{"id":27231,"date":"2025-12-02T22:45:17","date_gmt":"2025-12-02T22:45:17","guid":{"rendered":"https:\/\/familymedicine.uw.edu\/medex\/?p=27231"},"modified":"2026-01-30T20:04:20","modified_gmt":"2026-01-30T20:04:20","slug":"chapter-seven-the-birth-of-medex-northwest-part-one","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/medex\/magazine\/2025\/12\/02\/chapter-seven-the-birth-of-medex-northwest-part-one\/","title":{"rendered":"Chapter Seven: The Birth of MEDEX Northwest, Part One"},"content":{"rendered":"\n\t<div class=\"box has-hover   has-hover box-text-bottom\" >\n\n\t\t<div class=\"box-image\" >\n\t\t\t\t\t\t<div class=\"\" >\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"2003\" height=\"1394\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Dick-Smith-with-MEDEX-Staff2.jpg\" class=\"attachment- size-\" alt=\"Dr. Richard Smith speaks to the founding administrative team of MEDEX Northwest\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Dick-Smith-with-MEDEX-Staff2.jpg 2003w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Dick-Smith-with-MEDEX-Staff2-300x209.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Dick-Smith-with-MEDEX-Staff2-1024x713.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Dick-Smith-with-MEDEX-Staff2-768x534.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Dick-Smith-with-MEDEX-Staff2-1536x1069.jpg 1536w\" sizes=\"auto, (max-width: 2003px) 100vw, 2003px\" \/>\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t<div class=\"box-text text-center\" style=\"background-color:rgb(1, 66, 89);\">\n\t\t\t<div class=\"box-text-inner\">\n\t\t\t\t\n\n<h2 style=\"text-align: center\"><strong><span style=\"font-size: 170%;color: #faf7f7\">Multiply My Hands: <\/span><\/strong><\/h2>\n<h2 style=\"text-align: center\"><strong><span style=\"font-size: 170%;color: #faf7f7\">The Life of Dr. Richard Smith<\/span><\/strong><\/h2>\n<h1 style=\"text-align: center\"><span data-text-color=\"primary\">__________<\/span><\/h1>\n<h3 style=\"text-align: center\"><span style=\"font-size: 170%;color: #faf7f7\">Chapter Seven: <\/span><\/h3>\n<h3 style=\"text-align: center\"><span style=\"font-size: 170%;color: #faf7f7\">The Birth of MEDEX Northwest, Part One<\/span><\/h3>\n<h1 style=\"text-align: center\"><span data-text-color=\"primary\">__________<\/span><\/h1>\n<h1 style=\"text-align: center\"><span style=\"font-size: 80%;color: #faf7f7\">Written by Erik Steen with Jim Wehmeyer<\/span><\/h1>\n<h2><span style=\"font-size: 80%;color: #faf7f7\">Edited by Melanee Nelson<\/span><\/h2>\n<h3 style=\"text-align: center\"><span style=\"font-size: 80%;color: #faf7f7\">MEDEX Northwest Communications<\/span><\/h3>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t\n\n\t<section class=\"section\" id=\"section_950742529\">\n\t\t<div class=\"section-bg fill\" >\n\t\t\t\t\t\t\t\t\t\n\t\t\t\n\n\t\t<\/div>\n\n\t\t\n\n\t\t<div class=\"section-content relative\">\n\t\t\t\n\n<h4><strong><i><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-28900 alignleft\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/early-space-needle-mt-rainier-80b3803ae231321b02966159bbf61722-300x238.jpg\" alt=\"\" width=\"300\" height=\"238\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/early-space-needle-mt-rainier-80b3803ae231321b02966159bbf61722-300x238.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/early-space-needle-mt-rainier-80b3803ae231321b02966159bbf61722-768x610.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/early-space-needle-mt-rainier-80b3803ae231321b02966159bbf61722.jpg 970w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Seattle, Fall 1968<\/i>\u00a0<\/strong><\/h4>\n<p><span data-contrast=\"auto\">The pale Seattle light filtered through the windows as Richard Smith unpacked his few belongings in the small University of Washington office. Rain tapped a gentle\u00a0patter\u00a0against the glass, so different from the urgent percussion of\u00a0the\u00a0East Coast storms\u00a0he was accustomed to. He carefully placed a framed photograph of his family on the desk, then the\u00a0Salefou\u00a0brass figurines\u00a0he\u2019d\u00a0commissioned in Cameroon during his Peace Corps days. Finally, he withdrew a dog-eared notebook from his briefcase, its pages brittle and stained from Nigerian humidity.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He ran his fingers over the notebook\u2019s cover, feeling the weight of memory\u00a0with his touch. Inside were his earliest sketches of the healthcare model he now hoped to build\u2014drawings made by kerosene lamp in remote outposts when the concept was nothing more than a whisper of possibility.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A cold draft slipped through the window frame, and Smith tightened his sweater around his shoulders. The office was spartan compared to the polished surroundings of the Surgeon General\u2019s office\u00a0he\u2019d\u00a0left behind\u00a0in Washington D.C.<\/span><span data-contrast=\"auto\">\u00a0No mahogany paneling, no executive chairs, no team of administrative assistants; just a desk, a telephone, and a borrowed typewriter.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He\u00a0let out a slow breath. He had given up power, prestige, and security for this uncertain beginning.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\t<div id=\"gap-760030818\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-760030818 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"auto\">Walking Away from Power<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">A year ago,\u00a0Smith\u2019s\u00a0life\u00a0looked\u00a0very different.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">From his desk at the Office of the Surgeon General in Washington, D.C., he had directed some of the nation\u2019s most critical public health initiatives. He was rising through the ranks with unprecedented speed, building a reputation that opened doors previously closed to Black physicians. Senior officials had begun mentioning his name for positions that would have made history.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">But when they asked him to consider becoming Deputy Assistant Secretary of Health\u2014a role that would have placed him at the nexus of national healthcare policy\u2014he hesitated. His colleagues had thought him foolish. It was the kind of opportunity that most spent decades pursuing, often without success.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Still, he\u00a0walked away.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">Smith had packed up his family and moved across the country to Seattle because he understood a fundamental truth:\u00a0Real change\u00a0wouldn\u2019t\u00a0come from government directives or policy papers. It had to be built from the ground up, person by person, community by community.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">Not because he\u00a0didn\u2019t\u00a0recognize the honor, nor\u00a0because he undervalued what such a position would mean for a Black physician in 1968 America, b<\/span><span data-contrast=\"auto\">ut because his\u00a0professional\u00a0mission lay elsewhere.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Looking back, Smith saw\u00a0that\u00a0his time in Washington\u00a0was a stepping<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">stone toward his true purpose.\u00a0As\u00a0his mother had always reminded him,\u00a0it had been his way of\u00a0\u201cpaying\u00a0rent for living here on Earth.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Years at the highest levels of government had shown him the widening fissures in American healthcare. Physicians clustered in affluent urban centers while rural communities went without doctors entirely. Hospitals that had been forced to integrate under Medicare still found ways to marginalize Black patients. Highly skilled Vietnam medics returned home only to be told they were unqualified for even the most basic healthcare roles\u2014the very work they had performed under artillery fire.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He had seen enough from behind polished desks and through the windows of government cars.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith had packed up his family and moved across the country to Seattle because he understood a fundamental truth:\u00a0Real change\u00a0wouldn\u2019t\u00a0come from government directives or policy papers. It had to be built from the ground up, person by person, community by community.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\t<div id=\"gap-1829905872\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1829905872 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"auto\">Seattle\u00a0Has Its\u00a0Own Walls<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:280,&quot;335559739&quot;:0,&quot;335559740&quot;:276}\">\u00a0<\/span><\/h2>\n<figure id=\"attachment_28847\" aria-describedby=\"caption-attachment-28847\" style=\"width: 231px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28847 size-medium\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Report-on-Redlining-in-Seattle-1975-231x300.jpg\" alt=\"\" width=\"231\" height=\"300\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Report-on-Redlining-in-Seattle-1975-231x300.jpg 231w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Report-on-Redlining-in-Seattle-1975-790x1024.jpg 790w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Report-on-Redlining-in-Seattle-1975-768x996.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Report-on-Redlining-in-Seattle-1975.jpg 1024w\" sizes=\"auto, (max-width: 231px) 100vw, 231px\" \/><figcaption id=\"caption-attachment-28847\" class=\"wp-caption-text\">The front cover of a mid-70s community report on the long-established practice that Richard Smith was likely running into in his search for housing in Seattle: redlining. [\u201cRedlining, Racial Covenants, and Housing Discrimination in Seattle,\u201d HistoryLink.org]<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">But\u00a0Smith was soon to discover that even\u00a0in Seattle, a city that prided itself on being more tolerant than many, the barriers rose quickly.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><span data-contrast=\"auto\">Despite his credentials\u2014associate\u00a0professor at a prestigious medical school, physician, former federal officer\u2014finding housing proved unexpectedly difficult.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The responses came with practiced smoothness:\u00a0<\/span><i><span data-contrast=\"auto\">\u201cThat property just rented.\u201d\u00a0\u201cWe\u2019re not taking applications at this time.\u201d\u00a0\u201cHave you considered looking in another neighborhood?\u201d<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">At one house showing, Smith arrived early only to watch a white couple exit the front door, shaking hands with the real estate agent.\u00a0\u201cIt\u2019s perfect,\u201d\u00a0the husband said.\u00a0\u201cWe\u2019ll take it.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith had called about that same house that morning. The agent had told him it was no longer available.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">It\u00a0wasn\u2019t\u00a0personal, he knew. It was systemic. Seattle, like most American cities, had been carved up by decades of redlining\u2014an invisible architecture that kept Black families, regardless\u00a0of profession or income, confined to\u00a0designated\u00a0areas. Real estate agents employed elaborate codes to steer them away, banks found reasons to deny their loans, and landlords developed an arsenal of excuses.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Entire sections of the city remained effectively segregated, not\u00a0by laws or signs, but by unspoken rules and institutional practices.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI don\u2019t think this place is in your price range,\u201d\u00a0another landlord said without looking up from his desk, the dismissal automatic.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith silently removed his credentials from his briefcase, laying them on the table one by one: his faculty appointment letter, his commission in the Public Health Service, his salary documentation. The man glanced at them, expression unchanged.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Weeks passed. More rejections. More doors that never truly opened.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">When he finally secured a house, it\u00a0wasn\u2019t\u00a0because the system had suddenly recognized his worth. It was because he had learned through years of confronting\u00a0bureaucracy about\u00a0how to press until institutions did what they claimed was impossible.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><span data-contrast=\"auto\">The experience was merely a reminder\u00a0that even here, even now, some people saw only the color of his skin.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28908\" aria-describedby=\"caption-attachment-28908\" style=\"width: 900px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28908\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/redlining-and-race-maps-Seattle_combined.jpg\" alt=\"\" width=\"900\" height=\"679\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/redlining-and-race-maps-Seattle_combined.jpg 660w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/redlining-and-race-maps-Seattle_combined-300x226.jpg 300w\" sizes=\"auto, (max-width: 900px) 100vw, 900px\" \/><figcaption id=\"caption-attachment-28908\" class=\"wp-caption-text\">Mapping institutionalized racism in Seattle: Map 1 (left): 1936 Commercial Map of Greater Seattle marked with &#8220;grade of security&#8221; designations: &#8220;best&#8221; (A-green), &#8220;still desirable&#8221; (B-blue), &#8220;definitely declining&#8221; (C-yellow), &#8220;hazardous&#8221; (D-pink); Map 2 (right): 1936 Seattle Home Owners&#8217; Loan Corporation \u201cracial map,&#8221; marked &#8220;Negroes&#8221; (brown), &#8220;Jewish&#8221; (blue), &#8220;Orientals&#8221; (yellow), &#8220;Italians&#8221; (green). [\u201cRedlining, Racial Covenants, and Housing Discrimination in Seattle,\u201d HistoryLink.org]<\/figcaption><\/figure>\n\t<div id=\"gap-1706958727\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1706958727 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"auto\">The Vision\u00a0Begins to Take\u00a0Shape<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:80,&quot;335559740&quot;:276}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">Smith&#8217;s <\/span><span data-contrast=\"auto\">mind drifted back seventeen years to that pivotal moment in Cuba. A nineteen-year-old music student then, watching a child crawl across a clinic floor, tapeworms unraveling from his small body; the practical nurse Myrna\u2014a woman with minimal training but immense capability\u2014handling the situation with calm efficiency while he stood frozen in horror and fascination.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He\u00a0had decided\u00a0that day\u00a0to abandon his music studies and pursue medicine; not to become another physician treating patients one by one, but to multiply his hands a thousandfold,\u00a0and\u00a0to train others who could extend healthcare where doctors\u00a0couldn\u2019t\u00a0reach.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The steady rain against the window reminded him of earlier days in Washington\u00a0state, investigating outbreaks in remote communities. The faces remained vivid in his memory\u2014patients from the Yakima Valley, Okanogan County, and the Olympic Peninsula whose suffering could have been prevented with basic medical access. Those experiences had further crystallized his vision of what American healthcare could and should be.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28904\" aria-describedby=\"caption-attachment-28904\" style=\"width: 138px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28904\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/John-R-Hogness-UW-President-207x300.jpg\" alt=\"\" width=\"138\" height=\"200\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/John-R-Hogness-UW-President-207x300.jpg 207w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/John-R-Hogness-UW-President.jpg 400w\" sizes=\"auto, (max-width: 138px) 100vw, 138px\" \/><figcaption id=\"caption-attachment-28904\" class=\"wp-caption-text\">Dr. John Hogness, Dean, University of Washington School of Medicine<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">He remembered\u00a0the expression of Dr.\u00a0John Hogness, Dean of the University of Washington Medical School,\u00a0when\u00a0he\u2019d\u00a0first outlined his proposal. The slight tilt of the head, the narrowing of\u00a0eyes, the thoughtful pause before Hogness finally said,\u00a0\u201cIt\u2019s\u00a0a crazy idea, Dick. But\u00a0I\u00a0have to\u00a0admit\u00a0it\u00a0sounds intriguing.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith smiled at the memory. Unlike other medical administrators\u00a0who\u2019d\u00a0dismissed him outright, Hogness had been willing to take a chance, to provide institutional backing for an experimental program that could either transform American healthcare or fail spectacularly.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The telephone on Smith\u2019s desk rang sharply, interrupting his thoughts.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cDr. Smith?\u00a0There\u2019s\u00a0a Dr. Ray Vath here to see you.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith closed the notebook\u00a0he\u2019d\u00a0been\u00a0reviewing,\u00a0his fingers lingering for just a second longer. This\u00a0was\u00a0it. The first real step. He exhaled, straightening in his chair.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cSend him in.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The door opened to reveal a trim, thoughtful-looking man with penetrating eyes. Smith\u00a0observed\u00a0the straight posture, the measured movements\u2014<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">unmistakable signs of military training.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cDr. Smith,\u201d\u00a0Vath said, extending his hand.\u00a0\u201cI\u2019m\u00a0Ray Vath.\u00a0Word has it\u00a0you\u2019re\u00a0planning some kind of program with military corpsmen.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith\u2019s grip was firm as they shook hands.\u00a0\u201cPlease, call me Dick. And yes, though\u00a0\u2018planning\u2019\u00a0might be generous at this stage.\u00a0\u2018Envisioning\u2019\u00a0might be more\u00a0accurate.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He gestured to a chair and studied Vath as he sat. The psychiatrist moved with deliberate care, his gaze taking\u00a0in\u00a0the sparse office before\u00a0settling\u00a0Smith with undisguised curiosity.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI understand\u00a0you served in the military?\u201d\u00a0Smith asked.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28757\" aria-describedby=\"caption-attachment-28757\" style=\"width: 250px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28757 size-medium\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Ray-Vath-MD-1-250x300.jpg\" alt=\"\" width=\"250\" height=\"300\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Ray-Vath-MD-1-250x300.jpg 250w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Ray-Vath-MD-1-853x1024.jpg 853w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Ray-Vath-MD-1-768x922.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/Ray-Vath-MD-1.jpg 1000w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><figcaption id=\"caption-attachment-28757\" class=\"wp-caption-text\">Dr. Ray Vath, an Air Force veteran, community psychiatrist, and the first to join the MEDEX Northwest administrative team.<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">Vath nodded.\u00a0\u201cNine years in the Air Force as a meteorologist before medical school. I fought\u00a0in\u00a0the Korean War predicting weather patterns rather than digging foxholes. My preference is not to shoot people.\u201d\u00a0A slight smile crossed his face\u00a0as he\u00a0pushed\u00a0the conversation\u00a0forward.\u00a0\u201cDuring my internship at Madigan Army Hospital these past two years, I\u2019ve worked extensively with corpsmen treating casualties from Southeast Asia.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith leaned forward, his interest\u00a0sharpening.\u00a0\u201cTell me about that experience.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cMadigan has 1,500 acute beds, three times Harborview Medical Center\u2019s capacity. During wartime, there are never enough doctors, so they let interns do\u00a0almost anything\u00a0with proper supervision.\u201d\u00a0Vath\u2019s expression grew animated.\u00a0\u201cI performed appendectomies and delivered about a hundred babies. But what struck me most was the corpsmen. They\u00a0weren\u2019t\u00a0just\u00a0assistants;\u00a0they were the backbone of battlefield medicine. They adapted, problem-solved, and took responsibility far beyond what civilians might expect.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWe couldn\u2019t have managed without them,\u201d\u00a0Vath continued.\u00a0\u201cYet when they return to civilian life, what happens to all that\u00a0expertise?\u00a0It\u2019s\u00a0tragic!\u00a0They\u2019re\u00a0reduced to orderlies wheeling patients down hallways, while rural communities go without basic healthcare.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith gripped the edge of his desk, his pulse quickening. This\u00a0was\u00a0it. Vath had just articulated the very crisis MEDEX was built to solve. Thousands of trained corpsmen, discarded by the system, while rural doctors drowned in impossible patient loads.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThat\u2019s precisely the gap I want to address,\u201d\u00a0Smith said.\u00a0\u201cWe have thousands of medically trained veterans returning from Vietnam with nowhere to use their skills. Meanwhile, rural doctors are drowning in patient loads, and entire communities are losing access to healthcare.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">\u201cDr. Vath, I\u2019d like you to join us,\u201d\u00a0he said.\u00a0\u201cYour experience with both military medicine and community psychiatry is exactly what we need.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><span data-contrast=\"auto\">Vath looked slightly surprised at the immediate offer.\u00a0\u201cJust like that?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><span data-contrast=\"auto\">\u201cWhen the fit is right, why wait?\u201d Smith replied.<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">Vath nodded eagerly.\u00a0\u201cWhen I heard about what you were planning, it made immediate sense.\u00a0I\u2019ve\u00a0been wondering why no one had tried this before.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith let out a short, dry laugh.\u00a0\u201cYou know what\u2019s ironic?\u201d\u00a0he\u00a0said.\u00a0\u201cThe Soviets have been doing this for decades with their feldshers.\u00a0And the\u00a0Chinese have their barefoot doctors. But here? The moment you suggest anything outside the rigid medical hierarchy,\u00a0you\u2019re\u00a0accused of undermining the system. Or worse, promoting communism.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He\u00a0hadn\u2019t\u00a0intended to reveal his frustration with the medical establishment so openly, but something about Vath invited candor. The psychiatrist\u00a0didn\u2019t\u00a0flinch at the political implications of Smith\u2019s words.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cCreating change always triggers resistance,\u201d\u00a0Vath observed.\u00a0\u201cEspecially in medicine, where professional identity is so bound up with status and authority.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThat\u2019s exactly why I need someone with your background,\u201d\u00a0Smith said.\u00a0\u201cWe\u2019re\u00a0not just designing a training\u00a0program;\u00a0we\u2019re\u00a0creating an entirely new healthcare profession in a system\u00a0that\u2019s\u00a0notoriously resistant to change. I need someone who understands how to navigate that resistance.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">For the next hour, their ideas flowed\u00a0in sync,\u00a0with\u00a0challenges, solutions, and possibilities\u00a0unfolding\u00a0before them. By the time their conversation wound down, Smith had no doubt. Vath\u00a0wasn\u2019t\u00a0just a good\u00a0fit\u2014he was essential.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cDr. Vath, I\u2019d like you to join us,\u201d\u00a0he said.\u00a0\u201cYour experience with both military medicine and community psychiatry is exactly what we need.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Vath looked slightly surprised at the immediate offer.\u00a0\u201cJust like that?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWhen the fit is right, why wait?\u201d\u00a0Smith replied.\u00a0\u201cBesides, we have no time to waste. Every day, rural communities are losing healthcare access, and returning veterans are wasting skills that could help solve the problem.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Vath let out a slow breath, then nodded,\u00a0\u201cWell, I guess we should get to work, then,\u201d\u00a0he said with a smile\u00a0and a handshake.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">As Vath left, Smith remained at his desk, a new energy coursing through him. With Vath\u2019s commitment, they had taken the first concrete step toward making MEDEX a reality. But the psychiatrist\u2019s recruitment was just the beginning.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith pulled his notebook back toward him, flipping past the pages filled with vision statements and training models. He turned to a fresh page and began to write:\u00a0\u201cFunding Sources.\u201d\u00a0Two men alone\u00a0couldn\u2019t\u00a0build a new healthcare profession. MEDEX needed financial backing to recruit students, develop curriculum, and prove their concept.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He picked up the phone\u2014it was time to start making\u00a0some\u00a0calls.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The following weeks brought a flurry of activity as Smith sought the resources needed to transform his vision into reality. Each morning, he arrived at the office before dawn, using the quiet hours to draft plans, make notes, and prepare for the day\u2019s meetings.\u00a0And each evening, he left long after dark, his mind racing with\u00a0new ideas\u00a0and persistent challenges.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\t<div id=\"gap-1488595323\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1488595323 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"auto\">The Funding Challenge<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:80,&quot;335559740&quot;:276}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">Smith knew that the revolutionary nature of his program might make traditional funding sources hesitant. The program threatened the established order of American medicine, challenging the rigid hierarchy that dictated who could provide care.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">His first approach was to apply for $700,000 from the Regional Medical Program (RMP), a healthcare funding project\u00a0administered\u00a0by the Johnson administration<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">\u00a0 But during a review meeting, the resistance became apparent, and in fact took an ugly turn when a panel member voiced his opposition in the bluntest terms possible:<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cNo Black bastard is going to get his hands on that much federal money.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The room fell silent. Two staff members, stunned by the overt racism, resigned on the spot in protest. Later, they contacted Smith privately, shaken by what they had\u00a0witnessed.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith\u00a0closed his eyes, his hand clenching into a fist as they relayed the story. The familiar sting of racism, raw and undisguised, momentarily took his breath away.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><i><span data-contrast=\"auto\">All the credentials in the world<\/span><\/i><span data-contrast=\"auto\">,\u00a0he\u00a0thought,\u00a0<\/span><i><span data-contrast=\"auto\">medical degree, successful Peace Corps service, Surgeon General\u2019s office, and still, to some,\u00a0I\u2019m\u00a0just a\u00a0\u2018black bastard\u2019\u00a0reaching above my station.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith\u00a0didn\u2019t\u00a0waste time with anger. He had spent years battling institutional racism while leading the effort to desegregate American hospitals under Medicare. He had faced death threats and professional sabotage before. This was just another obstacle.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWe\u2019re going to get our money,\u201d\u00a0Smith assured them.\u00a0\u201cDon\u2019t worry about that.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">That night, Smith picked up the phone and called his most powerful allies in Washington, D.C.: Surgeon General William Stewart; Dr. Joe English, his former Peace Corps colleague who now ran the Health Services and Mental Health Administration; and Dr. Stan Shirer from the federal health resources division that would later become HRSA. These were men who knew Smith&#8217;s\u00a0track record, English from their overlapping years at Peace Corps headquarters, where Smith had served as Deputy Medical Director while English ran psychiatric services, and Shirer, who controlled federal health workforce training grants.\u00a0<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28881\" aria-describedby=\"caption-attachment-28881\" style=\"width: 624px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28881\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/stewart_english_shirer_combined-photos-1024x421.jpg\" alt=\"\" width=\"624\" height=\"256\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/stewart_english_shirer_combined-photos-1024x421.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/stewart_english_shirer_combined-photos-300x123.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/stewart_english_shirer_combined-photos-768x315.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/stewart_english_shirer_combined-photos-1536x631.jpg 1536w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/stewart_english_shirer_combined-photos.jpg 1782w\" sizes=\"auto, (max-width: 624px) 100vw, 624px\" \/><figcaption id=\"caption-attachment-28881\" class=\"wp-caption-text\">Powerful allies in Richard Smith&#8217;s rolodex: Surgeon General Dr. William Stewart, Dr. Joe English, Health Services and Mental Health Administration, Dr. Stan Shirer, HRSA.<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">Smith\u00a0didn&#8217;t\u00a0ask for help. He laid out why MEDEX was critical to solving the rural healthcare crisis and giving Vietnam veterans a pathway into medicine.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Thirty minutes later, the funding was secured.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">With\u00a0$750,000 secured\u00a0from\u00a0the\u00a0HRSA, Smith now had the resources to build his team and program.\u00a0\u201cWhat sold them was the fact that we had done our early preparation,\u201d\u00a0he later explained.\u00a0\u201cI went straight to people\u00a0I\u2019d\u00a0worked with before\u2014people who knew my\u00a0track record\u00a0and understood the urgency of what\u00a0we\u2019re\u00a0trying to do. I\u00a0didn\u2019t\u00a0have to convince them this was\u00a0a good idea. They already knew it was necessary.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\t<div id=\"gap-1967379481\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1967379481 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"none\">Assembling His Team<\/span><\/b><span data-ccp-props=\"{&quot;134245418&quot;:false,&quot;134245529&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:280,&quot;335559739&quot;:80,&quot;335559740&quot;:278}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">With funding secured, Smith could now focus on assembling the core team that would help transform his vision into reality.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28852\" aria-describedby=\"caption-attachment-28852\" style=\"width: 2118px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28852 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/basset_freeman_markarian_combined.jpg\" alt=\"\" width=\"2118\" height=\"558\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/basset_freeman_markarian_combined.jpg 2118w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/basset_freeman_markarian_combined-300x79.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/basset_freeman_markarian_combined-1024x270.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/basset_freeman_markarian_combined-768x202.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/basset_freeman_markarian_combined-1536x405.jpg 1536w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/basset_freeman_markarian_combined-2048x540.jpg 2048w\" sizes=\"auto, (max-width: 2118px) 100vw, 2118px\" \/><figcaption id=\"caption-attachment-28852\" class=\"wp-caption-text\">Members of the MEDEX Northwest&#8217;s first adminstrative team (l to r): Dr. Gerry Basset, Deputy Director; Bill Freeman, Associate Director (Lorna Carrier on phone to Freeman&#8217;s right, Richard Smith seated to his left); Mark Markarian, Administration and Finance. [Richard Smith Archvies]<\/figcaption><\/figure>\n<p>Dr. Gerry Bassett<span data-contrast=\"auto\">\u00a0joined as Deputy Director, bringing academic rigor and curricular\u00a0expertise. Smith had known Bassett\u00a0since\u00a0their days as commissioned officers in the Public Health Service. This was a fortunate connection that added instant credibility to the budding program.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">During their early strategy sessions, Bassett quickly embraced the name Smith had established years earlier: MEDEX.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI remember when Dick first explained the name to me,\u201d\u00a0Bassett later recalled.\u00a0\u201cHe\u2019d\u00a0been using it for years, even discussed it with the Surgeon General. It was an abbreviation of\u00a0\u2018medical extension\u2019\u00a0or\u00a0\u2018m\u00e9decin\u00a0extension\u2019\u00a0in French. He deliberately chose the strong\u00a0\u2018X\u2019\u00a0sound\u2014he had a real understanding of communications and imagery.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The name perfectly embodied their mission: extending medical care to communities that desperately needed it. With the name\u00a0established\u00a0and\u00a0funding firmly\u00a0secured, they could focus on building the right team.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Next\u00a0there was\u00a0the missing piece,\u00a0<\/span>Bill Freeman<span data-contrast=\"auto\">.\u00a0A real-life combat corpsman,\u00a0Freeman was\u00a0fresh from Vietnam, trained in battlefield medicine yet unable to use his skills in civilian life. He was exactly the kind of person MEDEX was meant for.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith had first\u00a0encountered\u00a0Freeman\u00a0some\u00a0months earlier, while Smith was still at the Surgeon General\u2019s office in\u00a0Washington,\u00a0D.C.\u00a0Smith had spoken often with his colleagues about his vision for training military\u00a0corpsmen but\u00a0had never actually met one.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI knew that corpsmen were independent operators on the battlefield,\u201d\u00a0he\u00a0later recalled,\u00a0\u201cbut I didn\u2019t know exactly what they did.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The introduction\u00a0to Freeman\u00a0had come\u00a0unexpectedly. A Peace Corps colleague called\u00a0Smith\u00a0one afternoon with excitement in his voice.\u00a0\u201cI\u2019ve got a corpsman in my office,\u201d\u00a0he told\u00a0Smith.\u00a0\u201cYou kept telling us that you wanted to meet a corpsman\u2014I\u2019ve got a real live medical corpsman right here, and he was a former Peace Corps volunteer in Colombia.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith\u00a0immediately\u00a0arranged lunch for the following day. The corpsman, Bill Freeman, was home on leave from Vietnam, where he served as a sergeant in the Special Forces.\u00a0Smith\u00a0and another officer wore their Public Health Service uniforms that day\u2014the gold bars of their rank prominently displayed on their sleeves.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><i><span data-contrast=\"auto\">I wonder how\u00a0he\u2019ll\u00a0react to all this brass<\/span><\/i><span data-contrast=\"auto\">,\u00a0Smith\u00a0thought as they waited at the restaurant.\u00a0<\/span><i><span data-contrast=\"auto\">Will he be intimidated? Resentful?<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">His concerns proved unfounded. Freeman, a slender, intense young man, was completely unfazed by the officers\u2019\u00a0rank. He spoke with confidence and clarity, describing in detail the medical procedures he performed in the field:\u00a0emergency surgeries, trauma care, even training local villagers in basic healthcare.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">Freeman promised to join Smith when his tour ended in six to eight months. True to his word, shortly after Smith had secured funding and\u00a0relocated\u00a0to Seattle, Freeman appeared at his office door, ready to start\u00a0immediately.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">\u201cI was so impressed with him,\u201d\u00a0Smith remembered.\u00a0\u201cI said,\u00a0\u2018Look, I want to do this program, but I need a definition of what these people can\u00a0actually do,\u00a0because\u00a0I\u00a0don\u2019t\u00a0know.\u00a0We\u2019re\u00a0going to plan it as we go along, and if\u00a0you\u2019re\u00a0comfortable with that, when you return from Vietnam,\u00a0I\u2019d\u00a0really like for you to come work with us\u2019.\u201c<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith was astonished to learn the extent of Freeman\u2019s training. Special Forces corpsmen received as many as 2,000 hours of formal medical training. Yet upon discharge, they could find no civilian path to use these hard-earned skills. The thousands of dollars in public funds invested in developing their medical capabilities were\u00a0essentially wasted\u00a0when they left the service and took jobs as auto-detailers, insurance agents, or truck drivers.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Freeman promised to join Smith when his tour ended in six to eight months. True to his word, shortly after Smith had secured funding and\u00a0relocated\u00a0to Seattle, Freeman appeared at his office door, ready to start\u00a0immediately.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cHe told me he would come\u00a0work\u00a0for me for no pay if I would give him a bed and feed him,\u201d\u00a0Smith recalled.\u00a0\u201cI had two kids, was married, and we lived on Capitol Hill. He moved in with us for three or four months until we got our program fully operational.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Living with Freeman provided Dr. Smith with invaluable insights into the capabilities of military corpsmen.\u00a0\u201cI lived with him day and night,\u201d\u00a0Smith explained,\u00a0\u201cand that\u2019s how I found out what these people could do.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">One thing Dr. Smith\u00a0hadn\u2019t\u00a0anticipated\u00a0was Freeman\u2019s appetite.\u00a0\u201cHe was a skinny runt of a guy,\u201d\u00a0Smith said with amusement,\u00a0\u201cbut what I\u00a0didn\u2019t\u00a0know was that his nickname in Vietnam was\u00a0\u2018GG,\u2019\u00a0which stood for\u00a0\u2018Garbage Gut.\u2019\u00a0He ate us out of\u00a0house\u00a0and home! But he earned his keep.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Bill\u00a0Freeman became the Associate Director, bringing crucial firsthand knowledge of what corpsmen could realistically do in civilian practice. He was the prototype, the bridge between Smith\u2019s vision and its practical implementation.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28883\" aria-describedby=\"caption-attachment-28883\" style=\"width: 1570px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28883 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Smith-Bassett_combined-photos-1.jpg\" alt=\"\" width=\"1570\" height=\"772\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Smith-Bassett_combined-photos-1.jpg 1570w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Smith-Bassett_combined-photos-1-300x148.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Smith-Bassett_combined-photos-1-1024x504.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Smith-Bassett_combined-photos-1-768x378.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Smith-Bassett_combined-photos-1-1536x755.jpg 1536w\" sizes=\"auto, (max-width: 1570px) 100vw, 1570px\" \/><figcaption id=\"caption-attachment-28883\" class=\"wp-caption-text\">Close colleagues: Dr. Richard Smith (Program Director) and Dr. Gerry Bassett (Deputy Director) [Richard Smith Archives]<\/figcaption><\/figure>\n<p>Carnick\u00a0\u201cMark\u201d\u00a0Markarian<span data-contrast=\"auto\"> joined to handle administration and finance, bringing crucial experience from his time as a Captain in the U.S. Public Health Service.<\/span>Carolyn Robbins<span data-contrast=\"auto\">\u00a0and\u00a0<\/span>Lorna Carrier<span data-contrast=\"auto\">\u00a0completed the\u00a0initial\u00a0staff as administrative assistants, though both quickly became integral to strategic\u00a0planning.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThis is just the beginning,\u201d\u00a0Smith told his newly assembled team during their first official meeting.\u00a0\u201cNow the real work starts. We need to build a structure. We need to develop a curriculum. And most of all, we need to start shaping this into reality.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28858\" aria-describedby=\"caption-attachment-28858\" style=\"width: 1848px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28858 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/MEDEX-Core-Team-seated-around-Smith.jpg\" alt=\"\" width=\"1848\" height=\"424\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/MEDEX-Core-Team-seated-around-Smith.jpg 1848w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/MEDEX-Core-Team-seated-around-Smith-300x69.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/MEDEX-Core-Team-seated-around-Smith-1024x235.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/MEDEX-Core-Team-seated-around-Smith-768x176.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/11\/MEDEX-Core-Team-seated-around-Smith-1536x352.jpg 1536w\" sizes=\"auto, (max-width: 1848px) 100vw, 1848px\" \/><figcaption id=\"caption-attachment-28858\" class=\"wp-caption-text\">MEDEX&#8217;s newly-formed administrative and support team (clockwise to left of Richard Smith): Bill Freeman, Carolyn Robbins, Dr. Ray Vath, Roth Kenny (member of the Washington State Medical Association and a frequent participant in MEDEX meetings), Gerry Bassett, Mark Markarian and Lorna Carrier. [Richard Smith Archives]<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">From the beginning, Smith established MEDEX as a formal collaborative venture rather than a purely academic initiative. The program would officially be\u00a0\u201cjointly sponsored by the Department of Preventive Medicine, School of Medicine, University of Washington, and the Washington State Medical Education and Research Foundation.\u201d\u00a0This partnership structure would be crucial for gaining acceptance that a university-only program might never achieve.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">With funding secured and a core team in place, MEDEX\u00a0Northwest\u00a0was ready to move from concept to implementation.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\t<div id=\"gap-1329532398\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1329532398 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"none\">Creating a Professional Identity: The Name and Image of MEDEX<\/span><\/b><\/h2>\n<p><span data-contrast=\"auto\">As the team\u00a0members\u00a0began working to implement Smith\u2019s vision, they turned their attention to\u00a0establishing\u00a0a professional identity for the program and its graduates. This identity-building was a crucial\u00a0component\u00a0of what Smith called the\u00a0\u201creceptive framework\u201d\u2014his comprehensive systems approach to supporting and sustaining this new profession through legal protection, community acceptance, physician buy-in, public awareness, and political support.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The creation of this new medical profession involved more than training personnel and\u00a0establishing\u00a0legal frameworks; it required careful attention to image and terminology. Smith\u2019s background in communications and earlier television work had taught him the power of strong visual and verbal identities.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He deliberately chose the term\u00a0\u201cmedex\u201d\u00a0(medical extension) for the program\u2019s graduates. It was more than just a descriptive term\u2014it was a strategic choice.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cIt was an attempt to develop a short bisyllabic name that could be used as a title which had an MX in it, which is a very strong communications image,\u201d Smith explained during a planning meeting with his staff. The program\u2019s MEDEX name, from the French \u201cm\u00e9decin extension\u201d or the Spanish \u201cextensi\u00f3n del medico\u201d, embodied the concept of extending the physician\u2019s capabilities.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">When the first graduates began practicing, Smith was pleased to see office doors and windows emblazoned with \u201cJohn Doe, MX.\u201d The visual parallel with \u201cMD\u201d was exactly what he intended. \u201cThe visual distinction between MD and MX matters,\u201d Smith recalled, \u201cit shows how they were related but separate, suggesting both connection and independence.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28944\" aria-describedby=\"caption-attachment-28944\" style=\"width: 1566px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28944 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Coles-blue-coat-Mx-signifiers-for-Betz-Snyder_combined-images.jpg\" alt=\"\" width=\"1566\" height=\"704\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Coles-blue-coat-Mx-signifiers-for-Betz-Snyder_combined-images.jpg 1566w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Coles-blue-coat-Mx-signifiers-for-Betz-Snyder_combined-images-300x135.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Coles-blue-coat-Mx-signifiers-for-Betz-Snyder_combined-images-1024x460.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Coles-blue-coat-Mx-signifiers-for-Betz-Snyder_combined-images-768x345.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Coles-blue-coat-Mx-signifiers-for-Betz-Snyder_combined-images-1536x691.jpg 1536w\" sizes=\"auto, (max-width: 1566px) 100vw, 1566px\" \/><figcaption id=\"caption-attachment-28944\" class=\"wp-caption-text\">Photo on left: The names of Paul Snyder and John Betz, both graduates of MEDEX Northwest Class One, identified by the professional abbreviation &#8216;MX&#8217; in a Othello, WA clinic. Photo on right: Tom Coles (another graduate of MEDEX Northwest Class One) working alongside a nurse in the visually distinct blue coat.\u00a0<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">This attention to imagery extended to the physical appearance of the MEDEX practitioners. Smith insisted that students wear blue coats rather than the traditional white coats of physicians. This was another visual distinction that would\u00a0immediately\u00a0identify\u00a0them as a new category of healthcare provider.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI\u2019ll tell them to wear polka dots if that\u2019s what you want,\u201d\u00a0Vath\u00a0had responded\u00a0when Smith first suggested the blue coats. But Smith understood that these visual distinctions were crucial. The blue coats would create immediate recognition and a clear professional identity separate from both doctors and nurses.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28892\" aria-describedby=\"caption-attachment-28892\" style=\"width: 250px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28892\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/C9-Eugene-Stead-300x200.jpg\" alt=\"\" width=\"250\" height=\"167\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/C9-Eugene-Stead-300x200.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/C9-Eugene-Stead-1024x683.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/C9-Eugene-Stead-768x512.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/C9-Eugene-Stead.jpg 1200w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><figcaption id=\"caption-attachment-28892\" class=\"wp-caption-text\">Dr. Eugenge Stead, founder of the nation&#8217;s first PA program, Duke University, 1965.<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">As the profession gained visibility nationally, a debate\u00a0emerged\u00a0about what to call these new health professionals. While Smith preferred\u00a0\u201cmedex,\u201d\u00a0Duke University\u2019s program,\u00a0the nation\u2019s first PA program,\u00a0which started up in 1965 and\u00a0had\u00a0graduated its first class\u00a0a year earlier in\u00a01967,\u00a0had been using the term\u00a0\u201cPhysician\u2019s Assistant\u201d\u00a0or\u00a0\u201cPhysician\u2019s Associate.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith\u2019s resistance to the term\u00a0\u201cphysician\u2019s assistant\u201d\u00a0wasn\u2019t\u00a0merely\u00a0semantics. In his writings, he articulated that he believed the phrase did not reflect the\u00a0medex\u2019s\u00a0training, skills, or competence. He felt the term\u00a0\u201cassistant\u201d\u00a0was pejorative and conjured up an image of inferior health service, when what they were creating was a new category of health personnel\u00a0altogether.<\/span><span data-contrast=\"auto\">1<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The debate continued in medical journals, with various professionals proposing alternative terminology. Dr. Henry Silver suggested\u00a0\u201cCinayatrist,\u201d\u00a0which had Greek origins. Smith himself proposed\u00a0\u201cCruizer,\u201d\u00a0after Oswaldo Cruz, a famed parasitologist\u2014chosen partly because it\u00a0contained\u00a0the letter Z, which Smith found phonetically powerful.\u00a0\u201cOsler\u201d\u00a0was suggested after the famous physician William Osler. Dr. Joe Hamburg from the University of Kentucky offered several\u00a0additional\u00a0creative alternatives.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">As the profession gained visibility nationally, a debate\u00a0emerged\u00a0about what to call these new health professionals. While Smith preferred\u00a0\u201cmedex,\u201d\u00a0Duke University\u2019s program,\u00a0the nation\u2019s first PA program,\u00a0which started up in 1965 and\u00a0had\u00a0graduated its first class\u00a0a year earlier in\u00a01967,\u00a0had been using the term\u00a0\u201cPhysician\u2019s Assistant\u201d\u00a0or\u00a0\u201cPhysician\u2019s Associate.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">\u201cWe found ourselves debating terminology in peer-reviewed journals,\u201d\u00a0Smith recalled with a hint of amusement.\u00a0\u201cSome of these names were becoming increasingly outlandish, but underneath was the serious question of how we position these professionals in the medical hierarchy.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Despite this spirited nomenclature debate, Smith watched as\u00a0\u201cPhysician\u2019s Assistant\u201d\u00a0gained traction nationally. He recognized the political reality:\u00a0Physicians needed reassurance that their\u00a0position\u00a0wasn\u2019t\u00a0being threatened. The terminology implied a clear hierarchy, with the physician firmly at the top.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThe name PA was a political move,\u201d\u00a0he later acknowledged.\u00a0\u201cIt alleviated the fears of physicians that this group would run away with their practices.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">According to Smith, the American Academy of Physician Assistants would periodically send a formal letter to the American Medical Association in the early 1970s, reaffirming that Physician Assistants worked in a subordinate relationship under physician supervision.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">For Smith, the naming debate was just one\u00a0facet\u00a0of a broader strategy to position this new profession within the established medical hierarchy. While he invested energy in\u00a0advocating for\u00a0his preferred terminology, he simultaneously pursued other avenues to build legitimacy and acceptance. The name might still be contested, but there were other ways to\u00a0establish\u00a0credibility and connection with organized medicine.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Early in the program\u2019s development, Smith made\u00a0another\u00a0strategic decision that reflected this comprehensive approach to building legitimacy:\u00a0He\u00a0relocated\u00a0the MEDEX offices from the University of Washington campus to the building\u00a0that housed\u00a0the Washington State Medical Association on Ravenna Boulevard in Seattle. This\u00a0wasn\u2019t\u00a0just a change of\u00a0address;\u00a0it was a calculated move to shape public\u00a0perception.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWhen we moved into the Washington State Medical Association\u2019s building, our mailing address became the same as theirs,\u201d\u00a0Smith explained.\u00a0\u201cWhen doctors wrote to us, they wrote to us at the same address that they wrote to the state medical association. We became very closely identified with organized medicine.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cPerception shapes reality,\u201d\u00a0Smith told his staff when explaining the move.\u00a0\u201cIf we look like part of the establishment, we become the establishment.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">As the MEDEX program evolved and expanded nationally, the terminology debate gradually receded in importance. Smith knew that the ultimate measure of success\u00a0wasn\u2019t\u00a0what these professionals were called, but what they\u00a0accomplished. While he continued to prefer\u00a0\u201cmedex,\u201d\u00a0the growing adoption of\u00a0\u201cPhysician\u2019s\u00a0Assistant<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\">\u201d\u00a0and eventually\u00a0\u201cPhysician Assistant,\u201d\u00a0across the country was a reasonable compromise in service of the larger mission \u2013 extending quality healthcare to communities that desperately needed it.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\t<div id=\"gap-1235191416\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1235191416 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"none\">Building the Receptive Framework<\/span><\/b><span data-ccp-props=\"{&quot;134245418&quot;:false,&quot;134245529&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:160,&quot;335559739&quot;:80,&quot;335559740&quot;:278}\">&nbsp;<\/span><\/h2>\n<p><span data-contrast=\"auto\">With the professional identity&nbsp;established, Smith and his team now focused on implementing the various elements of the&nbsp;\u201creceptive framework\u201d&nbsp;across multiple communities in Washington State. This&nbsp;wasn\u2019t&nbsp;just theoretical&nbsp;planning;&nbsp;it required systematic action to build support in every environment&nbsp;in which&nbsp;MEDEX would&nbsp;operate.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">During their early strategy sessions,&nbsp;Smith emphasized the dynamic nature of their mission.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI&nbsp;don\u2019t&nbsp;mean to sound too pedantic here, but what&nbsp;we\u2019re&nbsp;undertaking is a&nbsp;systems&nbsp;approach to social change.&nbsp;Transformation is a&nbsp;systems&nbsp;metaphor for change.&nbsp;It\u2019s&nbsp;more process-oriented and dynamic than simply training some people and sending them out into new jobs.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Vath leaned&nbsp;forward,&nbsp;his psychiatric training&nbsp;evident&nbsp;in his approach.&nbsp;\u201cAnd we certainly&nbsp;need to be strategic about community engagement,\u201d&nbsp;he suggested.&nbsp;\u201cWhen we present to communities, we should always send pairs\u2014one person presenting while another&nbsp;observes&nbsp;reactions and&nbsp;identifies&nbsp;concerns.&nbsp;It\u2019s&nbsp;about understanding group dynamics and addressing resistance before it becomes entrenched.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith nodded.&nbsp;\u201cYes. And&nbsp;identify&nbsp;the informal power centers in each town,&nbsp;the gatekeepers that&nbsp;determine&nbsp;what gets accepted.\u201d&nbsp;He looked around the table.&nbsp;\u201cWho should that include?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">Smith spread a map of Washington State across his desk, the team gathering around. On it, he had circled fifteen communities in red marker, the result of weeks of research and conversations with the Washington State Medical Association.&nbsp;<\/span><span data-contrast=\"auto\">\u201cThese are our initial targets,\u201d&nbsp;Smith said, tapping the map decisively.&nbsp;<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">\u201cThe churches,\u201d&nbsp;Freeman offered.&nbsp;\u201cIn small towns, ministers have tremendous influence.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cAnd the local bank president,\u201d&nbsp;Bassett added.&nbsp;\u201cOften they\u2019re the biggest financial force in rural economies.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWomen\u2019s groups,\u201d&nbsp;Carrier suggested from her desk in the corner.&nbsp;\u201cThey\u2019re often the social organizers in small communities.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Dr. Smith felt a surge of appreciation for this team forming around him. Each brought perspectives he&nbsp;wouldn\u2019t&nbsp;have considered on his own.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThis involves creating a receptive environment at every level,\u201d&nbsp;Smith agreed.&nbsp;\u201cFrom individual physicians to&nbsp;state&nbsp;medical associations, from rural communities to state legislators. We need to build allies in each sphere of influence.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cAnd our&nbsp;focus&nbsp;<\/span><i><span data-contrast=\"auto\">must<\/span><\/i><span data-contrast=\"auto\">&nbsp;be rural,\u201d&nbsp;he&nbsp;stated&nbsp;firmly.&nbsp;\u201cRural Eastern Washington has been severely underserved by new medical graduates for a long time. Some areas along the Columbia River Basin have one doctor for every 2,500 patients\u2014others have one for 5,000. Compare that to Seattle, where&nbsp;it\u2019s&nbsp;something like&nbsp;one for about 500.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cAnd the rural doctors we do have are aging out,\u201d&nbsp;Vath added.&nbsp;\u201cThe average age of general practitioners is significantly higher than physicians in other specialties. Many are approaching retirement with no replacements in sight.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith&nbsp;spread a map of Washington State across his desk, the team gathering around. On it,&nbsp;he&nbsp;had circled&nbsp;fifteen&nbsp;communities in red marker, the result of weeks of research and conversations with the Washington State Medical Association.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThese are our initial targets,\u201d&nbsp;Smith said, tapping the map decisively.&nbsp;\u201cCommunities where physicians are already at their breaking point. But we need to understand each situation on the ground before we&nbsp;proceed.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Freeman leaned over the map, recognizing military precision in Smith\u2019s approach.&nbsp;\u201cSo,&nbsp;we\u2019re conducting reconnaissance before deployment?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cExactly.\u201d&nbsp;Smith smiled at&nbsp;Freeman\u2019s&nbsp;apt military comparison.&nbsp;\u201cThis&nbsp;isn\u2019t&nbsp;about dropping a predetermined program into these towns.&nbsp;That\u2019ll&nbsp;never work.&nbsp;It\u2019s&nbsp;about understanding each community\u2019s specific dynamics, needs, and potential resistance points.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">This newly formed team\u2014the MEDEX team\u2014was finding its footing.&nbsp;<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n\t<div id=\"gap-2091067480\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-2091067480 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><span data-contrast=\"auto\">Assessing the Communities<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/h2>\n<p><span data-contrast=\"auto\">Smith\u2019s approach was far more systematic than it might have appeared to outsiders. Before launching the program in any community, he brought in community development&nbsp;experts&nbsp;Len Duhl and Cap Thompson as consultants. These specialists&nbsp;weren\u2019t&nbsp;merely&nbsp;advisors;&nbsp;they were strategic assets who Smith had known from his time in Washington, D.C.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI want you to visit every one of&nbsp;<\/span><span data-contrast=\"none\">these fifteen communities<\/span><span data-contrast=\"auto\">,\u201d&nbsp;Smith instructed them during their&nbsp;initial&nbsp;briefing.&nbsp;\u201cTalk to local leaders, assess the healthcare situation,&nbsp;identify&nbsp;influential figures\u2014both official and unofficial. Map out power structures, pinpoint potential allies, and flag&nbsp;possible resistance.\u201d<\/span><span data-contrast=\"auto\">&nbsp;<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Duhl and Thompson spent several weeks on the road, crisscrossing Eastern Washington in a weathered station wagon. They visited pharmacies and diners, attended church services and town council meetings, chatted with farmers at grain elevators and teachers in school staff rooms. They conducted dozens of informal interviews without ever revealing the full scope of their mission.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">This level of preparation ensured that when town meetings occurred, Smith already understood the power dynamics and potential resistance points in each community. He could&nbsp;anticipate&nbsp;questions and frame the MEDEX concept in terms that would resonate with each town\u2019s specific concerns. Rather than presenting a one-size-fits-all approach, he tailored his presentations to address the&nbsp;healthcare&nbsp;challenges facing each community.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">When they returned, they presented Smith with detailed reports on each community, revealing the layers of complexity beneath the surface simplicity of small-town life. The team compiled this intelligence into a document outlining the responsibilities of key stakeholders, schools, mayors, pharmacists, and others.&nbsp;\u201cI couldn\u2019t have picked better people,\u201d&nbsp;Smith recalled years later.&nbsp;\u201cTo this day, we talk about how crucial that groundwork was because when you introduce an idea, it needs to feel familiar, like something the community has already been thinking about.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Late one evening, as the office emptied and the rain tapped steadily against the windows, Smith and Vath remained, reviewing these community assessments.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThis isn\u2019t just about avoiding resistance,&nbsp;Dick,\u201d&nbsp;Vath observed, leafing through the reports.&nbsp;\u201cIt\u2019s about knowing exactly which buttons to push in each town, which emotional levers to pull.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith nodded, his expression&nbsp;thoughtful.&nbsp;\u201cMedical training teaches us to diagnose before&nbsp;treating.&nbsp;We\u2019re&nbsp;applying the same principle to communities<\/span><span data-contrast=\"auto\">:<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">&nbsp;Diagnose the social dynamics first, then tailor the intervention accordingly.\u201d&nbsp;<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">The two men smiled and nodded, pleased at finding themselves increasingly&nbsp;in sync.&nbsp;<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">This level of preparation ensured that when town meetings occurred, Smith already understood the power dynamics and potential resistance points in each community. He could&nbsp;anticipate&nbsp;questions and frame the MEDEX concept in terms that would resonate with each town\u2019s specific concerns. Rather than presenting a one-size-fits-all approach, he tailored his presentations to address the&nbsp;healthcare&nbsp;challenges facing each community.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">The next morning, Dr. Smith stood&nbsp;once again&nbsp;at the window of his office.&nbsp;Outside, cars and pedestrians&nbsp;navigated&nbsp;the busy road below, while inside,&nbsp;theories, strategies&nbsp;and frameworks&nbsp;arranged themselves in Smith\u2019s fertile mind.&nbsp;No&nbsp;longer just concepts on&nbsp;paper,&nbsp;they&nbsp;were about to face their first real-world test.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><i><span data-contrast=\"auto\">All the planning in the world means nothing until&nbsp;we\u2019re&nbsp;face to face with the people who need to make this work<\/span><\/i><span data-contrast=\"auto\">,&nbsp;Smith&nbsp;thought to himself.&nbsp;<\/span><i><span data-contrast=\"auto\">Now comes the real test.<\/span><\/i><i><span data-contrast=\"auto\">&nbsp;<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Freeman&nbsp;appeared in the doorway.&nbsp;\u201cOkay, the&nbsp;schedule\u2019s set, Dick. First community visit next week.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith&nbsp;nodded,&nbsp;his expression both&nbsp;determined&nbsp;and contemplative. Years of planning, months of preparation, and now everything would hinge on how actual communities responded to this radical idea.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n\t<div id=\"gap-1070599692\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1070599692 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"none\">Testing the Concept: Odessa, Washington<\/span><\/b><span data-ccp-props=\"{&quot;134245418&quot;:false,&quot;134245529&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:160,&quot;335559739&quot;:80,&quot;335559740&quot;:278}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">\u201cWho are the most overworked doctors in the state?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Dr. Smith posed this question to Dick Gorman, Executive Director of the Washington State Medical Association. They had been discussing the healthcare crisis in rural communities, and now Smith needed specifics. He needed names of the doctors so overwhelmed they might be receptive to his unconventional solution.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Gorman leaned back in his chair, considering.\u00a0\u201cThe first to come to mind is\u00a0Jesse Sewell in Odessa,\u201d\u00a0he said finally.\u00a0\u201cThe man\u00a0hasn\u2019t\u00a0had a full night\u2019s sleep in fifteen years. Covers a territory the size of Rhode Island by himself.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWould he talk to me about a potential solution?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cJesse?\u201d\u00a0Gorman chuckled.\u00a0\u201cHe\u2019d talk to the devil himself if it meant getting some relief.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28868\" aria-describedby=\"caption-attachment-28868\" style=\"width: 874px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28868\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Gorman-Jesse-Sewell_combined.jpg\" alt=\"\" width=\"874\" height=\"304\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Gorman-Jesse-Sewell_combined.jpg 1674w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Gorman-Jesse-Sewell_combined-300x104.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Gorman-Jesse-Sewell_combined-1024x356.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Gorman-Jesse-Sewell_combined-768x267.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Gorman-Jesse-Sewell_combined-1536x534.jpg 1536w\" sizes=\"auto, (max-width: 874px) 100vw, 874px\" \/><figcaption id=\"caption-attachment-28868\" class=\"wp-caption-text\">Dr. Richard Gorman (left photo), Executive Director of the Washington State Medical Association, introduced Richard Smith to Dr. Jesse Sewell (right photo), longtime Odessa country doctor and an unlikely supporter of Richard Smith and champion of the MEDEX idea in rural Washington.<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">The following week, Smith boarded a flight to Spokane in Eastern Washington. To his surprise, Jesse Sewell himself was waiting when he landed. The rural doctor had flown his personal airplane to collect Smith, a gesture that spoke volumes about his interest in the MEDEX concept.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cDr. Smith,\u201d\u00a0Sewell called out, waving him over to the small private\u00a0aircraft\u00a0parked a distance from the commercial terminal.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cDr. Sewell,\u201d\u00a0Smith replied, walking toward him.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI hope\u00a0you\u2019re\u00a0up for a little more flying, Dr. Smith. Figured\u00a0this would be easier than you having to rent a car for the long drive out to Odessa.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">As they climbed into the small plane, Smith noticed the well-worn but meticulously\u00a0maintained\u00a0interior. Sewell moved with the practiced ease of someone who had spent countless hours in the cockpit.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cSo\u00a0\u2026\u00a0you\u2019re the fella with the big ideas,\u201d\u00a0Sewell said once they were airborne, his Alabama drawl carrying over the engine noise.\u00a0\u201cDick Gorman tells me you think you\u2019ve found a way to keep doctors like me from abandoning ship.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith studied the physician\u2019s profile as he focused on the controls.\u00a0\u201cThat\u2019s\u00a0one way to put it. I prefer to think of it as giving good doctors the support they need to keep serving their communities.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Sewell glanced over, a hint of skepticism in his eyes.\u00a0\u201cAnd just how do you plan to conjure up that support? Medical schools\u00a0aren\u2019t\u00a0exactly producing doctors eager to settle in places like Odessa.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cNot doctors,\u201d\u00a0Smith replied.\u00a0\u201cMilitary medics returning from Vietnam. Men with years of hands-on medical experience who are currently driving trucks or selling insurance because no one will let them use their skills.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Sewell raised an eyebrow but said nothing, turning his attention back to piloting. They\u00a0soared above the rolling wheat fields of Eastern Washington. Vast\u00a0expanses of farmland\u00a0stretched\u00a0into the distance,\u00a0punctuated by tiny communities,\u00a0each\u00a0one dependent on a single physician\u2014assuming\u00a0they were lucky enough to have one at all.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cSee all that?\u201d\u00a0Sewell finally said, gesturing toward the landscape below.\u00a0\u201cI\u2019m\u00a0on call for most of it. Day and night, seven days a week. Been that way for fifteen years.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">They landed on a small dirt airstrip near Odessa, population 1,100. Sewell\u2019s weathered pickup truck was parked beside the airstrip. As they drove the 15<\/span><span data-contrast=\"auto\">&#8211;<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">minute\u00a0ride\u00a0from the airstrip into town, Smith took in the landscape<\/span><span data-contrast=\"auto\">:<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">\u00a0An\u00a0ocean of golden grain broken only by weathered farm buildings and grain elevators.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Sewell pulled up in front of a small medical clinic with white paint peeling at the edges and a simple sign reading\u00a0\u201cJ.Q. Sewell, MD\u201d\u00a0hanging above the\u00a0door.<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">\u201cSee all that?\u201d\u00a0Sewell finally said, gesturing toward the landscape below.\u00a0\u201cI\u2019m\u00a0on call for most of it. Day and night, seven days a week. Been that way for fifteen years.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">Inside, a receptionist with graying hair looked up from her typewriter.\u00a0\u201cHello, Dr. Sewell,\u201d\u00a0she said, then nodded politely to Smith.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cMartha, this is Dr. Smith from Seattle, that\u00a0I mentioned,\u201d\u00a0Sewell explained.\u00a0\u201cWe\u2019ll\u00a0be in my office for a while. Hold my calls unless\u00a0it\u2019s\u00a0an emergency.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">She nodded and returned to her typing as Sewell led Smith into his cluttered office.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">When Smith entered, he was momentarily taken aback. On one wall hung a membership certificate for the John Birch Society, the\u00a0infamous\u00a0right-wing, anticommunist political advocacy\u00a0group;\u00a0on the opposite wall, a campaign poster for Governor George Wallace of Alabama.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A wave of memory washed over him. He flashed back to hospital corridors in Mississippi and Alabama\u00a0he had walked\u00a0just two years earlier, where\u00a0he\u2019d\u00a0led the federal effort to desegregate American hospitals as part of Medicare implementation. The same symbols of resistance had adorned those walls.\u00a0He\u2019d\u00a0witnessed\u00a0the hostile rhetoric directed at integration efforts as he enforced Medicare\u2019s requirements.\u00a0He\u2019d\u00a0received death threats, been followed by pickups with gun racks, faced down administrators\u00a0who\u2019d\u00a0rather close their facilities than admit Black patients.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cI\u00a0really\u00a0appreciate you taking the time to meet with me, Dr. Sewell,\u201d\u00a0Smith said apprehensively.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cCall me Jesse. And\u00a0I\u2019ll\u00a0meet with anyone who might help me get more than a few hours of sleep at a stretch.\u201d\u00a0He settled back into his chair.\u00a0\u201cNow,\u00a0tell me more about military medics coming in to save the day,\u00a0keep me from packing up and leaving this town without a doctor?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">For the next hour, Smith outlined his concept for MEDEX. He described how trained military medics could extend the capabilities of overworked physicians, handling routine care under a doctor\u2019s supervision. He detailed the extensive training these men already\u00a0possessed. He talked about how they sutured wounds under fire, performed emergency procedures in jungle conditions, and managed trauma with minimal equipment. These\u00a0weren\u2019t\u00a0inexperienced\u00a0novices,\u00a0they were battle-tested medical professionals whose skills were being wasted in civilian life. Smith explained how a structured preceptorship could systematically refine and expand these existing abilities, transforming them into invaluable partners for rural physicians.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">To Smith\u2019s surprise, Sewell listened with growing interest, interrupting occasionally with sharp, practical questions rather than ideological objections. When Smith finished, the rural doctor was nodding thoughtfully.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cYou know, this might just work,\u201d\u00a0he said.\u00a0\u201cBut\u00a0here\u2019s\u00a0the real question: how do we sell this to the town? These folks have never even seen a physician\u2019s assistant or\u00a0medex\u00a0or whatever\u00a0the heck\u00a0you\u2019re\u00a0calling them.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cActually, they might be more familiar with the concept than you\u2019d expect,\u201d\u00a0Smith replied.\u00a0\u201cI\u2019d like to hold a town meeting to explain the program, but I\u2019ll need your help to arrange it.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Sewell cocked his head with great curiosity.\u00a0\u201cWhy would these folks understand it better than most?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Dr. Smith smiled.\u00a0\u201cMay I ask you a question?\u00a0What\u2019s\u00a0the name of this town?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cOdessa,\u201d\u00a0Sewell replied, looking puzzled.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cAnd do you know where Odessa is?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cSure,\u00a0it\u2019s\u00a0a city in the Soviet Union. A lot of our founding families came from that region.\u201d\u00a0Understanding dawned on his face.\u00a0\u201cAh, the\u00a0feldsher system.\u00a0You\u2019re\u00a0saying they might recognize the concept because of their Russian backgrounds?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cExactly,\u201d\u00a0Dr. Smith nodded.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">For over 150 years, the Soviet Union\u00a0and Russia before it\u00a0had\u00a0relied on\u00a0feldshers\u2014military-trained medical practitioners who provide primary healthcare to civilian populations.\u00a0It was\u00a0a proven model\u00a0found to be\u00a0particularly effective in rural areas.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Sewell objected with a laugh,\u00a0\u201cWell,\u00a0in this town, Dr. Smith,\u00a0you might want to keep mention of Russia\u00a0to a minimum.\u201d\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith\u00a0smiled,\u00a0then\u00a0quickly clarified,\u00a0\u201cI\u00a0wasn\u2019t\u00a0suggesting we frame it that way. I was just noting that the concept has historical\u00a0precedents.\u00a0Besides, many\u00a0families\u00a0here\u00a0came from Ukraine, which has its own rich medical tradition.\u00a0We\u2019ll\u00a0just\u00a0focus on the practical benefits,\u00a0like keeping you here, expanding access to care, and giving returning veterans meaningful work.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Sewell let out a deep, genuine laugh, momentarily softening the hard lines on his face.\u00a0\u201cSonny,\u00a0you\u2019re\u00a0either the smartest man\u00a0I\u2019ve\u00a0met in years or the craziest. Either way,\u00a0I\u2019m\u00a0in.\u00a0Let\u2019s\u00a0hold that town meeting.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">What Smith\u00a0didn\u2019t\u00a0expect was Sewell\u2019s next offer.\u00a0\u201cIn the meantime, why don\u2019t I fly you around to meet some other docs in the same boat as me? I know at least five physicians between here and the Canadian border who are one\u00a0bad day\u00a0away from\u00a0shutting down.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-28929\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/rural-spots-map-300x172.jpg\" alt=\"\" width=\"550\" height=\"315\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/rural-spots-map-300x172.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/rural-spots-map.jpg 687w\" sizes=\"auto, (max-width: 550px) 100vw, 550px\" \/><\/p>\n<p><span data-contrast=\"auto\">Over the next several weeks, Smith made multiple trips to small Eastern Washington towns in Sewell\u2019s private plane. They visited overworked physicians in Tonasket, Othello and several other small towns. Each had a similar story: crushing patient loads, constant on-call status, no backup or relief. Like Dr. Sewell, these physicians too immediately grasped the potential of the MEDEX concept, not as an abstract idea but as a lifeline.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">During this period, Smith and Sewell worked together to plan the town meeting in Odessa, which would serve as the test case for the MEDEX approach. In their conversations and flights between communities, Sewell transformed from a cautious participant to a true believer. By the time they scheduled the town meeting, Sewell had done more than simply arrange it; he had become a leading evangelist for the MEDEX concept.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-28926\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/odessa-windmill-150x300.jpg\" alt=\"\" width=\"100\" height=\"200\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/odessa-windmill-150x300.jpg 150w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/odessa-windmill-512x1024.jpg 512w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/odessa-windmill.jpg 738w\" sizes=\"auto, (max-width: 100px) 100vw, 100px\" \/><\/p>\n\t<div id=\"gap-1065104934\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1065104934 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><strong>The Town Meeting&nbsp;<\/strong><\/h2>\n<p><span data-contrast=\"auto\">When the evening of the town meeting finally arrived,&nbsp;Smith&nbsp;stood at the front of the American Legion Hall, facing rows of weathered faces. Farmers in worn jackets sat shoulder to shoulder with shopkeepers and&nbsp;school&nbsp;teachers. The air smelled of coffee and wool dampened by melting snow.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">His mouth was dry, his palms&nbsp;damp. As the only Black man in the room,&nbsp;possibly the&nbsp;only Black man many of these residents had ever seen in person, he felt the scrutiny of their curious stares.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><i><span data-contrast=\"auto\">This is the&nbsp;moment of truth. If we&nbsp;can\u2019t&nbsp;convince this community, MEDEX is finished before it even begins.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">Smith stepped forward, feeling the intensity of the crowd\u2019s anxiety. He\u2019d addressed international assemblies in Geneva, briefed Surgeon Generals, and advised members of Congress, but this audience seemed to matter more than all the rest.<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">Dr.&nbsp;Sewell stepped forward first, his tall frame commanding the assembly\u2019s attention.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cFolks, I\u2019ve been your doctor for fifteen years,\u201d&nbsp;he began without preamble.&nbsp;\u201cSome of you&nbsp;I\u2019ve&nbsp;delivered.&nbsp;Others,&nbsp;I\u2019ve&nbsp;patched up after farm accidents. A few of you&nbsp;I\u2019ve&nbsp;pulled back from the brink more times than either of us cares to count.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">A murmur of acknowledgment rippled through the crowd.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWhat I haven\u2019t told you is that I\u2019ve been thinking about leaving.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">A collective intake of breath filled the room. An older woman in the front row clutched her companion\u2019s arm.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cIt\u2019s not that I want to go, mind you,\u201d&nbsp;Sewell continued, following the exact approach Smith had suggested.&nbsp;\u201cBut one man can only do so much.&nbsp;I\u2019m&nbsp;on call twenty-four hours a day, seven days a week. The workload has become impossible to sustain. The physical and mental toll is just too much. I was&nbsp;actually planning&nbsp;on calling&nbsp;a moving van next month.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">He gestured toward Dr. Smith.&nbsp;\u201cThat\u2019s&nbsp;why&nbsp;I\u2019ve&nbsp;invited Dr. Richard Smith from the University of Washington to speak with us tonight. He has a proposal that might keep medical care in Odessa, and in rural communities across the state.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith stepped forward, feeling the intensity of the crowd\u2019s anxiety. He\u2019d addressed international assemblies in Geneva, briefed Surgeon Generals, and advised members of Congress, but this audience seemed to matter more than all the rest. These were the people his program would directly impact.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThank you for welcoming me to your community,\u201d&nbsp;he began, his voice steady despite his racing heart.&nbsp;\u201cI\u2019m&nbsp;here tonight because&nbsp;what\u2019s&nbsp;happening in Odessa is happening across America. Rural communities are losing their doctors, and with them, access to healthcare.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">He paused, making eye contact with various faces around the room.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cBut I believe&nbsp;there\u2019s&nbsp;a solution. A solution that some of your ancestors might recognize.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">A flicker of interest passed through the crowd.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cNow I know that many&nbsp;of your founding families came from&nbsp;Ukraine, from&nbsp;the Odessa region, if I have that right,\u201d&nbsp;Smith&nbsp;continued,&nbsp;deftly&nbsp;avoiding direct references to the Soviet system as Sewell had advised.&nbsp;\u201cAs you know better than I do, they&nbsp;brought with them a tradition of practical problem-solving. Tonight, I want to suggest a practical solution to our shared healthcare challenge.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">He went on to explain how thousands of military medics were returning from Vietnam with extensive medical training and battlefield experience. These men had performed emergency surgeries under fire, stabilized traumatic injuries, delivered babies in primitive conditions. Some Special Forces medics received up to&nbsp;2,000 hours&nbsp;of medical training. With&nbsp;additional&nbsp;training and proper supervision from Dr. Sewell, they could handle many routine medical problems, freeing him to focus on the more complex cases that truly&nbsp;required&nbsp;his&nbsp;expertise.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">A hand rose from the middle of the room. A weather-beaten farmer stood; skepticism etched in the lines of his face.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cYou\u2019re saying we should trust our healthcare to someone who isn\u2019t a real doctor? Sounds like second-class medicine to me.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith&nbsp;felt sweat prickling along his&nbsp;spine but&nbsp;kept his expression calm.&nbsp;Here was the objection he had been waiting for, the fear that must be addressed head-on.&nbsp;<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cA fair concern,\u201d&nbsp;he acknowledged.&nbsp;\u201cBut consider this: is healthcare you can&nbsp;actually access&nbsp;better or worse than healthcare that exists 75 miles away in Spokane? If Dr. Sewell leaves because&nbsp;he\u2019s&nbsp;overwhelmed, what then? How far will you drive for treatment? How many emergencies&nbsp;won\u2019t&nbsp;make it to the nearest hospital?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">The farmer\u2019s expression remained dubious.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThese&nbsp;medex&nbsp;won\u2019t replace Dr. Sewell,\u201d&nbsp;Smith continued.&nbsp;\u201cThey\u2019ll&nbsp;work with him, under his supervision, allowing him to focus on the cases that require his&nbsp;expertise&nbsp;while ensuring that&nbsp;everyone gets care.&nbsp;It\u2019s&nbsp;not second-class medicine<\/span><span data-contrast=\"auto\">;<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\">&nbsp;it\u2019s a practical solution to a critical shortage.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Another hand rose<\/span><span data-contrast=\"auto\">:<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\">&nbsp;a woman in her sixties, her gray hair pulled back in a beehive shaped bun.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cMy father was treated by a feldsher in the old country,\u201d&nbsp;she said, her accent still carrying traces of her Eastern European roots.&nbsp;\u201cWhen no doctor could come to our village for months at a time, the feldsher kept people alive.\u201d&nbsp;She looked directly at Dr. Smith.&nbsp;\u201cBut he knew his limitations. He knew when to send someone to the city&nbsp;for&nbsp;the doctor. Will your people know that too?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith nodded, grateful for the opening.&nbsp;\u201cAbsolutely. Knowing one\u2019s limitations is central to&nbsp;the training. These&nbsp;medex&nbsp;will be taught to recognize what they can handle safely and when to involve Dr. Sewell&nbsp;immediately.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">As the questions continued, Smith felt the mood of the room shifting. Where there had been suspicion, now there was&nbsp;a cautious&nbsp;interest. Where there had been resignation about losing their doctor, now there was a glimmer of hope.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">By the end of the evening, the town&nbsp;voted&nbsp;unanimously to support bringing a&nbsp;medex&nbsp;to work with Dr. Sewell. As the meeting dispersed, people approached Dr. Smith, shaking his hand and thanking him.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">An elderly man with gnarled hands gripped Dr. Smith\u2019s arm.&nbsp;\u201cMy grandson is coming home from Vietnam next month,\u201d&nbsp;he said, his voice thick with emotion.&nbsp;\u201cHe was a corpsman. Could he apply for your program?\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cAbsolutely,\u201d&nbsp;Smith replied, feeling a surge of emotion.&nbsp;\u201cPlease have him contact our office as soon as he returns.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">The pattern&nbsp;established&nbsp;in Odessa repeated across Eastern Washington. Similar town meetings were held in&nbsp;numerous&nbsp;small towns where physicians were desperate for&nbsp;relief,&nbsp;and communities feared losing healthcare access. From the Yakima Valley to the Columbia Basin, from the Palouse to the Canadian border, the MEDEX concept spread through rural Washington. Sometimes the reception was&nbsp;immediately&nbsp;positive; other times it&nbsp;required&nbsp;careful navigation of local concerns. But town by town, the receptive framework Smith had envisioned was beginning to take shape.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">The next morning, Jesse Sewell was ready&nbsp;with&nbsp;his plane again.&nbsp;\u201cGot three more towns that need to hear from you,\u201d&nbsp;he said with the enthusiasm of a true convert.&nbsp;\u201cDoctors in all of them ready to pack it in without help.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">As they flew to the next community, Smith reflected on the success in Odessa.&nbsp;<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><i><span data-contrast=\"auto\">We\u2019re&nbsp;not just extending&nbsp;healthcare.&nbsp;We\u2019re&nbsp;extending hope to communities that feel like&nbsp;they\u2019re&nbsp;being&nbsp;abandoned and&nbsp;giving purpose to veterans&nbsp;who\u2019ve&nbsp;been discarded.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">The pattern&nbsp;established&nbsp;in Odessa repeated across Eastern Washington. Similar town meetings were held in&nbsp;numerous&nbsp;small towns where physicians were desperate for&nbsp;relief,&nbsp;and communities feared losing healthcare access. From the Yakima Valley to the Columbia Basin, from the Palouse to the Canadian border, the MEDEX concept spread through rural Washington. Sometimes the reception was&nbsp;immediately&nbsp;positive; other times it&nbsp;required&nbsp;careful navigation of local concerns. But town by town, the receptive framework Smith had envisioned was beginning to take shape.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">Jesse Sewell proved invaluable in this process. Far from being just a participant,&nbsp;this&nbsp;\u201ccountry doctor\u201d&nbsp;became an active ambassador for the MEDEX concept, flying Smith to communities,&nbsp;vouching for&nbsp;the program with fellow physicians, and speaking passionately about how it could save rural medicine. The&nbsp;same&nbsp;doctor who had displayed George Wallace\u2019s poster on his wall had become Smith\u2019s most enthusiastic ally in creating a healthcare revolution.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n<p><span data-contrast=\"auto\">This unlikely partnership between a Black physician advocating for systemic change and a conservative rural doctor seeking relief from an unsustainable workload&nbsp;demonstrated&nbsp;the core principle of the MEDEX approach. Smith had long understood that when people recognize mutual benefit in an innovation, they invest in its success regardless of their differences. His work in hospital desegregation and with the Peace Corps had taught him this fundamental truth about social change. It was a powerful principle he applied deliberately as the program expanded beyond Washington state.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">&nbsp;<\/span><\/p>\n\t<div id=\"gap-1666346996\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1666346996 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"none\">Meeting Resistance Head-On\u00a0\u2013 A Communist Plot<\/span><\/b><span data-ccp-props=\"{&quot;134245418&quot;:false,&quot;134245529&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:160,&quot;335559739&quot;:80,&quot;335559740&quot;:278}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">Not every presentation went as smoothly as\u00a0it had in\u00a0Odessa. As\u00a0word of the\u00a0MEDEX program spread, organized resistance began to\u00a0emerge, particularly from\u00a0established\u00a0medical institutions.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Dr. Vath had\u00a0anticipated\u00a0this.\u00a0\u201cChange always triggers resistance,\u201d\u00a0he reminded the team\u00a0one morning\u00a0during their briefing.\u00a0\u201cEspecially when it threatens established power structures.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">What he\u00a0hadn\u2019t\u00a0fully\u00a0anticipated\u00a0was the intensity of that resistance, or how personal it would become.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A true\u00a0confrontation came during a presentation to the Spokane Medical Society. Dr. Smith had been invited to explain the MEDEX concept to the region\u2019s physicians, many of whom had heard alarming rumors about the program but few\u00a0accurate\u00a0details.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28948\" aria-describedby=\"caption-attachment-28948\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-28948\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Davenport-Hotel-1960s-Spokane-exterior-300x205.jpg\" alt=\"\" width=\"300\" height=\"205\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Davenport-Hotel-1960s-Spokane-exterior-300x205.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Davenport-Hotel-1960s-Spokane-exterior-1024x699.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Davenport-Hotel-1960s-Spokane-exterior-768x524.jpg 768w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Davenport-Hotel-1960s-Spokane-exterior.jpg 1128w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-28948\" class=\"wp-caption-text\">Davenport Hotel, Spokane, WA.\u00a0<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">The meeting room at the Davenport Hotel\u00a0in downtown Spokane\u00a0was filled with physicians in dark suits, their expressions ranging from curious to\u00a0openly\u00a0hostile. Smith felt the tension as he approached the podium, the weight of scrutiny from a hundred pairs of eyes.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><i><span data-contrast=\"auto\">Stay focused on the mission. This\u00a0isn\u2019t\u00a0about me or their discomfort with change.\u00a0This is about communities losing access to healthcare.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith delivered his presentation with measured confidence, outlining the program\u2019s structure,\u00a0the careful\u00a0selection\u00a0of candidates, the competency-based curriculum, and the rigorous supervision requirements. He emphasized that MEDEX was designed not to replace physicians but to extend their capabilities, thereby allowing them to serve more patients while focusing on cases that truly\u00a0required\u00a0their\u00a0expertise.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">Then a silver-haired man near the front stood abruptly.\u00a0\u201cI think this is a communist plot,\u201d\u00a0he declared, his voice carrying through the suddenly silent room.\u00a0\u201cWe need to squelch this\u00a0immediately.\u00a0It\u2019s\u00a0out to destroy the practice of medicine.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">As he concluded, Smith\u00a0sensed\u00a0the mood in the room had\u00a0softened somewhat. Several physicians were nodding thoughtfully. Others leaned forward with expressions of cautious interest.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Then a silver-haired man near the front stood abruptly.\u00a0\u201cI think this is a communist plot,\u201d\u00a0he declared, his voice carrying through the suddenly silent room.\u00a0\u201cWe need to squelch this\u00a0immediately.\u00a0It\u2019s\u00a0out to destroy the practice of medicine.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A ripple of murmurs spread through the audience. Smith felt his heart rate accelerate, a flush of heat rising from his collar.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He glanced at Vath, who had\u00a0accompanied\u00a0him to the presentation,\u00a0concern\u00a0in his eyes. Vath gave a slight nod and rose from his seat.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cLet me try,\u201d\u00a0he said quietly to\u00a0Smith\u00a0before turning to address the room.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cYou know, I have\u00a0some\u00a0concerns too,\u201d\u00a0Vath\u00a0began,\u00a0his voice measured and respectful.\u00a0\u201cI\u2019m\u00a0not\u00a0100%\u00a0sure if this is\u00a0a good idea\u00a0either.\u00a0It\u2019s\u00a0too early to tell.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Dr. Smith watched, impressed, as Vath established common ground before pivoting.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cBut when it comes to loyal Americans,\u201d\u00a0Vath continued,\u00a0\u201cI just got out of the military after ten years of active duty and four years in the reserves. I\u00a0don\u2019t\u00a0think my loyalty is going to be in question.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A subtle shift rippled through the room. Physicians who had been nodding along with the accuser now looked uncomfortable.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cLet me tell you,\u201d\u00a0Vath said, skillfully redirecting the concern into an opportunity for involvement,\u00a0\u201cwe\u00a0need people like you to watch our program. And if you see us doing something dangerous to anybody, I want you to call me personally.\u201d\u00a0He walked forward, handing his card to the skeptical physician.\u00a0\u201cBecause I can destroy this from the inside quicker than you can destroy it from the outside.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The tension broke. Several physicians chuckled, and even the accuser seemed taken aback by the direct challenge cloaked in respectful language.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">As they drove back to Seattle that evening, Smith turned to Vath.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThat was masterful,\u201d\u00a0he said.\u00a0\u201cThe way you transformed a potential opponent into an ally.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Vath smiled slightly.\u00a0\u201cWell,\u00a0it\u2019s\u00a0the\u00a0\u2018collaborative model\u2019\u00a0at work,\u00a0Dick.\u00a0In any effective collaboration, there is mutual investment, mutual benefit, and mutual accountability. By inviting critics to help shape the program, we give them investment. They benefit by having a voice in an inevitable change. And we all become accountable to the process we create together.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cThis comes from your psychiatric background, doesn\u2019t it?\u201d\u00a0Smith asked.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cYes,\u201d\u00a0Vath confirmed.\u00a0\u201cIt\u2019s\u00a0one of the basic tenets of family therapy, in fact. But it works remarkably well for institutional change too. The key is inclusion rather than defense. Most opponents just want to be heard and have some control. Give them a role in oversight, and suddenly\u00a0they\u2019re\u00a0invested in your success.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cBecause if we fail after they\u2019ve taken partial ownership, it becomes their failure too,\u201d\u00a0Smith realized.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cExactly. People defend what they help create.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Later, Dr. Smith learned that the physician who had raised the\u00a0\u201ccommunist plot\u201d\u00a0accusation became a supporter of the program and eventually the president of the Spokane Medical Society.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\t<div id=\"gap-150649234\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-150649234 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<h2><b><span data-contrast=\"none\">Meeting Resistance Head-On \u2013 Nurses Say No\u00a0<\/span><\/b><span data-ccp-props=\"{&quot;134245418&quot;:false,&quot;134245529&quot;:false,&quot;201341983&quot;:0,&quot;335559738&quot;:160,&quot;335559739&quot;:80,&quot;335559740&quot;:278}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">Nursing organizations presented another source of potential resistance. During a meeting with the Washington State Nursing Association, a representative challenged\u00a0the MEDEX team\u00a0directly.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWhy aren\u2019t you doing this for nurses? We have more training than corpsmen. If anyone should be taking on expanded clinical roles,\u00a0it\u2019s\u00a0nurses\u00a0with our established educational pathways. This program\u00a0seems to bypass\u00a0nursing completely.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith had\u00a0prepared\u00a0this question, but Vath responded before he could.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cWe wouldn\u2019t touch that with a ten-foot pole because you\u2019d accuse us of being male chauvinists, doing it for you,\u201d\u00a0Vath said with disarming frankness.\u00a0\u201cBut\u00a0we\u2019ll\u00a0do it\u00a0<\/span><i><span data-contrast=\"auto\">with<\/span><\/i><span data-contrast=\"auto\">\u00a0you.\u00a0We\u2019re\u00a0having our attorneys from the state medical society draw up the law to change the medical practice act. Why don\u2019t you join us?\u00a0Tell us what you think needs to be in there for nurses to move in this direction as well.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The nursing representative blinked, clearly surprised by the inclusive response. By the end of the meeting, the nursing association had agreed not only to withhold opposition to the MEDEX program but to actively\u00a0participate\u00a0in shaping the enabling legislation.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith felt a deep appreciation for Vath\u2019s instinctive understanding of how to navigate these challenging interactions. What could have become entrenched opposition was being transformed into cautious support through strategic inclusion.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_28950\" aria-describedby=\"caption-attachment-28950\" style=\"width: 150px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28950 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2025\/12\/Hildegard-Peplau-Nurses-Association.jpeg\" alt=\"\" width=\"150\" height=\"200\" \/><figcaption id=\"caption-attachment-28950\" class=\"wp-caption-text\">Hildegard Peplau, President, American Nurses Associaton.<\/figcaption><\/figure>\n<p><span data-contrast=\"auto\">But resistance\u00a0from nursing\u00a0would continue. When Hildegard Peplau, President of the American Nurses Association, flew to Seattle to discuss the program, Smith was hopeful for national nursing support.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The meeting began cordially enough in Smith\u2019s office. Peplau listened attentively as he outlined the MEDEX concept, occasionally nodding or asking clarifying questions. Smith found himself relaxing, believing they were finding common ground.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Then, without warning, Peplau stood.\u00a0\u201cThank you for your time, Dr. Smith.\u00a0I believe I\u00a0understand your program now.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">She walked to the door, then turned back.\u00a0\u201cI cannot in\u00a0good\u00a0conscience support this direction. It undermines established nursing pathways and creates unnecessary competition for limited resources.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Before Smith could respond, she was gone. Moments later, his assistant rushed in.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">\u201cDr. Smith, Hildegard Peplau is holding a press conference in the conference room down the hall!\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Smith hurried to the impromptu media gathering, arriving just in time to hear Peplau denouncing the MEDEX program as\u00a0\u201ca dangerous precedent that threatens patient safety and undermines established healthcare professions.\u201d<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<blockquote>\n<p><span data-contrast=\"auto\">Later, alone in his office with the door closed, Smith allowed himself a rare moment of unguarded emotion. His hands trembled slightly as he poured a glass of water, splashing a few drops onto his desk.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><i><span data-contrast=\"auto\">Is this how it ends? Before\u00a0we\u2019ve\u00a0even begun? One influential opponent making accusations to the national press?<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<\/blockquote>\n<p><span data-contrast=\"auto\">He stood at the back of the room, unseen by most, feeling a cold weight settle in his stomach as reporters scribbled notes.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He had\u00a0never expected this level of public opposition, especially not ambush tactics.<\/span><i><span data-contrast=\"auto\">\u00a0<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><i><span data-contrast=\"auto\">This could torpedo everything\u00a0we\u2019re\u00a0building.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Later, alone in his office with the door closed, Smith allowed himself a rare moment of unguarded emotion. His hands trembled slightly as he poured a glass of water, splashing a few drops onto his desk.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><i><span data-contrast=\"auto\">Is this how it ends? Before\u00a0we\u2019ve\u00a0even begun? One influential opponent making accusations to the national press?<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">He closed his eyes, trying to center himself. The face of the elderly man from Odessa came to mind\u2014the one whose grandson was returning from Vietnam. The weathered faces of the farmers and shopkeepers who had voted unanimously to support the program, who saw in it their only hope for continued healthcare access.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><i><span data-contrast=\"auto\">No. This is too important\u00a0for\u00a0too many people.\u00a0We\u2019ll\u00a0find a way forward.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The path\u00a0forward\u00a0would come\u00a0through continued community engagement. Rather than fighting the nursing opposition directly,\u00a0Smith doubled down on building local support. Each successful town meeting, each physician who agreed to become a preceptor, each community that embraced the concept created momentum that no single opponent could stop.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">By responding to resistance with inclusion rather than defensiveness and<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">by\u00a0focusing on the mission rather than the obstacles, the MEDEX team gradually transformed\u00a0many\u00a0potential adversaries into reluctant allies.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n\n\t\t<\/div>\n\n\t\t\n<style>\n#section_950742529 {\n  padding-top: 30px;\n  padding-bottom: 30px;\n}\n<\/style>\n\t<\/section>\n\t\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The pale Seattle light filtered through the windows as Richard Smith unpacked his few belongings in the small University of Washington office. Rain tapped a gentle\u00a0patter\u00a0against the glass, so different from the urgent percussion of\u00a0the\u00a0East Coast storms\u00a0he was accustomed to. He\u00a0let out a slow breath. He had given up power, prestige, and security for this uncertain beginning.\u00a0<\/p>\n","protected":false},"author":173,"featured_media":28900,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-27231","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-special-series"],"cp_meta_data":{"_edit_lock":["1769803564:1"],"post_order":["7"],"_edit_last":["1"],"_thumbnail_id":["28900"]},"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/27231","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/users\/173"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/comments?post=27231"}],"version-history":[{"count":132,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/27231\/revisions"}],"predecessor-version":[{"id":28953,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/27231\/revisions\/28953"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media\/28900"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media?parent=27231"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/categories?post=27231"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/tags?post=27231"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}