully will be developed to evaluate the importance for example of a network of mobility coronary care

units which will offer an added facility in the early treatment of coronary heart disease model stroke programs in which there will be an exe that exuded effort made to bring the essential rehabilitation facilities required by these patients to them at a time that is most appropriate in the course of their convalescence. These are refinements methodologies and techniques which hopefully can be afforded and implemented to accomplish the objective stated. And if I may develop the educational aspects the law abiders language provides for the accommodation of additional. Medical personnel to meet the needs of better health care and long since has been recognized the fact that the physician and the nurse must be relieved of some of the duties which have traditionally been assigned

them in health care and in specific patient care emerging now our programs accommodated by this funding which will train para medical personnel Dr. McEwen has made reference to a training program that is an operational one in our region which is training young men and women to be cardiovascular technicians and help support the acute coronary units that have been established in many of our hospitals. The refresher course is for nurses to endeavor to bring back in to the supporting community nurses who have not been in active practice for a number of years and our personnel too. To date have participated in such programs endeavoring to identify manpower needs and answer them. Dr. West you know what are some of the areas in which you said that there was some of the duties for doctors and

nurses would be they would be relieved of some of a support. What were those base but I think that the example which I cited is a typical one a concrete one and one that can be meaningful to our audience was a cardiologist technician. Right. And then the training of nurses to interpret EKG and to train them to observe the patient in constant surveillance program as is required by acute coronary care units. This means an educational process to the public as well. Because traditionally as I said it has always been the physician who has done this. This has significance and there will be repercussions felt in the areas of liability in the areas of insurance health insurance programs. These additional personnel to improve health care must be accommodated by the concepts that we now have for affording medical care to our public. I think that the same is true

of identified as an integral part of stroke management will be the rehabilitation of the desired tryst and they will come in and participate in the management early usually rehabilitation is the thing that has been thought of after the acute phase of the disease has passed. Dr. Karen are you a grant Taney of the Washington regional medical program as an individual or as an officer of the medical society. As a matter of fact they just a tip from the medical society is the grantee. And as President this is side A I am actually the grantee and theoretically at least responsible fiscally for the entire program. I think it might be worthwhile to point out something about the organization of the medical society and its work in this work in this function. Medical Society was chosen here as we pointed out because it is a

centrally located organization which communicates with all of the medical schools with the Department of Health and with the surrounding county medical societies. Therefore a resident of the Medical Society requested a planning grant from the Department of Health Education and Welfare as it is now at that time as the National Institutes of Health. This was granted to us and a coordinator who was then Dr Mattingly was appointed to manage the program to get it underway. This does not mean however that the medical society makes decisions entirely about the choice of which grants should be accepted which should be recommended because there is a and advisory group which really is the organisation which makes a decision about which grants should be accepted and this advisory group is not made up of doctors entirely but almost half of its members are civilians and representatives from various other

civilian organisations. Dr. Wentz who is now a coronet or has a number so so associate coordinators in each of the medical schools in the Department of Health and in the hospital count so these coordinators interest people in the possibility of applying for grants and then want to grant is is applied for the Grant goes through the the advisory group. It goes to the Medical Society Program Committee and if accepted by these organizations it is then sent in for funding. But the actual fiscal responsibility is in the hands of the medical society and as president theoretically it's in my hands rather frightening thing to have. Doctor how much money are we talking about the president in terms of the Washington regional medical program during the next during the next year I think Dr. once can can perhaps clarify this better than I can were dealing with about.

One million dollars I think in the next two years that correct I to ask you the next year and the next year the grants of course come through the medical society and then they're funneled to the various organizations which apply for it. Our current operational level level is somewhat in excess of a million and a half dollars. And what work would it likely be five years hence here any projections on their five year ends. The projection is for between 10 and 12 million dollars of funding for operational programs. Dr. Winston might be of interest to know the magnitude of the national funding. The current funding for the national program is 65 million dollars for this current year. A hundred and twenty million dollars for fiscal 1970 with a projection of around 500 million dollars a year within the next five to eight years.

Do you have the North hand how many regional programs are underway or are there are fifty four that are either in planning or operational. Now is there or is in some areas obviously there would be. The type of thing that is being accomplished would not necessarily be of value to exchange between but there might be some information. Is there some way that information can be exchanged between the various regional programs. There are emerging now efforts that into regionalization. These are for the most part the educational techniques and then exchange of this kind of information is beginning now between regions. Undoubtedly eventually it will have a greater sense of inner regionalization but only after operational programs emerge. Gentlemen thank you very much for your discussion of our MP The master plan for medicine. Our thanks to Dr. William S.

McKown president of the D.C. medical society and Grant t of the Metropolitan Washington regional medical program Dr. John S. Rose dean of the Georgetown University School of Medicine. And to Dr. Arthur Wentz program coordinator of the Metropolitan Washington Regional Medical Program. You have attended the weekly discussion program the Georgetown University radio forum broadcaster which was transcribed in the Raymond Rice studio on the campus of historic Georgetown University in Washington D.C. next week you'll hear discussed Russian Revolution at sea. Our panel land will consist of the Honorable Gerard S. Smith former assistant secretary of state and director of policy planning staff for the State Department Dr. Thomas W. Wolfe senior staff member of the RAND Corporation and Mr. L. Edgar prenups the Military Affairs Editor Copley News Service. We welcome your comments and suggestion this program has been presented in the interest of public education

by Georgetown University. Your moderator. WALLACE banning this program was distributed by the national educational radio network.