Salem, Dr Robert 1998

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Dr. Salem, a leading Lubbock surgeon and top administrator a Methodist Hospital, reminisces about his upbringing, his father and his career. He includes an insightful perspective on developments in Lubbock medicine, culminating in the merger of Methodist and St. Mary’s hospitals.

General Interview Information

Interviewee Name: Dr. Robert Salem

Additional Parties Recorded: None

Date: April 30, May 15 & 26, June 15 & 25, July 20, 1998

Location: Lubbock, Texas

Interviewer: Fred Allison

Length: 6 hours 25 minutes


Abstract

Tape 1, Side 1: Background, Raised in Sudan, Texas, Father owned department store, School in Sudan, To Texas Tech University, Studied chemistry and biology, Medical school at Southwestern Medical School in Dallas, Texas, Obtained medical deferment during Korean War, Served 3 years in the U. S. Air Force, 1 year internship at Fitzsimmons Army Hospital in Denver, Colorado, Air Force Hospital in Paris, France, Specialization in surgery, Surgical residency at Baylor Hospital in Houston, under Dr. Michael DeBakey for four years, Return to Lubbock, Texas (1962), General surgeon at Methodist Hospital, Private practice, Political activities on behalf of Texas Tech Medical School, President of Lubbock, Crosby, Garza County, Medical Society (LCGCMS), Senate and House hearings, Effect of Texas Tech Medical School on Lubbock medicine, Temporary chair of Surgery Department, Faculty shortage for three years, Dr. Michael DeBakey, Residency with (1958-1962), Pioneer heart surgeon, Synthetic arterial grafts, Nylon, Leakage problem, Improvements, Open-heart surgery, Characteristics, 20 hour days, Demanding, Didn’t leave hospital for 3 months, 1998 visit, 90 years old, excellent health, Effect, Inspiration, Artificial heart, Greatest contributions to health, Cardiovascular research, International stature, Innovations, Heart transplants, Supply, Mechanical hearts, Early interest in medicine, Boyhood in Sudan, Texas, Interest in science and helping people, Curiosity, Farm background, Sudan (c. 1940-50s), Dynamic, Labor force, large, little mechanization, Saturday nights, Farm mechanization and Lubbock caused, businesses to go out, Migrant workers, Origins of name, ‘Sudan’, Importance of irrigation for growth, Diminishing water supply, U.S. Air Force (USAF), General medical officer, Service at Fitzsimmons Army Hospital, Denver, Colorado, President Eisenhower, Heart attack while serving there, Treating, Security precautions, Paris, France, USAF Hospital (1957-58), President Eisenhower, medical precautions, Memories of dignitaries, John Foster Dulles, Gen. Curtis LeMay, Travels in Europe, Uncle's gravesite in Belgium, Grateful for freedoms of U. S., Contact with Eisenhower, Characteristics and impressions, John Foster Dulles, Led church service with him, Curtis LeMay, As characterized in movies, Decision to go to Lubbock.

Tape 1, Side 2: Robert Salem, Decision to go to Lubbock (continued), Friends’ influence, West Texas culture, Father’s work in Methodist Church, Member of Executive Committee of Northwest, Conference of Methodist Church, Takeover of Memorial Hospital (1954), Memorial Hospital, background, Methodist Church takeover (again), Service and mission of helping people, Older doctors’ perspective of takeover, Indebtedness, Dr. J. T. Kreuger (c. 1962), To Lubbock (1918), Dr. J. T. Hutchinson, background, Ear, Nose and Throat doctor, Dr. M. C. Overton, Partner with Dr. Hutchinson, Pediatrician, Dr. Krueger (again), Threatened in World War I because of German ancestry, Stroke while in operating room, Son, Dr. Tom Krueger at Mayo Clinic, Daughter, Carol married Bobby Layne, Bobby Layne, Characteristics, Salem operated on (1968), Death from liver disease, Reputation, Lubbock medicine (c. 1962), Booming city, Methodist Church takeover of Memorial Hospital (again), ‘Open Staff’ improved medicine, Specialists, Pioneer doctors, Dr. Sam Dunn anecdote, ‘Making round of oil wells’, First major vascular procedure in Lubbock, Visionaries, Background on Memorial Hospital (c. 1918), Set the tone for Lubbock medicine, 19th Street hospital attracted good doctors, Geographical coverage, Reputation as medical center, Known around the nation, Medical school, Texas Tech Medical School, origins, Shortage of doctors in West Texas (late 1960s), Competition with Amarillo and El Paso, Lubbock’s efforts, Combined effort of Texas Tech, community and LCGCMS, Preston Smith’s role, John Connally’s veto, University of Texas competition for medical school, LCGCMS support (again), Robert Salem, president, High percentage of doctors supported, Grover Murray, President of Texas Tech, support, Lubbock community support (again), Competition with Albuquerque, New Mexico, Vascular/cardiac surgery background, Dr. Don Bricker, first open-heart surgery in Lubbock (1970), Studied under Dr. DeBakey, Cardiac catheters and angiograms, Dr. Bricker’s move to Lubbock, Dr. Jerry Stirman, 1,000 open heart surgeries in 1997, Catherization surgery described, Coronary angioplasty, Laser surgery to dissolve clots, Lubbock pioneers invascular surgery, Robert Salem (again), Surgery he specializes in Golden Age of Medicine, Most enjoyable period in 1950s-60s, Little bureaucratic (government and insurance) interference.

Tape 2, Side 1: Robert Salem (continued), Golden Age of Medicine (continued), Government involvement and managed care, Doctors’ loss of control, New doctors have different attitude, Retrospective on career, Autonomous in first half, Controlled by outside agencies in second half, Standard of care equal, Regulations imposed by insurance, Screening criteria, Preapproval, Shortened hospital stays, Patients stay in motels instead of hospital, Doctor/patient relationships, Less patient care now, Future, State laws that mandate hospital stays, Example of hernia surgery, Laproscopic techniques, Gall bladder surgery, Most important development in general surgery, Positive aspects of managed care, Cost containment, Caused by rising costs, Progressivism of American medicine, Expensive, Private funding, Problems with French medicine, Amputation over rehabilitation, Medicare/Medicaid, Not a factor in commercial costs rise, Indigents never refused care before, Question need for, Agencies that cared for indigents, Emergencies, Effect on doctors’ image, Doctors’ refusal to treat, Medicare/Medicaid patients, Doesn’t pay enough, Paperwork, Irony of situation.

Tape 2, Side 2: Lubbock as a regional center, background, Lubbock Sanitarium (1918), Drs. Peebler, Ponton, Overton, Modern, Started influx of doctors and patients, Texas Tech (1923), Agriculture’s influence, Drs. Overton, Hutchinson, Krueger, Developed Lubbock Memorial Hospital (1953), Memorial becomes Methodist Hospital (again), Dr. Krueger (again), Salem with him when had stroke in operating room, Methodist Hospital ‘open staff’ (1954), ‘Closed staff’ defined, Specialists, Texas Tech Medical School, 1970 origins (again), Cooperation of city officials, LCGCMS and Texas, Tech (again), Robert Salem role, President of LCGCMS (again), Chief of Staff at Methodist Hospital, Bill Parsley role, Background, Lobbying efforts, Robert Salem his ‘medical informant’, Deals made at 40 Acre Club, Austin, Texas, Meeting with Frank Erwin, Governor Connally’s veto of first bill, University of Texas and Texas Tech competition, Agreement not to oppose each other, Effectiveness, Preston Smith role, Contribution to Lubbock medicine, Satellite campuses, Enrolling first classes, Students from 2-year schools, Salem’s agreement to be Chief of Surgery if town surgeons will assist, Setting up curriculum, Thompson and Drane Halls at Texas Tech, Administrative offices, Methodist Hospital teaching hospital, Students’ comments on training, On par with intern training, Salem, Chief of Surgery, 3 years, Replaced by Dr. Francis Jackson, Background, Veterans’ Administration, Organizational abilities, Problems recruiting faculty, Nothing to show them, Surgical residency program established (1980), Under SWAT (Drs. Salem, Tim West, Ted Allen and Teb Thames), Methodist Hospital residency program (again), General surgeons trending toward trauma care, Lubbock medicine, future, Pediatric surgical program, Try not to duplicate services, Cooperation between University Medical Center and Methodist, LCGCMS support of school in late 1960s, Support decreased with increased competition, Practices not negatively affected, Hospital competition.

Tape 3, Side 1: Texas Tech Medical School (continued), Enhanced attraction of Lubbock medicine, Enhanced doctor competence, Quality of Lubbock medicine, SWAT Surgical Associates, background, Fears that school would not survive, Funding threatened, Animosity from Amarillo and El Paso, School opened in record time, Support of city doctors, Not paid, Created their own competition, Service mentality, Increased doctor population in Lubbock, Managed care, Current trend toward primary care and away from specialists, Creating competition, Robert Salem—concerns, Less in impact in Lubbock, Few large medical groups, Changes in medicine, Medicine (c. 1946), Few specialists, Effects of World War II, Treating war wounds revealed need for specialists, Growth in specialization, Robert Salem (again), Attended medical school (1951-1955), Students headed for specialization, Technology as a factor, Views on Medicare, Opposed then and now by most doctors, Government intrusions, American Medical Association (AMA) opposition, Driving costs up, People demanded more medical care, Doctors could do more and get paid, Health Maintenance Organizations (HMOs) and PPOs further regulates, Description of regulations, Hernia example, Calling in blood counts, Screening personnel, Registered nurses (RNs) do initial screening, Insurance companies, Rarely override doctors, Little harmful effects in medical care from 3rd parties, Specialists vs. primary care physicians (again), Less hospital usage, Emphasis on preventative care, Cycles, Medicare/Medicaid (again), Questions actual need for AMA and doctors, Most indigents previously cared through churches, and other private means, Doctors’ contribution of time, AMA had no suitable options, Not an effective lobby, Political opposition from implementation.

Tape 3, Side 2: Robert Salem (continued) Medicare/Medicaid (continued) Doctors’ refusal to accept patients Pay too low Cost of medical training Caps on fees Advice for aspiring medical students Less autonomy, less money Doctors not content with changes Doctors searching for alternatives Rising costs, causes Medicare (again) Technology Doctor/patient relationship Making rounds—more time in past Importance of bonding Perspective on doctor as healer/medicine man Family relationships Example of Dr. Clifford Payne Dr. Arla Shoppa Childhood injuries Importance of old time doctors to communities Early interest in surgery Dr. Payne Surgery viewing areas Dr. L. T. Green in Muleshoe, Texas Attributes of old time doctors Changes brought by age of specialization ‘Calling’—Religious connotations Emotional responsibility Patient confidence Present-day doctors’ views Advice to new doctors Service oriented Effected by new regulations Political efforts Opposition to President Bill Clinton’s health care plan Political views Comparison to military medicine Panel that briefed Senator Phil Gramm Board of American College of General Surgery Doctors’ interest in politics Little opposition to Medicare.

Tape 4, Side 1: Robert Salem (continued), Political efforts (continued), Bill Clinton’s efforts (again), Government involvement caused less time to practice medicine, Need to balance business and profits, regulation and service, Minority doctors, Medical school class, Hispanics, Assisted black student to get in medical school, Women in medicine, Partner in surgical practice, Family practitioners, 30-40% in medical school now, 10% in his class, Causes for change, Husband and wife doctors, Tendency to get in medical groups, Time for family and leisure, Insurance companies preference for working with medical groups, Methodist and St. Mary’s groups, Few independent doctors now, Costs, Patients in health care plans, Methodist Hospital’s attempts to forestall HMO entry into Lubbock, HMO Blue and St. Mary’s medical groups, Questions if groups really needed, Interest in folk medicine and spiritual aspects of medicine, Chaplain’s role, Spiritual needs of patients, Women doctors, Differences in practicing methods, Women prefer women doctors, Patient relations, Little differences, Nursing care changes, Shortages of nurses, Managed care caused more home bound nurses, International nurses, Home health care, Nurses work for doctors, Number of home health agencies, Nurse practitioners, RNs, LVNs, Making house calls, Caregivers, Doctors’ concerns, Liability, Political action, AMA involvement.

Tape 4, Side 2: Robert Salem (again), First repair of ruptured abdominal aorta aneurism in Lubbock, Dr. Sam Dunn asked him to do it, Methodist Hospital equipment, Operation lasted 6 hours, Unusual character of surgery, Description, Dacron graft used, Developed by Dr. DeBakey, Patient’s recovery, Normal life span, Gall bladder surgery, 15 years later, Article in Texas Medical Association journal Irony, First time performed by Drs. DeBakey and Denton Cooley 10 years earlier on Lubbock man, Dr. Cooley’s talk, "Fly-over-syndrome", Training, preparation, Common surgery now, Little blood loss, Performed in two hours, Same type grafts used, Description, Dr. DeBakey, pioneer, Invitation to attend, International Surgical Society meeting in Portugal, Impact on medicine, Surgery on Boris Yeltsin, Lubbock’s medical reputation, Prominence of Methodist Hospital, Influx of specialists, Vascular surgery, Regional medical coverage, American College of Surgeons stopped ‘itinerant surgery’, Community hospitals, Limitations, CAREFLIGHT, Contribution to medical care, Unprofitability, Providing needed care, Negative effects of managed care, Political efforts, HMOs focus on the ‘bottom line’, Gatekeepers and primary care doctors, Limits on benefits imposed by HMOs.

Tape 5, Side 1: Managed care (continued), Unpopularity among doctors and patients, Lack of choice for patients, Cumbersome, Costs savings, Methodist Hospital’s strategy to deal with changes, Administrator William Poteet, Financial shortfall’s causes, Medicare payments less than expected, Subject to political whim, Hospital raised prices, Government costs underbid, Deceived by expected government payments, Methodist HMO seen by Poteet as way to stop loss of profits, Aligning with regional hospitals, Cardiac tower too grandiose, Development of Methodist Physician Group, Bought out practices, Excessive outflow of money, diminished cash reserves, Declining income from lowered government and insurance payments, Comparable to farm programs, Changing nature of government programs, Merger, St. Mary’s and Methodist Hospitals, Expansion of Methodist and shortage of income, Methodist sought merger, Common ideology: Christianity and philanthropy, Discussions started 2 and a half years ago, Methodist’s dispute with the Internal Revenue, Service (IRS), Helicopter service, Federal Trade Commission’s evaluation and approval, Signing ceremony, June 10, 1998, only 3 hours, before FTC deadline, Complexity of merger, Relative size of physicians groups, Lawyer involvement, Anti-trust, Medical merger experts, Vision, Consolidation and lower costs, Nature of the original problem for Methodist, 10% of profit returned to community, Supportive of Texas Tech Medical School, Residencies, Personal and historical loyalties set aside, Salem’s close ties to Methodist, Gala celebration on June 10, 1998, Salem presents history of Lubbock medicine, 5 most significant events, Creation of Lubbock Sanitarium (1918), Move to 19^th Street (1953), Methodist Church takeover (1954).

Tape 5, Side 2: Merger (continued), Gala celebration (continued), Lubbock medical history (continued), Creation of medical school (1972), Merger (1998) "Colossal", Summarization, Importance of unity, Monumental task, Committees (task forces) created to effect transition, Decision on surgery facilities, Impact on rest of hospital, Consolidation, Collecting data, Acute care moved to Methodist, Chronic care to St. Mary’s, Need for remodeling operating rooms, Cost savings, Cancer centers, St. Mary’s Joe Arrington Center, Background on Dr. Joe Arrington, Early Lubbock cardiologist, Dr. Sam King, Heart catherization, Coronary angiograms, Dr. Don Bricker, 1st heart surgery, Methodist’s Hodges Center, All cancer patients to Arrington, Expansion of Arrington, Hodges part of emergency room, Primacy of economics, Closing St. Mary’s emergency room, Savings incurred, Consolidating pediatrics, Other consolidations, Data gathering studies, Name change, Hospitals’ old names removed, Tugging at heart strings, Drs. Krueger, Overton and Hutchinson difficulties in releasing hospital to Methodist Church, Dr. Krueger’s background, Loss of control and autonomy, Hand picked physicians, Effects on Lubbock medicine, Positives of ‘open staff’, High standards, Theological implications of merger, Addressed by task force, Investigating different religions, Involvement by Rev. Cliff Wright, First Methodist Church, More similarities than differences, Importance of keeping health care in forefront, Hospital mission, Adjustments for each side, Federal government’s concerns, Monopolistic, Defense: competition included all of Texas, Example of Texas Instruments’ contract with Baylor Hospital, Houston, New Mexico attempting to restrict insurance to New Mexico, Covenant is 25^th largest health organization in U. S., 5th west of the Mississippi River, New Mexico laws restricting insurance (again).

Tape 6, Side 1: Robert Salem (again), Role in merger, Co-chief Medical Officer with Dr. James Burrell of St. Mary’s, President of Methodist Medical Group, Dr. Burrell at St. Mary’s Group, Importance of patient choice, Merger of two physician groups, Groups’ operations, Contracts in-place prevent merger, Reaction of UMC, Strong financial base (tax supported), Legal status, Faculty staffs hospital, Covenant’s pledge of support to Texas Tech Medical School, Residencies at Methodist required to keep school’s accreditation, Background on Methodist’s support of medical school, First teaching hospital, Dr. George Brewer’s opposition and concern, Bad experience with another hospital, Protective of Methodist, Methodist staff doctors’ opposition, Salem caught in middle, Chief of Surgery Department at medical school, Chief of Staff at Methodist, Brewer’s suspicion about loyalty, Saw need for medical school, Doctors’ fear of competition developed later, Over supply of doctors never a problem, Brewer, good administrator, Long term as director, Poteet’s responsibility in ‘bad’ decisions, Board of Directors’ responsibility, Consultants, Joe Salem (Robert Salem’s father), background, Born: Lebanon, to U. S. when 7 or 8 years old, School background, Various moves around West Texas, Mother from Spur, Texas, Business in retail and dry goods, Move to Sudan (1930), Established store in 1940s, Successful businessman and merchant, Robert Salem working at store as a boy, Prosperous even in Depression, Agriculture, Business good in 1940s, Laborers and little mechanization (again), Robert Salem memories of harvesting cotton, Sudan (c. 1940s-1950s), Businesses, movies, stores, Effects of farm mechanization (again), Effects of larger stores in Littlefield and Lubbock, Robert Salem, work ethic instilled by father, Joe Salem (again), Created Love Overcomes the World (LOTW) organization, Help to underprivileged children, Games in old store in Sudan, Library, Lay mission trips to other nations, LOTW (again), Religious services in store, Kids worked first, then played and had Bible lessons, Policeman in San Antonio who had been in program, Community effort, United Nations festival every fall, Activities, Attracted attention of the U. N. and Eleanor Roosevelt.

Tape 6, Side 2: Joe Salem (continued), LOTW (continued), Eleanor Roosevelt (continued), Acquaintance with Billy Graham (1964), Correspondence, Lay missionary work (again), Impact on Robert Salem, Publication of LOTW handbooks, Impact on Robert Salem (again), Work ethic, Helping people, Pursuit of medicine, Influence on medical scene, Lay leader of Northwest Texas, Conference of Methodist Church, Responsibilities, Takeover of Memorial Hospital, Leader in Boy Scouts and Red Cross, Tried to volunteer for World War II, Views on religion and medicine, Medicine second only to ministry as servant to people, Hypothesizing about his perspective of merger, Love of Methodist Church, Pragmatism, Religious background, Father was Greek Orthodox, Return to Lebanon for 50th wedding anniversary, Mother, Catholic, Robert Salem (again), Mother’s background, Maiden name: Harkey, Family original settlers in Spur, Texas, Established Spur Hotel, Father met mother there, Father (again), Dry good business, Traveled circuit selling goods, Discrimination faced, Diminished over time, Established city park in Sudan, Merger, St. Mary’s and Methodist Hospitals (again), Cost, efficiency and quality sought, Emotions and passions involved, Methodist to be acute care (again), St. Mary’s to be chronic care (again), Not feasible to move all pediatrics to Methodist, HMO Blue does not recognize Methodist, Hospital ‘camps’ and ‘groups’ created, Patients’ loss of choice, Robert Salem (again), Future will bring changes, Political issue now, Slogan of Covenant emphasis on Christianity, Pushed by St. Mary’s, Carryover, Sisters/nuns administrators, Pastoral staff at Methodist are support only, Direct link with Catholic Church, Methodist Church has no financial links, Dealing with dissimilarities, Keeping health care in forefront, Protestant opposition, Father’s views.

Tape 7, Side 1: Joe Salem (continued), LOTW (continued), Eleanor Roosevelt (continued), Acquaintance with Billy Graham (1964), Correspondence, Lay missionary work (again), Impact on Robert Salem, Publication of LOTW handbooks, Impact on Robert Salem (again), Work ethic, Helping people, Pursuit of medicine, Influence on medical scene, Lay leader of Northwest Texas, Conference of Methodist Church, Responsibilities, Takeover of Memorial Hospital, Leader in Boy Scouts and Red Cross, Tried to volunteer for World War II, Views on religion and medicine, Medicine second only to ministry as servant to people, Hypothesizing about his perspective of merger, Love of Methodist Church, Pragmatism, Religious background, Father was Greek Orthodox, Return to Lebanon for 50th wedding anniversary, Mother, Catholic, Robert Salem (again), Mother’s background, Maiden name: Harkey, Family original settlers in Spur, Texas, Established Spur Hotel, Father met mother there, Father (again), Dry good business, Traveled circuit selling goods, Discrimination faced, Diminished over time, Established city park in Sudan, Merger, St. Mary’s and Methodist Hospitals (again), Cost, efficiency and quality sought, Emotions and passions involved, Methodist to be acute care (again), St. Mary’s to be chronic care (again), Not feasible to move all pediatrics to Methodist, HMO Blue does not recognize Methodist, Hospital ‘camps’ and ‘groups’ created, Patients’ loss of choice, Robert Salem (again), Future will bring changes, Political issue now, Slogan of Covenant emphasis on Christianity, Pushed by St. Mary’s, Carryover, Sisters/nuns administrators, Pastoral staff at Methodist are support only, Direct link with Catholic Church, Methodist Church has no financial links, Dealing with dissimilarities, Keeping health care in forefront, Protestant opposition, Father’s views.

Range Dates: 1900-1998

Bulk Dates: 1962-1998


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