- Email: [email protected]
The Legacy of M. Douglas Jones, Jr, MD for Pediatrics in Denver
The Legacy of M. Douglas Jones, Jr, MD for Pediatrics in Denver
t is an honor to participate in this festschrift honoring M. Douglas Jones, Jr, MD. I am not going to spend much time discussing what an extraordinary individual he is; how extraordinary are his intelligence, integrity, perseverance, patience, collegiality, and congeniality. Nor will I dwell on what an all around terrific Chair he has been—not just for the Department of Pediatrics and The Children’s Hospital, but also for the School of Medicine, on whose Executive Committee and Practice Plan Board he served with distinction for 15 years. Rather, this will be a personal story, and because it involves events over many years, it will be only mostly accurate. My mother (who also happened to love Doug as if he were another son) taught me how to repress negative events, remember only the positive events and, if there is uncertainty regarding which is which, make up what happened in such a way as to provide a good story. That is my aim here. Let me also tell you what else I am not going to do. I will not reiterate the early years of Doug’s career— growing up in Texas, attending Rice University and the University of Texas Southwestern Medical School. Our history— his and mine—(and thus his pediatrics legacy in Denver) began on June 23, 1968 when we wound up alphabetically close (separated only by Joel Kaye) as new interns in the University of Colorado’s Pediatric Residency program. The quirks of scheduling were such that we never rotated on the same service that year, but we got to know each other nevertheless. On July 15, 1968, I began a rotation at The Children’s Hospital–2West/Youth Center. Jules Amer was my attending. The 22 days that I spent there were among the most extraordinary clinical days of my training that year. We saw 22 children with meningitis—1 a day, including streptococcal, hemophilus influenza, staphylococcal, meningococcal, and tuberculous forms of that now nearly extinct disease. Throw in cases of plague and tularemia, and my later statement made at a Pediatric Department faculty meeting to the effect that our education at Children’s was among the best part of our residency training was not surprising (although it was not appreciated by some of our faculty at the time). Jules Amer and the patients taught me what I needed to know. By 1969, C. Henry Kempe, Department Chair, and Frank Cozetto, the medical director at Children’s, had managed to merge the 2 separate residency programs into a single consolidated program. Although this was not yet the amalgamation of the services that they had dreamt of, it was a start. On July 1, 1969, Doug and I were on call together on the first day of the “combined University of Colorado–Children’s Hospital residency.” We sat in the call room that night
I
talking excitedly: “Now that the residency is combined, it won’t be long before the 2 places get together; won’t that be terrific?” We never anticipated that it would take 21 years, that I would be involved in making it happen, and that he would be the one to make it work. Our long-range vision as residents was to make it until 6:00 PM the next night, when we got off call. Fast forward through the 1970s and 1980s. When deciding to place residents at an affiliated hospital, it is important to a Pediatric Chair that the faculty there be as good as possible, so that the residents will be well-trained. During that time period, Fred Battaglia, the new Chair of Pediatrics, and David Tubergen recruited many (about 40) terrific faculty members to the department, to be paid by and based at Children’s Hospital but hold full-time faculty appointments in the Department of Pediatrics. One of those faculty members was Doug Jones, who had completed his neonatal fellowship with Fred Battaglia and went to work with Joseph Butterfield at Children’s. Shortly thereafter, he and Michael Simmons were recruited away to Johns Hopkins University in 1977. During these years, we (the University and Children’s) were unified in our educational and research missions, but the harsh realities of the clinical environment created an impossible situation for the University’s Department of Pediatrics. By 1987, the Department had developed an impressive research program, housed mostly on the third floor of the Research Bridge at the Health Sciences Center and out at the Animal Farm, where the large animal perinatal research facility was located. Clinically, the department was losing money on a busy but uninsured population of children at University of Colorado Hospital. Most of the insured patients were being seen at Children’s. Except for 2 private pediatric practices, all other private physicians in the region referred their patients to Children’s. Fred Battaglia and I went to the Dean of the School of Medicine and Bernard Nelson, the new Chancellor of the Health Sciences Center, and told them that we either needed to merge with Children’s or pull Reprint requests: Richard D. Krugman, MD, School of Medicine, University of Colorado back all of the faculty at Denver and Health Sciences Center, and compete. The sta4200 E. Ninth Ave, Box C290, Denver, tus quo was unacceptCO 80262. E-mail: richard.krugman@uchsc. edu. able. J Pediatr 2007;151:S3-S5 A study by the 0022-3476/$ - see front matter University found that Copyright © 2007 Mosby Inc. All rights it would cost $3.3 milreserved. lion to hire away all the 10.1016/j.jpeds.2007.08.012 S3
faculty from Children’s (assuming that they would come), and that we would need to find sufficient office and laboratory space to accommodate them. The University had neither the necessary resources nor the required space, and because Bernie Nelson was already in discussions with the Chair of The Children’s Hospital Board of Trustees and both believed that it was in everyone’s best interest to affiliate, this option was chosen. It is fair to say that the relationship between the University’s Department of Pediatrics and The Children’s Hospital was not all sweetness and light over the years. Periodic explosions occurred depending on the individuals that each entity had recruited to leadership positions of importance, leading to an obvious pattern of chronic approach–avoidance behaviors. To his enormous credit, Fred Battaglia decided that once the decision had been made to proceed to a formal affiliation, he would step down as Chair of the Department of Pediatrics so that the combined entity could start with fresh leadership. So the affiliation talks began in 1987, culminating in January 1990 with the closure of the Pediatric Intensive Care Unit at University Hospital. In March 1990, I was the last attending on the pediatric ward service. Considering that there were many individuals (including the University Hospital President and many Children’s-based physicians) opposed to the affiliation and the move, it was amazing that it actually happened. Considering the closeness of the vote on the Children’s Board, we are grateful that it actually happened. Meanwhile, the search was underway for a new Chair for the Department of Pediatrics, headed by our Chair of Medicine. Doug Jones was a candidate. Bernie Nelson and Salty Wellborn (Chair of the Children’s Board) knew that whoever took the job of Chair and Pediatrician-in-Chief of Children’s Hospital would have to be more than just an outstanding scientist (the search committee’s priority qualification). I confess to not knowing any of the details here. Jerry Merenstein, Acting Chair of Pediatrics, has related a story about a trip to Baltimore with Bernie Nelson and Salty Wellborn to convince Doug to accept the job. Happily, they prevailed, and in October 1990, Doug returned to Colorado to serve as Chair of the Department. By then, I was Acting Dean of the School of Medicine. Suffice it to say, that I only found out 4 years ago that Bernie, Salty, and Jerry’s plan to make this affiliation work also included having me in the Dean’s Office at the same time that Doug was appointed as Chair. On my first day as Dean, I learned a couple of pretty important lessons. The first was that when a Department of Pediatrics is moved from one hospital to another for its own good and survival, it produces unintended consequences that have enormous effects on other people. The movement of the Department of Pediatrics to Children’s Hospital created an immediate 30% hole in the budgets of the University’s Departments of Pathology, Anesthesiology, and Radiology. It also created a huge windfall for the private practitioners of those specialties at The Children’s Hospital. Second, I learned that not everyone thinks, acts, or S4
Krugman
collaborates in the same way as pediatricians. It wasn’t until 1990 that I realized that 90% of physicians in this world are not pediatricians. So, Doug Jones arrived in Denver and went to work. He had much to do. He was in charge of a department spread over 4 institutions (including Denver Health and National Jewish Medical and Research Center). Throughout the 1987 to 1990 courtship period, there was considerable focus on what I call “false dichotomies.” We (the University) did great research and teaching, and we (Children’s Hospital) did great clinical work. The other “we” clearly did not do what the other “we” did, but at least each “we” appreciated the other “we” for what they did. Doug’s job was to grow and maintain the research and teaching missions of the Department of Pediatrics while making sure that the “pointy-headed” University faculty recognized that the care of sick children was equally important. He quickly recognized the folly of the dichotomy and brilliantly assisted the “we–we” groups (no pediatric pun intended) to work together. Doug’s 15-year tenure as Chair of the Department of Pediatrics brought enormous growth. The research enterprise grew from $8 million to $48 million, and clinical revenues grew from $7 million to more than $24 million. In fact, Pediatrics became the largest clinical revenue generator of all School of Medicine departments. There were many reasons for this— one being that Doug understood that an academic department could not be simply a research institute. If this were the television show “You Bet your Life,” the duck would have just dropped down with a $50 bill in its beak. The word for today is “academic.” Many people at Children’s Hospital believed (and some still do) that “academic” means teaching, and because all pediatricians in this community teach students or residents, they are “academic.” This really isn’t the case, however. As I see it, the difference between those physicians who have chosen a career in practice and those who have opted for full-time teaching is that the former get up each morning excited about the challenges that will come their way each day embedded in the minds and bodies of the patients that they are seeing. For them, it is simply fabulous to wake up each morning and know that this day will be different, and they gain their joy from watching the children and parents leave their office feeling better. Integrating that daily event over a child’s pediatric lifetime and watching the family’s growth and development, this joy is multiplied a thousand-fold. Academic physicians have different passions and joys. For them, the challenge is a disease or a problem that afflict many children. Their challenge is to perform the basic, clinical, translational, or outcomes science to eliminate such problems as prematurity, infectious disease, even child abuse, so that children throughout the world can be spared these problems and diseases. Their joy also comes from the training of students, residents, and fellows—an opportunity to make graven images of ourselves—so that the next generation of children will have the researchers and practitioners that the world will need in the future. The Journal of Pediatrics • November 2007
Neither the practitioner nor the academic is inherently “better” than the other. Both play important roles in the world of child health. Herein is revealed the real legacy of Doug Jones in pediatrics in Denver. What we have witnessed over the last 15 years is a blending of the worlds of pediatric practice and academic pediatrics in 2 institutions that has been “simply fabulous” (to use a favorite phrase of Doug’s). By 2 institutions, I mean, of course, The Children’s Hospital, which is ranked among the top 10 in the nation, and also the University of Colorado School of Medicine and its Department of Pediatrics, which has modeled the importance of maintaining positive relationships with the community, providing the best clinical care possible, and providing the time
and resources to pursue academic excellence. There are an awful lot of institutions in the United States that have tried to do this, but few have succeeded as well. Our mutual transformation could not have happened without the hard work and indefatigable shuttle diplomacy of Doug Jones. His legacy is clear. His legacy is here! Bernie and Salty were right on! Doug, the pleasure hasn’t been all yours; don’t think it hasn’t been fun, and thanks for the memories. Richard D. Krugman, MD School of Medicine University of Colorado at Denver and Health Sciences Center Denver, Colorado
S5
t is an honor to participate in this festschrift honoring M. Douglas Jones, Jr, MD. I am not going to spend much time discussing what an extraordinary individual he is; how extraordinary are his intelligence, integrity, perseverance, patience, collegiality, and congeniality. Nor will I dwell on what an all around terrific Chair he has been—not just for the Department of Pediatrics and The Children’s Hospital, but also for the School of Medicine, on whose Executive Committee and Practice Plan Board he served with distinction for 15 years. Rather, this will be a personal story, and because it involves events over many years, it will be only mostly accurate. My mother (who also happened to love Doug as if he were another son) taught me how to repress negative events, remember only the positive events and, if there is uncertainty regarding which is which, make up what happened in such a way as to provide a good story. That is my aim here. Let me also tell you what else I am not going to do. I will not reiterate the early years of Doug’s career— growing up in Texas, attending Rice University and the University of Texas Southwestern Medical School. Our history— his and mine—(and thus his pediatrics legacy in Denver) began on June 23, 1968 when we wound up alphabetically close (separated only by Joel Kaye) as new interns in the University of Colorado’s Pediatric Residency program. The quirks of scheduling were such that we never rotated on the same service that year, but we got to know each other nevertheless. On July 15, 1968, I began a rotation at The Children’s Hospital–2West/Youth Center. Jules Amer was my attending. The 22 days that I spent there were among the most extraordinary clinical days of my training that year. We saw 22 children with meningitis—1 a day, including streptococcal, hemophilus influenza, staphylococcal, meningococcal, and tuberculous forms of that now nearly extinct disease. Throw in cases of plague and tularemia, and my later statement made at a Pediatric Department faculty meeting to the effect that our education at Children’s was among the best part of our residency training was not surprising (although it was not appreciated by some of our faculty at the time). Jules Amer and the patients taught me what I needed to know. By 1969, C. Henry Kempe, Department Chair, and Frank Cozetto, the medical director at Children’s, had managed to merge the 2 separate residency programs into a single consolidated program. Although this was not yet the amalgamation of the services that they had dreamt of, it was a start. On July 1, 1969, Doug and I were on call together on the first day of the “combined University of Colorado–Children’s Hospital residency.” We sat in the call room that night
I
talking excitedly: “Now that the residency is combined, it won’t be long before the 2 places get together; won’t that be terrific?” We never anticipated that it would take 21 years, that I would be involved in making it happen, and that he would be the one to make it work. Our long-range vision as residents was to make it until 6:00 PM the next night, when we got off call. Fast forward through the 1970s and 1980s. When deciding to place residents at an affiliated hospital, it is important to a Pediatric Chair that the faculty there be as good as possible, so that the residents will be well-trained. During that time period, Fred Battaglia, the new Chair of Pediatrics, and David Tubergen recruited many (about 40) terrific faculty members to the department, to be paid by and based at Children’s Hospital but hold full-time faculty appointments in the Department of Pediatrics. One of those faculty members was Doug Jones, who had completed his neonatal fellowship with Fred Battaglia and went to work with Joseph Butterfield at Children’s. Shortly thereafter, he and Michael Simmons were recruited away to Johns Hopkins University in 1977. During these years, we (the University and Children’s) were unified in our educational and research missions, but the harsh realities of the clinical environment created an impossible situation for the University’s Department of Pediatrics. By 1987, the Department had developed an impressive research program, housed mostly on the third floor of the Research Bridge at the Health Sciences Center and out at the Animal Farm, where the large animal perinatal research facility was located. Clinically, the department was losing money on a busy but uninsured population of children at University of Colorado Hospital. Most of the insured patients were being seen at Children’s. Except for 2 private pediatric practices, all other private physicians in the region referred their patients to Children’s. Fred Battaglia and I went to the Dean of the School of Medicine and Bernard Nelson, the new Chancellor of the Health Sciences Center, and told them that we either needed to merge with Children’s or pull Reprint requests: Richard D. Krugman, MD, School of Medicine, University of Colorado back all of the faculty at Denver and Health Sciences Center, and compete. The sta4200 E. Ninth Ave, Box C290, Denver, tus quo was unacceptCO 80262. E-mail: richard.krugman@uchsc. edu. able. J Pediatr 2007;151:S3-S5 A study by the 0022-3476/$ - see front matter University found that Copyright © 2007 Mosby Inc. All rights it would cost $3.3 milreserved. lion to hire away all the 10.1016/j.jpeds.2007.08.012 S3
faculty from Children’s (assuming that they would come), and that we would need to find sufficient office and laboratory space to accommodate them. The University had neither the necessary resources nor the required space, and because Bernie Nelson was already in discussions with the Chair of The Children’s Hospital Board of Trustees and both believed that it was in everyone’s best interest to affiliate, this option was chosen. It is fair to say that the relationship between the University’s Department of Pediatrics and The Children’s Hospital was not all sweetness and light over the years. Periodic explosions occurred depending on the individuals that each entity had recruited to leadership positions of importance, leading to an obvious pattern of chronic approach–avoidance behaviors. To his enormous credit, Fred Battaglia decided that once the decision had been made to proceed to a formal affiliation, he would step down as Chair of the Department of Pediatrics so that the combined entity could start with fresh leadership. So the affiliation talks began in 1987, culminating in January 1990 with the closure of the Pediatric Intensive Care Unit at University Hospital. In March 1990, I was the last attending on the pediatric ward service. Considering that there were many individuals (including the University Hospital President and many Children’s-based physicians) opposed to the affiliation and the move, it was amazing that it actually happened. Considering the closeness of the vote on the Children’s Board, we are grateful that it actually happened. Meanwhile, the search was underway for a new Chair for the Department of Pediatrics, headed by our Chair of Medicine. Doug Jones was a candidate. Bernie Nelson and Salty Wellborn (Chair of the Children’s Board) knew that whoever took the job of Chair and Pediatrician-in-Chief of Children’s Hospital would have to be more than just an outstanding scientist (the search committee’s priority qualification). I confess to not knowing any of the details here. Jerry Merenstein, Acting Chair of Pediatrics, has related a story about a trip to Baltimore with Bernie Nelson and Salty Wellborn to convince Doug to accept the job. Happily, they prevailed, and in October 1990, Doug returned to Colorado to serve as Chair of the Department. By then, I was Acting Dean of the School of Medicine. Suffice it to say, that I only found out 4 years ago that Bernie, Salty, and Jerry’s plan to make this affiliation work also included having me in the Dean’s Office at the same time that Doug was appointed as Chair. On my first day as Dean, I learned a couple of pretty important lessons. The first was that when a Department of Pediatrics is moved from one hospital to another for its own good and survival, it produces unintended consequences that have enormous effects on other people. The movement of the Department of Pediatrics to Children’s Hospital created an immediate 30% hole in the budgets of the University’s Departments of Pathology, Anesthesiology, and Radiology. It also created a huge windfall for the private practitioners of those specialties at The Children’s Hospital. Second, I learned that not everyone thinks, acts, or S4
Krugman
collaborates in the same way as pediatricians. It wasn’t until 1990 that I realized that 90% of physicians in this world are not pediatricians. So, Doug Jones arrived in Denver and went to work. He had much to do. He was in charge of a department spread over 4 institutions (including Denver Health and National Jewish Medical and Research Center). Throughout the 1987 to 1990 courtship period, there was considerable focus on what I call “false dichotomies.” We (the University) did great research and teaching, and we (Children’s Hospital) did great clinical work. The other “we” clearly did not do what the other “we” did, but at least each “we” appreciated the other “we” for what they did. Doug’s job was to grow and maintain the research and teaching missions of the Department of Pediatrics while making sure that the “pointy-headed” University faculty recognized that the care of sick children was equally important. He quickly recognized the folly of the dichotomy and brilliantly assisted the “we–we” groups (no pediatric pun intended) to work together. Doug’s 15-year tenure as Chair of the Department of Pediatrics brought enormous growth. The research enterprise grew from $8 million to $48 million, and clinical revenues grew from $7 million to more than $24 million. In fact, Pediatrics became the largest clinical revenue generator of all School of Medicine departments. There were many reasons for this— one being that Doug understood that an academic department could not be simply a research institute. If this were the television show “You Bet your Life,” the duck would have just dropped down with a $50 bill in its beak. The word for today is “academic.” Many people at Children’s Hospital believed (and some still do) that “academic” means teaching, and because all pediatricians in this community teach students or residents, they are “academic.” This really isn’t the case, however. As I see it, the difference between those physicians who have chosen a career in practice and those who have opted for full-time teaching is that the former get up each morning excited about the challenges that will come their way each day embedded in the minds and bodies of the patients that they are seeing. For them, it is simply fabulous to wake up each morning and know that this day will be different, and they gain their joy from watching the children and parents leave their office feeling better. Integrating that daily event over a child’s pediatric lifetime and watching the family’s growth and development, this joy is multiplied a thousand-fold. Academic physicians have different passions and joys. For them, the challenge is a disease or a problem that afflict many children. Their challenge is to perform the basic, clinical, translational, or outcomes science to eliminate such problems as prematurity, infectious disease, even child abuse, so that children throughout the world can be spared these problems and diseases. Their joy also comes from the training of students, residents, and fellows—an opportunity to make graven images of ourselves—so that the next generation of children will have the researchers and practitioners that the world will need in the future. The Journal of Pediatrics • November 2007
Neither the practitioner nor the academic is inherently “better” than the other. Both play important roles in the world of child health. Herein is revealed the real legacy of Doug Jones in pediatrics in Denver. What we have witnessed over the last 15 years is a blending of the worlds of pediatric practice and academic pediatrics in 2 institutions that has been “simply fabulous” (to use a favorite phrase of Doug’s). By 2 institutions, I mean, of course, The Children’s Hospital, which is ranked among the top 10 in the nation, and also the University of Colorado School of Medicine and its Department of Pediatrics, which has modeled the importance of maintaining positive relationships with the community, providing the best clinical care possible, and providing the time
and resources to pursue academic excellence. There are an awful lot of institutions in the United States that have tried to do this, but few have succeeded as well. Our mutual transformation could not have happened without the hard work and indefatigable shuttle diplomacy of Doug Jones. His legacy is clear. His legacy is here! Bernie and Salty were right on! Doug, the pleasure hasn’t been all yours; don’t think it hasn’t been fun, and thanks for the memories. Richard D. Krugman, MD School of Medicine University of Colorado at Denver and Health Sciences Center Denver, Colorado
S5