UNIVERSITY OF WISCONSIN-MADISON ARCHIVES
ORAL HISTORY PROJECT

Interview #356
LEVENTHAL, ELAINE

LEVENTHAL, Elaine (1932- )
Medical Student; Assistant Professor of Internal Medicine
At UW: 1967-1988

Interviewed: 1988	
Interviewer: Laura Smail
Length: 2 hours, 23 minutes

Experiences in Medical School; Self-training in geriatric medicine; Establishment of Geriatric program at VA Hospital; Medical School's attitude toward program;  Institute on Aging; Problems of UW Hospitals; Effect of Health Maintenance Organizations (HMOs) in Madison; Reasons for leaving UW.

First Interview Session (June 10, 1988): Tapes 1-2
Tape 1/Side 1
Time		Keywords

00:00:00	Start of Interview/Interviewer’s Introduction.

00:01:14	Question: Your career as a student at the medical school and as a faculty member? Answer: Elaine Leventhal (EL) clarifies funding problems, which are due to trouble melding research and clinical work and lack of glamour for programs like elderly care.

00:02:24	[no question]UW Medical School unwilling to develop elderly care program despite growing need and demand. Not a high priority in a medical school, even though it is popular with the public.

00:04:35	Question: When did you come to Madison? Answer: EL's arrival at UW in 1967.  Had Ph.D. but little opportunity due to nepotism rules. Very few women on faculty. Women used to lose their tenure track position if they married. Taught at Whitewater, commute very demanding. Taught for a year.

00:07:25	[no question] Job at UW as genetics research associate.  Worked with Allen Fox. Did a lot of experiments in cell genetics. Decided to apply to medical school. Seemed like the only way to do independent work outside of the university hierarchy. Never had considered it because of the cost.

00:09:13	[no question] Turned down due to age, sex and status as a mother. Dean said women often dropped out. Eventually became friends with this dean.

00:10:37	[no question] Admitted on third try by Robert Coyle, on trial basis. Conditions of trial – took gross anatomy in a lab without air conditioning in the summer. 

00:12:13	[no question] Women in medical school—debunking myths. EL’s class had 14 women and 12 graduated. This is 3 times more women than before. EL felt like a pioneer.

00:14:00	Question: Was it psychologically difficult to be a woman in medical school? Answer: Yes. There were a lot of sexist jokes. Had to dissociate emotionally to avoid being affected. More on medical School experience. In a clinical setting, there are many hierarchies.  A woman in an authoritative position was alarming at the time. Being older allowed EL to step back and observe her surroundings in medical school. Treated differently because of her age – she wouldn’t tolerate abuse. 

00:17:34	Question: Quality of medical school? Answer: Despite many great laboratories, the medical school has never been as strong as the rest of the university. Caliber of research in medical school not up to par. In clinical setting, the teachers were relatively poor. Learned a lot from negative examples. The medical school is mediocre. 

00:20:29	[no question] Recollections of William Middleton as teacher. He was wonderful. Very few interactions but great experiences. He was very up-to-date and had beautiful clinical skills. He had a teaching session every week.

00:22:53	Question: More role models like Middleton? Answer: Not enough. Lack of role models at UW for students in internal medicine. Students are at a crossroads. Some surgeons are good teachers, as well as people in pediatrics. 

00:24:07	[no question] School's refusal to look outside for faculty. Mediocrity perpetuates mediocrity. Madison is protective and standards for promotion aren’t adequate.  

00:26:15	Question: What did you specialize in? Answer: EL first encouraged to go into OB; decision to go into medicine. EL more interested in the entire body. 

00:29:05	End of Tape 1, Side 1. 

Tape 1/Side 2

00:29:06	[no question] Continuing previous thoughts. Medicine demanding, interesting.  Previous training in embryology and genetics helpful. Approached medical career with a process.

00:30:10	[no question] Drawn to work on aging.  It was an evolution in EL’s approach to medicine. Cal Kunin invited EL into Veteran's Administration geriatrics program in 1979.  Cal was very bright and became chief of medicine after Middleton. He started a fellowship program. 

00:33:23	Question: What did you want to do with your degree? Answer: Wanted to do ontology, but decided to combine research and patient care.  UW not eager start geriatric program.  Kunin set EL on the path to geriatrics. 

00:36:05	Question: Were you more academically oriented? Answer: Yes, more than fellow students.  Few of the students wanted to talk to EL about academics.  Medical School interested in turning out practitioners.

00:38:03	Question: How did you meet Kunin?  Answer: Kunin and EL became acquainted socially.  Kunin excellent, perceptive medical man: a good mentor and excellent supporter.  Advanced geriatrics  as the population grew.  Kunin had no faculty to train the fellows and eventually left.  EL and a colleague trained themselves in geriatrics.  Trip to Europe with the VA, got foundation for geriatrics program.  Went to England and formed basis of EL’s career.  

00:42:50	[no question] Committed to maintaining independence for elderly.  Learned this abroad in England.  Colleagues concerned with frailty of patients.  EL focused on aging at a different time in the life span.  Preserve quality of a person’s life.

00:44:41	Question: What did you do in the program at the VA?  Answer: Set up clinical settings.  Put in place intervention programs to maintain independence.  Focused on nutrition of patients as well.  Education of others as well as selves in program.  Education rapid because necessary.  Did a lot of educating of others, as EL educated herself.  Everyone looked to EL and her colleagues as experts in geriatrics.

00:48:19	Question: Who was head of VA hospital? Answer: Walt Sumstrum. 

00:48:50	[no question] Kunin's grant money.  Money for assessment.  Grant provided core staff that could man an out-patient clinic. Two pots of money were very well integrated.     

00:51:08	[no question] Continues talking about VA program.  Geriatrics had very little faculty.  Wanted the program to blossom.  Very few people had training in geriatrics.  Training in geriatrics a bit pressurized and almost accidental.

00:53:03	[no question] EL finished training in 1981.  Medical School refused her, as did all clinics around Madison.  There was no money to start a new program in geriatrics.  No one interested in women doctors at that time.  Started looking around the country.   

00:54:34	[no question] Federal help for geriatric programs, but EL still had trouble finding good position.  NIA, a young institution, organized geriatrics awards to faculty members so they could put in place a program in medical schools.  In 1981, EL applied to get one of these awards for UW-Madison, while applying for institutions around the country.  Nothing meshed for EL.  

00:56:40	End of Tape 1, Side 2. 

Tape 2/Side 1

00:56:41	[no question] Continues talking about job opportunities.  Nothing seemed right.  EL and husband were thinking of going to Chicago.  But was awarded the grant; allowed to start program on her own.  Medical School was not going to give her help, however.  

00:57:40	[no question] Support from Medical School hierarchy –Dean, chair of the department of medicine, got some money and space.  Vice Chancellor was very supportive, but he had no power.  Gave her money to get a nurse and a clinic on Friday afternoons.  Friday afternoons are a terrible time.  

01:00:04	Question: Were you given an appointment?  Answer: Yes.  EL appointed as an assistant professor.  There were no offices on the medical school.  EL got an office in the nursing school.  Also appointed to task force to look at needs of elderly.  Vice Chancellor set up this task force.  

01:02:19	Question: Were you alone on campus?  Answer: Yes.  Pretty much alone on campus.  Impressions of Martin Loeb.  EL not in position to do anything as a fellow.  Institution reflected Loeb’s bias.  

01:04:00	[no question] Results of task force.  A proposal came about from this task force.  EL was very active in this task force.  EL had a vested interest.    

01:05:46	[no question] Search committee set up to find head of geriatrics program in 1983.  EL not sure where all of the money went.  EL hoped to get a national figure, a mentor for the program to bridge between disciplines.  EL gave committee a list of names of people to assist in recruiting.  

01:08:02	[no question] Concern that EL would be too forceful on committee.  EL's concern for quality faculty.  EL wanted the program to grow, and she was seen as being aggressive.  VA's attitude.  VA coordinator was a social worker.  VA did not want medical staff.

01:09:30	[no question] Poor conditions to start geriatrics program at VA.  Sexism at VA.  Chief of staff was very hostile towards geriatrics.  Chief of Staff at the time was an obstruction.  There was very little medical output at this time.  Sexist bias very real at the VA.  The director of medicine had strong feelings on this.   

01:11:40	[no question] Outside people brought in to advise committee.  It was a good committee.  EL's opinions.  Outside people suggested a man run the program.  EL was fine stepping aside.  Committee could not find anyone to head program; EL cannot find out why.

01:13:27	[no question] Aging Institute now part of campus.  Trying to put together a credible institute.  Status and goals.  No one knows what happened to all the money and how it was spent.  People creating a report on how the money was allocated.  Shows lack of cooperation. 

01:16:01	Question: Do you think the problems are with the dean?  Answer: Yes.  Problems are at dean level of Medical School and departmental levels.    

01:17:37	Question: Has this affected your aging institute?  Answer: No.  EL can’t facilitate growth.  Programs prevented from growing because of funding problems with Medical School.  Not enough people around to serve the community.  

01:19:23	[no question] Lack of personnel.  Medical School wants people to be consultants to develop more resources.  Extension cannot help, Legislature refuses to help.  Legislature helped at one point, but it was not approved the next round.  This is why an opportunity to relocate is exciting.

01:21:44	[no question] Rutgers' offer to EL solid and exciting.  Rutgers had a supportive legislature and plenty of money.  A solid commitment.

01:23:00	[no question] Graduate School wanted keep EL, but Medical School did not care.  EL did not funnel grants into Medical School because of a lack of support.  EL funneled her grant money into the aging institute.  Medical School dean lacks vision.  

01:24:34	Question: Clinic work?  Answer: It has been very rewarding. The residency training has a geriatric curriculum.  Geriatric program has grown despite Medical School apathy.

01:25:58	End of Tape 2, Side 1. 

Tape 2/Side 2

01:25:59	[no question] EL's long-term commitment is to medicine despite previous training and experience.  Wanted to show medical community that clinic had something special to offer.  

01:27:12	[no question] Growth of clinic.  Expand clinical base without taking colleagues clients.  Allowed patients to self-refer.  Continued training.  Grew into a five-day-a-week clinic.  There is a rotation for residents in the clinic.  Phase-out by county – couldn’t afford a nursing home.  EL didn’t have to go to nursing home anymore.  Impact on curriculum.  Teaching of medical students. 

01:31:55	[no question] Fellowship program still going at VA.  Clinic provides excellent services.  Increasing demand for care.  There is trouble meeting demands.  

01:32:53	Question: Is this the same as internal medicine?  Answer: No. Geriatrics clinic separate from Internal Medicine.  EL does some internal medicine – which is a problem with this institution.  Increasing roster at Geriatrics.  More patients than just geriatric patients.  

01:34:30	[no question] Clinic's growth stunted by misallocation of resources by hospital.  New personnel allowed only when demand overwhelming.  There is enormous turnover.  EL could be more efficient with space and people up front.  Lack of space.  Certain specialties take up more space. 

01:36:14	[no question] Hospital's priorities bad.  Procedures cumbersome and slow.  Politics and lobbying.  Hospital is reactive, not proactive.  

01:37:05	[no question] Hospital running a deficit because of Medicare procedure.  Funding structures and caps.  Has to do with dirty politics.  There is an egalitarian perspective.  Lobbyists have not been good to the University.  Hospital running a deficit.  Costs pushed up.  Quality of care is good here. 

01:42:10	[no question] Clinic not getting enough money compared to surgery.  Clerical turnover enormous.  More people would make physicians more efficient. 

01:43:11	[no question] Not enough space to allow for teaching in clinic.  The hospital designed for phases of growth.  Legislature put a clamp on the phases of the hospital.  They are building a new building.  Demands for parking are greater than specialty clinics.  There is a competition with interns as well.  Hope for more space in future dim.

01:45:48	[no question] Federal categories for Medicare reimbursement neglect age and chronic illness.  The hospital will lose money if the patient stays longer.  The older patient requires more care and time.  This has changed hospitalization.  People discharged too early.  

01:47:20	[no question] Changes in funding for residency education and effect.  Money comes as a percentage of Medicare fees.  Who will pay for residency training?  There should be money to pay for fellows.  There have been good fellows.  

01:49:05	[no question] Running both VA and University programs too tough.  Put efforts into maintaining research program.  Money troubles.

01:50:10	End of Tape 2, Side 2. 

Tape 3/Side 1

01:50:11	[no question] Geriatric program since 1981.  The hospital has seen a shift.  Changes in referral patterns due HMO system.  St. Mary's affiliations with rural hospitals.  St. Mary’s tied insurance programming into rural hospital cooperative.  UW hospital, as part of Wisconsin Idea, always provided services in state.  Shifted and the hospital tried to strengthen existing relationships.  So creating new relationship.  Wanted EL provide geriatric consulting in southwest section of state.  One person can’t do this, and there is no money.

01:54:39	[no question] Developing research program addressing geriatric issues.  EL’s most exciting time is spent with patients who will further her studies.  EL performed studies on utilization of health care.  Fellow who worked with her.  Most applicants just want administrative experience, but this fellow had potential to be an academic geriatrician.

01:57:58	[no question] Grants from National Institute on Aging for studies.  Interest among patients being studied.  Patients teach the residents and doctors.  People were so willing to be test subjects.  There have been very few refusals from patients.  There are a lot of opportunities, but Medical School not interested.  Other departments are.  Graduate School and L&S cooperate.

02:00:30	[no question] Access for research to patients not using U-Care very limited.  The competition, fear that trying attract people away.  Town and Gown relations much worse due to HMO competition.  There has been interpersonal conflict.  Loss of money.  Shift in income for people, and HMOs are not successful with providing services at certain costs.  Promised too many services.

02:03:12	Question: You worked with Howard? Answer: Yes. Howard Leventhal's work.  He looked at real stress provoking settings and other health settings.  Allowed him to come up with predictive models.  Howard not interested in aging issues.   

02:05:25	[no question] EL's question about use of healthcare facilities across life span ties in with Howard Leventhal's work.  EL looked at behavioral issues and life span.    

02:06:29	[no question] Institute on Aging depends on members' providing overhead.  Hard to have an institute flourish.  Featherman has put two big grants through Institute and Leventhals have also put a big grant through.  No other departmens contributed to the Institute.  Institute lacks space, resources.  Nothing will change unless the Regents decide so.  Has to have base in academic campus.  Should not have medical person as a director – they have not been supportive.

02:10:12	Question: Why did Howard Leventhal leave?  Answer: There were no colleagues in his area.  The department is small and does not seem to be growing.  Howard irritated that EL’s position won’t change.  Howard would like to see a health psychology program.  There is no likelihood, though.     

02:11:35	Question: Did anyone regret your leaving?  Answer: Yes.  EL’s chairman of Medicine will not take steps to keep EL – not willing to make waves or push the VA.  There should be an attempt for growth.  Dean used money that was intended for EL.  There is a lot of turnover.

02:14:06	[no question] Weaknesses in Department.  There is no good endocrinology.  GI is losing good people.  Hospital is keeping people because they brought grants with them, not because they are good employees.  No research.  Hospital won’t recruit people.  Pulmonary is not strong – brought in a junior person.  Other departments sad EL is leaving.  Chairman's advice – told EL much won’t happen to her if she stayed in Madison.  VA situation – planning to phase out old VA people.  Didn’t plan on bringing in new people.  Chairman told her to take the new position.  

02:18:52	Question: Was it all the dean?  Answer: Not just him.  He could push the people at the VA.  There are links to the University hierarchy that gives certain people more power.  Judy Craig – not that powerful, Howard does not think she is very good.  Chairman of medicine is naïve.  

02:21:35	End of Tape 3, Side 1. 

Tape 3/Side 2

02:21:36	[no question] Medicine pompous toward academic campus.  It is a part of EL’s profession.

02:22:43	End of Tape 3, Side 2. 

END OF INTERVIEW #356