New Beginnings for D.O.s in California

Mitchell Kasovac, DO, interviewed by Dr. Michael Seffinger, DO

in Chicago, Illinois in Fairmont Hotel, at a AOA House of Delegates meeting
July 14, 2006

• Dr. Kasovac:  Hi, my name is Mitch Kasovac, DO, conducting a questionnaire and interview as provided to me by Mickey Seffinger. I was born on September 7, 1937 in Detroit, Michigan. We moved out to a suburb, Dearborn, Michigan when I was four years old and lived there for my time in the state of Michigan. I attended Dearborn High School from ‘51 to ‘55 and then went to Wayne State University from 1955 to 1959 in the premed course work. I matriculated to the Chicago College of Osteopathic Medicine in 1959 to 1963. Subsequently, after I graduated, I moved to Phoenix, Arizona where I did my internship from 1963 to 1964 at Phoenix General Hospital. My introduction to osteopathic medicine was through several fraternity brothers from a premed fraternity at Wayne State University. A couple of them had gone out to the Osteopathic school in Des Moines and several of them were at the Chicago College of Osteopathy. I talked to them during my senior year at Wayne State. I didn’t know anything about osteopathic medicine up to my senior year as an undergrad. I had applied to the University of Michigan Medical School and I was an alternate there. When I just happened to be talking to one of my premed fraternity colleagues out at the Des Moines school, I asked, “What is this osteopathy?” He explained to me about the principles and the osteopathic manipulation. He said it was an approach to patient care that maybe you wouldn’t have to write prescriptions for somebody or maybe you wouldn’t have to do surgery on a patient. It was another alternative choice, if you will, to taking care of patients. And it really appealed to me. I thought, “Wow, that’s so much less invasive than putting chemicals in their body or invading their body with a knife.” So I looked into it more. They sent me some more information. Then I drove out to the Des Moines school and to the Chicago school to see the campus and talked with others out there. I really liked what I saw. Chicago was a little closer to Detroit, so I ended up getting an application and applying to the Chicago school. I had an interview and within three weeks I was accepted. I knew where I was going and started there in the Fall of 1959. My past history as far as with California was none. I didn’t know anything there. The merger happened to occur in my senior year in 1962 and obviously it was being touted throughout the osteopathic profession and to all of us students that were in the other five osteopathic schools as to what was going on. That kind of got my attention and I thought, “Well this is terrible, if they are going to try to eliminate us, then we have got to fight back on this.” Well, after I graduated, I married in my senior year and my wife and I moved out to Phoenix, Arizona where I was going to be doing my internship from 1963 to 1964 and then I started my family practice in the Fall of 1964. Well, the merger in California had occurred of course and the counter lawsuit by the osteopathic profession in California had occurred and they were asking for support for all of their legal fees in order to fight this thing. So even though I was new and just starting in practice, I thought they need all of us out there in the profession to support this. They had set up a $65 fee in support of their legal fees because the $65 is what DOs had to pay to get a new MD license. So I thought that was a good tie. So I started contributing to that legal fund, I think in 1964 or 1965. And I did yearly until the whole process got reversed in 1974. When that happened in 1974 I was in practice with a colleague. We both made a commitment at the request of the DOs in California to go on out and get licensed in California. So we both went and got licensed in California in 1975. I had maintained my active California license up until a couple of years ago; since I’m retired I didn’t see the continuing need with that. But I’m very pleased over the years of that support that I gave. Then I had 15 years of family practice in Phoenix and then 9 years as a Director of Medical Education. Our hospital closed and we lost all of the education programs. I became the Medical Director at a new hospital we had, but it wasn’t what I wanted to do. I wanted to get into academia, and had an opportunity when Dr. Krpan became Dean at the College of Osteopathic Medicine of the Pacific (COMP) in 1989. He recruited me to be Assistant Clinical Dean at COMP because we were one of their major teaching hospitals through the 1980’s when COMP was first developing. So it was a wonderful career opportunity and I went to COMP. I moved to California in the summer of 1989 as an Assistant Dean of Clinical Affairs. This included contacting all of the hospitals, developing third and fourth year clerkships with other individual physicians. I also was charged with the development of post-doctoral programs (internships and residencies). Well, I was an Assistant Dean at COMP for six years, and then my last five years there, I was the Dean at COMP when we became Western University of Health Sciences. Dr. Krpan became Provost. But over those 11 years I made a lot of contacts and worked with hospitals all over the state; but I also worked with the states of Arizona, Nevada, New Mexico, Utah, Oregon, and Washington. We went all over trying to develop clinical training for our students and post-doctoral program development. I did a lot of work in California with ex-DOs who were MDs. They identified this to me when I would call on them, or meet them at a medical staff meeting, or an education meeting and they were very supportive of what was going on at that time in the 1990s. They were very supportive of training of our students at that time. That was very rewarding to me to see that they had to make their career decision way back in 1962 of what they thought was right, and to open the door for them to have some hospital privileges that they didn’t have because they were blocked out. So I respected that. But I also respected that they never forgot their profession and that they were willing to give back to our students today. Pertaining to my mentors over the years - probably, one of the first of my mentors was when I was a medical student at Chicago College of Osteopathic Medicine, that was Ward Perin, DO. Dr. Perin was head of Internal Medicine there. He also was really a wonderful primary care physician, had wonderful relationships with his patients, and taught the human side of what to be as a physician. There were other mentors, as I got involved in the profession through the House of Delegates with the AOA. I met Dale Dodson, D.O. from Minnesota who ultimately became president of the AOA. He was just a quality individual and a quality gentleman with the highest ethics and integrity. Those were things that I felt fit me, and he just encouraged more of that development. And my other mentor from the national standpoint was Joe Stella, D.O. from Pennsylvania. Joe again became a president of AOA and was an active member on the AOA Board of Trustees. Once I was on the AOA Board, Joe talked a lot about what had happened in California and what they were doing to make sure that same thing didn’t happen in Pennsylvania. He was very supportive of all the work that we had done out in California, and again was a fine osteopathic physician, following all of the principles of A.T. Still and with the highest ethics and integrity, which I loved. Challenges I’ve had over the years especially the 11 years that I had in California - the greatest challenge was to continue to develop a professional relationship with the MDs - those that were not only ex-DOs, but also the MDs that were active practitioners and educators in the state of California. I met with deans and assistant deans from medical schools. In order to gain some other interaction and put forward my own professionalism and to gain respect for the osteopathic profession, I joined the national Society of Teachers of Family Medicine (STFM) because I was at a school. I wanted to be involved with a group to help me develop my academic skills. I also joined the Association of Hospital Medical Educators (AHME), which was the MD counterpart to our AODME organization. Both of those organizations with their national meetings ultimately gave me wonderful interactions, professional respect, and development for our osteopathic profession. I hope I brought forward those qualities, if you will, to the people that I interfaced with. My advice to DOs in programs today is to maintain your osteopathic manipulative medicine principles and practices, and demonstrate your skills in OMM. No matter what specialty you are in, there are applications. Do it in all fields of practice, and do it as part of your patient care. Remember to bring those principles forward in everything that you do every day. One of the other nice things to do is to share it with other professional colleagues; with other MDs at the hospitals and organizations that you are involved with, nursing staff at the hospitals, other allied health personnel whether it is physical therapist, nurse practitioner, or physician’s assistant. All of it helps our profession grow. My advice to MDs in the training programs is that they have an opportunity to be exposed to osteopathic residents in their program and other osteopathic faculty members in their program. Then they will realize that we have a skill that they didn’t learn in medical school. They weren’t even taught it. It wasn’t even talked about, but we are willing to share. We were willing to share and we created courses for them to learn the principles and the techniques and to become proficient in those skills. I think it is a wonderful way to expand our osteopathic profession and maybe we can look at this and say, “We are willing to accept 126 medical schools once they put our principles and practices into their curriculum and we will make them all DO schools nationwide.” As to other documents or things to reference with this, I don’t have any thing else to tell you about, or anything to put forward. As to whom else in California do I know that was instrumental in the history of osteopathy, I’m sure you already have Ethan Allen, D.O. on your list and perhaps even Don Krpan, D.O. And I think they are excellent ones and Ethan particularly for the past because others have obviously passed away and are no longer available to us. Lastly, what else is there to do or talk about ‘osteopathy’ in California. I just say to all the DOs out there, and thank goodness we are into thousands that are out there now, ‘Go DOs!’ - keep up the good work and be professionals, ethical, honest, good patient care givers and continue to do all of the good work we have done over these years; and continue to maintain the respect and recognition that we’ve gained from the public as well as our colleagues in other professions.
• Dr. Seffinger:  Dr. Kasovac, before you came to COMP, weren’t you the President of the AOA. Could you tell us a little bit about that experience of working within the national organization? How long you were in it? How did you rise up to become the president and then when you became president, both as president-elect and the year after presidency? You do a lot of traveling to a lot of schools and you get to learn about the profession as a whole. I’m interested to know what you saw as a status of the profession in the 1980s nationwide, in comparison to what you saw in California; then when you moved to California and worked within there to build up California Educational system. Could you give us that perspective?
• Dr. Kasovac:  Yes. I had 16 years on the AOA Board of Trustees from 1977 to 1993. I was the national president from 1990 to ’91, so July ’90 to July ‘91. I have to say that my going to COMP and being invited to come over as an Assistant Dean, they knew I was in line for a nomination. But the Dean and the President of this school were willing to support me in my time away to work for the profession nationally and I really appreciated that. Part of what I saw, I think of difference in the ‘80s, was when I became involved in the education with the hospital in Phoenix. COMP had started its first class in 1978. Then in 1980 their first students were out on clinical rotations. They only had one hospital in California that they could go to. I believe it was Pacific Hospital of Long Beach at that time and us, Phoenix General Hospital. They had to come out of their charter class of 36 students; there were maybe 32 or 33 by third year. I took 10 a month in Phoenix, and if they didn’t have us as a teaching hospital there would have been a lot of struggles. Now, I think there were a teaching hospital up in Washington, one in Mesa, Arizona, and one in Tucson, Arizona. I think there may have been some students going to those sites also; but we know that we were a major teaching hospital in Phoenix early on with COMP. Part of that reason was it had only been a few years from when the legal argument and everything had been reversed in 1974, and then this school starting in 1978. Well I don’t think that the attitude of the MDs over in California had changed at all. They were upset that the legal system had reinstituted our profession and licensure and everything else. ‘Now they are coming to start a school! Oh my God, well we are not going to have them come to our hospitals.’ Well, I think as time matured, as more discussion of the DOs that did remain in California took place, and in working with their MD colleagues including the ex-DO/MD colleagues - we were able to make some inroads to other institutions for clinical clerkships and so forth. That took several years to do, I don’t know exactly but my guess would be 5 to 8 years for that kind of maturation. When I went over there in ’89 and began more work in this clinical area, there was still a limited amount of clinical opportunities in California for the students from COMP. At that time we were up to class size of 100 and it went to 125, but there were struggles throughout and we had to maintain contacts with DOs and other osteopathic teaching hospitals in the western states, because without them COMP wouldn’t have survived. It would have had a hard time and they would have had to cut back class size and then ultimately not been able to develop into Western University of Health Sciences and all the professional schools that are with that. Yes, there were a lot of differences and a lot of changes that I saw from those two decades of the ‘80s and the ‘90s and today’s world. The willingness, you know. As I mentioned before, Dr. Krpan and I had contacts, social chatting, as well as professional discussions with Deans and Associate Deans of UCLA, USC, UC Irvine, UC San Diego, UC Davis, and San Francisco, etc. I mean we contacted all of the other MD schools in the state, the University of Washington, Oregon Health Sciences, and the University of Arizona Med School. We made contacts where we could, trying to be professional and breaking down some of the barriers in the process. Ninety percent of it didn’t work, but the ten percent that did, gave us a foot in the door. Then others heard about, ‘Gee, the performance of these DOs, wow! Whatever they’ve done, you know, it’s different than what we knew 30, 40 years ago.’ Also, I think a lot of that was the newer generation of academic administrations in those schools who were of our vintage. They were not of the vintage of the people when all of this happened in the ‘60s. They were graduates from medical schools in the late ‘60s and into the ‘70s, and now in the ‘90s they are Associate Deans, and Deans of medical schools. They knew about what had happened, but they weren’t involved with it. They didn’t have negative attitudes or anything else and many of them trained in their residency program with DOs as fellow residents. They had a lot of respect for the education, the training, and the abilities of the DOs and respectful of the osteopathic manipulative skills of the individuals; particularly where it was used more in family medicine and the primary care arena. Whatever, it was an acceptable thing. So I think that was very helpful.
• Dr. Seffinger:  So when you came to California you went to the presidency? You became president of the AOA while you were at COMP then?
• Dr. Kasovac:  Yes, my first two years.
• Dr. Seffinger:  Then you were the first president from California since before the merger. The last president, I think was in 1951 or so, that came from California. But there wasn’t obviously anybody after ’62, and then there wasn’t anybody from California until yourself then and following you about a decade later maybe with Dr. Krpan, right?
• Dr. Kasovac:  Yes.
• Dr. Seffinger:  I thought that you were coming from the Small State Society or from Arizona Coalition.
• Dr. Kasovac:  Arizona claimed me and the Small States Society supported me.
• Dr. Seffinger:  Now how did that work that you didn’t get claimed by California?
• Dr. Kasovac:  Well, I had been in Arizona from ’64 and it was ’89 that I was going to be transitioning over. So it was July 1, 1989 that I was going to COMP and the AOA House of Delegates was meeting, like, 10 days or 12 days later, and Arizona had already put my name forward as a nominee for President Elect of the AOA. That happened in July of ’89 all-be-it I had relocated over there. But they wouldn’t give credit to California. They weren’t going to give it up. And I said, “Well, but I’m over here, its okay, I’ll take co-sponsors,” and they said, “No, No, you have more time here,” and it was true. They are the ones that put me in the AOA House of Delegates in 1972. It was because of Arizona and one of the Arizona AOA Board members back in the ‘70s, Harmon Myers, D.O. He was on the AOA Board and they approached him in 1977, I think, during that ’76 -’77 year about moving up, and he said he couldn’t. He couldn’t take the time necessary away from his practice and thanked them very much and said his term was going to be up in ’77. He was going to go off the board so the political process at that time asked him, “Well, is there anybody else you think might be interested in Arizona.” Well, I had just finished my Arizona presidency from ’74 to ’75 and I had made a commitment to my family that I wouldn’t stay involved in politics for another five years in order to give time back to the family. Then when that phone call came for the national opportunity, we had family discussion. I had a lot of support from my wife as well as my children to proceed with it, so I did. That’s when the 16 years on the AOA Board started. I have to tell you also during this time of the ‘70s and ‘80s I had 19 years on the Chicago College Osteopathic Medicine Board of Directors. I started in ’72 because I was President of the Alumni Association. As President of the Alumni group we had a seat on the Board of the school. I had that office for two years. I sat on the Board for two years then got elected to subsequent three year terms. I ended up there, I think, until 1991 when I went off when I was finishing my presidency with the AOA. It was just too much. I said when they got someone else to take my place I was willing to step away. But it also helped me a great deal by learning and understanding all of the administrative decision making and things that go on, not just with the school, but we had one hospital and we built a second hospital. In later years I was Chairman of our Board of the hospitals because we had a separate board when we became Midwestern University. I chaired that for a couple of years besides sitting on the College Board, as it gave me additional professional growth, if you will, in understanding of things so that when I was at COMP and going out to hospitals, when I talked to an administrator or some other board member at a hospital about teaching programs and so forth, I had some background. I could speak to issues that I thought would come up in their mind and have answers for them or explanations.
• Dr. Seffinger:  And then when you visited other schools and other states as AOA President, around that time you could obviously see the difference between California’s status of education and training and the rest of the country. Now before the merger I understand California had one of the more advanced training opportunities at the County Hospital in Los Angeles and a lot of residencies and things. It was a matter of building up over a matter of time. It was obviously decimated. But in the other states at the same time, and after 1975, everything built up and they had tremendous opportunities elsewhere. I believe much more so. Can you give us that perspective of what it looked like in the ‘80s and ‘90s compared to what it was in the ’50s and ‘60s, you know, when you started out?
• Dr. Kasovac:  Well, in the ‘50s and ‘60s, as we all know, the hospital I was with in Phoenix, and all other osteopathic hospitals were built by DOs because everywhere in the country DOs were not allowed on to MD hospital medical staffs. They were just blocked. So the DOs banded together, the surgeons, the internists, and the family practice docs. They put their own money up (they put their own financial papers up) and got the loan money (hundreds of thousands of dollars) to build the 50, 75, 100 bed hospitals. Then those hospitals grew. When I interned at Phoenix General in the early ‘60s, it was a hundred bed, one story facility. Ten years later we were a 300 bed, five story facility; and subsequently built a second satellite hospital. We had the first urgent care center in town and then developed three more after that. Also, along that time and into the ‘80s, it was happening elsewhere in the country in our profession, the expansion of our osteopathic hospitals that were there. Then all of a sudden some MD hospitals started to lose their occupancy; not enough MDs; not enough patients coming in. Looking like it was going to close; they opened the doors to DOs. They helped to proliferate the growth and development of additional hospitals for osteopathic physicians. You know, I saw that in various states, mostly in the bigger states where we did have a lot of osteopathic hospitals, but there was a growth of DOs in those states, like Michigan, Pennsylvania, and Ohio. So there was room in not penalizing osteopathic hospitals. If DOs got on the staff of another hospital, it was okay. One of the reasons is that the osteopathic hospitals were 110 percent full. You couldn’t get another patient in even though that was your primary hospital. When you had the opportunity to be on staff at a second hospital, well you knew you had a back up if you couldn’t get somebody in the osteopathic hospital; you could get that patient in there. You didn’t lose the patient because they were so critically ill; you just had to get them to some MD to get them in another place. You could still follow that patient; you could still take care of them. So some of that occurred and probably much of that was more in the ‘70s, but even into the ‘80s. Yes, there is a lot of history with them. Then again as you say in the AOA presidency, in getting around to the various states, I had opportunities when at state conventions to know a doctor or two in that state. They would say, “Come on let me show you our hospital, it’s just down the street here from this hotel.” So I would see some of the osteopathic hospitals They were wonderful sites and places that grew from nothing because the DOs made the commitment. They put up the money, built them, supported them, and made it happen because they had to. There was no other way. There was a lot of pride in the profession back then, as there should be. It was tremendous. Also going around to the schools and seeing the schools that were back in the original batch with the California one originally being the sixth school. Des Moines, Kansas City, Philadelphia, Chicago and Kirksville were wonderful schools and they were looking at growth. There was a lot of publicity as the California merger unveiled, and the legalities of it. There were many newspaper articles across the country. I don’t know how I want to say this, but it banded the DOs in the country together. They said, “Hey, we won. It’s not going to happen anywhere else. We are going to go forward. We are going to grow from here.” I think we saw the schools start to expand. Then all of a sudden we had this other new school in Michigan, at Michigan State University, and I think that was in 1969. It was before the California thing was over. Well, they were the first one of 10 schools to develop in a 12 year block from ‘69 to ’81. We had ten new schools with the five that had existed, and of course those 15 schools today, have grown to 23 with another five or six on the drawing board in the next several years. So we are growing in a very vitalistic profession with a lot of excitement and opportunity.
• Dr. Seffinger:  It appears that your career has seen this tremendous growth in the profession where it started out seemingly decimated, you know, not to exist perhaps, even by the time you graduated to tremendous growth and expansion and success. So that sounds like a wonderful life.
• Dr. Kasovac:  It has been.
• Dr. Seffinger:  Thank you for sharing with us.