On entering the Family/Community Medicine Residency (in the Community Medicine track) in 1973-74, I was working as a volunteer physician and medical director at St. Elizabeth of Hungary Clinic. After one year in the residency, the Community Medicine (or MPH equivalency) track was terminated, and I continued in family medicine. I continued on at St. Elizabeth for several years before entering private practice in geriatric medicine, in large part inspired by work at another Catholic agency Villa Maria Nursing Home as medical director and primary physician. I believe this was in 1978. I was associated with Bill Farr, MD PhD, another FCM graduate who had been in geriatric and family medicine practice for several years. After a slow start, the practice did well and, through Bill, I became an assistant medical director at Hillhaven Hospice, the first combined inpatient and home care hospice in the United States. Sadly, the hospice did not fare well financially and the program was eventually absorbed by St. Mary's Hospital.After six years in private practice, I became medical director of the Pima County Long Term Care Program (PLTC), having sold the geriatric medicine practice to Dr. Jim Belitsos. I held this position through 1986 and was instrumental in getting Family Medicine residents involved as part of the patient care team at PLTC.I was then recruited by Carondelet Health Systems (CHS), the operators of St. Mary's and St. Joseph's Hospitals and the Nogales Holy Cross Hospital, to become Vice President for Geriatric Programs in 1986. The goal was to make the CHS hospitals the preferred provider of Medicare services in Southern Arizona. Unfortunately, just at the time I started, the Medicare Diagnosis-Related Group (DRG) reimbursement system entered a phase severely adverse to hospitals with high Medicare patient loads! While at CHS, I brought in a "senior affiliation" program called ElderMed that became wildly successful and became the largest single program in the nation-wide ElderMed system. Our printing bill alone for member newsletters became twice the budgeted amount for the whole program. Clearly, this could not go on forever, especially with dwindling Medicare reimbursements.Well, after some other peripheral activities within CHS, I separated from them in 1990 and became sort of a free-form consultant with many jobs medical director again at St. Elizabeth, medical director at the new Carondelet nursing home "Holy Family," assistant medical director at Mercy Care Plan (part of AHCCCS), medical consultant for eligibility for the Arizona Long Term Care System (ALTCS) and medical director of the Pinal County Long Term Care System. At one time I held all of these jobs simultaneously, which engendered at least four potential conflicts of interest! But, my employers seemed happy to have me, and the Attorney General never called.Tired of "denying heart transplants and kicking little old ladies out of nursing homes," I made a career change in 1998, went to Antioch University New England, got an MS degree in Environmental Biology, and just after the disaster of 9/11 got a job in Boise, Idaho as a wildlife biologist with a global engineering company, MWH Americas. I wrote environmental impact statements, did a lot of research and became a reasonably capable Geographic Information System (GIS) and Global Positioning System (GPS) map maker.I retired from MWH in 2007, but established my own little limited liability corporation (LLC) so that I could continue to do project work with them. I am currently writing the "Wildlife and Habitats" and "Threatened, Endangered and Special Status Species" analyses for the proposed Lake Powell Pipeline a $3+ billion project to pipe water from Lake Powell to the St. George, Utah area.When I am not working on that project, I travel with my wife Kathy, ride my bike on the Boise Greenbelt, volunteer as a Boise Police Volunteer Greenbelt patrolman, and volunteer at the Idaho Museum of Mining and Geology.As the Navaho people ("Din4") would say: "Ya' at' eeh," "It is good."
