Dr. J. R. McCord

by Darryl Gossett

he School of Medicine has always depended on the kindness of volunteer teachers. In fact, from its founding in 1915 until the middle of World War II, the school was able to support just one full-time clinical faculty member on its payroll. And he worked cheap.

Dr. J. R. McCord, the so-called dollar-a-year man, was able to head up obstetrics at Emory only because his successful private practice allowed him to work for next to nothing -- which was the going salary in those days.

When Emory's medical school coalesced in 1915, Atlanta's community physicians rallied, like a family, around the new institution. Volunteer clinical faculty like Cyrus Strickler Sr., Stewart Roberts, J. Edgar Paullin, and J. R. McCord supplemented the efforts of a paid (and overworked) basic science faculty and helped Dean Russell Oppenheimer keep the school going. ("Dr. Opp," as he was known, was no slacker himself when it came to giving his time. Known as "the one-man medical school," he spent the better part of two decades toiling as dean, professor, and administrative chair of medicine, as well as superintendent and medical director of Emory University Hospital.)

Such sacrifice likely was regarded by some as unavoidable -- before, during, and even after the war, budgets were excruciatingly tight. In 1942, for example, the entire medical school was run for only $23,500. If not for the generosity of Atlanta's private-practice doctors, Emory's School of Medicine - and the hospital it had opened on campus in 1922 - would have been unable to survive.

But survive it did with the help of its largely volunteer cadre of clinical instructors. By extension, the very term "clinical faculty" has come to mean, in a generic sense, an unpaid adjunct, synonymous with "volunteer" or "noncompensated."

That volunteerism has continued at Emory as the medical school has grown to become consistently ranked as one of the best in the country. Today's volunteers come in all stripes -- old and young, Emory alumni and those with no Emory connection at all, private-practice physicians, public health lecturers, retired community doctors. In any given year, hundreds serve the school in some capacity. The variety of their backgrounds is seemingly limitless, as are the reasons they give for choosing to donate their time and energy to teach Emory medical students.

For more than 30 years, Carlos Stuart has
faithfully served not only patients like
Glenn Irwin (who has seen him since
age 12)

Following his studies, Stuart returned to Peru, but he came back to Atlanta in 1958 to accept an offer to join the clinic of Mason Lowance in Buckhead's Sheffield Building, adjacent to Piedmont Hospital. Stuart remained with that practice for the next 40 years -- through various changes of locale, Lowance's retirement, the acquisition of the clinic by Emory in 1994, and its subsequent closing in 1998. Today, Stuart is an assistant professor of medicine at Emory; loyal patients from his Buckhead days are making the trek to his new practice site at The Emory Clinic's 1525 Building.

As a clinical volunteer, Stuart has taught virtually everything that can be learned at the bedside, says Dr. Ken Walker, long a leader in Emory's clinical education program.

Since he was first recruited as a volunteer teacher by Emory cardiologist Robert Franch, Stuart has worked with hundreds of Emory students and medical residents as they rotated through Piedmont Hospital. He has taught both the freshman and sophomore medical courses and given lectures to students as well as lay and professional groups. Not just Emory has benefited from his service. From 1958 to 1968, Stuart voluntarily cared for indigent patients with terminal cancer at Our Lady of Perpetual Health in Atlanta. In recent years he and Pat, his wife of 40 years, have traveled to several countries, including his homeland of Peru, to lecture about thyroid and coronary diseases and to preach preventive medicine.

"Carlos is simply phenomenal," says Walker. "Without the thousands of hours that community friends like Carlos Stuart have given to the school and its students, free of charge, Emory wouldn't be the place it is today. People like him are the mortar that has held the school together." At a ceremony in February of last year, Emory and Piedmont honored Stuart's three decades of volunteer teaching and the selfless service he has given to the Atlanta community.

Why give so much much for so little in return?

"This country has been extremely nice to me," says Stuart, who became a citizen in 1962. "It has adopted me, educated me, opened horizons for me. I met my wife here, raised my family, learned what it is to be a doctor. I am in debt to Atlanta and to those people at Emory, St. Joseph's, Piedmont, and elsewhere who taught me and who gave me a chance to teach others. Teaching is an expression of the gratitude I feel."

Mark Silverman's penchant for theatrical
garb is a hard act to follow. Each year he
surprises Emory freshmen anatomy
students by bursting into class, wearing
a 17th century-style costume and
accompanied by chamber music, to
lecture on blood circulation in the
persona of English physician William
Harvey. He also has been known to grow
a goatee so he can play a more
convincing Willem Einthoven, the Dutch
inventor of the electrocardiogram. Here,
Barry Silverman, also a clinical faculty
member, lends his brother a hand.

Flush with that success, Hurst created a similar program at Northside Hospital in 1973, recruiting a Hopkins cardiologist to administer it -- Barry Silverman, Mark's younger brother. Scores of dedicated Atlanta volunteer faculty members have supported these programs run by the Silvermans, clearing their private-practice time in the interest of educating Emory medical students, residents, and fellows.

Although the Northside program has since been phased out, Barry Silverman has continued to serve Emory as a volunteer faculty member and tireless recruiter of other clinical faculty, in addition to his duties at Northside.

While Mark Silverman, as a paid member of the Emory faculty, is obviously not a volunteer, he has spent his career in Atlanta preaching the virtue, and necessity, of volunteering time to the School of Medicine. And Barry Silverman - who has taught in such diverse areas as noninvasive cardiology techniques at Grady, the sophomore patient diagnosis course, and various senior electives - has spent decades practicing what his brother has preached, encouraging others to do the same in his role as head of Northside's educational programs.

Volunteerism is of enormous mutual benefit to Emory and to the community physician and hospital, according to Mark Silverman. "The community hospital offers a large group of experienced, practicing physicians who can contribute to student and fellow education," he says. "It also provides a large patient population that can aid in teaching. Community outlets provide Emory students with exposure to the practice of medicine before they have to make the crucial decision of internship and residency, and they allow the university an opportunity to extend its postgraduate programs and ideas directly to the physician practice site."

Community physicians, on the other hand, benefit from the stimulation and education of working with students, fellows, and faculty from a major academic health sciences center, he says. "A relationship with Emory not only adds to the capabilities of the hospital, it directly improves patient care through the development and direction of diagnostic laboratories and intensive care units, consultation from faculty and fellows, especially for acutely ill patients, and this spills over into nursing and paramedical education." Furthermore, he says, an Emory connection brings the hospital recognition as a teaching, university-related hospital, thereby enhancing its prestige.

In today's environment of escalating competition between hospitals for patients, it is gratifying to see these long-standing, historical patterns of cooperation continue unabated among teachers of medicine, says Mark Silverman.

Today doctors "often work for or are affiliated with managed care companies, and our income is commonly connected to how many patients we see," he says. "Consequently, we're not always free to make the decision to volunteer."

Even when the decision is possible, it is still a huge commitment for private-practice doctors, says Barry Silverman. "Even if it's only an hour or two a week or once a month, those are hours you aren't seeing patients. The overhead is the same. Lights, nurses, malpractice insurance -- all have to be paid regardless. You have to love teaching in order to do this."

A heart-warming number of people apparently do. In just one course that Mark Silverman administers at Piedmont - sophomore clinical methods - community doctors have given as many as 4,000 uncompensated hours to Emory. Some are Emory medical school or house officer alumni, but many are unaffiliated with Emory and are merely acting in the great tradition of doctors as teachers and mentors.

Joanna Buffington, a commissioned officer
in the US Public Health Service and medical
epidemiologist at the CDC, is spreading a
public health message to Emory medical
students as a volunteer teacher.

Buffington sees her mission as a physician in spreading the word about public health. "Teaching medical students allows me to do double duty on that call," she says, "by informing young people about the importance of public health issues while they're engaged in learning at the bedside. These students will soon become physicians in their own right and will be able to incorporate that message into their practice and patient education programs."

Buffington, who came to CDC in 1990, began volunteer teaching at Emory last year. In her two semesters of work, she has served as a small group leader of a two-hour seminar for students enrolled in the patient/doctor course and also has led four discussion sessions on various public health topics.

"The sessions I did last year and this fall were terrific!" she says. "It ended too soon for me -- though probably not for the students. I look forward to continuing in this role."

Her involvement with Emory came about at the urging of Steve Jones, a volunteer teacher himself and a CDC researcher who works on health issues surrounding illegal drug injection. Jones convinced her the experience would be fun and meaningful and would help her further her efforts in public health education.

In Buffington's case, the issue of pay is irrelevant. "As an officer in the Public Health Service, I am on duty for CDC 24 hours a day, 365 days a year," she says, "and I can't be paid for any work outside of that. But by volunteering, I get to talk about public health and encourage medical students to consider it as not only an area that holds lots of exciting research and prevention work but also as a very worthwhile career."

"If I had wanted to be wealthy, public health practice wouldn't be the way to get there. The work is extremely fulfilling. In many ways I feel luckier than my private-sector counterparts. They may have more money, but I bet I'm having a lot more fun."

Now retired, Joe Wilson, 47M, did bedside
volunteer teaching for several decades in
his practice at Crawford Long Hospital.
Now he serves as a mentor in Emory's
problem-based learning classes. "I'm
glad to help out," he says.

"I might have retired from the practice of medicine," he says, "but as a physician I still have an obligation to serve as a mentor. You can retire from the job but not from the obligation."

A native of south Georgia, Wilson came to Emory as a premed major in 1941, just before Pearl Harbor. At that time, premeds were deferred from active duty so the country could continue to educate doctors, but they were rushed through college and medical school on accelerated programs so that, when needed, they could be called on for service. Luckily for Wilson, the war ended before he was called to active duty in Europe. He did spend two years in the Army during the Korean War, however, on finishing his postgraduate training at Grady Hospital in 1951.

During Wilson's salad days - the 50s, 60s, and 70s - the lion's share of Emory's teaching faculty were still volunteers. Their work was based primarily out of Grady Hospital and, to a lesser extent, Piedmont and Crawford Long. Like the other volunteers, Wilson would oversee his students on rounds to care for his hospitalized patients. Now, without such patients to share with Emory students, he has moved into the classroom at the urging of his old Crawford Long associate, Jack Shulman, now Emory's executive associate dean for medical education and student affairs.

Last year, Wilson served as a mentor with Shulman in the first-year problem-based learning classes. These classes - divided into groups of eight - use two mentors for each group. Students are presented with a clinical problem to study over a period of weeks, with the goal of working out for themselves the clinical problems that the patient presented. This fall he taught sophomores.

"The point is to reinforce the basic science the students are learning as freshmen," Wilson says, "and to help them see how it relates to situations involving patients. My job is to point them in the right direction."

The new model is quite a change from the traditional medical school experience, in which the first two years are strictly preclinical. "In my time, it was the third year before you started clinical work," Wilson says. "Then they just threw you into the den and you had to fight your way out. Introducing students to the clinic earlier on has merit, in my opinion. The students seem to enjoy it so much, and they put so much effort into it."

Wilson says he has greatly enjoyed meeting today's crop of medical students. They are bright, he says, with a lot to contribute and a genuine interest in things clinical.

"In general, though, this has not been so much a teaching experience for me as it has been a mentoring experience. I am helping them understand problems in such a way that they can solve them for themselves."

"Medicine is my profession, and I don't want to give it up. I realize that the full-time faculty, with their busy schedules and all the demands they face, might not be able to juggle all the things they are asked to do, at least not easily. That's OK with me. I'm glad to help out."

Darryl Gossett, a long-term member of the Emory Medicine staff, is now an editor with Atlanta's WebMD.

Historical information in this story came from The Quest for Excellence (Scholars Press, 1997) by Dr. J. Willis Hurst.