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John P. Geyman Festschrift

Joseph E. Scherger, MD, MPH

(Fam Med 2016;48(2):91-4.)

One good turn deserves another. In the January 2011 issue of Family Medicine, John Geyman, MD, published a Festschrift of G. Gayle Stephens, MD.1 A Festschrift is a publication presented as a celebration of a respected person’s contribution to a field, usually while the person is still living. John Geyman may be the most prolific writer among the founders of family medicine and is certainly deserving of widespread celebration. Over the age of 80, John Geyman continues to write and contribute to the improvement of health care in America.

John Geyman’s contributions will be covered over three phases of his career: his early academic leadership, his role as editor of two major family medicine publications, and the books he has written after his retirement from academic medicine. I had the honor of being mentored by John from the beginning of my career in the mid-1970s. I have observed his career with inspiration and admiration and continue to follow his example into the later stages of my professional life. John Geyman ranks among the most important founders of our specialty and academic discipline (In this article, the term family medicine is used for what was called family practice in the early decades of the specialty. Originally family practice referred to the specialty while family medicine referred to the academic discipline. They were often used interchangeably, causing confusion, hence the change was made to just using family medicine. Family practice will be used only when it was part of a proper name, such as the Journal of Family Practice).

John grew up in Santa Barbara, CA, the son of a radiologist from rural Minnesota. Medicine was not a youthful calling for him, and he majored in geology at Princeton. After 3 years in the military he chose to study medicine. He enrolled at the University of California (UC), Berkeley for premedical courses before attending medical school at UC San Francisco. From the beginning he planned to be a rural general practitioner and never wavered, despite being honored with the Golden Headed Cane award at UCSF as the outstanding student in his class voted by his classmates and faculty.

John did a rotating internship at Los Angeles County Hospital in 1960–1961 and then a 2-year general practice residency at Sonoma County Hospital in Santa Rosa, CA, to learn the surgical and other skills for rural practice. Additional training for general practice was not required and not commonly done, but many of the founders of family medicine did this to expand their knowledge and skills. True to his calling he went to Mt. Shasta, CA, as one of two physicians in a town of less than 3,000 people and a small hospital. He did full scope family medicine and the anesthesia as needed in the hospital.

Seven years later, in 1969, a close friend and colleague from Sonoma County, Ed Neal, called to let him know that the county hospital general practice program was going to convert to a new family medicine residency and needed a director. John answered the call and returned to Santa Rosa. There were only 15 family medicine residencies starting at the time, and the first directors became an important peer group.

Before assuming the residency director role, and being the only full- time faculty member, John toured the country to visit other hospitals starting new programs. This tour included Wichita, KS, where he met with Gayle Stephens, described in Geyman’s Festschrift of Stephens.1

After 2 years in Santa Rosa, John realized that family medicine needed academic leadership at more medical schools, and he was inspired to be part of that. In 1971–1972 he was at the University of Utah before going to the University of California, Davis as residency director and vice chairman of the department. Through his writings, leadership activities, and being the founding editor of the Journal of Family Practice, John Geyman became a major national leader in family medicine.

In 1976, John became the second chairman of the Department of Family Medicine at the University of Washington (UW), replacing Ted Phillips, MD. I was a second-year resident at UW at the time and was thrilled that my mentor and role model was coming as chair. Over his 14 years at UW he took an excellent early department of the new family medicine and made it an academic powerhouse of research, education, and clinical care. With characteristic understatement he referred to this as a department of record, meaning a department that served as a model for others in academia. Across the four states of Washington, Alaska, Montana, and Idaho (WAMI), UW was the only medical school and admitted students and built education programs across about 25% of the land mass of the United States.John appointed Roger Rosenblatt as vice chair and joined Roger in establishing a rural health research and training program.

John Geyman retired as chair in 1990 and returned to rural practice, this time in Friday Harbor in the San Juan Islands of Washington. He continued as professor emeritus at UW until 1993. On his 70th birthday in 2001, John suffered a heart attack and cardiac arrest while swimming. He was revived by a nurse practitioner swimming next to him and an emergency medical technician who happened to be at the pool. His heart revived, and he was flown to Bellingham, WA, for an extended hospital stay and recovery.

Since his heart attack and retirement from rural practice, John has written 11 books calling for reform of the health care system away from corporate medicine and toward a single payer model. In 2005–2007 he served as the president of the Physicians for a National Health Program (PNHP). His most recent article is in this issue of Family Medicine2 and draws from his most recent book, How Obamacare Is Unsustainable.3

The following is a selection from the bibliography of this pioneering family physician. John Geyman has authored 19 books and 171 peer reviewed articles. He was the founding editor of the Journal of Family Practice, 1973–1990, and editor of the Journal of the American Board of Family Practice, 1990–2003.

Early Academic Leadership

The Modern Family Doctor and Changing Medical Practice (1971)4

This first book came out near the birth of family medicine as a specialty and academic discipline. The book gave a history of general practice and why family medicine was a “new kind of specialty.” He draws on the recommendations of the Millis Commission for comprehensive and continuing health care5 and the Willard Report for a graduate education program of 3 years with specific content.6 John described problems of health delivery in the United States and called for a new health care system, themes he has writen about throughout his career.

A Network Model for Decentralized Family Practice Residency Training (1976)7

John Geyman started one of the first family medicine residency networks in the United States while at UC Davis and described how such a network should be established to be successful. This residency network model endures today with a medical school department having its own residency and a regional cluster of community hospital programs affiliated in ways that allow for the sharing of academic resources. Such articles became a hallmark of his career, writing “how to” articles to guide others. Similar articles were written for many parts of departments of family medicine.8-19 For this, John Geyman has been referred to as the “scribe” of the new specialty.

Family Practice and Changing Patterns of Obstetric Care (1976)16

I include this editorial from an early issue of the Journal of Family Practice because I have retained memory of it throughout my career. Here John observed that the cesarean section rate in the United States had risen over a short time from a historic constant of 5% of births to 10% of births coincident with the introduction of electronic fetal monitoring. He observed that maybe the 10% was better for the safety of the mother and fetus but stated that it should not rise much higher than that. Of course with modern obstetric practice the cesarean section rate has risen to 25% nationwide and even 35% in some hospitals.20 John would consider this the interference caused by specialization.

A Major Figure in Academic Family Medicine

Family Practice in Evolution: Progress, Problems, and Projections (1978)21

This was John Geyman on a grand stage with a special article in the New England Journal of Medicine. This article was written to counter an article by Robert Petersdorf, at the time chair of internal medicine at UW.22 Petersdorf was a major leader in academic internal medicine and had been openly critical of family medicine. The Petersdorf article was considered hostile to family medicine, and as a third-year resident at UW at the time we had a meeting to discuss it. We were proud when our chair John Geyman wrote a rebuttal discussing the positive evolution of family medicine. Dr Petersdorf later became much more supportive of family medicine when he became president of the Association of American Medical Colleges (AAMC).

On the Developing Research Base in Family Practice (1978)23

Throughout his academic career, John Geyman participated and supported research in family medicine. While his administrative duties prevented him from being a principal investigator, he facilitated a wide range of clinical and health services research. And of course he wrote much about that.

Training Primary Care Physicians for the 21st Century: Alternative Scenarios for Competitive vs Generic Approaches (1986)24

John Geyman became controversial when he joined with a few other academic leaders in family medicine calling for a single primary care specialty with common pathways for training programs. Primary care in America was struggling, especially in the 1980s as specialist incomes were rising rapidly and medical student interest in primary care was declining. John saw strength in the three primary care specialties joining forces for the early years of residency education and presenting a united front to medical schools and the public.

Textbook of Rural Medicine (2001)25

Co-edited with Tom Norris and Gary Hart, this first edition textbook of rural medicine helped define this important area of clinical practice and cited the volumes of work done by the rural research program at UW.

Reforming Health Care in America

No one has been more prolific than John Geyman after age 70 and a major heart attack. The titles of his 11 books from 2002–2015 tell his passion to end profit-taking by corporate health plans and have a government run single payer system for all Americans. All of these books show the Geyman trademark of being rich with data in the form of tables and figures.


The Corporate Transformation of Health Care: Can the Public Interest Still Be Served? (2002)26

Falling Through the Safety Net: Americans Confront the Perils of Health Insurance (2005)27

Shredding the Social Contract: The Privatization of American Medicine (2006)28

The Corrosion of Medicine: Can the Profession Regain Its Moral Legacy? (2007)29

Do Not Resuscitate: Why the Health Industry is Dying (2008)30

The Cancer Generation: Baby Boomers Facing a Perfect Storm (2009) 2nd Edition (2012)31

This book focused on one disease area, cancer, and how profiteering contributes to the growing costs of cancer care, raising concerns that an increasing number of cancer patients might bankrupt American medicine.

Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform (2012)32

Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans (2012)33

How Obamacare Is Unsustainable: Why We Need a Single Payer Solution for All Americans (2015)3

Through all of these later writings, John cared for his beloved wife Gene as she advanced with Alzheimer’s disease. After she died, he wrote a book about this experience that has been widely praised as a major contribution to caregiving in the face of this devastating illness.

Souls on a Walk: An Enduring Love Story Unbroken by Alzheimer’s (2012)34

After each book in the past 10 years I have wondered when John was done writing and would relax to pursue other interests such as his love of airplanes and flying.35 Writing is his calling, and I suspect there will be contributions from John until the end of this truly remarkable life journey. Like Gayle Stephens, John Geyman has a strong moral compass and does not hesitate to speak out often telling us what we may not want to hear.

Correspondence: Address correspondnce to Dr Scherger, Eisenhower Medical Center, 45280 Seeley Drive, La Quinta, CA 92253-6834. 760-835-9123. Fax: 760-610-7301. jscherger@emc.org.

 

References

 
 
  1. Geyman JP. G. Gayle Stephens Festschrift. Fam Med 2011;43(1):7-12.
  2. Geyman JP. Beyond the Affordable Care Act: alternate futures for family medicine and primary care. Fam Med 2016;48(2):121-5.
  3. Geyman JP. How Obamacare is unsustainable: why we need a single payer solution for all Americans. Friday Harbor, WA: Copernicus Healthcare, 2015.
  4. Geyman JP. The modern family doctor and changing medical practice. New York: Appleton-Century-Crofts, 1971.
  5. Citizens Commission on Graduate Medical Education. The graduate education of physicians. Chicago: American Medical Association, 1966.
  6. American Medical Association. Meeting the challenge of family practice. The Report of the Ad Hoc Committee on Education for Family Practice of the Council on Medical Education. Chicago: American Medical Association, 1966.
  7. Geyman JP, Brown TC. A network model for decentralized family practice residency training. J Fam Pract 1976;3(6):621-7.
  8. Geyman JP. On entry into phase two in family practice development. J Fam Pract 1977;4(1):15.
  9. Geyman JP. Conversion of the general practice residency to family practice. JAMA 1971;215:1802-7.
  10. Geyman JP. Family medicine as an academic discipline. J Med Educ 1971;46:815-20.
  11. Geyman JP. A competency-based curriculum as an organizing framework in family practice residencies. J Fam Pract 1974;1:34-8.
  12. Geyman JP. Toward a research base in family practice. J Fam Pract 1975;2:3.
  13. Geyman JP. A new look at continuing education in family practice. J Fam Pract 1975;2:119-22.
  14. Geyman JP. The practicing family physician as a teacher and learner in a family practice residency. J Assoc Hosp Med Educ 1976;Summer-Fall:30-2.
  15. Geyman JP. On defining quality in family practice education. J Fam Pract 1976;3:133.
  16. Geyman JP. Family practice and changing patterns of obstetric care. J Fam Pract 1976;3:359.
  17. Geyman JP. On entry into phase two in family practice development. J Fam Pract 1977;4:15.
  18. Geyman JP. The developing academic base of family practice in the medical school. J Fam Pract 1977;5:35-6.
  19. Geyman JP. The “one-and-two” program: a new direction in family practice residency training. J Med Educ 1977;52:999-1001.
  20. Menacker F, Hamilton BE. Recent trends in Cesarean delivery in the United States. National Center for Health Statistics. Centers for Disease Control and Prevention. NCHS Data Brief No. 35, March 2010.
  21. Geyman JP. Family practice in evolution: progress, problems and projections. N Engl J Med 1978;298:593-601.
  22. Petersdorf RG. Internal medicine and family practice: controversies, conflict and compromise. N Engl J Med 1975;56:326-32.
  23. Geyman JP. On the developing research base in family practice. J Fam Pract 1978;7:51-2.
  24. Geyman JP. Training primary care physicians for the 21st century: alternative scenarios for competitive vs. generic approaches. JAMA 1986;255:2631-5.
  25. Geyman JP, Norris TE, Hart GL, eds. Textbook of rural medicine. New York: McGraw-Hill, 2001.
  26. Geyman JP. Health care in America: can our ailing system be healed? Woburn, MA: Butterworth-Heinermann, 2002.
  27. Geyman JP. Falling through the safety net: Americans confront the perils of health insurance. Monroe, ME: Common Courage Press, 2005.
  28. Geyman JP. Shredding the social contract: the privatization of American medicine. Monroe, ME: Common Courage Press, 2006.
  29. Geyman JP. The corrosion of medicine: can the profession regain its moral legacy? Monroe, ME: Common Courage Press, 2007.
  30. Geyman JP. Do not resuscitate: why the health industry is dying. Monroe, ME: Common Courage Press, 2008.
  31. Geyman JP. The cancer generation: baby boomers facing a perfect storm. Monroe, ME: Common Courage Press, 2009; Second Edition, Friday Harbor, WA: Copernicus Healthcare, 2012.
  32. Geyman JP. Hijacked: the road to single payer in the aftermath of stolen health care reform. Monroe, ME: Common Courage Press, 2010.
  33. Geyman JP. Health care wars: how market ideology and corporate power are killing Americans. Friday Harbor, WA: Copernicus Healthcare, 2012.
  34. Geyman JP. Souls on a walk: an enduring love story unbroken by Alzheimer’s. Friday Harbor, WA: Copernicus Healthcare, 2012.
  35. Frey JJ. Five careers and eight airplanes: an oral history of John Geyman, MD. Ann Fam Med 2007;5:368-70.

From Eisenhower Medical Center, Rancho Mirage, CA.


Copyright 2017 by Society of Teachers of Family Medicine