CGP Community Stories

Dr. Walter Franck, November 16, 2015

Title

Dr. Walter Franck, November 16, 2015

Subject

Columbia-Bassett Program
Cooperstown, NY
Mary Imogene Bassett Hosptial
Medical Education
Medicine

Description

Dr. Walter Franck was born in Shanghai, China in 1941, the son of Belgian parents engaged in international finance. In 1943, Franck and his family were interned by Japanese forces in a concentration camp until Japan’s surrender in 1945. Following the internment period, his family lived in China until the 1949 Communist Revolution, after which his father’s work led the family to move to many cities throughout Asia. In 1953, his family moved to the United States. Franck advanced rapidly through school, entering Yale at age fifteen and later graduating from Columbia University’s medical school.

After serving residencies at the University of Michigan and Massachusetts General Hospital, along with a stint in the military as chief-of-medicine at the SHAPE/NATO hospital in Belgium, Franck was hired in 1973 by Mary Imogene Bassett Hospital in Cooperstown as their first rheumatologist. During his time there, he became involved in academic research and the teaching of residents who came to Bassett for training. This work continued along with his main medical duties after he became chief-of-medicine at the hospital in 1981, a position he held until his retirement in 2008.

During his later years as chief-of-medicine, Franck helped spearhead the creation of the Columbia-Bassett Program, an innovative program where medical school students spend their clinical training in Cooperstown, working at Bassett Hospital and gaining experience with a rural health care environment and the inner-workings of a larger regional healthcare network. Franck served as the senior associate dean of the program from 2009 until his retirement from this position in January 2015.

I met with Dr. Franck on November 16, 2015 at his home in Cooperstown. Dr. Franck discussed his early years abroad and the impact they had on him, his years in medical school and how this shaped his thoughts of medical education. He also discussed how Bassett Hospital, the medical field, and medical education have changed over the years, and how his experiences informed his work at Bassett, both as chief-of-medicine and in the creation of the Columbia-Bassett Program.

As much as possible, I have attempted to capture the nature of conversation between Dr. Franck and myself during the course of our interview. That said, for the purposes of flow and continuity, I have removed several pauses and false starts that occur through the interview, as well as a number of extraneous words or phrases such as “so,” “you know,” “I mean,” “and,” etc. For a more accurate experience of our discussion, it is recommended researchers consult the audio recording.

Creator

Andrew Lang

Publisher

Cooperstown Graduate Program, State University of New York at Oneonta

Date

2015-11-16

Rights

Cooperstown Graduate Association, Cooperstown, NY

Format

audio/mpeg
27.5 mB
audio/mpeg
27.5 mB
audio/mpeg
14.0 mpeg
image/jpeg
2592 x 1936 pixels

Language

en-US

Type

Sound
Image

Identifier

15-007

Coverage

Upstate New York
1941-2015
Cooperstown, NY

Interviewer

Andrew Lang

Interviewee

Dr. Walter Franck

Location

7 Lakeview Drive South
Cooperstown, NY

Transcription

Cooperstown Graduate Program
Oral History Project Fall 2015

WF=Walter Franck
AL=Andrew Lang

[START OF TRACK 1, 0:00]

AL:
This is the November 16, 2015 interview of Dr. Walter Franck by Andrew Lang for the Cooperstown Graduate Program’s Research and Fieldwork Course. Dr. Franck, I want to thank you again for agreeing to this interview. I hope you’re well this morning.

WF:
I am. Thank you for asking me to participate in this program.

[TRACK 1, 0:19]

AL:
Oh, not at all. I’d like to begin by having you tell me about where you were born and lived during your early years.

WF:
I was born in Shanghai, China, and my parents were Belgians who were sent to China to represent the interests of a Belgian firm. And while in Shanghai, the participation of Belgium in World War II as an active combatant occurred, and so we became residents of China, and when the Japanese invaded China we became hostile immigrants to that country. I was born there in a free China, but when the Japanese came in—I think it was in the middle of 1942—my family, which consisted of my parents and my older sister, four years older than I, and we were interned in a concentration camp, a Japanese concentration camp, for two-and-a-half years until the end of the war. Those were my earliest years of early growth and development.

[TRACK 1, 1:30]

AL:
Is there anything from these experiences you remember? These early years?

WF:
It’s hard for me to know if I remember them or if I remember them because I’ve been told stories about them. I don’t remember atrocities, although I know they occurred. I remember snippets of things through the eyes of a child. Simple things like, I remember one time there was, in the sky, these puffs of smoke that appeared, and people were saying these were “anti-aircraft.” I was looking for the figures of a woman, an “aunt.” I had no idea what they were talking about. I remember that. I remember large groups of people in small spaces, because we were in a school that was used as a concentration camp. [We were] in a classroom with another family with several children. So we were in a very confined space. I remember the crowding. Not as a problem, but just as a reality. It was like being part of an extended family, and I remember that as being sort of a good experience, as a child, just to have a lot of people to be with all the time. I think that I was shielded from a lot of the things that would have made that a frightening experience, because I have no bad memories along those lines of people being tortured, as I know happened, or killed, as I also know happened. I remember the end of the war. I remember that when the war was over there was a lot of jubilation in the camp, but I also remember that we weren’t released. We couldn’t go out, and it’s because our captors failed to recognize the fact that it had happened. They couldn’t believe it, because the atomic bomb is what stopped the war. I remember that the emperor had to be heard. There was a radio in the compound and he came on speaking Japanese. They all bowed, and I remember that. After that event occurred, then they went and opened the gates and everybody ran to be on the other side of the gate, but they had no place to go. But they just needed to be where they had never been able to be. I remember that. Exodus.

[TRACK 1, 3:42]

AL:
And after that happened, when you and your family were released, what did you and your family do after that?

WF:
Well, we returned to Belgium because that was their home. And I remember that part of it. We returned on a converted passenger ship, which was used to evacuate troops and civilians. And I remember being on that boat. One funny little story is that I had been so used to living in a community where there was so much poverty—in a concentration camp you had to fight for everything that you got—that I remember passing my hat around, and coming back to my parents with my hat full of money: coins. And they were just mortified that I had done that, and I thought that I had done something very good. [Laughs] But we returned, back to Southampton is where we returned to, because that was where the ship was going, in England. And then we returned back to Belgium, which is where my parents’ families were. And we were there for a little while. Then we returned to China, actually.

[TRACK 1, 4:57]

AL:
Okay, and how long were you in Belgium, approximately, after you returned?

WF:
I would say six months.

[TRACK 1, 5:01]

AL:
Okay. And when you went back to China, was it again, for the business reasons….

WF:
Yes.

[TRACK 1, 5:12]

AL:
….that your father was involved with?

WF:
He picked up the same business, with the same contacts that he had established back in the late thirties and early forties. And we resided in the same community. In Shanghai, there were different communities: there was a French community, and we as Belgians fit into that [community]. Belgium is much too small a group of people to have their own community, but we were part of a French community, and I spoke French. French was the language in which I was raised. I learned English in the concentration camp, from English children. That was how I learned English.

[TRACK 1, 5:47]

AL:
I was wondering if you could tell me a little bit more about your parents, and your memories of them during these early years.

WF:
I just remember that they were ever-present and very protective. Very warm, certainly sacrificing. I know my father lost so much weight, that from a distance, some of our Chinese acquaintances thought that he was me, until they realized that he was fully grown. And they lost all of their teeth. I think they would pass on anything nutritious on to their children. They were just very giving people. And my father was a businessman who started at the bottom of the ladder. What he did was really innovative, to go to China to represent the interests of the company as a young man. Back then you sailed to China. Took us three months to get there by boat. And he then went ahead of us, and helped set up an apartment for my mother and sister. I wasn’t born yet when he went over, obviously. But very family-oriented. My mother was a housekeeper through her whole life. And my father, as his business grew, he really became very good at what he did. And because of world events we had to leave China because the Communists then came down to Shanghai, and we didn’t want to be captured again. But he had a term to fulfill, so we then moved from there to India, where he completed his term. So we lived in India for a year, acquiring more experience dealing with a different population of Asians. And he got to really understand how to deal with them, respecting their culture, and understanding their economics. And after that we went back to Belgium. He then accepted another assignment, and this time it was Pakistan. We went there for two years, and he then gained further experience. Went back to Belgium, recharged his batteries. And the next time he was sent to the United States.

[TRACK 1, 8:07]

AL:
What was it like for you and your family to live in all these different areas while you were growing up?

WF:
Well, it drew us closer together as a family so we became a very self-sufficient, yet solitary group. We really weren’t in any place long enough to establish lifelong friends, because we were just in so many different places for significant periods of time, but all in very transient situations, kind of like being a military family. Even when we came to the States, we were in San Francisco for three years, and then my father moved to New York and then he moved to Montreal, so they were always on the move. He didn’t really settle down until he retired. I think, for us, it meant that we became more interdependent as a family unit, and closer as a family, and perhaps more private and sheltered in that regard.

[TRACK 1, 9:08]

AL:
Were there any difficulties for you, as a child, moving around this much?

WF:
Difficulties? I mean, life is filled with difficulties, challenge. Every time you went from one place to another it meant learning [and] establishing new relationships with new people. All of that took time, and all of that took work. We had our family unit as a constant, which was very helpful, but just getting used to new places and new people was a challenge every step along the way. And that was compounded by my schooling. Every other school I went to, for a number of years, alternated between French-speaking and English speaking. That’s literally true, for four or five cycles. So I became very adept at those languages. Traveling is very educational, so I learned a great deal about a lot of things. So my education was accelerated, and I was also gifted with being able to learn easily. And the easiest way to adapt academically was to keep skipping grades. It became really more of an issue as I entered adolescence, when I was in high school at eleven. My age differential between me and my peers became greater, at that part of my life, and that created some social isolation. But I don’t want to overemphasize that, because it didn’t really affect my happiness or my performance; it just was part of the way life was for us. It was just different. And so we survived that. But I think that it must have affected me in a sufficient way so that when it was my turn to raise a family—that kind of gets back to later on in my life—I really wanted a place where I could establish roots and raise a family in one place. So when we came here in ‘73 I was looking for not just a place where I could do what I could do professionally, but where I could also raise a family with some constancy. And that’s what we successfully accomplished.

[TRACK 1, 11:47]

AL:
Just before we talk about Cooperstown, I wanted to just ask a little bit about when you and your family moved to the United States, you said that you were in San Francisco for three years, and then moved to New York City. What was that experience like, coming to the U.S.?

WF:
It was fabulous. The countries in which we had been living were really impoverished nations. When I went to school in Bombay, regularly, I would walk past people who had died overnight. Or pyres of people being burned in, in Farsi crematoria, by the street. Coming here, we sailed by the Statue of Liberty in New York Harbor and saw all of these things which people only dreamed about. That was just phenomenal. And so we landed in New York City, and my father bought a nice car. And we drove to California. And by that time my brother, who had been born in China the second time we went there, was quite a bit younger; he’s seven years younger than I am. But we drove the Southern route through Arkansas and places that we had just read about. And New Mexico. And saw some amazing sights. And we were actually in Los Angeles for a few months before we moved up to San Francisco. And then ended up living in Redwood City and it was just a gorgeous place. I went to school in Santa Clara. Took the train every day. I made some friends who would commute with me by train. And while we were there we traveled extensively. The Grand Canyon, the Sequoia, Yosemite, all of the places you would expect to see. My father would make us write reports on all of those things, and we did. We didn’t like doing it, but we learned from it. We went down to Mexico, to Tijuana and Ensenada, and we just made the most of the opportunity. It was great. When he accepted the job in New York City both my sister and I were completing our junior year in high school. We stayed there as boarding students to complete our third year. We were juniors. And then, we took the California Zephyr, the train, back to New York, and then we did our senior years in New York. I went to Fordham Prep.

[TRACK 1, 14:43]

AL:
And you again mentioned that you were a few years ahead of the peers you were with at this time.

WF:
By that time I was four years ahead, yeah.

[TRACK 1, 14:53]

AL:
How did you feel being much younger than the other students you were with?

WF:
I felt younger. I had younger interests. I had matured faster, I think, because of all the traveling I had done, so I didn’t look as young as I was, which helped a little bit. And I guess I chose my circle of friends with people who had interests similar to mine. And it worked out okay. But, I didn’t feel like I was really socially their peer. I was really more of a curiosity, at least at that point and time. But I wasn’t bullied. And I think it was sort of a curiosity more than anything else.

[TRACK 1, 15:44]

AL:
Now after you were done with high school and prepared to go to college, was a career as a doctor something you were considering?

WF:
Yes.

[TRACK 1, 15:56]

AL:
Okay.

WF:
I sort of knew I wanted to be a doctor all my life. No one can really, I think, adequately explain why they go into particular careers or fields. I think a lot of it just comes naturally as a result of some complex of experiences that one feels. I interview medical student applicants and I never ask them that question—“Why did you decide to go into medicine?”—because the answers will always seem contrived. As if they’re trying to find a reason to explain what they did. But they usually don’t really know why they did it. And I don’t, but I do know that there were events in my life that, I think, influenced me. And one was the suffering that I saw. I didn’t see the suffering that my parents saw in the concentration camp, but I saw it in the populations in India: in Bombay, in Mumbai, in Karachi, in Calcutta. I always wanted to help. The desire to take care of people. I could have been a nurse, could have been anything [but] it was a doctor at that point. But then I also have an uncle in Belgium, after whom I was named, curiously, who is a GP [general practice] obstetrician in a very small community in Belgium. And I was always drawn to him and what he did. And whenever we’d go to Belgium during these visits, I would go and spend some time with him. And even when I was [an] early teenager, I would shadow him and go into the operating room with him. And so when I went to college, I thought I was going to be an obstetrician. And if you read my yearbook coming out of college it says I wanted to be a surgeon. I even had an idea that’s the kind of person I wanted to be. But I really didn’t know, until I got to medical school—even after medical school I didn’t really know what kind of a doctor I wanted to be. But I knew that I wanted to go into medicine.

[TRACK 1, 18:02]

AL:
And where did you attend medical school, again?

WF:
I went to Columbia. [Columbia University College of Physicians and Surgeons]

[TRACK 1, 18:05]

AL:
Okay. And this was after your undergrad years at….

WF:
At Yale.

[TRACK 1, 18:11]

AL:
Okay. So you graduated in what year?

WF:
From Columbia?

[TRACK 1, 18:16]

AL:
Yes.

WF:
1964.

[TRACK 1, 18:17]

AL:
Okay. And what was medical education like at this time, when you attended Columbia, when you were training to be a doctor? What was the field like at this time?

WF:
Well, medical education at Columbia in the sixties was, was very hard, very demanding, very accountable, and very, very stressful. Very, very stressful. Very competitive. I’m not sure that was true in all medical schools: my experience is limited to Columbia. You were in with a bunch of very bright people, all of whom had been very successful in their earlier lives, in college and other things that they had done. But the group of individuals who would collaborate and help you or work together in smaller groups for a common goal was fairly limited. You did make a small circle of friends, and that was useful. But I don’t think back upon those years fondly. I think of them as stressful, and as competitive, and as arduous. Until the clinical years when that component of it—although the competitiveness continued—that component of it was balanced by the reward of being able to relate to people and patients. I remember classmates of mine who would then present to the professor of medicine, and faint. Just drop faint. Four of my classmates committed suicide. Two in medical school, and two shortly thereafter. We were a class of one-hundred-and-twenty. It was not a big class. And so it was hard.

[TRACK 1, 20:25]

AL:
So you mentioned that when you got to your residency, your clinical practice, that was a different experience for you.

WF:
Yeah, it was.

[TRACK 1, 20:36]

AL:
How was it different?

WF:
Well I wanted to escape that culture. And I, with three of my classmates: we were all looking for internships, for first years of residency. And we drove across the country. Had I told you that?

[TRACK 1, 21:01]

AL:
When you were….

WF:
Had I mentioned that to you?

[TRACK 1, 21:04]

AL:
No, I don’t believe so.

WF:
No. One of them from New Hampshire had a convertible. The license plate said “P&S,” which is the abbreviation for Columbia Medical School. And the four of us drove across the country interviewing for internships. And between the four of us, we interviewed at a lot of different places. But we actually went all the way to the West Coast, right up to Vancouver. Interviewed in Cleveland, and Ann Arbor, and just along the way different ones of us interviewed at different places. Drove all the way down to Mexico and came back through Las Vegas, Houston, Dallas, Houston, St. Louis. We covered a lot of miles in a month. But I guess what I was getting at is, one of my first interviews was in Ann Arbor [University of Michigan], and that was the first time I had ever experienced a culture that was just so different than what I experienced at Columbia, that I just knew I wanted to go there. There, people were friendly. They were nice. They were open. I saw interns in the emergency room who would take care of patients, and then they would do their write-up—well because they had gotten the data, but also to help out the interns on the floor who would be receiving the patient, who would then have a partially-completed write-up—and they would just do it out of collegiality. There was that kind of connection that was nurtured. I was just so overwhelmed by that, that I just knew that that’s really where I wanted to go. I think I might well have felt the same way if I had gone to Minnesota, or Indiana, or other parts of the country, where that way and the culture and these, the most competitive medical schools might have been different, although Michigan was pretty highly-rated. But it just felt different, and it was. I ended up going there [Michigan] for my internship and residency, and loved it, loved every moment of it. And found all of my years there that we all worked together so that we would all succeed. That we would all help each other take care of our patients, and cover for each other when we had personal needs. When my wife would go into labor, my colleagues would cover for me so I could be with her. They felt nothing about it. That’s perhaps too obvious an example, but there are many other times where there would be sickness or whatever. They would just go out of their way to help you, and professors would be understanding. I loved them so much that, during my internship, I wanted to be whatever rotation I was on. If I was on pediatrics, I wanted to be a pediatrician. And if I was in the ER [emergency room], I wanted to be an ER doctor, I liked those guys so much. Finally, I had to make a choice, and fortunately, I think, I was on medicine at the time with a rheumatologist as an attending. I had to make a decision on where my next residency job would be, so I picked medicine. So that was just a great experience. I think that the culture at Columbia is different now than it was then. I know it is, because I’ve now worked with Columbia medical students and with the faculty there. I think that that’s perhaps the way that medical education may have changed in the course of the last fifty years. Quite a bit. So as to become much more empathetic to the needs of students. And I don’t think it’s just in medicine. I think it’s true in other professional fields as well.

[TRACK 1, 24:53]

AL:
All right, you had mentioned briefly that your wife, [was] in Michigan.

WF:
I met my wife at Columbia.

[TRACK 1, 25:07]

AL:
Okay.

WF:
Yeah. My wife was a nurse. At Columbia, that’s where I met her.

[TRACK 1, 25:13]

AL:
And how did you two meet, if I could ask?

WF:
Well, the first time that I saw her was at a Christmas dance, and she was escorted by one of my friends, and I noticed her. Then the second time that I met her was, we were both Catholics, and I happened to bump into her at mass, in a church near Columbia. So that was the second time, and we started seeing each other. But shortly after that she made plans to go to Europe with three of her friends for three months. So we dated briefly before she went to Europe. And then she did. And when she came back, then our relationship resumed. When she came back, she then came back to Columbia, and worked on the metabolism unit as the assistant head nurse. So we dated until I graduated and we got married the first Saturday after graduation.

[TRACK 1, 26:19]

AL:
And she accompanied you out to Michigan….

WF:
She did.

[TRACK 1, 26:24]

AL:
….for your residency?

WF:
Yeah. Oh yeah, she did. She was with me all the way.

[TRACK 1, 26:31]

AL:
Yeah. Now after you completed your residency, were there any other experiences, were there any other programs or internships that you were a part of?

WF:
Yes. The way subspecialties work in medicine, and certainly in medicine and some of the other disciplines is after you complete a residency in medicine, if you want to be a subspecialist—a cardiologist, or a dermatologist, or a cardiologist, or an allergist, or a rheumatologist—you then have to do two additional years of training in rheumatology. And I loved it in Ann Arbor so much that I tried to—let me take a step back. In order to allow me to complete my education—and by that time we were having children and I wanted to complete my residency before serving in the military—there was a plan called the Berry Plan, which would guarantee you that they would let you complete your education, and then you would definitely serve in the military, wherever they would assign you. And that was sort of the deal. This is now during the Vietnam War.

[TRACK 1, 27:43]

AL:
Okay.

WF:
So, I was destined to enter the military in 1968. But I really wanted to be a rheumatologist. So I asked if my deferral could go another two years, so I could stay at Michigan and do my fellowship in rheumatology at Michigan. And the army said “no,” they wanted me in 1968. Knowing that I then, reluctantly, started looking at other fellowships, because I knew we would not go back to the Midwest to live. Getting back to the first part of our conversation, we wanted to be close to family, but we wanted to establish roots.

[TRACK 1, 28: 26]

AL:
Yes.

WF:
And Linda’s family is from Waterville [New, York], which is just down the road here, and my family, at that time, had gone from New York to Montreal, and they were living in Quebec. And we wanted to be in the Northeast. The programs that I thought were the best programs in rheumatology were both in Boston. One was the Massachusetts General Hospital, and the other one is the Robert Brigham Hospital, which is part of the Brigham Consortium of Hospitals. So I applied there, to those two places. I got into them both, and I decided to go to Mass General. So Mass General understood that I would go there at the end of my military service, which would be a three-year commitment. I entered the military in 1968, exited in 1971, and then went and did my rheumatology fellowship in Boston for two years, and then I was done with my training. That’s the end of my formal training.

[TRACK 1, 29:38]

AL:
And when you were done with your training in 1971, were you then….

WF:
My military in ‘71.

[TRACK 1, 29:46]

AL:
Military in ‘71. Then in 1971 you went to Mass General?

WF:
In ‘71 I went to Mass General.

[TRACK 1, 29:55]

AL:
Okay.

WF:
Yes.

[TRACK 1, 29:57]

AL:
And you were there….

WF:
Yes.

[TRACK 1, 29:58]

AL:
….for two years?

WF:
For two years. Yes.

[TRACK 2, 0:00]

AL:
Okay.

WF:
And my military service—I applied for, at the recommendation of someone at Michigan, a position in Belgium. And got it. Part of it was because I could speak French, and Flemish, and English. So, I could be useful to the local population that served the base. But also, since I was a fully-trained internist I could be useful as an internist, at the SHAPE [Supreme Headquarters Allied Powers Europe] hospital.

[TRACK 2, 0:33]

AL:
Just quickly: what was your experience like, serving at Belgium, in SHAPE [Supreme Headquarters Allied Powers Europe], at the military hospital there?

WF:
It was phenomenal. We had doctors from all of NATO. SHAPE is the military arm of NATO [North Atlantic Treaty Organization].

[TRACK 2, 0:32]

AL:
Okay.

WF:
And the only NATO country that wasn’t in SHAPE was France. They had withdrawn from the military part of NATO about then. That’s why the hospital moved from Paris to Belgium.

[TRACK 2, 1:06]

AL:
Okay.

WF:
They had to build a brand new hospital. I actually got to Belgium before the hospital was completed. So I met Turkish doctors and Greek doctors and English doctors and German doctors, and got a chance to share; we educated each other. I got to learn about the drugs they were using. I got to take care of patients from their hospital. The hospital part of that complex was all American. That was [the] 196th Station Hospital. So they didn’t take care of any in-patients: we did all the in-patient work, but they had clinics. They saw out-patients, but if they were sick and had to be admitted, then they would come in to the hospital and we would take care of them. And we were the only ones who were on call at night, covering the emergency room. So we would take care of all nationals at night. So to answer your question, we saw a variety of different illnesses that I hadn’t seen during my residency or fellowship. We got a chance to meet colleagues from across the country. We got to meet military families, and, we were part of the evacuation process for some of the soldiers that had been injured. We were very close to the Air Force and military hospitals in Germany, so we were part of the support system for the war. So we had some contact with that. So from a professional point-of-view, it was great, from an educational point-of-view. I was the most senior internist there, for a while, so I actually was the chief-of-medicine there, just as a fledgling out of my training. But, I gained some administrative experience there. And as a place to live, we were in Belgium, so we would go to England as a family, we’d go skiing in the Alps, we’d go to Spain and Italy. We just traveled when we could, in our free time, and we’d stay at military bases when we did that, so the expenses were low.

[TRACK 2, 3:04]

AL:
Yeah.

WF:
I mean, I would have stayed in the Army another year if they would have let me.

[TRACK 2, 3:10]

AL:
I just want to clarify one quick thing before we move on. This was during the Vietnam War, correct?

WF:
It was.

[TRACK 2, 3:18]

AL:
Is there any particular reason you were in Belgium to serve as a military doctor? Was there something going on there?

WF:
Well, the military had to staff all of its bases.

[TRACK 2, 3:33]

AL:
Okay.

WF:
SHAPE was an important base because it was where all the brass in Europe was based. So we had generals from all these countries. So they had to keep a population of physicians there.

[TRACK 2, 3:50]

AL:
Okay.

WF:
And I think I was very fortunate not to go to Vietnam. I would have gone if they had asked me to go, but they didn’t ask me to go. I think they thought that, given my linguistic skills and my training, I was better suited there [Belgium] than I would have been in a battalion, traumatic environment. For me and for my family it was kind of an amazing opportunity. Also, to avoid combat. I wasn’t in combat, I was in a support role.

[TRACK 2, 4:32]

AL:
And your family at this time: you and Linda, did you have children at this time?

WF:
Yes, we had two children in Ann Arbor, and one was born in Belgium.

[TRACK 2, 4:45]

AL:
Okay. And, you mentioned that it was 1971 when you were done with your military service, and then you went to Massachusetts General.

WF:
Right.

[TRACK 2, 4:55]

AL:
And then, you had said that you wanted to stay in the Northeast….

WF:
Yes.

[TRACK 2, 5:01]

AL:
….when you were all done with your….

WF:
Yes.

[TRACK 2, 5:03]

AL:
….training and residency. So how is it that you came to be in Cooperstown?

WF:
Yes. The way that the quest went is, when I was trained, I was trained as a clinical rheumatologist.

[TRACK 2, 5:18]

AL:
Okay.

WF:
But I also learned a great deal of immunology. So, I was in a position where I could have been useful in setting up an immunology laboratory program; support some research along those lines. And I also wanted to teach. I’d always wanted to teach. So I looked around the Northeast for job opportunities, and the one that stood out the most was Dartmouth. I liked the geography of the Dartmouth program—Hitchcock Clinic—and I liked the people that were there. I interviewed there and it went really well. I also looked at Portland, Maine, where there was a rheumatologist who had trained at Mass General. And I liked that, but not as much. That was more private practice in a community hospital and I wanted to be more part of an integrated unit where there was an opportunity to do teaching and research. So Dartmouth was my first choice. And then I looked at a practice in Springfield, Massachusetts and that was even more private-practice oriented. I applied for the Dartmouth job. And at that time, they were also recruiting for a pulmonologist. And it turned out that the person that they were looking at was a friend of mine from Michigan. And, they decided that year that they were going to hire one more person into the clinic, not two. So they asked me to wait a year, because the greater priority for them was pulmonology. So they offered Peter the position, but I had to wait a year. And my life as a fellow was really arduous. We got paid very little. I had three kids. Housing was a cost. I was commuting thirteen miles a day to work. And I had four other jobs, in addition to my fellowship, just to make ends meet. One was working at a rehab hospital. I was doing a lot of different things. And it would have meant another year like that. And I just did not want to wait for another year in that environment. And then, Linda’s father—who was a lawyer in Waterville [Waterville, New York]—he had some contact with an orthopedic surgeon at Bassett. And I’m not sure what it was about. It must have been something related to some kind of litigation. But he happened to ask him—his name was Ed Carey—if Bassett had a rheumatologist. And Ed Carey said “no.” So I wrote to the chief-of-medicine here, saying “I’m looking for a position as a rheumatologist and I understand you don’t have one. Would you be interested in receiving an application from someone?” And then I sent them my CV [curriculum vitae]. I had known about Bassett because Bassett is a Columbia-affiliated hospital and while I was at Columbia, a number of my friends came here for rotations. I think that I might have too, except that I was dating Linda and I didn’t want to leave her, so that’s why I never came. But I knew it was a really good place, but I had never seen it. He wrote me back saying “we’d love to see you. Come on up. Take a look. Let’s look around.” He said, “we’ve never had a rheumatologist.” At that time, there weren’t even boards [medical exams] in rheumatology. It’s something that some people did. But it hadn’t received the formal recognition of a specialty that cardiologists had. You had boards in internal medicine and then you also got tested, and then had boards in cardiology. The first boards that were ever given in rheumatology I took, after I was at Bassett. So I came up and I gave a talk and I loved it: I loved the area, I loved the hospital, I loved the people that I met. Basically, the only question that they asked me was, “Look, we’re not quite sure if you’ll fill up your schedule with rheumatology patients, because we’ve been taking care of them without a rheumatologist all these years. If you’re not full, would you be willing to do general medicine?” I said, “Sure I would,” because I was trained as an internist and I had my whole time in the service. And so I then came back with my wife for a second visit, and loved it even more. So we just decided that this was what we were going to do instead of Dartmouth. And Dartmouth still, at that time [was] in my mind. If I had had both options, I probably would have preferred Dartmouth, because of its location, and the fact that there was a university right there. I think those were appeals, and I suspected that the education for the kids would be better there. It was closer to the big cities. There were a lot of geographic reasons too, and there seemed to be more going on in the community in Hanover [Hanover, New Hampshire] than in Cooperstown. But this seemed like a great alternative. And then, just to support that decision, a number of years later—not that many, four or five years later—a job opportunity at Dartmouth became available. And I was offered it, and I turned it down. Because by that time, we were settled here. We were really happy. All of us were happy: Linda was happy, the kids were happy, I was happy. Loved my colleagues. I had established some programs which I loved. This was, we knew, the place I wanted to be. So that’s how we came to come here.

[TRACK 2, 11:16]

AL:
And when you first started at Bassett, what was the hospital like when you started? As an institution? What was Bassett like at this time?

WF:
It was much smaller than it is now, and therefore more intimate. People knew each other better. There was a much smaller patient population that was just more manageable. From the social aspects of knowing staff, knowing nursing staff, knowing housekeepers, knowing everyone that worked here. And developing programs, it was just easier. It was sort of in its infancy of providing tertiary care [specialized health care]. It was really good at providing primary care. Let me talk about the Department of Medicine, which was what I knew best. I think I was the 10th or 11th member of the Department of Medicine. When I left it [in 2008] there were about 80. That just gives you an idea of the growth. But, in that group of 10 or 11, there were two cardiologists….

[TRACK 2, 12:32]


[At this point in the recording, Dr. Franck received a telephone call. Both he and I decided we would let the answering machine pick up the message, but Dr. Franck’s phone and answering machine were on audio playback, so the phone message was broadcast to us as our interview was being recorded. This resulted in an approximately one minute and 15 second phone message that exists on the audio recording.]

[TRACK 2, 13:47]

WF:
So anyway, getting back to the Department of Medicine. But the giants in the department. Bill Mook, he was a giant; general internist who happened to do endocrinology. He wasn’t an endocrinologist, but he did endocrinology really well. And Emery Herman, who’s still alive here in the community; he was a general internist, but he did hematology and pulmonary medicine. And Bob Sioussat was a general internist, but he also was a neurologist. Now, at that time, we did actually have another real board-certified neurologist. But Sioussat knew every bit as much as he did. So these were vocations. Don Pollock—whose wife just [passed], her funeral was just last Saturday—was an internist who did dermatology. So he was the dermatologist. So these were internists who were doing everything, and over the course of the next years, each of those disciplines became divisions, with many people in them, all of whom were board-certified. So now there are four neurologists, and seven or eight cardiologists, and four rheumatologists. There are two groups of internists: one group that does principally outpatient medicine, and another who are all hospitalists. It has become much more sophisticated, complicated. It’s an organization which is really much more tertiary. A tertiary component has emerged on top of a primary care base. And the principal primary care base now is in the regional healthcare system, where we have so many family practitioners, and internists, and nurse practitioners, and physician’s assistants, and all of the communities that surround Bassett that are part of the integrated healthcare system, and the other hospitals that are part of the Bassett Healthcare System. Back then there was one hospital. There was one physician’s assistant who did dermatology. He was the first physician’s assistant in New York State. But it was just a much smaller, much tighter group, with much less in the way of specialized care. But a place of academic excellence, and committed to education with residency programs. Back when I came, there were programs in medicine, surgery, OB [obstetrics and gynecology], psych [psychology]. And there were five. Now they’re down to three, and there had been more before that. In the early years there were fellows in ophthalmology coming here from Albany who were doing a number of months here. So, there was that level of training. And there was always medical student training, with students on rotations from a number of medical schools, principally Columbia, but [also] Albany, and Syracuse, and Rochester, and then from around the country. So, it really had all the ingredients of a medical center, but it was with a lowercase “c.”

[TRACK 2, 17:02]

AL:
And you had mentioned earlier, when you were considering hospitals that teaching was something that you were very interested in.

WF:
Yes.

[TRACK 2, 17:11]

AL:
What was the importance of the academic component at Bassett for you?

WF:
Vital. Vital. The things that I could see myself doing, and that I mentioned to the chief-of-medicine when I came here, was that I could set up a clinical program, but I could also set up a training program for residents, specifically in the field of rheumatology, which I did. I had a training program for medical students, which is a different curriculum, because it’s teaching at a different level of education. And then I could dovetail that with my immunology background, and that I could set up an immunology lab, which would provide clinical service so we could actually do immunology tests for the hospital, as well as an immunology research lab where we could do research and help teach residents and staff on research that was ongoing or some of their own projects. And one of the things that lent itself to the latter was Dave Blumenstock was the chief-of-surgery here at that time and he was doing a lot of work on lung transplantations. And initially, these lung transplantations were done between beagles, so that the genus of the dog—it’s beagle-to-beagle lung transplantations. And then they started doing the transplantations crossing lines, so that they were beagles-to-mongrels. And, they would then learn what kind of immunological interventions would be possible to enable these lungs to survive in the recipient with radiation and chemotherapy. And part of what would help them is looking at the transplanted lungs and seeing what immunological damage was done by the host to the lung. And that’s something that my lab could provide. We did all of that: clinical lab, research lab, two training programs, and the clinical practice. So I was in seventh heaven.

[TRACK 2, 19:19]

AL:
In addition to these clinics, what were some of other roles that you held at Bassett from the time you first arrived there?

WF:
I was involved from the get-go in the identification of students, applicants for residencies. That was an important part and fit in with my interest with teaching. I served on different committees. I ended up becoming chairman of the medical records committee. Things like that. I can’t even remember which committees I was involved with. Perhaps the most important committee work that I did was, there was a group the chief-of-medicine then, Joe Lunn, put together after Bill Streck—does that name ring any bells to you?

[TRACK 2, 20:21]

AL:
Oh yes.

WF:
Bill Streck came to Cooperstown in 1978. And he was—he is—a visionary. And he really had a lot of ideas as to how the hospital, how the Department of Medicine, could be organized. Lots of great ideas that he bounced off the rest of us. So Joe Lunn asked us to form a committee on goals, priorities, strategies, for the future. And we met for a year. And we met once to twice a week, usually in the evenings. And put together [a report], and I brought it here to show it to you. It will just take me a second to get it.

[TRACK 2, 20:58]

AL:
Yeah, please, go ahead.

WF:
I put it in the other room.

[TRACK 2, 21:00]

[At this point, Dr. Franck left the room to retrieve the report that the committee he refers to put together as the result of their study and analysis. He returns to the interview at 21:21.]

WF:
This is it. Bill was the chairman, and then Bill Mook, and Dave Spahn. I was on there, Alan Kozak, and an administrator. And we together put this whole document, which studied the department, looked at its strengths and weaknesses, and came up with a plan on how to deal with all of the important issues of access, finance, reorganization. And this actually served—this was put together in ‘79, and I became chief-of-medicine in 1980—but this served as the blueprint for what I did in organizing the Department of Medicine over the first few years. That was the most important activity [in which] I was [engaged], and I got to work with Bill very closely.

[TRACK 2, 22:12]

AL:
Now, you mentioned in 1980 you become chief-of-medicine….

WF:
I became acting chief in 1980, and permanent chief in 1981.

[TRACK 2, 22:21]

AL:
Okay. And when you took on that role, what were the new responsibilities that you faced?

WF:
Well the issues were that people who came to Bassett, as I did, were given carte-blanche. The assumption was that you could come, you would do what you did, you would work hard, you would do it well, and the outcome would be good. And it wasn’t always the case. What was evident was that there needed to be more accountability and some more responsibility; some more clarity and definition over responsibilities. Better organization, better understanding of costs, which were often ignored. People would order tests without even realizing how much they cost. That wasn’t a factor in their thinking, because that’s what they thought they would need and not look at alternative ways of providing the same value for less money. All of those things were issues that needed to be done. That needed to be incorporated into the management culture of the department, but also of the institution. So we viewed this as an approach that would lead the organization, while at the same time protecting the reasons that people [physicians] came here. This wasn’t a private practice situation; we didn’t expect people to work as private practitioners. We did expect them to contribute in education. To [do] research, if that’s what they wished. Or do some other avocations that related to the hospital business; that we had sabbatical programs that would help encourage that and the like. But we also wanted them to stay. We wanted them to like it here, we wanted their families to like it here. So we wanted them to feel good about being engaged in the lives of their families and of their children. And for that there would be an economic sacrifice; you couldn’t earn as much as you could if you were in private practice. And people who came here accepted that. They were still being well-paid, certainly on an absolute scale. Not as well paid as private-practitioners, but we wanted to make sure that they were paid comparably to those that were in situations like ours, like other clinics. Not to say that we’re the Mayo Clinic, but to systems that were organized like that, where they value these other missions. Where there was recognition of the importance of devoting time to academics. That was my charge.

[TRACK 2, 25:20]

AL:
In your estimation, how has medical education at Bassett changed from the time you arrived, during your tenure, particularly during your tenure as chief-of-staff?

WF:
Medical education has changed a great deal, as has the distribution of physicians in health care. Part of it is economics, and part of it is the evolution of technology. But let me just talk about the economics for a moment. When I came, hard to believe as it may be, all of the physicians at Bassett were on the same salary scale, be you a neurosurgeon or a pediatrician. You got a thousand dollars more if you passed your boards. And then you advanced as long as you did your job well, to the degree that the organization could afford. Now, the disparity between what people earn at places like this goes from—I’m going to guess now with numbers, because I’m not really privy to what people in other departments make—but probably from $150,000 to $550,000. That disparity just didn’t exist, and that disparity is now also known to medical students as they’re looking for residencies. It’s not just Bassett; it’s the world of health care. And that $550,000 in private practice could be millions in the right community with the right practice set up. And, the issue of debt has just risen exponentially, as it has for all students in colleges, medical schools and the like. It’s not at all unusual for medical school graduates to have $200,000 worth of debt. So the attractiveness of primary care fields, economically, is just much less appealing to individuals nowadays than it was back in the seventies. Back in the seventies, most of the applicants to Bassett—again, your question reflected our experience here—were for the internal medicine residencies. I remember we used to have one-hundred-and-fifty to two-hundred applicants for six or eight positions. All from great medical schools. And we ended up with great residents. In the last ten years, or the last twenty years, there’s been such an attrition of U.S. graduates looking for primary care residencies everywhere, including here, that we’ve had to actively seek the best possible candidates from the world. Henry Weil [Assistant Dean for Education at Bassett Healthcare, Columbia University College of Physicians and Surgeons] went to Thailand to establish links with medical schools there. And now we have some Thai residents who are very good, and often end up going to fellowship programs at Mass General, or at University of Michigan, or Michigan State, setting up cath labs and the like. I went [to] Ireland and England to recruit from those medical schools. And Al Kozak came with me one of the times that I went, and Jim Dalton’s been. So we’ve really had to struggle to find quality residents. And we have. We continue to have quality residents; good doctors. But they’re not from our own culture. And that’s created a problem for the community, to some degree, because they don’t understand their doctors as well. And it’s created some cultural problems for them, coming here and living here, in places that are so alien to where they were born and raised. They have their own communities, but we have residents from India and Pakistan in the same program. Two countries that are traditional foes. So the competition for primary care residences has become an enormous quantum shift in all of the years that I’ve been here. The quality of education, I think, has continued to excel. And I think that the medical school, the introduction of the medical school program—

[TRACK 3, 0:00]

WF:
—has enhanced it further, because it’s empowered the disciplines that don’t have residencies to be active in the educational process, like OB, or PEDS [Pediatrics]. The residencies are in medicine and surgery, principally. But the other smaller departments, if they see a residency it’s part of a smaller rotating internship, what we call “transitionals” here. Otherwise their conduct had been trivial. But now they’re all involved in the teaching of medical students. So everyone gets to savor the enjoyment of being with these incredible students.

[TRACK 3, 0:42]

AL:
You mentioned the medical school program. You talk about students, both the residency program, which Bassett has had for a long time, but also this medical school program. I was wondering if we could discuss how this came to be, or how this began.

WF:
Yeah. It’s a fascinating story. The medical school program came up as an idea of Henry Weil’s; it was his conception. And the reason for it was something with which we all wrestled. The problem was we had great residents; we tended to retain internists either in primary care or as hospitalists. Sometimes specialists would come back. But our yield of retention from the residency was our richest source of recruitment for faculty that would come and stay. But we didn’t see that much with medical students. Medical students would come for a month and then they would go back. Even if they had a wonderful time here, after they went back to the place from whence they came, I think that they’d forget about us. Or, if they chose to go to New York, they chose a very urban medical school. When they chose a residency, they didn’t come to Bassett. So the idea was “what kind of strategies could we come up to have medical students come here and stay here longer?” Henry’s idea, which was a very interesting idea, but didn’t have much general support, was that we could become a medical school. And he and Bill LeCates—who just came back from Liberia; six months he was a nephrologist at the hospital—and Steve Heneghan—who was chief-of-surgery, and is now chief-of-professional services at the hospital—and I, the four of us, we went to Harvard Medical School, and met with them and discussed our ideas. The reason we went there instead of Columbia was because back in those days, Harvard realized their lectures were poorly attended. So they would actually film all of their lectures and then put them online for their students to see; to audit offline. And they did that. And they did that very well. And so we knew that and we were wondering if we could audit those lectures. If we could work out an agreement with them, whereby we could use their lectures for the preclinical years—and we just didn’t have the faculty for that; they just weren’t here, we couldn’t afford to hire a faculty—then we would have the clinical faculty here who could take those lectures and, with small groups of students, make them clinically relevant and discuss their content. And then we could teach the clinical disciplines here. Well, for a number of reasons, that idea just didn’t go anywhere. Our board didn’t support it, the Columbia part of our board didn’t like our working with Harvard, understandably so. And the impracticality of having remote learning in your first year-and-a-half or two years, after we had really looked into it, didn’t really make any sense. Still, our goal remaining getting students to come and stay here longer, we felt even if they just came for their clinical training here that would be one to two years. That’s a long time. And that’s enough to perhaps have someone imprint themselves and want to come back. So we put together this clinical program with a different kind of a model, the longitudinal model—which you have probably read about—which was developed at Harvard and which we studied, and which they use for about fifteen students in their class at the Cambridge City Hospital. And we felt that we could do that here, and do that pretty well, and put it together in a way that really demonstrated its feasibility. And that generated a lot of interest from a lot of schools. All of the schools were under pressure to expand their classes, especially to expand their classes for primary care, because primary care was in short supply. And so we had really interested schools: Vermont, Rochester, Albany, Syracuse. All of them came here with their deans to look at this program. A school in Australia. Columbia’s level of interest was minimal. They came and looked at it, and really were not very interested in our program. And then we were really advancing, probably to working this out with Vermont, when Columbia suddenly got very interested. And they got very interested, in part, because the President of the AAMC [American Association of Medical Colleges] really thought that this was the real thing. And that it looked like a Columbia-affiliate hospital was going to be lost to some of their competitors for what appeared to be a good reason, that maybe they should take a second look at it. And our board has so many Columbia people on it, including the chairman, who then became an advocate of this program—he wasn’t at first—that we were….“encouraged” is a mild word. A relationship with Columbia, we were told, was the one that was going to have to happen. So we did that. And while that was [happening] details had to be worked out. Like Columbia wasn’t crazy about this being a primary care oriented program; it had to be for students to do anything they wanted, so we had to modify it to that degree. It took a while, and then even after the agreement was worked out, before we would see a student here, it would be two years, and we had to recruit, and then we had to find students, and they had to be in New York a year-and-a-half before they came here. Here, we had trained our faculty, gotten a mission statement going, [and] were ready to go. And Albany [Albany Medical College] oversubscribed a class. In medical school, what they do is they typically invite more students than they have positions for, because they know that they’re competing with so many others that, if they offer a hundred positions, they might get fifty. So they offer a hundred-and-fifty. Well, Albany ended up with seven or eight more students than they had room for. It’s not a problem in the first two years when it’s all classroom learning. But it’s a problem in the next two years when you need to be taught at the bedside. So they [Albany] knew about our program and asked us if we would teach seven of their students. And we said “Sure. Which seven?” And they said “Well come on up here and describe your program to this second-year class and see if you get seven volunteers.” So we did. And we had twice as many volunteers; we had more than that. So they ended up picking the seven. So we did that, with seven, and that worked out so well that the next year they weren’t oversubscribed, but we still had a year without students here. And we had done it for a year [and] they asked us to take twelve. So we did that. And that was tough, to do twelve with the size of our faculty. We did it, and we did it well. And the students loved it. But we learned that twelve was more than we could handle with our current faculty. And by that time, we were with Columbia; there was a Columbia-Bassett program [and] we had picked the first-year class, but they were in New York. So we had another year without students. So we took another group, I think, of eight, in the third year. And that was the last year of Albany. So that was a three-year pilot, which for us was fabulous faculty development that enabled us to put together the SLIM [Systems, Leadership, Integration, and Management] curriculum and put structure into it, and get faculty involved, and the lectures and how to organize that with seminars. And then the next year the first Columbia-Bassett class came here. So that’s how it all came to be.

[TRACK 3, 10:42]

AL:
It’s truly an interesting story. And I just want to mention: we’re coming up a little bit on time here, so I just want to ask one thing here that relates to an earlier point you made. You said that in your experience at Columbia, it was kind of a stressful experience, when you were in medical school, and that when you went to Michigan for your residency it seemed much more communal. How did those experiences influence what you wanted to achieve with the Columbia-Bassett Program?

WF:
Excellent question. And a very important point. Because I wanted to achieve that culture here. And I think it exists here.

[TRACK 3, 11:25]

AL:
Could you elaborate a little on that? We have a little bit of time.

WF:
Okay. I think that the residents here and the faculty are very supportive of each other. And part of that is the group practice where you share things. Cancer Treatment Center has radiation oncologists and medical oncologists and surgical oncologists sharing care. There isn’t that economic competitiveness among them. There’s a climate of collaboration. In the earlier years before things became really more complicated, our conferences used to have all of the members of the Department of Medicine and the residents coming together to the same conference at lunchtime with their brown bags, in the same room. Now, they’re far too many of us to do that. Now we’d have to go to [Clark] Auditorium. But we were able to do that, so I don’t think it’s quite as intimate as it was when it was smaller. And I relate that more to size than to the culture. But I think that the culture of mutual respect, support and understanding, and affection is present here. And I think educators, in general, recognize the value of that humanism, and not just the practice of care but the treatment of peers. And I think that organizations monitor that too. They’re much more sensitive to monitoring abuse when people do go astray, and some do, and dealing with it when it happens.

[TRACK 3, 13:15]

AL:
I think we have time for probably just one more question from me. You were at Bassett for 42 years, and you’ve lived in Cooperstown for that amount of time, and you started this program, and you served as chief-of-staff. You did all these things at this one place. What has it meant for you to work in Cooperstown these 42 years and to be here in this area?

WF:
For me, it was kind of like coming home. The whole first part of my life was going from port, to port, to port, to port. This has represented stability and security. And now in my retirement I’m discovering much more about the community that I never had an opportunity to tap into because of my work. Things that are being offered at the museum: lecture series, movies, talks at the library, courses that are being given at SUCO [State University of New York, College at Oneonta]. There’s adult education. There’s just a lot of different things that we’ve now, both Linda and I, have now become involved with that we didn’t appreciate. We thought that we were going to be leaving Cooperstown, once I retired, to go live in the peri-Boston area where one of our kids lives and two of our grandchildren are still in high school there. Our two here are now both in college. But we decided to stay and we’ve discovered that everything we would have been looking for there is here. The only thing we don’t have is a proximate airport. [Laughs]

[TRACK 3, 14:59]

AL:
Oh, that’s a problem for everyone in this area.

WF:
I know.

[TRACK 3, 15:02]

AL:
I think I’m about set. Is there any other points you would like….

WF:
No, I think you’ve covered a lot of ground.

[TRACK 3, 15:11]

AL:
Then I want to thank you again for interviewing.

WF:
You’re welcome.

[TRACK 3, 15:16]

Duration

30:00
30:00
15:16

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128 kbps

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Citation

Andrew Lang, “Dr. Walter Franck, November 16, 2015,” CGP Community Stories, accessed December 12, 2018, http://cgpcommunitystories.org/items/show/233.