Family Medicine Comes to Massachusetts (cont'd.)
A Distinctive Culture
Understandably, a distinctive culture bound members of the program together during the first decade of the program. Many were aware of the precariousness of the new department's financial standing and the still-experimental nature of Family Medicine in the eyes of many specialists. A few of the early cohort explicitly recalled feeling distrusted by the specialists they encountered while working at the hospitals, as in these words from Dr. Ken Fabert (FHSSC, 1982):
Well, you know, it was still an era when family practice was new enough, particularly here in Massachusetts, that there were derogatory comments, frankly, there was active discrimination—oh, the short end of call schedules, a lot of it was subtle stuff. You'd hear comments—well, of course internists will learn more about this than you will, or pediatricians are more qualified to deal with this than you are—there were people that took the opportunity to sort of impress upon us that we should regard ourselves as second-class citizens and inadequately trained pediatricians, internists, and ob/gyns as opposed to family docs, and clearly those were people who didn't get it.(48)
Within four or five years of the start of the residency, residents from each program site were being assigned to inpatient rotations in the hospitals associated with each different site. The attitudes toward Family Medicine in a given hospital could, therefore, create qualitative differences in the experiences each site provided. Some rotations were notoriously unfriendly to Family Medicine residents; others were more amenable, especially in smaller community hospitals previously staffed by general practitioners. Obstetrics was especially problematic since some OBs clearly viewed family doctors as potential competitors, and lesser-educated ones at that. Likewise, some Internal Medicine rotations, especially at University Hospital in that period, were quite unfriendly to Family Medicine residents, for most of the same reasons. Dennis Dimitri recalled:
At Hahnemann, the teams consisted of combinations of Family Medicine and Internal Medicine (IM) residents and we all worked very cooperatively together and the residents got along very well in that setting because it was a small number of residents in a small community hospital and we all had to depend upon each other. At the University Hospital, it was a little bit different because the Family Medicine residents doing inpatient medicine rotations there were kind of like visitors or interlopers almost on the Internal Medicine service—there would be one or two of us at a time integrated into what was basically a medicine service. So I had good experiences there, and the residents I worked with … I got along with OK, so the experience there was OK on a resident-to-resident basis. But the faculty at the university, not all, but some of them, were still not quite sure why are these Family Medicine residents taking up time on our Internal Medicine service. So that was a less supportive environment.(49)
In the face of these conditions, Walton fostered a sense of camaraderie by hosting the residents at his own house (even now his wife recalls that early group as a part of their family), and they all collaborated on a large garden at the back of the Freys' house. Walton's videotaped remarks to the residents at the thirtieth anniversary reunion in 2006 give some of the flavor of these years. That was, he reminisced,
…a stressful time for the staff, the residents, and the administration, but we were very supportive of each other. We had a gardening group and we bought a rototiller, John and Julie Frey, Jerry and Barbara Commons, Lenny and Carolyn Cotsonas, Sue and myself, Bruce Kaler, and we had a lot of fun, except someone put the oil in the wrong orifice, and we ended up buying a new rototiller. We had a garden that was operated by Bruce and Lenny at the back of the Frey's house that was large enough to feed all of Paxton, but we had a wonderful time together. I still recall Lucy hitting me in the head with a large shovel full of horse manure, that she said was completely accidental and I know that you all believe that.(50)
John Frey acknowledged that Worcester itself in those days was not much of a draw for potential residency recruits. But, the idealism
of the mission—and their commitment to it—plus a demonstrably familial ethos among many residents and faculty, often did the
trick. An iconic photo of the first residency class, replete with spouses and children piled up together at an indoor volleyball court,
did double duty as a wall decoration and a testament to that spirit.
Bob Singer, who graduated from the Fitchburg program in 1981, spoke to the group's esprit de corps:
I do remember [our] making, and seeing other residents make an effort to garner respect of our own by trying to do as well or better than the residents that we were training with. I do remember that there was a sense of pride that we were family practitioners. We had a distinctive way of dressing which distinguished us … the chief of medicine at that time, whose name I do not recall, said to me at one point you can always tell the family practice residents; they all look like they're just about ready to go outside and chop wood. Many of the male residents would wear working boots, hiking boots, as opposed to regular men's shoes. The men did not wear dungarees but wore more casual khaki pants, there was an agreement that the men in family practice did not wear ties, whereas there was an agreement that the men in internal medicine would wear ties. Very few of the family doctors ever adopted a white coat, although there were certain situations in intensive care or other times where that might be worn but in general, not wearing a white coat, having a neat shirt but not wearing a tie, and showing a bit more casual attitude and the idea was, somehow, more to try to identify more with the patients than identifying with the medical hierarchy.(51)