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     Interview with Dr. Donald Sparkman, former Director of the
     Washington-Alaska Regional Medical Program and 
     Mr.  Jim Hoviland, Medical School Information Officer 
     Date: September 29, 1993
     Location: ? 
     Interviewer: Stephen Strickland

           Strickland: In December of 1991, Dr.  Lindberg and the
     National Libarary of Medicine convened some of the people from the
     fereal government, the Congress, the executive branch and a number
     of former heads of Regional Medical programs in Bethesday.  I don't
     remember if you were ther Dr.  Sparkman.

           Sparkman: No.

           Strickland: In prepartaion for that meeting, Don himself did
     a half dozen, maybe even more, interviews with persons who had bee
     involved, and then directed the NLM staff to put together in one
     place all the documents the library had about regional medical
     programs.  For the last year and a half I have been reading through
     those and occassionally talking with people, and in the next couple
     of months I need to finish the research and the, two month after
     that I have to produce a mauscript.  We don't know exavtly under
     what form it will be published.  I'm thinking of a book.  It's
     easier for me to do a project to think in terms of a short book.
     Perhaps 10 to 12 chapters.

           I hope to have a little bit of a forward spin on it, meaning
     I hope to be able to elevate some of the things that occurred under
     Regional Medical Programs, particularly those with state boundaries
     (although Washington has Washington and then Alaska and Montana) to
     see if there are any lessons for the proposed extensive reform and
     reoganization of the health care system that's going on.  I've
     written one little piece that appeared in the Houston Chronicle
     suggesting one area in which I though there might be some lessons.
     But the principal point of the book is just to have a good
     historical record of this very interesting program.  A lot of
     people thought the program was very worthwhile and would have
     served us well if the federal government had of continued it.  So I
     just want to get your reaction to the program generally, and get
     some specifics about what wen on in Washington.  I hope to get you
     to answer the question: "Why does everybody way Washing't was one
     of the best programs?"

           Sparkman: We'll try, but I also want to give you these
     reports.  This is very well written good background here.

           Strickland: Thank you, thank you.  I will turn copies of
     these over to the Library of Medicine.  One of the questions that I
     have is, how did the Washington programs seem to get off the ground
     so rapidly?  One of the elements in the programs that were
     successful seem to be that they were somehow poised to do something
     like this.  That was my impression about your state.  I don't know
     the particulars.  How did you get involved?  How did that work?

           Sparkman: I guess we had the usual amount of interest in
     heart, cancer and stroke.  Bob Van Citters, then the dean, I think
     had resonable outlook as to how a medical school might be involved.
     And I had pretty good contact with people, doctors and others
     around Washington.  I was interested in those three categorical
     areas and the idea looked like a good one to me and I approached
     part time sitters and went from there, on a general basic right we
     got into it reasonably well, I don't have any better answery.  Jim
     would know better that 1.

           Hoviland: Well this is a matter of deduction on my part
     because I can't document it.  But there have been stirrings on the
     part of seceral states which ended up being the WAMI programs.  To
     initiate seperate individual medical schools.

           Strickland: I see.

           Hoviland: When did RMP start?  1970?

           Strickland: No, earlier.  It started before.  The legislation
     was in 1966, the programs started cranking up in 1967, and I think
     the first grants to the state programs were probably in 1968.

           Hoviland: Well, somwhere along just about that time there was
     a good deal of interest in establishing new medical schools in the
     Northwest and Mountain States.  Roy Schwartz and others looked into
     it, and they became convinced as did a number of other people that
     none of the other three states which had such plans -- Montana, or
     Idaho -- had the population base or the economic base to support a
     medical school.  But it took a long time to convince the people
     that controlled the purse strings and the educaiton programs in the
     other states to create a joint program, the Washington, Alaska,
     Montana, Idaho (WAMI) medical education program.  RMP came along
     about then and I suspect that one of its first contributions was to
     actually further the WAMI concept which was then only a concept.
     The challenge was to see if RMP was the sort of thing that could
     make it a viable long term program.  Now that's just my evaluation
     of it.

           Strickland: That sounds reasonable.  I talked to Gus Swanson
     a little bit and he was mentioning the same concern and sort of a
     pilot effort before RMP to bring students from the three states to
     study here for the same purposes you say: just so those states
     wouldn't make an effort to build their own medical schools.  That
     was sort of an idea that everybody had.  In those days, it was as
     if you couldn't be a self-respecting state unless you had a medical
     school.

           Sparkman: Are you familiar with WITCHI, the Western
     Interstate Coaltion for Higher Education?

           Strickland: Yes, somewhat.

           Hoviland: Of course you know went way back into the late 40;s
     and early 50;s.  I don't think it was federally funded originally.

           Strickland: I think not.

           Hoviland: It was worked out among the various states.  You
     remember that don't you.

           Sparkman: Yes.

           Strickland: Western Interstate Commission for Higher
     Education.

           Hoviland: and medicine had a part in that.  It was not @st
     medicine or nursing.  The question was how can you manage this
     enormous geograophical expense where people are scattered and do it
     financially in a satisfactory way.  So I think it was the RMP and
     WAMI subsequently and the idea fell on fertile ground.  You would
     know that, Don, better that 1.

           Sparkman: I think you know that timewise RMP was in business
     a long time before WAMI was even considered as an entity.

           Hoviland: Yeah, that's right.

           Sparkman: My viewpoint on all this was that of somebody from
     outside the medical school.  The medical school had relatively
     little interest outside the conventional kind of role they played.
     So RMP was kind of looked upon with a fair amount of suspicion
     exvept for people like Van Critters and others who recognized that
     the possibility of the medical school extending out into the
     community.

           Hoviland: I think ther's no question about that.  The
     school's executive committee, made up of the heads of all the
     individual departments really is quite parochial in its general
     outlook.  That's why I say I think that Van or Schwartz and Swanson
     were unusual.

           Strickland: Who was Ray Schwartz?  I've heard the name and I
     even had it written dow, but I don't quite remember.

           Hoviland: Ray Schwartz is the person who actually put the
     WAMI together.  He's the one who went out and lobbied and who
     persuaded the four state legislatures; three of them put the money
     in to establish the program, and the fourth one not to put funds in
     the general education budget but dedicate it to medical education.

           Strickland: Uh huh.

           Hoviland: So I think that's right, the school itself was
     quite parochcial but fortunately some of the leaders had a much
     broader vision.

           Strickland: Was the University of Washington Medical School
     in any case the most natural place for students from other states
     to come to medical school?

           Hoviland: Not originally, the state legislators felt that
     their state was adequate.  They didn't have any concept what it
     cost, what was involved in terms of population base to support
     medical education.

           Strickland: Well, but in fact the RMP as you say was
     organized several years before it was up and going.

           Sparkman: That's right.

           Strickland: And what were some of the other prinicples?  --
     How did you organize it?  You had to rely on the medical school to
     some exten I suppose.

           Hoviland: Well, we had a good state medical association with
     reasonable leaders and reasonable outloook and some contact with
     Alaska which needed help in health care, especially in any kind of
     sophisticated way.  Van Citters had a pretty good outlook
     recognizing that there might be some cooperation between Washington
     and Alaska.  The governor appointed the head of the health
     department who turned out to be a guy who was interested in this
     sort of activity.  He was not a rigid kind of person.  So it turned
     out to be easy to get involved with alaska.  They recofnized the
     benefit to them of the time out with us.

           Strickland: Do you remember who that was whom the governor of
     Alaska appointed?  There is a man, a doctor, who had something to
     do with Alaska but I don't know if that's who it was, Ted Phillips,

           Hoviland: He comes in later, 4 or 5 years later

           Strickland: I see.

           Hoviland: The man the governor appointed was an old time
     Alaskan who was not a physician.  I can't remember his name.

           Editors Note: Dr.  Sparkman subsequently referred to for most
     answers about program content, those documents being turned over to
     NLM. They proved very helpful in drafting the chapter on Alaska and
     so the remainder of the tape was not transcribed.