Dr. JoAnne Rogers
Interview with: Dr. JoAnne Rogers
Interview by: Stephanie Fuglaar
Date: June 17, 2009
Transcribed by: Michelle Kokes (edited by Stephanie Fuglaar and JoAnne Rogers)
Location: River Oaks Medical Center, 4126 Southwest Freeway
SF: Today's date is June 17, 2009, and we are here talking to Dr. JoAnne Rogers for the African-Americans Physicians project. Conducting the interview is Stephanie Fuglaar. Thank you for joining us today Dr. Rogers. We are here at her office at the River Oaks Medical Center, 4126 Southwest Freeway in Houston, Texas. Let's get started with your background. Where were you born and where did you grow up?
JR: I was born in San Diego, California in 1963, and I grew up here in Houston, Texas. We moved here when I was about 6 years old.
SF: Did your whole family move here?
JR: All of my family moved here except for my brother Bradley, who graduated from the University of California-San Diego. My father happened to have been in the Navy, and that's why I was born in San Diego, but both parents are from Texas for generations.
SF: What did your parents do?
JR: My father started off in the Navy, and then he got his undergraduate degree at the University of Houston, and got his Masters degree at Sam Houston State University. He was interim dean at San Jacinto Community College and actually taught electronics. My mother finished at, they both started at Prairie View University, Prairie View A&M University, and that is where they met because they are both here from Texas. And then married and my mother finished at San Diego State University, that is where my mother finished college. She got her Masters and part of her doctorate at Texas Southern University, and she was on faculty and was a professor at Texas Southern. She was active in the Head Start program, and then she finished her career in child development at Houston Community College.
SF: Do you have a lot of extended family that have been in medicine?
JR: I am actually the first physician in the family.
SF: What school did you go to in Houston?
JR: I was in the Vanguard program throughout my schooling. I actually went to Lanier Middle School and went to Vanguard School, which used to be Jesse Jones and now it is Carnegie.
SF: What sort of clubs were you in? What kind of hobbies did you have when you were younger? Did you know that you were going to be a doctor? Did you schedule or get involved in things early in life?
JR: That was a good question. Because my parents pursued higher education, I always knew I was going to college. Initially I thought I was going to be a dentist. There was a Dr. Riddle, who was an African-American dentist in San Diego, that I went to, and he was very engaging with children, would give out toys, gifts, was very nice, very intelligent, very kind And I think at that point, when I was about 4 or 5, I figured I was going to be a physician. Everything kind of moved forward from there. I thought I was going to be a dentist initially, and somewhere in college at Emory I decided I was going to pursue a career in medicine. There is another dentist in the family, who was the second African-American graduate -- second or third African-American graduate -- from the University of Texas Health Science Center, their dental school here in Houston, Edgar Burton.
SF: So you have been exposed to a higher education throughout your entire life?
JR: Yes.
SF: Had expectations from the beginning. In your bio it talks about the CoEttes.
JR: Oh, I have a picture of the CoEttes right over there if you want to see it.
SF: Can you tell me a little bit more about that and maybe how that influenced you?
JR: When we came back to Houston from California, my parents both being from Texas, both meeting at Prairie View, there was a group of women, generally that were doctor's wives and women of high society, that started an organization that I believe started on the East Coast called the CoEttes of America. The CoEttes were the upper crust, the upper echelon; it was a group that consisted of young women that they were modeling to be socially acceptable, kind of a predebutant group. So we would have teas and different receptions and lunches and community activities and social awareness lectures. We'd take trips. We would do volunteer work. We would have balls, formal balls with music and we would have recitals, musical recitals, talent shows. It was extremely nice.
SF: I see you were involved a lot in community service throughout your career. Did that begin with the CoEttes, or was that influence from your family as well?
JR: Well I was influenced by family. I was also influenced by CoEttes, also the community where the CoEttes were kind of based in Third Ward, Texas in Houston. A very interesting group of upper-class, upper middle-class African Americans that were generally professional. People in my mother's family were pretty well educated and usually graduated in the top of their classes and went on to higher educations as well. So I had a lot of � you know there were lawyers that were before me in the family, my extended family, a dentist, as I said Dr. Burton. So I was exposed to various educated people throughout.
SF: Tell me a little bit about the neighborhood that you grew up in. I mean you obviously had a lot of exposure to higher education throughout your life and people you could really look up to. Did you find that in your Houston community as well, maybe in school or church or anything like that?
JR: I grew up in kind of a smaller community. I was born in 1963. I went to private schools in San Diego. I think I was in the first group of kids that integrated higher education schools, private schools, etc. I had a unique perspective. We were like one of the first families at the country club that we belonged to, Columbia Lakes in West Columbia, Texas, because my father was a big golfer; he learned that in the military. Also in our neighborhood, it was predominantly kind of a middle-class white neighborhood, we were one of the few black families that initially moved there -- socially in Third Ward most of the people that I knew� my adopted godfather was a dentist. A lot of people that I knew, a lot of the people that I associated with, are from the Vanguard program were children of people that either worked in the oil and gas industry in administration or they were doctors or lawyers or they were teachers. So that was kind of the environment in which I grew up. Well pro football players or athletes too that happened as well.
SF: Did you have any other interests?
JR: I played piano since I was 4. I was in fashion shows. I also was in choir and voice -- probably lessons since I was about 6 or 7. I competed competitively with the UIL competitions for voice and choir, and that was fabulous. I did that even at Lanier. We won awards. I did some of it when I was in the gospel choir at Jones in high school. Even in college, I did some gospel choir, so I loved to sing. I haven't done much lately since I have been practicing medicine, but I love to sing.
SF: In your bio it also talks about kibbutz. Tell me a little bit about that and how you got involved in that. Did it affect you in any way? What kind of experience was that?
JR: I was active with Congressman Mickey Leland's task force when I was in junior high and part of high school. It was a political awareness group by the late Congressman Mickey Leland to get kids more active. He was really good at trying to engage children in politics and letting kids know how effective they could be in the process. I was in the first group of kids that the Mickey Leland's Kibbutz internship program recruited to go to Israel as Ambassadors for the U.S., and that was in 1980. They selected the top ten students to go to Israel, but I think there were probably, usually 40 to 80 people that applied. And how you are chosen is you either live in Mickey Leland's district, 18th Congressional District or you go to school there. And I happened, since I went to Jones, to have been in the 18th Congressional District so that is I how I got chosen -- high academic achievement, good interviews, etc. I remember some of the people that are legislators today actually were the people that interviewed me. Allen Cohen who is now state representative, J. K. Freeman who is a prominent attorney here in Houston, Vick Samuels who owns Victory Packaging, which is a phenomenal company -- an international company. So a lot of people I actually learned and got exposed to early on. The Kibbutz experience was extremely unique it actually goes on today. I am actually on the board and have been on the board since I got back from my residency. So we actually still send about 10 students every year to live on a Kibbutz in Israel and experience the Middle East, first hand.
SF: What made you choose Emory as a place to start?
JR: I wanted to get out of Houston, get out of Texas and be exposed to other parts of the country. Emory was very well recognized, it was a well recognized pre-medical program. I had a girlfriend who actually went before me that was also pre-med. They had a high acceptance rate to medical school, and it was in Atlanta, Georgia. So I figured I would have the best of both worlds. I would be in Atlanta, I would be away but I would also be in a good academic, private and relatively small institution that had a good reputation.
SF: I'm going to transition into your career a little bit.
JR: Okay.
SF: What made you choose the medical school you went to?
JR: I went to the University of Texas Health Science Center - San Antonio predominantly because of my interviews, the fact that it was located in a nice suburban area, it wasn't in an inner urban dilapidated area like Southwestern, and it wasn't at home like UTMB and UT Houston. So it kind of gave me the opportunity to be in a different environment a little bit away from home, but not too far. And it also had the best living conditions close to the institution. And, A&M was a little bit too rural for me. I admit Texas A&M was the first institution that accepted me to medical school. So, I have to give them kudos for that.
SF: How did your family react to your decision to become a doctor?
JR: Oh they were ecstatic!
SR: Were they concerned in any way about anything?
JR: No. I think most people want their kids to become physicians.
SR: Why did you choose your specialty?
JR: That is kind of interesting. When I went to medical school I thought I was going to be a dermatologist first, anesthesiologist, ophthalmologist. I had basically no idea, no clue. I maybe even considered briefly pediatrics. But I had never been to a family physician, but during my junior year in medical school, my third year, I rotated -- you are obligated to do a rotation in primary care -- and I came across a doctor that works in kind of the poor area of Houston, Dr. Alfred Lewis, who precepted me for a month. And I thought it was phenomenal that he would go to see different types of patients, diagnose different things. There was a lot of diversity. It wasn't the same. It wasn't monotonous, and he actually did a lot for his community, so I think that engaged me. The other thing was I need sleep. So, even though I have been heavily recruited to do obstetrics, gynecology and enjoyed it and was very good at it. And initially did my rotations to reflect that, I didn't want to be restricted to just see women all the time. I didn't want to be restricted to just deliver babies. I actually wanted to make a difference. I think as a family physician I have the opportunity not just to be a good diagnostician but also to do a lot for the community and to do a wide range of things. So I am never bored. That is definitely the case, so that I was what persuaded me. I was going to be a psychiatrist but I think my father said he was going to disown me if I wasted his money and became a psychiatrist. When he didn't think that people who had true mental illness, that the major people that were psychopaths, etc. couldn't be cured. You may not want to put that in there, but that was kind of the case. It was OB/GYN versus psychiatry because I thought psych was fascinating. I figured family medicine encompassed all of that.
SF: Let's go back to the medical schools. How many did you apply to?
JR: Probably nine. Generally speaking when you actually go to apply to medical school you usually apply to all of your state schools and then do a few outside the state. Texas is unique in that it is obviously the largest state in the United States, but it has five medical schools, which is kind of unique, most places have one or two. Also, the medical schools when I went, Texas had the best facilities and the least cost for medical school. Most schools, I think Howard was maybe $20,000 a year. I think it was maybe $15,000 to $20,000 when I interviewed. Texas schools in the medical schools were like $400 a semester, and then your facilities were better, your living conditions were better, the cost of living was better. So it was a no-brainer; Texas just had it going. It had a better system -- a less expensive system.
SF: Do you feel that you have encountered difficulties in your medical career because of your race or your gender?
JR: I think both. First of all, medical school is not for the weak-hearted. It definitely challenges you to overcome fears, obstacles. Being the first physician in the family and not having really perspective was a little difficult and challenging, and not having other people to model after was really difficult. But, I think San Antonio was a good place to go just because, while race was a factor and obviously being female was a factor, there were enough nice, kind, culturally-aware and culturally-sensitive people that it kind of balanced out. So you always had some support. I think now versus back when I went, which was 1985 to 1989, I think things are a little different. But obviously race does play a factor in terms of your perception of you, your feelings of competitiveness, your trust of other folks and vice versa. There were kids though that did protest. I was one of six African Americans in my class, of African-American descent. I was the only one to go from first year to second year, and there were protests there. I remember kids saying that you got in because of race and not because of academics. And that was crazy. There were engineers in my class. There was a guy lived above me that had a D average that had actually worked for a while that had done real well on his class scores and was in medical school as a white guy. You know it was kind of crazy that they would come up with these things but obviously back then there was this rumor and I think affirmative action issues had come up pretty strongly then. I think that was during the Ronald Regan era when he was repealing a lot of affirmative action issues so there was a lot of anger. So there were protests but I remember also there were some counter protests that Dr. Carver, who is a great guy, --I think he is a family doctor up north, they protested against the protesters. But you know you have to consider that it was somewhat of a different environment. The biggest issue I had was cultural. I grew up in kind of an upper middle- class environment around educated people and people that kind of knew that there were other educated African Americans, and I went to Emory, which was kind of, people kind of, it was in Atlanta. Atlanta has the Atlanta University Center, Spellman, Morehouse. People were used to seeing educated intelligent, articulate African Americans; UT, not so much. So that kind of was an issue. A lot of the kids were kind of upper middle class in medical school I mean at Emory, and you know relatively affluent, not so much at medical school. So you had kind of a different milieu of folks. You also had older people at my particular medical school. You didn't have a lot of people that had matriculated from undergrad to San Antonio. You had a lot of people who had done engineering or were researchers, had other careers and then came back to medical school later. So, it was different.
SF: Do you feel that your training at medical school prepared you to be a small business owner?
JR: No, that is an easy question. Medical school gave absolutely no education at all about business. It was kind of a fluke that I learned business. I actually had several uncles that were entrepreneurs. Plumbers, that were really good at their businesses and other folks that were in business and some of the mentors that I had actually helped me with business. Some of the doctors that had been in practice, like Dr. Lewis and some of the other doctors kind of helped in terms of making good business decisions but medical school did not help.
SF: So since then as you have learned the ropes of being an entrepreneur, how have you balanced being a small business owner with being a physician?
JR: How have I balanced? I don't know if I have balanced it so well. Actually, because I am somewhat of a workaholic I don't have much of a social life. But that is probably personality versus medicine, per se. I think some people get it, and some people get the business aspect of it and some people don't. And I think I was lucky to have mentors of people in business that there are two rules that you learn. The first thing you learn is that you have to keep accurate books and records, you have to be honest, you have to pay the government first, you have to keep up with your taxes. You pay your employees, you pay yourself last, and you never live above your means. It is always better to live under your means and you definitely have to save as you go. So I think I mean there are just certain principals that you have and you never count on something before you get it and I think I learned that from my father, pretty much. Those are just basic guiding principals. I think there are two things that helped a great deal. One was I worked in a couple of managed care systems and I had the opportunity to work in my own office and was able to oversee but not necessarily perform some of the administrative duties that were not done correctly. So I actually got to see what not to do. So that helped a great deal. Then I have actually been very active politically so you know, people think you are in this you are in that well the reason I got more active with the Harris County Medical Society, Houston Medical Forum is to get insight as to how to be a better business woman. I also have peers and friends who are in business so that helps a great deal. We kind of communicate with each other to some extent. You also have to get very good business contacts. Every physician needs a good accountant, an excellent accountant, even if it costs a lot of money. You need a good insurance broker, someone to help you get all your insurances in order, your overhead insurance, your disability insurance, life insurance, health insurance. I mean all kinds of insurances that you need. You also need an excellent lawyer, a business lawyer that can help you read contracts and teach you how to read contracts and teach you how to negotiate, not only insurance contracts but if you are doing an employment contract you need to be able to negotiate that. I think a lot of times doctors just assume that people are going to treat them well because they are doctors, oftentimes that is not the case. You have to kind of learn how to finagle and learn how to read things and navigate things for yourself. So, you know, accountant, lawyer, insurer, insurance broker and you need to have relationships, friendships with these folks. The other thing you need to potentially, even though that may or may not be so great now is to get a financial planner. Just to, maybe, point you in the right direction so you can manage your own finances. Right now with the downturn in the economy a lot of people have trusted their brokers and not so much now, the Madoffs and everything else. So you have to learn how to do things on your own. You have to learn how to navigate through finances and business on your own. Even if you allow someone else to do it you still need to know what is going on. Physicians who don't know what is going on in their offices and don't oversee their staffing, don't take care of their finances, don't know anything about accounting, leave it up to someone else, generally have problems with people stealing from them, taking advantage of them or they get in trouble and that is when you have major issues. You need to stay ahead of the game and learn as you go or actually even better, learn before you get there.
SF: Alright, that leads me to my next question. Have you always been in private practice and if not what have you done before?
JR: When I was in residency at Baylor I did my family medicine residency at Baylor I actually moonlighted because I took out a couple loans while I was in medical school for art and to travel that were not included in my allowance of course and so I worked and moonlighted I think to the tune of around $80 an hour. Managed care was just starting to take over and I worked for this company called University Medical Group that insured most of the teachers in Houston. Then after my residency was completed, they were so impressed with me that they gave me a really good offer. They have me an offer and then I counter-offered and they took me up on the offer I gave them. So I worked for them for a couple of years and then University of Texas and Memorial Hermann, specifically, came and recruited me from them because they heard I was a good physician and they really wanted me. And so they offered me a little bit more than what I was doing before but then I didn't take it but then I renegotiated it and then maybe three months later they gave me what I asked for. So that lead me to having my own office that they oversaw with some other doctors. That didn't quite work out well so I got my own practice and that entity went away as an entity because of some issues, some administrative issues, but I was able to maintain my office, all my furniture and everything else and I was able to sell that again to another hospital entity, which obviously was helpful financially and then I in turn moved in with five other doctors. But unfortunately some of those doctors that were managing the group weren't really looking at the financial aspects so I actually disengaged from that. That wasn't pleasant but it happened. Then I have been in practice on my own every since 2000 so that's been about nine years. Actually it will be nine years officially July 1st.
SF: Wow, congratulations.
JR: So but it wasn't easy. There were a few bumps and lumps in the road, a few legality issues and a few stressors but obviously, I've prevailed so it's good.
SF: At the point you are in your life with your career right now what would you say are the qualities that are most important for being a doctor?
JR: The first thing I think you need to have when you are a doctor is you have to care about people. If you don't care about people and you don't care about the welfare of people you can't be a good doctor. They don't pay you enough to deal with the complaints, the problems, the liability issues, the business aspects, the insurers not wanting to pay you� they don't pay you enough for that. What drives me and keeps me going every day even when I have bad, bad days is: for instance yesterday I saw a patient that I had scolded repeatedly to get a colonoscopy and he ended up with pretty advanced colon cancer. He came yesterday after I hadn't seen him in a couple of years just to hug me because he had been, you know he had surgery, he had chemo, radiation, etc. and he came for his check up because he is through with his treatment and he is cancer-free and he came and he hugged me. He is an old scruffy white guy that you could see he actually works at a dealership. I'm sure he was� a tear just came to his eye and he said, "Can I hug you?" I mean that's what makes it all worthwhile. The other day� I mean that's kind of the crux of it. Essentially you really can have a positive impact on people. You really can make a difference in their lives. At the end of the day you really feel rewarded. I don't think there are very many jobs at the end of the day that you feel good about the impact you have and you can make a pretty positive impact into people's lives. You can save their life and, I think, at the same time medicine helps you grow. I think it challenges you enough if you do it well that it helps you be a better person. I think I am a better person because I chose medicine as a career. I think I'm a little bit bruised because I chose medicine as a career, probably a little bit more stressed. But I think in terms of my purpose on the planet, I think I can do more for more people because I am a doctor. I think the knowledge that I gained and the journey that medicine has taken me through helps me be positive and be positive in the lives of other people. I think that is the most important thing. At the end of the day that's what's important. I may not have kids. I may not have a husband. I may not have some of the other things I want but I think I am really good at what I do and I think because I've dedicated myself to it I think I've made a positive impact. So yesterday was a good day. I have a PA student, I usually have students come through the office either medical students or residents or somebody doing a rotation, and I have a PA student from my medical school and she just kind of goes, "Wow that was impressive!" You know this was a big guy. But at the end of the day medicine makes you better and I think in turn you really have to care about people in order to make it work. If you don't care about people it's painful. But it's worth it. I've diagnosed a lot of people with cancer, brain tumors. I remember the child on the wall that I have framed in a picture. I was having a really bad day, I was on an airplane, I was going, I think, to California to a medical meeting and I was just down. I picked up a Southwest Airlines magazine and my patient was in there that I had diagnosed when he was less than two with acute lymphocytic leukemia and I did that when I was in kind of a transition with the practice, etc. and you know he is still living and he still sees me and he's like 14 years old. Its like: I did this. I recognized this, didn't know exactly what it was, knew it wasn't supposed to be there and got him to the proper people and he got his chemo, radiation, etc. (I think he got chemo predominantly) and you know I saved his life. I saved somebody's life. I mean it's incredible, it is absolutely incredible. So that day when I saw him my face lit up and I'm like, I'm okay today! I'm okay. That's okay! There's no other job I think that can do that for you. I don't think it's a job most days I think it's more of a lifestyle.
SF: Do you think your experience in medicine has differed from previous and subsequent generations?
JR: Well of course. Every generation is different than the next but I think the crux of medicine and the essence of medicine and there is a quote that I had during my residency director's office: for those who love medicine there is a love of humanity. I think every since the beginning of time if you have the interest in helping or healing people you have to care about them. That essence of medicine has been consistent. I think the context in which medicine is practiced is different. The context in which I practice is I deal with people from different ethnicities. I probably have 50% other ethnicities and 50% African American in my practice. I have people from different religions, from different parts of the world and essentially you know that's probably a product of my Mickey Leland experience, my CoEtte experience, my Emory experience, my UT San Antonio experience. I don't think I felt throughout most of my life that I had to be restricted to go to an all African-American school. I don't think I felt that, the restrictions and the limits are no longer there. And I think there is more inclusiveness, but I think my generation kind of experienced the benefits of integration and I am able to practice within that context versus my parents' generation that would have been relegated to take care of only African Americans or Caucasians or whatever. So that's the difference.
SF: If a youngster, say a freshman in high school approached you today and said, "I'm thinking about being a doctor" what would you tell them?
JR: Well there are a lot of things going on in medicine. I mean Obama is, rightfully so is proposing changes in healthcare, to increase access to healthcare. The biggest issue is the number of uninsured or the people that don't get access to healthcare and I think Texas is at the top of that list. Despite our numerous resources in the United States we haven't done well with taking care of the sick or giving the sick access to quality healthcare. So there are some major changes that are going on. I think they are actually going to stick this time even though there is going to be a big fight. I think even with all of that and with changes in reimbursement, changes in physician accountability, the need for electronic medical records, the need for us to use clinical guidelines in order to care for patients consistently to show proven outcome or at least demonstrate proven outcome and treatment, I mean it's different but I think there's no other profession that really stretches you and educates you and I think it's worthwhile. I think we are actually going to go through a painful phase but I think at the same time it's probably going to be more of an inclusive phase. So I think it is a good time to practice medicine, but it's not going to be the medicine that I am used to practicing or my forefathers. So we'll have to see how it goes, but it's worth pursuing. If you really like science, you really like math, you really like people, you don't want to sit behind a desk, you want your life to be interesting, and you want to have some autonomy. And you want and you need instant feedback from the good that you do in the world as a profession, medicine is good.
SF: As you mentioned Obama's administration is looking into medical insurance and the issue of medical insurance in the United States. Since you have been in politics obviously you have been aware of it. How do you feel about the medical insurance situation right now and how does it affect your practice?
JR: The biggest headache that I have as a physician is trying to get reimbursed from insurance companies and the amount they reimburse me for my services and the fact that even after I render services to a patient, utilize my overhead, the staff, my time and sacrifice part of my life, insurance companies hold the amount they pay me and reduce the amount that they pay me at will. There is no other industry that allows you to do that. If you go out to get your hair done you are required to pay for services rendered at the time of visit. Insurance companies as well as several other entities have taken advantage of physicians because we are altruistic; we are generally very scientifically- minded. They know we don't have great business acuity often times and we are very much distracted. It is very heart wrenching for you not to be reimbursed or paid for services rendered for two reasons. One is it makes it difficult for you to pay for your overhead, pay for you to even exist, and the other thing it is flat out unfair. So I think it is good that we are having an extension for access to healthcare. The problem that may occur is who is actually and how quickly are they going to reimburse the physicians for services rendered, because we do live in a capitalist society. We do have overhead which is generally increasing, we do have expenses which also are increasing and the cost of medical education is increasing as well. So therefore it would stand to reason that the physicians need to be paid in a more timely fashion meaning at the time of visit which would be ideal and physicians need to be paid at a comparable rate. So, in essence, the answer to your question in a nutshell is insurance is a headache. Based on how it is allowed to delay payment, reduce reimbursement and get free labor out of physicians. And also as an employer, my premiums for staff as well as myself have gone through the roof yet the services that are provided and the access to care has diminished. So, that is not fair either.
SF: What do you want your practice to reflect to your patients?
JR: An environment where they can get quality care, they can get compassion. They need to be involved in their own healthcare, and where we can have feedback and dialogue so we can both improve.
SF: A little bit more explanation on some of the organizations you are involved in. Can you tell me a little bit more about the American Academy of Family Physicians?
JR: The American Academy of Family Physicians is the largest specialty organization of specialists and physicians. And, usually it is general physicians and physicians that have completed a residency and are board-certified, such as myself in family medicine. So, I forget how many physicians there are, but, I think is probably over 100,000. So it is the largest specialty society in medicine because family medicine is the largest specialty. I think we are the crux of primary care. So, many people do not know what a family physician is. A family physician, as opposed to a general physician. A general physician is someone who went out, went to medical school, did a year of internship, and practiced general practice. A family physician is someone who went to actually medical school, did and internship, and completed a residency in family medicine. Family medicine is and all encompassing specialty that allows you to take care of people from birth until death. So we can take care, we can deliver babies, we can do surgery, minor surgery on patients. We are the initial point of contact for most patients and we have the broadest scope of any specialty. Now some people restrict family medicine. Obviously in Houston being next to the medical center it is not feasible for a non obstetrician to deliver babies. It is also not feasible for a non surgeon to do major invasive surgeries. That is because of the malpractice issues that is because they have access to people that are really sub-specialized in this setting. But in rural communities often times family physicians see the patients, deliver the babies, do house calls, take care of the infants, take care of the children, do the circumcisions, do the tonsillectomies, appendectomies, cholecystectomies they do everything because that's all certain communities have or have access to. So we are the most comprehensive specialty and you can sub-specialize as a family physician in sports medicine, geriatrics, sleep medicine and you can do OB and maternal centered care. I think there might be one other area that I might be missing and addictive medicine but you have that as an option. But most people don't know exactly� and I didn't to be honest with you. I had never seen a family physician until medical school and I became a family physician.
SF: Can you tell me what it means for a physician to be board certified?
JR: That means you usually have to complete an accredited residency program that is recognized by your specialty that is an accredited or good positive program and gone through the credentialing process. The other requirement is usually you have to go through a certain number of years of training or fellowship training and you have to have completed a series of exams either written or oral or both and you have to maintain that certification. I did my boards after residency. My boards initially were every seven years so I did them in 1993, 2000 and 2007 but this year I have the option to extend my board certification through my recertifying exam to ten years. I have to do certain clinical steps to get there to qualify to extend it another three years but that is an option as well.
SF: What is the Harris County Medical Society?
JR: Harris County Medical Society is the largest county medical society in the United States. We have about 11,000 physicians in Harris County in Houston and in the surrounding counties. I have been active with the Harris County Medical Society probably 10 to 12 years and I am currently on the executive board and president-elect of the Houston Academy of Medicine which is the scientific and charitable arm of Harris County Medical Society.
SF: What other organizations are you involved in, in the area?
JR: I was president for the last two years of the Houston chapter of the National Medical Association which is the African-American Association that was actually formed when African Americans could not get membership into the American Medical Association. In addition it was formed because a lot of African American physicians because of that, because of their race and ethnicity weren't admitted to certain hospitals and weren't given certain privileges and actually weren't able to join Harris County Medical Society or the Texas Medical Association. I was president of that organization for two years and I am one of the reasons why we are actually speaking today because I was one of the founding members and one of the people that were extremely instrumental in setting up this historical project to depict the history and the contributions of African- American physicians in Houston.
SF: What inspired you to do that? This has been a big project. What has kept you going? Did you just think it was absolutely necessary; did you have a personal stake in it?
JR: I have a biracial background. I think my father is really a history buff and having grown up around African-American physicians and gone to Houston Medical Forum meetings one of the issues that I have is: well who are the African-American physicians in Houston and how can we actually let other places know that there have been contributions by African-American physicians and how can we inspire students to get involved in careers in medicine? Having the fact that my parents are educators and I have relatives that are educators, principals of schools, school teachers, you know lawyers� nieces, nephews it would be nice for them to actually have one succinct location to find out that there are African-American physicians, how they came about in Houston and what their history is. Because of those African-American physicians I am a physician. Dr. Harris Bransford and I remember he would be on his couch when I would be playing with his daughter Tracey who was in CoEttes with me and he would be so exhausted after he would have his surgery or on the weekends and I remember one day he said, "You can do this. I can do this. Who says you can't do this?" So I think if other people had the exposures and the unique experience that I did and we are able to kind of use technology to advance that I think more people would choose careers in medicine and they would believe it would be possible and it would be fulfilling but you need to kind of� medicine is unique in that unless you are really inspired to do it and unless you are driven to do it, if you are not exposed to it you don't have an idea, it seems too overwhelming for most people. But, since I saw those people in action I wanted to bring to the Houston Medical Forum the combined history and also to students and inspire them to choose careers in medicine or at least know what contributions African- Americans have made in medicine in Houston.
SF: Who do you want to see this website and who do you have in mind when you are discussing the different aspects of it?
JR: Well I think the majority of physicians see it as well. I think anybody that is interested in African Americans, African-American History or the history of medicine -- regardless of their ethnicity. Kids especially, so they can be inspired, junior high, high school, even elementary kids. It would be a form of education and enlightenment to a lot of people and I think it has a far-reaching appeal. And I think it is a very unique project, actually. I do not think there has been anything similar to this done in the country, if not the world. So, I think that is incredible. And UH, of course, being my father's alma mater, was able to bring that to fruition. So, I am appreciate that. Also, I also think that..I got a lot of flack about involving UH versus Texas Southern versus Prarieview, but see my issue is that I think the world needs to look at things in terms of not color but in terms of contribution. And I think that UH being that that you have gotten awards for Public History and are known for that internationally were in a good position to help this come to fruition. And through my contacts in the Harris County Medical Society I was able to contact you all to actually bring this to life. So, this is a phenomenal project.
SF: I'm going to catch a few more things about your career that students might want to know. What was the most difficult part of residency?
JR: Well the hardest thing was staying up for two or three days. Although I don't do that anymore, they have outlawed that, they realize it is not good for the residents as well as for the patients. It is a safety issue. When I went through residency, I remember being up for two and three days at a time. It was torture.
SF: What was the worst thing about medical school?
JR: The best thing about medical school was being in medical school. The worst thing about medical school was the fact that it was a ton of work. And the absolute worst thing about medical school were the cadavers. It was not pleasant.. smelled like formaldehyde for the entire year. I just didn't enjoy that. I enjoyed the dissection part of it, I enjoyed seeing were all the organs, veins, muscle groups, etc were. Did not enjoy the formaldehyde or working on a dead body that was not pleasant. I think that was the worst part of my career.
SF: I'm going to switch to general questions to get your opinions. How has technology changed medicine in your lifetime?
JR: Oh, incredibly! In fact, I just had Memorial Hermann System. They are allowing physicians at a very low cost to integrate electronic medical records into their offices. And they are making it more low cost and helping you be more competitive with insurance companies which will help reimbursement. Electronic medical records, e-prescribing, we are on the web. I have a website for the office. People can make appointments through the web. People can get more information about me on the web, what my credentials are, who I am, what my interests are. It has just opened up communication. But it has also put more stress on us to communicate and to respond. So technology has made a huge impact. Reimbursement, we electronically file we don't just mail things anymore. We send them electronically. We can get paid electronically it will go directly into a bank account or into a lock box. It has changed drastically so I am playing catch up with technology.
SF: It's always that way. I think everybody is. You already answered a lot of things that I have. We talked about managed care. Let's talk about the Houston Medical Forum a little bit more. How long have you been a member of the Houston Medical Forum?
JR: I served on the Houston Medical Forum when I was a medical student. I used to go when I was a kid though I think. At least they would have meetings at places. Probably in '87 so that's been about 22 years. I went in when I was working with Dr. Session, Josephine Session who is a retired neurologist one of the first African Americans to finish neurology program at UT and then Dr. Lewis was a family physician I mentioned earlier. I went to meetings with him and I did that rotation in '87 I think or '88.
SF: What level of activity do you have with the Houston Medical Forum?
JR: I am a past president and one of the co founders of U of H of the website, very active.
SF: Have you been as active during your entire membership?
JR: Well I've ascended through the ranks in terms of being secretary, treasurer, vice president, president I mean we kind of did that. I have always been somewhat tied to it because if it hadn't been for the African Americans that I met through the CoEttes and through Third Ward that were in the Houston Medical Forum I probably wouldn't have been as influenced and supported to be a physician. So I've been active since I've pretty much been here and finished my residency.
SF: In today's world where African American physicians can be admitted to any society is the Houston Medical Forum still important?
JR: Of course. One of the reasons is and I actually grappled with this for the longest because I have these duel roles, it is kind of an interesting kind of split. I've been really active with Harris County Medical Society and at the same time active with the Houston Medical Forum. Historically Harris County Medical Society has been historically white. When I was on the board for the longest I was the only African American on the board or in the organization. I would be chairman of meetings and I would be the only African American. I think I am a new introduction. I think I have been the most active African American they have ever had, female. Dr. Flemming who is now president of the Texas Medical Association, William Flemming was actually the first African-American president a few years ago but I'm the first female that has been active in the organization as much. So I kind of grapple with that a little bit. I think it is important because of our rich history as African Americans and the context of Texas, the South, medicine, having that� there's a certain commonality, certain shared experiences that we have that I think are unique and I think that because we do trust and know each other from a cultural perspective it really is enriching and we are really able to help that segment of the population that is probably suffering from lack of health care and lack of access so I think it is really important that the Houston Medical Forum remain, exist, flourish, thrive. Also at the same time work, and we've worked on this, and work cooperatively with the Harris County Medical Society and in turn I think Greg Bernica, who is now the current CEO of Harris County Medical Society is trying to get actually more people from the Houston Medical Forum to be active with the Harris County Medical Society so I think it needs to be a reciprocal exchange and more of a trust exchange. Because I think initially having been a member of the Houston Medical Forum with the older physicians who had been subjected to exclusion because of race, there are wounds there that will probably won't heal in their lifetime but it will have to be my generation like the first generation of integration that will help those wounds heal and I think this project will really help. If it hadn't been for Greg Bernica at Harris County, if it hadn't been for their contacts with U of H, if it hadn't been for some of the other doctors that were on the board, Bernard Harris is one of our Houston astronauts, aerospace engineer who has actually done an interview here with the help of Dr. Clemmons, who has been active with some of the foundations of Harris County Medical Society and HAM, this project wouldn't happen. So I think we are starting to get more of a dialogue and I think it is important for us to work cooperatively.
[End of tape 1- 54:45]
SF: In your experience how have people's environments or behaviors affected their health?
JR: Well behavior is an easy one. If you don't eat right, you don't eat the right foods meaning if you don't eat fruit and vegetables, ideally organic fruit and vegetables, ideally organically grown in your own back yard fruit and vegetables grown in organic soil, I mean that is the cream de la cream. If you don't exercise, if you don't drink water, if you don't get adequate rest, if you are under too much stress those things actually negatively impact health. People that are poor or people who don't have access to fresh fruit and vegetables or they are unaffordable or people don't have access to clean water. People that are in environments where there is lots of cigarette smoke or people in very negative or stressful environments tend to have worse outcomes in terms of disease. I have even experienced people that have used anabolic steroids for body building and weightlifting because of low self esteem issues early on in their life that ended up seeing me with very high grade, very aggressive malignancies later. So, even the mental health milieu you grow up can negatively impact your health, but also positively. If you are in a positive environment where you are encouraged, you are recognized, you are reinforced in a positive way, you are given praise, you are given positive exposures to education, activities, the arts, music, etc. sometimes those things skew you in a positive direction. If you are in an environment where people eat healthily, and eat regularly and not starve themselves in terms of skipping meals for financial reasons or for stress reasons or because they are busy, people learn better eating habits. In an environment where people get up and have breakfast, lunch and dinner if they exercise on a regular basis, those people tend to be more in charge of their health and even if they can't ward off every single disease they adapt more effectively when they do get illness and they tend to not have a lot of hurdles to overcome so environment does play a huge role. Your growth environment, as well as the environment that you live in does have a significant impact on your health. The easiest is the people that use drugs or alcohol or even food for that matter. I have patients that are like 400 and 500 pounds that even the simplest thing like drawing blood is very difficult and when they get really sick it is very difficult to do resuscitation on them or to give them a breathing tube to help them breathe because they are so excessively overweight and it's a big issue that is coming out. As society gets busier and things become more stressful people tend to not exercise as much and they don't pay as much attention to their own health, which tends to go on the back burner. So the other thing that happens too is that people go out and eat fast food a great deal or even eat out a lot. They tend to get more salt in their diet and certain populations such as African Americans, Hispanics tend to get more disproportionate cases of hypertension, diabetes, high cholesterol, heart disease and stroke and even cancers and have poor outcomes because of lack of knowledge, lack of access and probably base line decreased nutritional status as well as increased stress. So environment has a huge impact positive and negative on health experience and health outcome.
SF: Can you tell me a little bit more about what causes a stroke, what a stroke is?
JR: Well there are several types of strokes. There is ischemic, hemorrhagic strokes are often caused by uncontrolled, systoloic hypertension of the upper number. The patients that come in with blood pressure 170, 180, 190 or 200/80, the systolic number is high. Those people are at high risk for stroke, hemorrhagic stroke. People that have underlying aneurisms or like balloon vessels in the brain, the vessels are actually a little weaker, and a little ballooned out, if they get even increases in pressure, maybe even 140, 150 sometimes they will have those little weak areas in the wall of the vessel will break and they will get a hemorrhagic stroke. Often times the problem with those is that when you get hemorrhagic strokes it tends to do a lot of damage because the brain doesn't like a lot of blood in the tissue. The embolic strokes are often times due to atherosclerosis. Atherosclerosis is basically the build up of plaque in the vessels of the body and you can have a plaque build up not just in the brain but in the neck and what will happen is it will break off and then go in and clog up an area so you don't get enough blood flow to the brain just like you would in the heart when people have a heart attack. Plaque build up is usually somewhat hereditary. I have had people as young as in their 20s and 30s that just have the gene that causes them to build more plaque but it also has a lot to do with diet, exercise, keeping the blood pressure down, keeping the cholesterol as low as it can go and taking Statin drugs also helps to a large extent in terms of decreasing your risk of having a clotting embolic or what we call an ischemic stroke.
SF: Can you tell me a little bit about cholesterol? There is a lot in the public about good cholesterol versus bad cholesterol, what is your advice to your patients?
JR: The simplest thing and from a family physician standpoint it has really gotten complex I mean look at management they are basically people that are lipidologists they are people that actually study, manage and look at every single particle related to lipids. But simply put and probably in a context that most patients would be able to understand, LDL is kind of the bad cholesterol. We generally want people's LDL to be less than 100. If you have diabetes or if you have had a heart attack then we would like for your LDL to be 70 or less. Some lipidologists, or specialists in lipids, think it should be even lower than that. Generally you would need a Statin drug in order to lower your LDL in combination of diet and exercise. There are some people that have familial type hypercholesterolemia meaning their livers no matter what they eat or drink; they naturally produce more bad cholesterol. Those need special care and special management, etc. and you kind of have to do that on a case by case basis. The good cholesterol, the protective cholesterol that helps your body, that helps decrease the negative effects of the bad cholesterol or even be protective of the heart are called HDL, high density lipoprotein or HDL and that generally relates to how much aerobic exercise you get. So generally in a man we'd like it to be over 45 and in a woman we would like it to be over 55, 60. So the higher that number is, like if you are an avid athlete then it would probably be in the 100s. If you are somebody that is really, really high risk for heart disease, I've seen LDLs in patients with bad livers to be as low as 20 or 30 which is pretty bad so we don't have the protective benefits of that HDL cholesterol which is usually related to exercise or cardiovascular exercise in particular. So that's the crux of it. Obviously there are a lot of permutations on LDL or small density there's high density. I mean there are all kinds of permutations, the different lipid panels you can actually do that are more specific and you can kind of target or tailor what you give a patient or how you modify things based upon these low, these small particles, these dense particles. Also triglycerides are important. People that eat a lot of French fries or fried food or processed foods, triglycerides, especially that which is over 300 has been implicated in heart disease. But we now know that it is a combination of the lipids, lipids are generally, simply, triglycerides, cholesterol and cholesterol is LDL, HDL, triglycerides generally relate to what you've eaten probably in the last four to six hours -- I mean the triglycerides are. The LDL is more a function of kind of your overall eating pattern over time. That is generally why we like them fasting, we used to get them fasting, now the lipidologists that like to see what they are normally because if you eat a certain way you are probably not going to be fasting and we want to see how your body responds to the intake of certain foods and see where they are. In essence, LDL is bad HDL is good.
SF: How has the Houston Medical Center changed since you have come into practice?
JR: Oh it has flourished. The Texas Medical Center you mean?
SF: The Texas Medical Center.
JR: The Texas Medical Center was actually founded in the 60s through Michael DeBakey, Baylor College of Medicine, split off from Baylor University in Waco and created a medical school in the 60s. DeBakey who recently just passed way, is a famous cardiovascular surgeon, actually originally from Louisiana. I think he went to Tulane. I had the pleasure of learning from him in medical school and residency. But anyway he actually founded with a group of philanthropists and other folks the Texas Medical Center. It is internationally known. It has just run out of space almost. There is almost no space at all left. It houses Baylor College of Medicine, University of Texas Health Science Center at Houston, Prairie View A & M Nursing School, Texas Women's� I think their nursing school is there as well. Saint Luke's Hospital, Methodist Hospital, Herman Memorial Hospital, it has just flourished and Texas Children's Hospital. The University of Texas Public Health School, UT, MD Anderson Cancer Center it is just phenomenal. I think that the bio medical research the technology is just incredible. Is that it?
SF: You have covered everything that I have. Do you have anything else that you would like to say or tell me about or maybe pass on and put on the web site or that you think is important that I haven't brought up?
JR: I think U of H needs to be applauded and Dr. Brosnan in particular and also Dr. Melosi for their dedication and commitment to this project as well as the African American Studies program at the University of Houston as well as you grad students that have done such a wonderful job in dealing with us doctors that are busy in terms of tracking us down and interviewing us and implementing, editing and all the work that you have done to put into this phenomenal project and hopefully, I have good feelings that we can actually have this project be a positive, a positive impact on the future of medicine and the need for us to have people that are compassionate, caring and culturally sensitive to take care of patients.
SF: Thank you very much I appreciate you interviewing. Can you hold on one minute? Stay as still as possible because we want to get a good still picture of you.
End of Interview 1:07:22