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Interviewee: Dr. Robert McCormack, Emeritus Professor and Chairman of Plastic Surgery

Interviewer: Dr. Elethea Caldwell

Date: 2/86

Dr. Caldwell: It's my pleasure this afternoon to talk with Dr. Robert McCormack, Emeritus Professor and Chairman of Plastic Surgery. Dr. McCormack has had a long and distinguished career in Rochester. New York, coming to Rochester in 1944 as a surgical intern. graduated from Swarthmore College in 1940, the University of Chicago Medical School in 1943. His training was done here in Rochester, interrupted by two years with the United States Army at William Beaumont Hospital in El Paso, Texas, where he was with the Hand Service. and was Chief of the Hand Service in 1947. He returned to Rochester in 1947 for his plastic surgical residency from 1947 to 1949. He then went to spend a year in Milwaukee in private practice of plastic surgery, and returned to Rochester in 1950 as Chairman of the Division of Plastic Surgery. He has been here ever since that time, has seen many changes and will share those. I hope, with us this afternoon. His curriculum vitae is long and very distinguished. Important to me is the fact that he has served as president of three national societies of plastic surgery: The American Society for Surgery of the Hand, American Association of Plastic Surgery, and the American Burn Association. He has also been awarded many honors. He was awarded the Award of Merit of our Rochester Academy of Medicine. He was a distinguished alumnus of the University of Chicago, he received the Gold Medal Award of the University of Rochester, and was named Clinician of the Year of the American Association of Plastic Surgeons in 1975. Also very special in Dr. McCormack's list of awards is being awarded the Sports Illustrated Silver All-American in 1967 in football. He refers to Swarthmore as a small girls' school in Philadelphia. I would not agree with that, but that award means a lot to him and it certainly means a lot to me. Dr. McCormack?

Dr. McCormack: Well, thank you Lee, it's a pleasure to have this interview with you and have an informal chat about some of the times and at the University of Rochester over a long period of time. I came here in 1944, and it's now February 1986. And, so that makes my time here over 60 years and... I beg your pardon, my time here about 42 years, and as the school has been opened for approximately 61 years, it means that I've been here essentially 2/3 of the time that the University of Rochester. School of Medicine and Dentistry, Strong Memorial Hospital have been in existence. There obviously have been many changes that we can talk about. I came here in the war years. The resident staff was small. I counted the other day in some old publications, it was about 55 people. And now the resident staff of Strong Memorial Hospital is about 550. so you get some idea of the tremendous growth in numbers of people that are being trained. The medical school has increased to approximately 100 students in a class, number of more graduate students, more nursing students. Just everything has enlarged. And I think it's kind of interesting to follow that during one's career and how these various changes have influenced one's own career and integrated into the community and the practice of plastic surgery as one of the surgical specialties here at Rochester. Dr. John J. Morton was the original professor of surgery, was a professor... everyone called him Professor when I came here and he retired in 1953. During those early years, it was a pleasure to operate with him. He was very informal, a relatively small man. with small hands. He wore what was called a #7 cadet-size glove which has especially short fingers, and my hands were small and short-fingered also, so I always got the second set of #7 cadet gloves which was quite a pleasure. Dr. Morton would talk softly to himself at the table and say. "Well. I think it should be in this area. The books say it should be...". and then of course. he was in exactly the right place all the time, and carefully dissecting out whatever the pMalllem. So, it was... he was one of the pioneers in general surgery in this country, and I think all of us who have been through the Department of Surgery during his era were influenced greatly by his personality, his integrity, his honesty, and his imprint on the University of Rochester of course is immeasurable. Dr. Morton in those days had a small but key faculty. Dr. Herman Pearse; Dr. Merle Scott, and Dr. Earle Mahoney. The faculty, of course, during the war years was depleted, and they were all very busy and doing a lot of general surgery in the broadest sense of the word throughout that period. Immediately after the war as so many former residents and interns had been away, the University of Rochester and Strong had an informal policy that they would take everybody back as a resident if at all possible if they wanted to come back. So, probably at no time did we have more people around as far as various positions in the department. Certain affiliated positions were created of... oh, they went to Bradford, Pennsylvania for three months, for example. They went to Canandaigua for several months. They rotated several people on surgical pathology, and so that era immediately after the war was an era of rapid expansion in numbers of house staff, the GI Bill of Rights had come through so there was financial help for residents from extramural sources for the first time and the housing project left over from the war _years, nicknamed "Splinter Village" was across the street next to Helen Wood Hall for many of the young residents, many of us lived with our start of the baby boom era, many young children around and so on. And it was an interesting and full time. Dr. Morton continued to be Chairman of the Department until 1953 and that was the same year that Dr. Whipple, the original Dean and our founding father of this institution as we all know, also retired as Dean. It's been kind of interesting that during my time here of seeing five Deans of the Medical School... Medical Center... and also five Chairmen of the Departments. The first. of course. was Dr. Whipple, then Dr. Anderson from... started in 1953 and then in the mid '60s Dr. Orbison was appointed, first as acting Dean and later as the permanent Dean. Dr. Young in approximately 1980, Dr. Frank Young of Microbiology, and this past year, 1985 Dr. Robert Joynt. a neurologist, was appointed Dean. So, they have been very active years working with these various heads of the center during eras of expansion and so on, and that's been a pleasure to have contact with all of these five Deans. Similarly, in the Department of Surgery, we've spoken about Dr. Morton. He was followed by an interim period of several years when Dr. Herm Pearse, head of the administrative duties and Dr. Merle Scott was appointed after that interim period as Chairman in 1955, when Dr. Donald Anderson was Dean. Dr. Scott had been here many years as sort of the second person in the Department of General Surgery coming from Cleveland and he headed the Department through a very short time but a time of rather great changes in many things from 1955 to 1960. It was at that time for instance that the faculty compensation plan which defined more definitely the full-time faculty and the so-called part-time or clinical faculty. And the full-time faculty compensation plan came into being in 1956 after much discussion by the Advisory Board and the various departments, and it was during Merle Scott's term as Chairman of the Department of Surgery that this came in. After Merle Scott left, Dr. Anderson appointed, to the surprise I think it's fair to say. of many people in American surgery, a British citizen as Chairman of Department of Surgery. It was rarely done in the United States, although it was relatively common to have a British surgeon as a Chairman of a department in Canada or Australia. This is, of course, Dr. Charles Rob. There is kind of an interesting sidelight along that story that I haven't voiced many times in the past. I was attending an international Congress of Plastic Surgery in London, England, in July of 1959, and I got a special delivery airmail letter from Donald Anderson, asking me if I would interview, contact and set up an interview, with Dr. Charles Rob, since I was in London. The meeting was at the Royal College of Surgeons Auditorium, right in the heart of London. So, I turned to some of my British friends who knew Charles Rob. I didn't know him at the time and I contacted several friends that of course knew of him, one of whom had gone to medical school with him during part of his clinical phase at St. Thomas Hospital in London, and I also took the time to go the library of the Royal College of Surgeons, and figured, well, before I meet this man I better find out a little bit about him. And, so I looked him up in the directory of the Royal College of Surgeons and found out that he went to Cambridge and had trained at St. Thomas and so on and so on, had a distinguished war record as a one-time physician to some of the paratroops that went into Yugoslavia, and many other basic facts about Dr. Rob. As many of you who know him, he did a similar thing when he got the note from Dr. Anderson that I was going to contact him. He had looked me up in some directory, so when we first met at St. Mary's Hospital in London, over lunch one noon hour, the opening conversation, of course, was, "Well. have you been back to Cambridge recently?" And he said, Have you been at Swarthmore recently?" And it was obvious that we knew a little bit of background on either side and I think a certain amount of respect for each other started right then, and actually continued during the entire 17 years that he was here. That was an interesting era in the department as far as general surgery was concerned. Vascular... Dr. Rob, of course, was a pioneer in vascular surgery, having done some of the very early carotid endarterectomies and other procedures, was widely known

for his writings in those areas, and vascular surgery partly due to previous influences of Dr. Merle Scott, Dr. Mahoney, and now with Dr. Rob here, vascular surgery grew rather rapidly, and to this day remained... I think it's fair to say... remains an important part of the surgical residency. This brings up I think also another point of the post-war period along vascular surgery being a subspecialty area, an area of interest of general surgery, many of the other specialties had grown dramatically after the war. We have to reflect a little bit that the American Boards of Surgery, Orthopedic Surgery Urology and so on, all came into being primarily in the 1930s as far as any major impact. And residencies were just beginning in the late 30s in the specialty areas just prior to WWII. For instance, in our field of plastic surgery, we were the first... we were a subsidiary board of general surgery in 1937 when the American Board of Plastic Surgery was founded, but we only identified separate training programs a year later in 1938 and at that time there were only four in the country. There were two in New York, one at King County, one at Presbyterian, there was one at University of Pennsylvania Hospital in Philadelphia, and there was one at the Mayo Clinic. And those were the early, earliest programs in plastic surgery. Well. soon others developed, of course, but it gives you some hint as to how small some of the specialties were, particularly in an official sense of training programs, and training by apprentice, by preceptor was still a very common way of attaining surgical training in those pre-war days. Well, during the war, of course, because of the large, particularly because of the large number of casualties in all services, identifiable Army services were developed in all the fields. There was a tremendous amount of orthopedics, for example, practically every Army general hospital and at the height of the war there were 60 of them in this country, had huge, large numbers of patients and numerous wards of orthopedics as well as general surgery and other specialties, but when this group of physicians, surgeons, came back from the war, they had had rather specific training in say, orthopedics, and they had to make some career choices. A typical example here in Rochester were Philip Winslow and Norman Egel, who had gone through the general surgical residency at Strong prior to their entrance into the Army, had had... in those days the orthopedic resident was a six-month rotation in the latter years of the general surgical program. Well, they had had a fair amount of orthopedics. And when the Army realized that they had had some background in orthopedics, they ended up doing a lot of orthopedics in overseas, and when they came back to Rochester after the war, they were Board qualified according to the standards at that time in both general surgery and orthopedics, and they had to make a decision. Well, they made a decision to become orthopedic surgeons, even though they could have just as well become general surgeons and they opened their office together and later built one of the first medical buildings near Strong Memorial—the one at the corner of Elmwood and Mt. Hope, the 797 building, one of the first external medical office buildings near Strong. Well, those were the kind of decisions that many people made and it illustrated how people got into specialties, got interested in them and in my own case, I had had three months' rotation as an assistant resident. During the war years some people will remember the internship was nine months, assistant residency...they had what they called a 9-9-9 program. And you could be... everybody got a nine-month internship and got deferred from service. After that, many people went into service directly, a few were chosen to stay on for another nine months of training, practically no one was chosen for the third nine months unless you had some physical disability. The manpower situation was that tight. So, during my second nine months, I rotated on plastic surgery and on orthopedics, actually at the same time. Those days we operated on Saturday, and I would scrub Monday, Wednesday and Friday on orthopedics, and on Tuesday, Thursday, Saturday on plastic surgery. Well, it was time-consuming and busy, but it gave me at least some beginning exposure to these two fields, and so when I went into the Army with a thousand other doctors, after basic training they looked at your card, and they said "Oh, you've had a little orthopedics and plastic." And in those days, not many people had had that combination. So they sent me down to the service command out of Dallas. Texas, primarily because I'd had that. And down there they said, "Well, we have this big hospital out in El Paso, William Beaumont General Hospital, and they have a big orthopedic service, and they have a big plastic service, and they also have a hand service." Well, I had never heard of a hand service in those days, so I got on a train and took a 24-hour train ride out to El Paso from Dallas, which is a long ways, and typically, shall I say, of the U.S. Army, they said, "Oh, we don't need anybody on surgery today. We have plenty of surgeons. We need somebody on medicine." So, they put me on internal medicine, more specifically the subspecialty of gastroenterology. So, having had surgical training up to that date it was an interesting experience. The most interesting, which again I haven't told many people around here, but was...this was fairly late in the war, that I arrived there, and then after the atom bomb and VJ day and all. many, many patients flooded back from overseas so the hospitals were very, very busy. At the height of it, we had 6000 patients at William Beaumont Hospital, and we were next door to Biggs Air Base. Biggs Airfield, and to Fort Bliss, Texas, which was a big anti-aircraft. Well, we had a whole ward of hepatitis, 45 people to a ward and in those days we kept them at bedrest for six weeks and more or less symptomatic treatment. Well, the first bed was occupied by a gentleman who was rather interesting, talked very intelligently about numerous subjects and people would come in to see him all the time, civilians, some rather higher-ranking officers. This was right after Labor Day in 1945, and we would make our rounds—these were big open wards, and our GIs, this was an enlisted man's ward, were primarily reading their comic books and listening to their what has now become country and Western music, as this was the southwest, of course, and most of the patients were in general from the southwest, and this gentleman in the first bed would be reading the handbook of chemistry and physics. So, we got to know him fairly well. He spoke English. He had a slight accent, and he began to talk about rockets. And he started talking about how much propulsion you would have to do, to do this or that, and as a matter of fact he drew me a sketch which for some reason or another I've lost, of a three-stage rocket that would ultimately have enough propulsion to get to the moon and return with a third stage, which is, as you may recall, how they did it. Well, as you might guess by now this gentleman was Wernher Von Braun. So I often tease that my contribution to the space program was taking care of Wernher Von Braun's hepatitis as a surgical assistant resident out of Strong Memorial Hospital. We did get to know him quite well. I only saw him once after that. Many years later he talked at the American College of Surgeons in Chicago at a huge meeting as the invited speaker, and after that I was able to go up and at least say hello to him, but of course there were so many people around we couldn't really reminisce. He has now passed away, as you may know. He died of carcinoma of the colon, I believe, when he was about 64 years of age. He was 34 at the time I knew him. And that was the beginning of what they called in those days, the guided missile battalion at Fort Bliss, and they set up the early rocket shoots from White Sands proving ground which was 40 miles to the north. What had happened as you might guess, both the Russians and the Americans wanted these rocket scientists very badly and there was quite a race to get them to various parts of Europe as it was being separated. Von Braun realized this and he made a point to go to Bavaria because he knew it was occupied by the Americans, and he made a point I think frankly to be captured by the Americans. And he subsequently became an American citizen, and although he was never in charge of a space flight, he was in charge of the rockets themselves, and in charge of the Redstone arsenal in Huntsville, Alabama, where he spent most of his career after leaving the White Sands proving ground area. But it was an interesting time. They had captured 150 B2 rockets and brought them to America, and of course the Americans didn't know how to run them, so they brought over 400 Germans to start our rocket program and it was right after the war, and many of our soldiers had been in Europe and injured and been prisoners and whatnot, and they gave part of the hospital grounds that included a swimming pool, and made over some hospital wards into apartments for these people. They created a bit of a feeling as you might guess, with being so close to the end of the war, but it was a start, and in those days the security of a rocket launch was rather meager, particularly if you were in uniform, and a friend of mine and I, another doctor... we used to go up... they used to shoot one off every Thursday. So we used to go up on Thursday afternoon and watch one of the rockets go off, and various things happened. Some would just go '/4 of a mile and land in the desert, and one, one time, went over El Paso and landed in Mexico. And of course, it didn't get on the evening news right away and it was kept rather quiet. But fortunately they had no serious problems, and no fatalities. But it was an interesting sidelight of having been a surgical trainee here at Rochester and ending up in El Paso in medicine, and then have contact with Wernher Von Braun. Well, I think, when I came back the residencies were beginning to be established here in the various specialties, so we had the beginning of residencies in orthopedics, urology... we had had one on otolaryngology for some time and in ophthalmology, but they were growing and they were becoming competitive for positions in these training programs. Neurosurgery residency was started and so on. For instance, in our field, Warren George was really the first trainee of Forrest Young. He came back from the war a little sooner having gone in sooner and he trained more by the fellowship or preceptorship method. I was, I think, the first formal resident who was in a white uniform and paid by the hospital a magnificent fee of $38 a month, and things like that. It was an era of growing interest in the specialties and the organization of the specialties and the training programs. There was a lot of talk about how much training in general surgery you should have before you go into a specialty as there still is...and I think it was the beginning of the formalized impact of specialties on our national picture, now through the residency programs and the American Board examinations. This is then reflected in the American College of Surgeons and the figures roughly run even to this day that about half the people who are in the American College of Surgeons represent the specialties if you count obstetrics and gynecology as one of the broad specialties. A lot of people in that area are members of the College of Surgeons. So this has been an important growth. It wasn't always very rapid. I think ifs fair to say Dr. Morton's era who grew up as broad general surgeons, they were not particularly interested in seeing a narrow area grow quickly and rapidly and in large volume, and felt that as do many people to this day in surgery that fragmentation is not the best way to care for some surgical problems, and this can be debated of course, long and hard, as to how much specialty contributes to care. Obviously the only justification for a specialty is improved care....(end of side #1 of tape)

... division into too many parts as we all know. You may lose sight of the whole and certainly at this school, a leader in the field of a total concept of the patient, the psychosocial, psychomatic side of medicine. Things that have been stressed very strongly here at Rochester, particularly since WWII with the growth of the Department of Psychiatry and Dr. Romano and Dr. Engels' influence. These are all very important contributions, and Rochester has become known as a place that looks at the total patient. I don't think we ever got caught up in being superfragmented or building such high walls that we couldn't see the other side. One of the pleasant things I think, about Strong and the University of Rochester over the years, in addition to our relatively small size, is that we've always had quite informal and easy communication between areas of interest, even between the basic sciences and the clinical sciences, and between the various specialties within surgery, within medicine. Many things that are now departments in the school were merely areas of interest within the department. For instance, in medicine, radiology when I came

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here in 1944 was part of the Department of Medicine, and Neurology was a one-man part of the Department of Medicine, Dr. Garvey. And so it went, in the Department of Medicine various sections developed, units in Cardiology and Nephrology, Infectious Disease and so on, but because they didn't have a special American Board in each one of those areas, although that has changed somewhat more recently with subsidiary boards of one form or another. The specialization came a little later I think in medicine, and to this day isn't quite as separate perhaps as surgery, because they don't have separate examining boards, many of them take a basic period of two or three years of internal medicine before they go into one of these areas of interest and similarly in pediatrics they do that. So medicine and pediatrics have specialized in a somewhat similar fashion. Surgery has specialized with a little more definitive identification, calling them divisions of orthopedics, divisions of urology and so on, as have many medical schools, most medical schools. Because each of them have a separate examining board, a separate residency review committee, a separate identifiable residency that you applied for as a separate thing and so on. But now of course, many of those areas in medicine are separate departments and similarly in surgery we've had a significant development of separate departments out of what was the entire Department of Surgery in the '40s and '50s and in the early days of this institution. Orthopedics became a separate department in 1975 and Dr. Mac Evarts was one of our graduates. had been at the Cleveland Clinic and came back, and brought Dr. Del-lawn and Dr. Burton with him, and rather rapidly built a large, strong and important—important in teaching, important in graduate education, important to the community—a rather large department, rather quickly out of what used to be with Dr. Plato Schwartz, a relatively small division with Dr. Schwartz, Dr. Zuck and others, and a good bit of the clinical part-time faculty taking on quite a bit of the teaching load in those days. Well, similarly it's happened in urology. Recently urology became a separate department. Dr. W.W. Scott, who was the original Chairman of Urology, left a considerable amount of monies to the institution and a development of the Department of Urology with Dr.

(Kockitt) as the Chairman as a result. Ophthalmology became a separate department seven or eight years ago. And under Dr. Metz' leadership has grown a lot, had a lot of investigation going on, have excellent clinical facilities on the floor of the new ambulatory wing, what we still call the new hospital that opened in 1975. So all of these represent on both the medical side and on the surgical side... reflect the development of specialties in the national and international picture. The picture is quite similar all over the world with some variations in just how it's done depending on the country, but I think the early years with Dr. Morton and Dr. McCann were not particularly anxious to see formal separation, formal training programs in specialty areas, so the budgets were rather minimal. In the early days people will recall the specialty heads of the divisions were all part-time. They received a very small salary from the University of Rochester. I think $1000 a year as I recall from what Dr. Forrest Young told me, and but... in those days with Dr. Young, Dr. Schwartz, Dr. W.W. Scott, Dr. Clyde (Healey), Dr. John Gilmer, they were part-time, they had practices with... most of them had offices outside of the building, although Dr. Schwartz and Dr. Forrest Young had their offices in the building. They, in those days, we did not have a formal compensation plan, and the specialties developed essentially around those men.

Now, in fairness to Dr. Morton, he encouraged them to have areas of special interest and he is the one who told them to go work with so and so, become good in it, because I think we need, say a urologist at Rochester. Forrest Young told me that it was suggested to him after he finished his training in 1934, having come here as an intern from Stanford in 1930, Dr. Morton himself knew he was interested in reconstructive surgery in the rather broad sense of the word, and he suggested to Dr. Young that he go to Washington University of St. Louis, which is where Dr. Blair was running a well-organized and rather famous plastic surgical service at a teaching hospital at Barnes, Dr. Barrett Brown, Dr. McDowell, and Dr. Byers, it was a strong group in the '30s and throughout the war years, and then into the '50s, Barrett Brown was essentially in charge of all of the plastic surgery during the war years, organized numerous centers and services and then later on in the Veterans Administration, so Dr. Young went to St. Louis at the suggestion of

Dr. Morton and was there for around roughly six months and then came back here to Rochester and started as the plastic surgeon to Strong Memorial Hospital. And he was essentially in the very early days, Dr. Merle Scott for instance did the cleft lips and palates, but when Dr. Young got that additional training in those days, when he came back from St. Louis, he was doing the lips and palates and that was sort of the start of the plastic surgical service. There is a State of New York children's program financially to help low income families, where they have a congenital anomaly or an acquired anomaly that something can be done about, and so about to this day, as you know Lee, about a third of the work on the plastic surgical service involves children and much of it through what we nickname state aid, state medical rehabilitation program. Well, that's the way Dr. Young started and some of his earliest papers, he has one paper on surgery and gynecology and obstetrics back in the '30s, the late '30s on cleft lip and palate and it's a very good paper. And so, he did a wide variety of procedures. His early writings, he was one of the first people to write about immediate excision of full-thickness burns and skin grafting and it's so long ago now, that these older papers all get lost to... you know. we tease that if you quote a paper over 10 years ago, it's ancient history in medical terms, so he wrote about ear reconstruction, he wrote about cartilage grafts, putting them into (vitalian molds) in the subcutaneous tissue into the abdomen and making a new ear out of these little diced pieces of cartilage that grew together with fibrous tissue and then bringing it up to the ear. He wrote about many, many things, that he was really ahead of his time, and then when I was here from '47 to '49 and then the year in Milwaukee, the university called me in Milwaukee one day and said. Dr. Pearse called me and he said, "Would you come back and cover the plastic surgery service? Dr. Young is going to take a sabbatical." He was a California native and I don't think ever really got used to the winters here in Rochester, and he said, "He's going to take a sabbatical in California and think about what his future plans are going to be. If he does not come back, you might be considered, along with others, for the position. Salary: Zero." Those were the conditions I came back on from Milwaukee, which, if we made similar offers today, I'm afraid it would be rather ludicrous. But I had missed the contact with students and residents in Milwaukee, we were pretty much in straight private practice, in a nice community but I had missed the teaching side of it and the contact with young trainees, so I did come back in September of 1950, and have been here ever since as you know. So, well, I've been rambling on here. .. what... any particular questions you'd like me to...

Dr. Caldwell: Well, obviously being focused a little bit on plastic surgery, one thing that you have done among many other things was to serve as Vice-Chairman of the Department of Surgery from 1968 until 1983 and perhaps you would like to make some comments about the interface and interdigitation of plastic surgery or the other specialties and general surgery during that particular era.

Dr. McCormack: Well, it was an interesting era. Dr. Rob had come in 1960 and Dr. Duthie was here at the time in orthopedics. And Dr. Duthie was well trained and eager, ambitious for his specialty and I think many of us in the specialties at the time felt that we perhaps weren't allowed to expand fast enough. Dr. McDonald was here in urology, Dr. Snell in ophthalmology, and so on. And there were obviously limitations, financial and otherwise that you could only have so many residents in a given field, no matter how the individual felt about his own field, but I think some of us felt that the expansion was rather slow as far as trainees, as far as operating room space, as far as numbers of beds and you remember this was in the old hospital, and everyone was feeling the pinch for beds and expansion was difficult. We went so far as a matter of fact and again, I don't think this is widely remembered, those of us who were head of the specialties, got together and got up a proposal in writing to create a Department of Surgical Specialties, as we felt that departmental status would be important to the specialties, and it would be unique amongst medical schools. I still think it was a pretty good idea. It ws proposed to the Advisory Board, which as you know in that time, was the ruling body of the medical school, our Advisory Board consisting of the Chairman of the various departments and the Director of the Hospital and so on, and the Advisory Board voted negative on the proposal, so we never did establish a Department of Surgical Specialties, but the thought was behind it and then shortly, reasonably shortly after that, within eight or ten years, the Department of Orthopedics was formed. the Department of Ophthalmology, and some of those facts that I talked about before, so the expansion actually did take place with these people represented on the Advisory Board and with, well, partly in reaction I think to the problem, Dr. Orbison appointed an external committee to review the Department of Surgery, and it consisted of an anesthesiologist from Boston, an orthopedist from I believe it was either Dallas or Columbus, Ohio, and a general surgeon from Johns Hopkins. And these three people came, interviewed everybody in the department including all the specialties and essentially told their side of whatever their problems were and so on, and I don't know what their report to the Advisory Board and the President of the university said, but at any rate, some changes did occur, one of which was appointment of a Vice-Chairman of the Department of Surgery as a Dean's appointment with a seat on the Advisory Board. And I was appointed to that position and actually, and I think it was more or less, although it was never spelled out that way... you act as a citizen of the school on the Advisory Board, you don't act in only a parochial interest of your own department or area of research interest, and so on. I was appointed more or less to be the representative shall we say, of the surgical specialties, and that's what I tried to do in the broadest sense of the word as well as being a good citizen of the school. and it was interesting, it was time-consuming, of course, but it was an interesting phase in my career and I tried to contribute to the work of the Advisory Board. And I was actually on that for 13 years I believe, '68 until '80 or '81. Well, now there's a Chairman of Orthopedics that sits on the Advisory Board, the Chairman of Ophthalmology, the Chairman of Urology, obviously that's not needed anymore. And there's a lot of representation of specialty areas. So, it's within the administrative organization of the medical school particularly for a rather large department, I think it was a reasonable thing to do, because again these surgical specialties represented roughly 50% of the beds that were occupied in the hospital, 50% of the ambulatory care that was going in the clinics and the private areas, so it was a lot more than just general surgery in the Department of Surgery, so that... but now with these new departments, the new hospital having more identifiable areas, which of course again people have pros and cons about that. Instead of having the old floors that were mixed-B2, C2, X2, X1 and so on that we all remember—we now have two orthopedic floors, we have a neurosurgical floor, we have a burn and plastic floor, and we have several general surgical floors, some of which are primarily cardiovascular and as well, of course, a surgical intensive care area. So, it's a different physical organization, the new hospital, and that has identified these specialty areas even more.

Dr. Caldwell: In this present day and age of serious consideration of our national budget, you've been a citizen of the university community for a long period of time. You've also been a citizen of the community of Rochester, New York, where I think if my facts are straight we experienced as an experimental prototype one of the first communities to participate in a 3`d party payment system via Blue Cross Blue Shield, and if you would just give us a few words about how that impacted perhaps on the school and on the community and was it divisive, or was it unifying?

Dr. McCormack: Well, the Blue Cross came first, and Blue Shield came after WWII, and people like Ed and Sam Stabins were leaders in getting this... Harry Kingsley, were all leaders in getting this accepted by the surgeons particularly and the other physicians in all areas in the community. I think in the early '50s, I don't recall exactly, I believe it was 1952 or so, essentially the Industrial Management Council, which of course, was Kodak, Xerox, Bausch and Lomb, and all the industrial representatives, essentially strongly indicated that they wanted a service-type plan in contrast to an indemnity type of service plan, whereas a service type means that up to a certain income, which is supposed to be'/4 of the people in the community, up to that income level, whatever fee the plan pays to the surgeon say, that's the fee and he will accept it, and there's no extra billing, and that kind of thing. Well, this is rather, still is rather new in the entire country to get a community of physicians and surgeons to accept this concept of a service contract. In contrast with an indemnity contract where they pay, or perhaps you pay the first 20% and then they pay 80% up to a certain amount and so on and so on... there are many different ways health insurance is written, but this service-type contract came in in the '50s and was very strong for a long, long time with essentially 100% participation. Well, of course, in those days there were also some penalties if you didn't participate, you would only get 10% of the fee, which now has been changed by various legal actions I guess, and if you are a nonparticipating physician but lived in the community, there was no question you were penalized. So there were some incentives economically to join. I think on the whole it has worked very well. All areas, all specialties worked hard on the fee schedule, there was give and take of everybody to develop a reasonable fee schedule and it worked pretty well for 25 years or so. Well. then the cost of medicine, the cost of all kinds of things, concerning operating rooms, equipment, nurses, everything went up, the cost of hospital beds. And I think it's fair to say in the last five to ten years, that concept has almost been priced out of existence. A separate private insurance company just cannot do that and foot the entire surgical or medical bill for the community, the in-hospital medical bill, ambulatory bill, etc. It's.. . so we've now gone to other mechanisms as we all know, with prepaid plans, HMOs, that have some kind of a control on them as far as the fees, but there's usually an element of extra billing somehow for a larger segment of the population. They don't try to... you know, they used to brag here with our local Blue Shield, that the doctors accepted 90+% as their total fee, even though the range of the ceiling income for eligibility for the fees was supposed to be set at 75% of the community, but it's true that 90+% of the doctors accepted those fees in full. Well, that went on for a long time, but now it's become economically almost impossible to do that. Some groups have dropped out of that concept by choice and there's more and more fine print, exceptions, so I think we're in a different era now where a single insurance company just cannot balance the budget and pay the entire fees for health care for an entire community. Even the government probably cannot do that. And Ontario, for instance, in Canada, is finding this out.