25 years of service to the specialty

After 25 years of unparalleled dedication and service, TAFP Executive Director Jim White is retiring. The history of his years with the Academy is not just a tale of the growth and maturation of TAFP. It marks an important chapter in the evolution of family medicine in Texas.

In the words of one of TAFP’s most respected leaders, Seth Cowan, M.D., “Jim White transformed the Academy.” When Jim took the helm in 1982, TAFP was like a “mom-and-pop organization,” Dr. Cowan says. The Academy had four employees, a couple of executive typewriters and a mimeograph machine. Since then, TAFP has grown to be one of the strongest and most active chapters of the American Academy of Family Physicians. The Academy wields significant influence in the state’s health policy circles and in the Texas Legislature, and TAFP has become a pillar of continuing medical education for primary care physicians in Texas.

Jim White describes himself as a lone wolf, a personality type befitting his management style. He’s not one for glad-handing and he has little patience for socializing when there’s work to be done. He puts his faith and trust in the Academy’s physician leadership, a core of strength through the years that has been as much Jim’s benefactor as it is his legacy.

“You serve your leadership effectively and that’s how you endear yourself to them,” Jim says. “Rather than try to get them to like you, you try to get them to value you. There’s a big difference. They didn’t hire me to be their friend. They hired me to run this organization.”

Many of those leaders call Jim White a visionary executive. AAFP Vice Speaker and TAFP Past President Leah Raye Mabry, M.D., calls him her “idea man.” He’s a process guy, a systems man, the consummate administrator, mustering staff and resources to pursue objectives with tenacity. He works best behind the scenes, in the background, putting others out front while he hunts for the next opportunity. Credit he leaves for others to take.

“It’s never been about me. My guiding principle has always been ‘do what’s best for the specialty.’”

To understand Jim White and the development of the Academy, you have to understand where the specialty was 25 years ago. The struggles family medicine faces today are part of a long arc of historic struggles, a series of victories and losses that began even before there was a specialty called family medicine.

In 1947, a group of general practitioners caucused during a meeting of the American Medical Association in Atlantic City, N.J., and declared themselves charter members of a new organization, the American Academy of General Practitioners. In May 1948, Joseph Bryson Copeland, M.D., called a meeting of about 30 general practitioners during a conference of the Texas Medical Association and organized the Texas Chapter of AAGP. Family medicine in Texas was born.

The first challenges faced by the fledgling specialty were to establish departments of family medicine in medical schools and to secure funding, space and resources for those departments. Then came the difficult decisions to initiate a certification board and to rename the specialty “family medicine.” All the while, impassioned leaders in the Academy worked to elucidate society’s need for family medicine—a specialty of “people doctors,” some would say­—and to garner support among their specialist colleagues.

Their greatest victory came in 1977, when a group of family physicians succeeded in convincing the Texas Legislature to pass House Bill 282, securing state funding for family medicine residency programs through the Texas Higher Education Coordinating Board. Some of TAFP’s most courageous leaders took part in that win: Jack Haley, M.D.; Edwin Franks, M.D.; Warren Longmire, M.D.; Thomas Nicholas, M.D.; Chris Ramsey, M.D.; and Bill Ross, M.D.; just to name a few. The late Sam Nixon, M.D., wrote that this was the first “political action lobbying enterprise of the Academy in Texas,” but it wouldn’t be the last. The victory fueled a growing fire within the Academy.

Knowing TAFP’s first executive director, Don Jackson, would soon retire, the Academy’s leadership began the search for his replacement. In 1982, Harold High, M.D., suggested they consider a promising administrator he’d been working with on a project with TMA, and before long, Jim White found himself interviewing for the job.

“I looked at them and I sort of shrugged and I said, ‘To be honest with you, I don’t know much about the Texas Academy of Family Practice.’ And old Ed Franks chimed in and said, ‘Well the first thing you’ve got to do is learn what the name is.”

Since then, Jim never lets anyone make that mistake without a correction.

Harold High went on to become one of Jim’s most valued mentors, and at a dinner in Jim’s honor held during TAFP’s 2007 Annual Session in Corpus Christi, Dr. High told the audience he knew there was something special about Jim right from the beginning. “Jim White has been a tremendous asset to the Texas Academy of Family Physicians and it’s been the salvation for us all.”

• • •

Jim came on board at a time of great change in the Academy and he brought with him the essential tools that would aid the association as it grew. He had acquired experience in hospital administration during a stint in the U.S. Air Force and he’d gained senior staff experience in the Surgeon General’s Office, and while working for the Texas Medical Foundation and for TMA.

In those years, TAFP’s leaders were determined to strengthen the Academy and the specialty. “You have to understand, I was their instrument, but they were writing the music,” Jim says. “They were putting together the score on how they wanted this symphony to turn out and they made it very clear that they weren’t satisfied with the status quo. They wanted to bring TAFP to a different posture within medicine and within AAFP.”

In 1983, the Academy’s leadership set two objectives that would chart the course for years to come. They would increase TAFP’s involvement in AAFP and they would increase the Academy’s political influence in Texas. With few resources and many lessons yet to learn, Jim set to the task of achieving those goals.

“The important thing is that these leaders were the impetus for getting this done,” Jim says. “They had the vision, and they said ‘Jim, go do it.’ If you don’t have this type of infrastructure and people backing you up, you don’t get things done.”

To become more active in AAFP, TAFP had to get members appointed to AAFP commissions and they needed to build the expectation that Texas would run candidates for AAFP offices and positions on the AAFP Board of Directors. After unsuccessfully attempting to elect Dr. High to the Board of Directors, TAFP President Glen Johnson, M.D., and Jim realized they needed some partnerships at the national level.

“Back then in AAFP, you had what was known as the Northeast Block and that was where all the power was,” Jim says. “If you didn’t have the Northeast Block voting for you, you didn’t get elected.”

Each state chapter of AAFP sends two voting delegates to the Academy’s policy-making body, the Congress of Delegates. In this system, states with large memberships have no more say in policy decisions than states with small memberships. The Northeast Block was a loose coalition of small New England states that had banded together to swing the balance in their favor.

In 1987, Dr. Johnson and Jim worked with a physician from New Mexico to organize their own coalition. They recruited chapters in California, Louisiana, Arkansas, Oklahoma, Nevada, Kansas and Missouri. They called this group the Multi-State Forum, and since their first meeting, more than 20 members have been elected to AAFP Board positions and offices from those constituent chapters, including five AAFP presidents.

• • •

In the early and mid-1980s, much of TAFP’s health policy efforts in Texas focused on strengthening family medicine education. Departments of family medicine in academic health centers were struggling with the age-old turf battles that many still face today, and the recently won funding for residency programs required constant attention. Texas suffered from a severe shortage of physicians in rural areas, a problem TAFP leaders surmised could be addressed by encouraging more medical students to pursue careers in family medicine. Studies at the time showed that by introducing students to family medicine through clerkships in the third year of medical school, more of them would enter family medicine residencies. As Jim tells it, there was virtually no support for such an effort in the academic health centers.

“In 1988 something called ‘Black Tuesday’ happened to primary care and family medicine when the bottom fell out of the match and residency programs across the country didn’t fill very well,” says Roland Goertz, M.D., who was part of a young vanguard of leadership coming up in the Academy during Jim’s early years at TAFP. “A group of people got together with Jim urging us on and said we’ve got to do something about that.”

Gov. Bill Clements appointed TAFP member and soon-to-be TMA President Jim Bob Brame, M.D., to chair a Blue Ribbon Task Force on Rural Health that would conduct an interim study and report recommendations in advance of the 1989 legislative session. Dr. Goertz volunteered to write testimony to provide the task force. “We were nobodies at that time,” Goertz says, “but we were put up to the head of the podium and our testimony was heard about how family medicine needed to be a part of the future.”

“So I’m sitting in my office and I get a phone call from Jim Bob Brame,” Jim recalls. “He says, ‘Jim, we’re about to finish up the report. Anything you guys want in it?’ I said, ‘Yep. We’d like to have mandatory third-year clerkships.’” Dr. Brame told Jim to contact a certain staff person assigned to the task force, who in turn asked Jim to write some text for the report that would achieve TAFP’s goal. Jim called on Dr. Goertz and the Academy’s longtime legal counsel, Sam Stone, and the three of them crafted two simple sentences. Those sentences were dropped into the report and the report was eventually dropped into a huge piece of legislation called H.B. 18, the Omnibus Rural Health Care Recovery Act of 1989 sponsored by Rep. Mike McKinney, M.D., the only physician member of the Texas House.

“It was a very long bill,” Jim says, “and we did a Brer Rabbit. We laid low. We didn’t lobby it; we didn’t say anything about it; we just laid low.” Evidently the detractors at the medical schools didn’t read the bill and they were unpleasantly surprised once the legislation passed and was signed by the governor.

“The medical schools were not happy,” Jim says with a sly grin. By law they were now required to offer third-year clerkships in family medicine but the Legislature hadn’t provided any additional funding to carry out the mandate.

Dr. Goertz told the audience at Jim’s retirement dinner that the success of H.B. 18 ranked alongside the 1977 passage of H.B. 282 as one of the most important legislative milestones in the history of family medicine in Texas. “Jim has never liked taking the limelight. He’s always let others take credit and a lot have taken credit for what happened and what got put in place with the third-year clerkship in 1989. But I’m here to tell you that Jim White had as much to do with that as anybody did and he has never gotten full credit for that.”

That year the Academy hired its first full-time lobbyist. Political advocacy has been a major part of TAFP’s purpose ever since. Securing funds for medical education, the patients’ bill of rights, prompt pay legislation, managed care reforms and tort reform are just a few of the legislative successes the Academy can boast during Jim’s tenure.

• • •

Right from the beginning, Jim understood that to achieve great things, the Academy must have plentiful resources. At Jim’s retirement dinner, Dr. Harold High told a story about Jim’s early days. Back then, the leadership tried to keep enough savings to cover six months’ operating costs in the bank, “but times were tight until we got a hold of Jim.” He told the group that after Jim had been with the Academy for six months, he looked at the books and found that instead of having $4,000 or $5,000 in the bank, they had $50,000. “I said, ‘Jim, where in the hell did you get this $50,000?’ Jim said, ‘Well, have you ever heard of CME?’”

Providing quality education is one of TAFP’s charter obligations and Jim has always taken that charge personally. In 1992, Jim worked with staff to create a novel mechanism to solicit unrestricted educational grants. “I don’t think we’d have done that if Perry Gross hadn’t buttonholed me and said, ‘Listen bud, you’re missing the boat,’” Jim says.

Perry Gross, M.D., is a TAFP member from Dallas who cornered Jim in a hallway at a one of TAFP’s CME conferences. He wanted to know how much educational support TAFP had received for the program. “When I told him he said, ‘That’s ridiculous. TAFP should be getting significant grant support from the pharmaceutical companies and what you need to do is develop a plan to ask them for it.’”

With that encouragement, TAFP established the Golden Circle Educational Grant Program. Steve Watts, M.D., who used to practice in Arlington, became TAFP’s “hammer.” At Jim’s instruction, when pharmaceutical representatives would come into his office, Dr. Watts told them that on their next visit, he wanted to see their district manager. Then he’d tell the district manager that he’d like to arrange a meeting between the company’s regional director and TAFP’s executive director. Speaking with regional directors was the key to establishing relationships that resulted in significant grant support. “In each and every one of those meetings,” Jim says, “TAFP stressed that these were educational grants and that the CME presented would be fair, balanced and non-promotional.”

In 1996, TAFP achieved educational accreditation through the Accreditation Council for CME, which allowed the Academy to provide Category 1 CME. Then in 1997, Jim and TAFP’s longest serving director of education, Jo Ann Kindinger, launched PrimeCME, a model for small, regional single- and multi-hour education events allowing the Academy to take its education on the road to any community. The innovation of Golden Circle and PrimeCME plus TAFP’s ACCME accreditation laid the groundwork for remarkable growth. Since 1997, TAFP has provided education to more than 60,000 health care professionals in 29 states.

• • •

There’s so much more to tell. There’s the creation of the Texas Academy’s Matching Service, which was a system Jim developed in 1987 for matching physicians with job opportunities—an idea well before its time. Then there’s the development of InternetCME in 1999, another business venture that put TAFP ahead of the curve. There are all the stories of staffers Jim influenced over the years, and the buildings he worked to purchase, and the prosperity of the TAFP Foundation and the various Academy committee and commission restructuring efforts and all the changes in family medicine he’s witnessed and … .

Well, over 25 years, Jim and the Academy have grown together. Jim has imbued the Academy with his passion and hunger. TAFP has become the innovative force that Jim gave to it. The strong core of leadership that Jim inherited and to which he attributes the Academy’s many successes is the same core of leadership that he shaped through the years.

At his retirement dinner, every former TAFP president that rose to speak on Jim’s behalf praised him for the mentorship he gave them as they progressed from members to leaders. Perhaps that tradition of leadership is Jim’s most important legacy for the Academy and for the specialty.

Jim would tell you that’s what good staff work is all about. “Staff has always been where my heart is,” he says. “I believe that in an organization like TAFP, the staff has a tremendous opportunity to do things that we could never do on our own. While we don’t set policy, we can influence it. We can do things that will help the community and the state because of who we work for.”

The Academy is in an excellent position today, with a competent and confident staff, abundant resources and a fresh crop of enthusiastic leaders awaiting their opportunities. The specialty TAFP serves is as relevant today as it ever has been. Family medicine may even provide the cure to what ails the U.S. health care system and TAFP is ready to carry that message. But as the years pass and the new endeavors come and go, the Academy will certainly miss having Jim White working behind the scenes.