Carl Robert Bogardus, MD, FASTRO
By Paul Wallner, DO, FASTRO
In 2004, ASTRO established the History Committee for the purpose of documenting and recording the history of radiation oncology in the United States. This interview took place in Oklahoma City on April 22, 2004.
Question: This is Dr. Wallner, the date is April 22, 2004, and I am on the phone with Dr. Bogardus, in Oklahoma City. Bogardus has graciously agreed to be interviewed for the History Committee’s oral history. Bogardus, thank you very much. There’s a question that’s always occurred to me, it’s Carl R. Bogardus Jr., when did you pick up the nickname “Bob?”
Dr. Bogardus: This came about in the early years in my life because I am junior as you can see, and my father always went by Carl, so the next obvious thing was to call me Bob. My son is Carl Robert Bogardus III, and we call him Robert.
Question: Okay. Was Carl senior a physician?
Dr. Bogardus: My father, Carl Robert Bogardus Sr., MD, was a general practitioner. He started out practicing in the little town of Hyden, Ky. It’s in the southeastern section of Kentucky, a coal mining community. Dad went there as payback from the state of Kentucky. When he went through medical school, he had financial support from the state and, as a consequence, he had a payback time to do for the State Health Department. He worked as the county health officer for a period of three years in this small coal mining community to pay back his time that he was supported in medical school. While he was there he met my mother, got married, and I was born in Hyden, Ky.
Question: In your childhood had you thought about medicine in your career?
Dr. Bogardus: I grew up in a household with a general practitioner as my father. I can remember Dad getting up in the middle of the night and going out to deliver babies or somebody would be banging on the door at night, “Hey Doc, I’ve got a problem,” and he would just see them at any hour. As I got older I would go with him on a lot of these night forays, and I was helping him deliver babies by the time I was 15 years old.
Question: And did you ever consider obstetrics or general practice?
Dr. Bogardus: No, that was enough to cure me right there. I worked in the office with him. I would help him, doing things that today would just be unthinkable, but as a teenager I would help him do drip ether anesthesia while he was doing local procedures in his office.
Question: So you literally came to medicine genetically.
Dr. Bogardus: I came into medicine genetically and learned from the ground up. By the time I hit medical school I already had a pretty extensive clinical career. I was one of the few medical students in my class who had even been an assistant, much less having done a delivery.
Question: You graduated Hanover College in 1955. Can you tell me a little bit about some of those years?
Dr. Bogardus: Hanover College was a small school of about 500 students in the little town of Hanover, Ind., on the Ohio River. It was about 20 miles from where I grew up. The reasons I chose Hanover were: first, it was close, second, it was a liberal arts college and had a lot of things I wanted, and third, and probably more important, Dad was a graduate and supporter of Hanover, so it was all very favorable. When I went there it was with open arms, “here you are and let’s see what we can do for you.” It was a great experience. I enjoyed those four years.
Question: Was it co-ed?
Dr. Bogardus: Hanover was a co-ed school with a broad curriculum. I graduated from Hanover with majors in Chemistry and Physics, and I had a minor in Geology. I took all kinds of interesting courses. From Hanover, I went to the University of Louisville School of Medicine, where I graduated in 1959.
I chose the University of Louisville Medical School again following Dad’s footsteps. He was graduate and long time supporter. I was accepted at Indiana and the University of Louisville.I didn’t apply any place else, in fact I never really thought about applying any place else; I applied to Indiana as a back-up, but there was never any problem. I was accepted at the University of Louisville and thoroughly enjoyed my time there. It was a hard school with the usual tough medical school professors in those days. I worked my way through school without any real problems at all.
I was married in the second year of medical school.
Question: Did you find that difficult for medical school?
Dr. Bogardus: It really wasn’t, about 15 in our class were married. There were three of us who were, and still are, close friends starting out as freshmen, and all three of us got married at the same time and lived within a few miles of each other. We all finished school that way and had kids and did all the things you’re supposed to do. It really worked out very well for us.
My first year in medical school was spent doing the things you had to do to survive the first year. We had two-and-one-half months in the summer to do whatever you wanted to do, you had the summers off. Everybody in med school tried to find some medically-related job. I had a great interest in electronics, mechanics, electrical things and a good background in physics. The professor of biochemistry had inherited an air-driven ultracentrifuge as military surplus, and he wanted that ultracentrifuge for his research work, but there wasn’t anybody who could figure out how to put it together. It was just this giant crate of parts and no instructions. I spent that entire summer assembling that air-driven ultracentrifuge and its optics and got it working. After the summer project I worked during the winter while I was going to med school in Schlieren Optics where we would look at optical interfaces as we were spinning down organic compounds. I never found this particularly interesting as a long-term career, but it was fun work.
In the spring of my sophomore year I still wasn’t sure what I wanted to do. There was nothing else in biochemistry because the centrifuge was running, and so I had worked myself out of a job. I was walking through the basement of Louisville General one morning and went past an open door. I looked at the really neatest machine I had ever seen, and I realized it was doing binary counting. I went in and talked to the professor who was running it and he said yes, you’re right, this is a binary counter. You know what that is? I said yes, he said, do you want job this summer? I’ll hire you because you knew that you must know something about radioisotopes. This was the new science of radioisotopes. A nuclear medicine laboratory had just started at the University of Louisville, and the professor who was head of it was Patrick Cavanaugh, MD. Dr. Cavanaugh was the head of radiation therapy and nuclear medicine (one of the subspecialties of radiology). He said if you want to work with me next summer we can pay you, and I’ve got a project I’d like you to start with; the project was to build a rectilinear scanner.
I built the first rectilinear scanner in Louisville. I even cast the pinhole collimator for it and built the printout device for it and the machinery to make it work. That scanner ran for a couple of years just scanning thyroids, but it worked perfectly for that. Later, they bought a new nuclear gamma camera, and then my machine disappeared into scrap. That was my introduction into radiation therapy, it was fun, and the more I worked with it the more interested I became. There was a hospital in Louisville that had a Van de Graaff generator, and the physics staff at the University of Louisville kept the Van de Graaff running. The Van de Graaf was a very particular machine, and it tended to break frequently. When the Van de Graaff would be down we would have to fix it. That was really fun, taking one of those apart, repairing it, replacing belts, resistors, whatever it took to get it running. At that time, I was really more interested in the mechanics of radiation therapy than I was in treating patients. But, I felt that this was really a breakthrough in cancer treatment, so I took an elective in radiation therapy.
As I worked more and more with Cavanaugh, he said, “You’re a natural; you really need to go into radiation therapy.” I understood the equipment; it was really equipment and physics intensive in those days. Cavanaugh was a graduate of del Regato, and he said he could get me into del Regato’s radiation therapy residency. Initially, I didn’t know who del Regato was, but the more I read, the more I realized that if I was going into a residency I needed to go into this residency. I made an application, got accepted and that was the reason I ended up at Penrose, and just to save myself travel,; I did my rotating internship out there also.
The program was fantastic because what I ended up doing there was working with del Regato, Chahin Chahbazian and the others who were residents at that time:
· Bob Lindberg
· Victor Marcial
· Jerry Vaith
· Frank Wilson
· Jim Cox, just to mention a few
Del Regato was a very clinically-oriented physician, he believed in patient care and the examination of the patient to make your decisions about what you’re going to do. He never allowed us to label a patient a name of a disease or a number. We would never say, I’ve got this prostate patient, it’s not a prostate, there’s somebody attached to that, and he would chastise us badly if we talked about the case related to what it was. We always had to do a full evaluation. Every patient had a total workup, top to bottom, and he always said you will be amazed at what you will find if you start looking outside where the cancer is. I still find this to be true even today. Many physicians don’t look at the rest of the patient. Del Regato always taught us to do that. Those years at Penrose were really fantastic. We had the opportunity to meet with those I consider the big names at the time (Fletcher, Buschke, Kaplan, Powers, Lampe, Kramer); anybody you could name in that era came through Penrose at least one or more times when we were there, and they would spend many days with us, lecturing to us, talking with us, and it was really a one-on-one because in the country there weren’t that many radiation oncologists or residencies.
Question: What kind of equipment did you use?
Dr. Bogardus: When I went there the first year, I was there as an intern, and they were installing the Eldorado cobalt unit. In Louisville it was called a cobalt bomb. Del Regato never like that term: he said that this term is way too destructive, he said this is to cure patients, he said it is a cobalt therapy unit, and he said it was an Eldorado mercury shutter machine. The machine’s shutter mechanism was a pump that moved liquid mercury into a chamber to seal off the beam and when you turned the machine on you would pump the mercury out of the chamber. In my second year of residency one of the hoses broke and all the mercury ran out of the machine, which then left the source exposed and the mercury all over the floor. It was a few weeks before they got that fixed. There weren’t very many of these machines built that were mercury shutter units.
Question: Did you have other equipment?
Dr. Bogardus: We had a GE 250 kvp and a superficial unit, and about the second year, I was there when they put in a GE resonant transformer 400 KEV unit, which was a pretty good piece of equipment.
We had a huge supply of radium; del Regato was a great believer in radium, and we treated many patients, especially cancer of the cervix, skin cancer and head and neck cancers. Radium was used as the boost almost always, no matter what we were treating; if we could get to it with a radium application, we would do it. We had a fantastic radium experience.
Question: Do you think del Regato or any of you at that time had any sense of where the specialty was really going?
Dr. Bogardus: Del Regato was a visionary, and he was one of the early pioneers who actually came into radiation therapy as a radiation therapist. He did not come in as a general radiologist, which many of the other “dinosaurs” did; many were general radiologists who specialized in radiation therapy. Del Regato always felt that this was a true specialty and it should be treated that way.
Question: So he had a sense of where it was going?
Dr. Bogardus: He knew exactly where the specialty was going. He was instrumental in forming the American Club of Therapeutic Radiology, which was the first gathering, officially, of as many radiation oncologists from North America as were practicing at that time. He was instrumental in making those club meetings occur because he knew, from the beginning, that this would be a driving force in organizing radiation therapy as a specialty.
Question: 1963-1964, you were a fellow at the Mallinckrodt Institute of Radiology in St. Louis. Why did you do that, and tell me a little bit about your experiences there?
Dr. Bogardus: In those years the residency in radiation therapy was three years, and you could go out and work after three years. Del Regato said you should take an extra year but you can’t take it here, you need another experience. So, I went to The Mallinckrodt Institute of Radiology in St. Louis. Mallinckrodt was an interesting experience; St. Louis itself was not where I really wanted to go after living in Colorado Springs, but it was a fun place for a year. I went there on the recommendations of Bill Powers. Bill had talked to us many times, and Bill was a gadgeteer like I was; he liked to build equipment. He liked to build new machines. A lot of people don’t realize this but Bill was probably the person who was instrumental in developing the multileaf collimator, the first MLC that I ever saw Bill Powers had developed and was using in Detroit. It had eight moving leaves on each side of it. He was predicting what a great device this was going to be someday. He and I both enjoyed building things and building appliances, so I thought this would be a great year. So I accepted the fourth year fellowship. Shortly after I got there Bill resigned and went someplace else, so I was left wondering, what am I going to do now? Fortunately, Michael Ter-Pogossian was there, and he was a superb physicist, and it didn’t take me long to gravitate to physics. I spent the first six months of my fellowship doing radiation physics. We developed some new scintillation probes for central body reading of radiation doses primarily around the cervix. We designed the first computer program to actually calculate radiation doses instead of doing them by hand, then Bill came back, and I spent the rest of the year doing clinical radiation therapy. Carlos Perez was a fourth-year resident when I was there, and Carlos and I became good friends. We shared a lot of patients together.
Question: Who were some of the other people there at that time?
Dr. Bogardus: Actually, Carlos is the person I worked with the most in radiation oncology. There were other general radiology residents going through there, but none of them stand out in my mind.
Question: The philosophy of patient management, cancer management, was significantly different at Mallinckrodt than it was at Penrose?
Dr. Bogardus: Penrose was a very clinically-oriented program, whereas at Mallinckrodt, it was you take care of the patient, get the work done and get on to the next patient. There was a lot of basic radiobiology research being done. Bill was really big on killing mice. I mean we killed thousands of mice the year I was there. A lot of good basic radiobiology work was done.
Question: Now, following your experience with Mallinckrodt, you turned up at the University of Oklahoma. Tell me how that happened.
Dr. Bogardus: As I was finishing my year in St. Louis, Bill was in the process of resigning, again, and I wasn’t so sure that I wanted to stay there. It was up in the air as to who actually was going to be running the department. They wanted me to stay on and they offered me a salary of 16,000 dollars a year to stay there on faculty, coming from 9,000 dollars a year from the fellowship, this was a good raise. Then the University of Oklahoma was looking for faculty, and they offered me 18,000 dollars a year, so I moved. I was just that simple. At the time, it seemed like a much better offer. Sy Levitt was Director of Radiation Therapy at the University of Oklahoma, and we had previously met at RSNA, so I came to Oklahoma, spent a couple of days here and liked it. The University of Oklahoma was a very friendly school. I met the dean, who said, “We’ll support you and do whatever we can do for you.”
My first year in Oklahoma, I was an assistant professor, an associate radiation therapist and a section chief of radioisotopes and nuclear medicine. When I arrived, the University of Oklahoma did not have a nuclear medicine program at all. One of my expertises was nuclear medicine; I had worked in nuclear medicine in medical school. As a resident, I helped develop the nuclear medicine program at Penrose; Mallinckrodt already had a very good isotope program. So I designed the first radioisotope program at the University of Oklahoma as the section head of nuclear medicine.
The Radiology Department at the University of Oklahoma was called the Department of Radiological Sciences, made up of sections; nuclear medicine, radiation therapy and diagnostic radiology. I headed the section on nuclear medicine, which I did for quite a few years, until it eventually got to be such a big operation that I could not do that and radiation therapy together. I eventually turned the nuclear medicine duty over to an internist as the chief of nuclear medicine.
ASTRO: As a resident of del Regato’s we were associate or junior members of the American Society for Therapeutic Radiology; we couldn’t become a full member until we became practicing radiation therapy physicians. All of us were expected to become members of ASTR (as it was then called). So we all became members of ASTR during its formative years. It was del Regato, myself and a few other people who organized that first meeting at the Mountain Shadows Resort in Scottsdale, AZ. In 1968, I was the secretary of ASTR at that time and was responsible for making sure all of the arrangements for the meeting were in place and everything worked out. Del Regato was a major driving force behind organized radiation therapy. As Del Regato was trying to get that first meeting together, everybody who was really doing radiation therapy in the U.S. was invited to that meeting. This first meeting was very, very informal. I remember the scientific sessions were held around the swimming pool, and there was no real structured program at all that first meeting. There were topics that were suggested, and we talked about breast cancer and head and neck cancer. Simon Kramer was there talking about a new project that he was trying to get off the ground called RTOG. Dr. Fletcher and Del Regato would always get into arguments because they would never see things the same way and the more heated the argument got the more they spoke French, but it always ended up that we came to conclusions. I think a tremendous amount of interchange took place, and the residents and faculty who were there really profited by our experience.
The meeting was both clinical and scientific. People talked about some of their new research projects they were doing. Dr. Kramer was talking about what he was doing with methotrexate, the RTOG and all of the new techniques we were trying with radiation. We heard new and exciting ideas regarding the treatment lymphomas from Kaplan and head and neck cancers from Fletcher. We talked about residency programs and what ought to be included in them and how the training should go. Reimbursement was never an issue. Nobody ever talked about how they were going to be paid for all we did because almost everybody there was from an academic institution and didn’t worry about that. Del Regato was not interested because we never charged for anything we ever did in Penrose. It was all supported by Penrose Hospital and donations. You never sent a bill for anything, it just wasn’t done.
Question: Fifteen years later you became the president of ASTRO.
Dr. Bogardus: ASTR grew to ASTRO. The meetings got bigger every year, each bigger than the last, and each one of them became more of a project. In those years I became very actively involved with the ACR much more so than with ASTRO. As ACR was growing, ASTRO was a piece of the ACR. As a piece of the ACR, ASTRO was carried right along with them. I know and remember Nick Croche, Otha Linton and Sheila Aubin and others who would blend the ASTRO meeting with the ACR. All of the arrangements for the ASTRO meetings were done through the ACR, as they were managing ASTRO. So, we were basically wed at the hip for a long period of time until the ACR and ASTRO finally went their own way.
Question:In 1991 and 1992 you were president of the American College of Radiology, now how did you feel in that position as a radiation oncologist?
Dr. Bogardus: My working with both the ACR and ASTRO put me in a unique position. It was unique because I was one of only two radiation oncologist (Roy Deffenbach was the other one) who has been president of the ACR, and I am the only one who was president of both organizations. It was challenging and hard work, but very rewarding.
I could see that there were problems on the horizon. In my presidential address at ASTRO I really pushed hard that as radiation oncologists we need to stand firm with the ACR. I felt that we could not go forward by splitting these two societies apart at that time. I realized that if we lost the clout of the ACR, radiation oncology simply did not have enough political horsepower to be able to carry some of the key elements forward in terms of reimbursement. It was clear to me that reimbursement was going to be the key to survival of radiation oncology and, in fact, it has been and still is.
ACR: In 1973 I was president of the Oklahoma State Radiological Society; I then formed the Oklahoma State Radiation Therapy Society and was president of that group also. I was very politically active in the state. I pulled all of the general radiologists, diagnostic radiologist and radiation oncologists together as the Oklahoma State Radiological Society. I formed the first of our scientific meetings, put the programs together, brought in national speakers and brought in diagnostic radiologists and therapeutic radiologists to speak at these meetings and as a consequence became more and more politically involved. I was elected as councilor for the ACR from Oklahoma in 1979. T.J. Brickner and I had known each other since he moved to the state, and we worked together through those years trying to make the meetings work and working on the socioeconomic aspects of radiology. All this led me into the inner circle of the American College of Radiology going in as a councilor and then on to the council steering committee and just working my way up through the ranks of the ACR until I finally became president.
Question: Now the American College of Radiology created the relative value system tool in radiology before it was created for the rest of medicine. Can you give me a little bit of the background of why that happened, how that happened amd what the philosophy was of sort of leading way?
Dr. Bogardus: RVS:My earliest involvement with the financial aspects of radiology and radiation oncology started with the ACR supplement number two published in 1975. That was the first of what now we now call the user’s guides for radiation oncology. In the fall of 1973, Morris Wizinberg, Dale Fuller, Robert Moreton, myself and a few other others met in Chicago and devised the first codes that we thought would be appropriate for radiation therapy. Earlier that year, HCFA had contacted the ACR and said, “You are wasting an enormous amount of time doing billing a hundred different ways, and we’re spending way too much money trying to figure out what you’re doing. You need to standardize what you’re doing or we’ll standardize it for you.” That was a challenge. This committee met, and we developed those first codes. That was my intro into putting together the whole system. Once that had happened, every year as more and more procedures developed in radiation oncology, our committees developed more codes. We worked with everybody that we needed to work with. When Chaio, MD, came on the scene, he was just someone we needed to work with to develop the RVS system.
Working with Dr. Chaio was an interesting experience. It was obvious to us that when Chaio got into the RVS problem. the more he realized he was in a lot deeper that he really wanted to be. I think he was set up to put together the relative value system the way the Feds wanted to put it together. Chaio finally took everything almost verbatim that we had designed and made the relative value system fit that. It was very fortunate for us, and for all of radiology, because we had done our homework upfront, and what we put into the RVS was very accurate and actually was what we wanted. I think the system worked better than any of us would have anticipated in the beginning. Jim Morefield and I had these discussions many times; Jim was worried about the diagnostic side, I was worried about the therapy side of it, and we were all worried about what was going to actually happen to reimbursement. We knew we (radiology) were the first group that was going to be the test group to fill out the relative value system, and we actually came out in pretty good shape value wise. We were able to develop a system that worked internally really quite well. We compared the work of a simulation to a chest X-ray to an IVP and were able to come out with values that we felt realistically valued all the procedures. We put a huge amount of work into that process.
Jim Morefield and our colleagues on those committees were clearly visionaries and even prophets. There was some opposition within the profession in radiology and radiation oncology. In the beginning there was opposition because people were billing on the usual and customary system, some were making a lot of money off the UCR system because they had gotten in early and were billing high values. Medicare would establish your profile, then they would literally pay whatever you were billing. There were others who had no idea how to bill and realized the RVS would probably help them. Many groups and individual physicians were sharing numbers (illegally under the rules of the FTC) with those of us on the committee, so we were able to see huge differences in what people would bill from one practice to another. What the RVS was designed to do was equalize payment, so everybody across the country was billing the same amount and receiving the same amount of payment for services. I think it has worked out very, very well; we came out far ahead of where we would have been if it had been left up to the government to design the system. The RVS system has been fully accepted, and new physicians coming into the specialty probably will never realize where it would have been if it hadn’t been worked out this way.
Question: Now 40 years in retrospect after those glorious days at Penrose, how do you see the specialty? How do you see training programs, practice, and what are some of the important issues you think are facing us today?
Dr. Bogardus: The specialty of radiation oncology has grown phenomenally over the past 60 years; all you need to do is go to an ASTRO meeting, it is a huge international meeting, unbelievable. None of us could have foreseen this trend of growth when we were sitting at Mountain Shadows. I can remember a few years into our early ASTRO meetings there were heated discussions about whether we should have vendors come to the meeting. We now realize meetings wouldn’t be near the magnitude they are now if we didn’t have the vendor participation. They are an integral part of radiation therapy, and vendor scientific support is very valuable. This is really where the specialty should be.
TRAINING PROGRAMS
Question: Do you think there’s anything significantly different we should be doing in training programs or in development of our practices at this point?
Dr. Bogardus: I think we lost sight of programs with strong clinical emphasis. Most of the training programs now place heavy emphasis on research and radiobiology. All of this is very important, but there are a lot of physicians who want to be clinical-based; they don’t care that much about basic research and radiobiology, they just want to take care of patients. That’s one of the reasons why the program at the University of Oklahoma is strongly clinical-based; we didn’t have the resources to invest in enormous research activities. You need physicians to train physicians to take care of patients. I would like to see more of these type programs.
Question: Can you, off the top of your head, give me names of five or six people who had the most impact on you, radiation oncology, your career and on the specialty?
Dr. Bogardus: The past leaders … if you started at the top of the list, the following are the fathers of modern radiation: Juan del Regato, Gilbert Fletcher, Henry Kaplan, Bill Moss, Mort Kligerman, Simon Kramer, Bill Powers, Franz Bushke, Edith Quimby, Harold Johns and Phil Rubin, and then you just go down the list. From there, you begin to find people who are my generation, and here we’ve got a list of about 20 or 30 people who have continued what these first individuals started. A handful of physicians really began this specialty and pushed it where it needed to go. These are the people that drove the specialty; they’re the ones who trained the residents and set the standards.
HOBBIES AND OTHER INTERESTS
Question: Now in going through your CV, you have what I think would surprise many people: in addition to a significant body of scientific, academic publications and presentations, one of the things that fascinated me was a number of articles on model railroading and socioeconomic issues.
Railroading, tell me a little bit about that.
Dr. Bogardus: I’ve always loved railroads. My first recollection of a train was when I was just over a year old, Dad was in practice in rural Kentucky, and the back side of our house abutted the main line of the L and N Railroad, and I can honestly remember seeing trains go by. I’ve always liked trains, and I’ve always had trains. I still do model railroading; I am certified to operate full size trains at a number of railroad museums across the country. It’s my hobby. I don’t play golf or tennis. Everybody has to have something where you can go and retreat to that place and leave the world behind. And yes, I’ve written numerous articles on railroading.
I have always had a very strong interest in the socioeconomic aspect of radiation oncology. Starting from the first ACR Supplement in 1973 and the Users’ Guide in 1980, through the tumultuous years of RVS, to the present day, continued stress on documentation and correct billing. This has been my passion. I have written extensively about reimbursement issues, and my present Users Guide was first published in 1995 to fill in a void in information during the 10 year hiatus between the early ACR user’s guides and today’s ASTRO Guide. The ACR published three versions of the earlier Users Guide, the last was 1989, and a further guide was never published, but drafts were widely disseminated as User Guide 1993. The ACR/ ASTRO Guides and my cause now have taken on a life of their own.
IN SUMMARY
Question: Now we’ve sort of freewheeled over a lot of issues. Is there anything else you would like to add, anything specific that we haven’t talked about or advise that you can give young people in radiation oncology or who are considering radiation oncology? Or where do you see us going within the next generation?
Dr. Bogardus: I really think that radiation therapy is a marvelous specialty and looking back on my career I would not have done anything differently. I always knew what I wanted to do, which is unusual. By the time I was a junior in medical school, I knew where I was going. Many people don’t find out until later, and so I was blessed with the fact that I never wasted time doing another specialty. I would not change what I do now. I have always really enjoyed taking care of patients, and I still do. I’ve got a very active practice and, hopefully, I can go on for a few more years. I am 76 years old this year, and I still carry a full clinical load.
Question: Do you have any sense at all, premonition, where we’ll be in 10 years or 20 years?
Dr. Bogardus: I don’t think there’s any doubt that radiation therapy will always remain a key element in cancer therapy. Time and science may provide the magic silver bullet. We know there are over 120 different kinds of cancer, and you’re not going to find a way to cure all cancer. It’s like saying you’re going to cure disease. Radiation therapy is still the most cost effective treatment that we have today to treat malignancy and still preserve natural function. It’s a specialty that is critical to cancer management. What we’re doing will always be needed. It’s a method of treating a disease (cancer) that is going to be this nation’s number one health problem in another few years. Modern medicine is combating so many other diseases that patients will live long enough to get a malignancy and often more than one. It’s going to be up to us, radiation oncology, to cure these people.
Question: Do you see any significant problems for the future?
Dr. Bogardus: Problems have always been with us, and this won’t change. The problems will be new and different, but solutions will be found. There may not be enough radiation oncology physicians over the next few years completing training. Right now, there are many openings for staff, but it is hard to find good, qualified staff to work with. Most people are finding good jobs. Part of what I’m doing now in my career is looking at programs, looking at individual departments and practices. Good people will always gravitate into this field, but to do quality radiation oncology you’ve got to be a little bit smarter than the average physician.
Question: OK, anything else you’d like to say for the record?
Dr. Bogardus: I’d really like to see us go back to the family practice bedside manner of taking care of our patients; to take the time to see a patient the day they’re referred to you. To spend the time with the patient; to take 20 minutes, take an hour, take two hours, whatever it’s going to require; talk to the patient, talk to the family. When you’re done, you know what the problem is, and the patient bonds with you and knows that you’re a doctor who is going to take care of them. The patient is not just a number, not just a disease but a real person with a big problem that you may be able to fix. That’s a feature that we cannot lose track of, and I think probably, overall, radiation oncologists do this very well.
Question: Well, thank you very much. I want to especially thank you for your graciousness and hospitality and more importantly to thank you for your unbelievable contributions to the profession. We are where we are today because of people like you and especially because of you, and thank you for taking this time and for all your work.
Dr. Bogardus: I appreciate it very much. Thank you.
In 2004, ASTRO established the History Committee for the purpose of documenting and recording the history of radiation oncology in the United States. This interview took place in Oklahoma City on April 22, 2004.
Question: This is Dr. Wallner, the date is April 22, 2004, and I am on the phone with Dr. Bogardus, in Oklahoma City. Bogardus has graciously agreed to be interviewed for the History Committee’s oral history. Bogardus, thank you very much. There’s a question that’s always occurred to me, it’s Carl R. Bogardus Jr., when did you pick up the nickname “Bob?”
Dr. Bogardus: This came about in the early years in my life because I am junior as you can see, and my father always went by Carl, so the next obvious thing was to call me Bob. My son is Carl Robert Bogardus III, and we call him Robert.
Question: Okay. Was Carl senior a physician?
Dr. Bogardus: My father, Carl Robert Bogardus Sr., MD, was a general practitioner. He started out practicing in the little town of Hyden, Ky. It’s in the southeastern section of Kentucky, a coal mining community. Dad went there as payback from the state of Kentucky. When he went through medical school, he had financial support from the state and, as a consequence, he had a payback time to do for the State Health Department. He worked as the county health officer for a period of three years in this small coal mining community to pay back his time that he was supported in medical school. While he was there he met my mother, got married, and I was born in Hyden, Ky.
Question: In your childhood had you thought about medicine in your career?
Dr. Bogardus: I grew up in a household with a general practitioner as my father. I can remember Dad getting up in the middle of the night and going out to deliver babies or somebody would be banging on the door at night, “Hey Doc, I’ve got a problem,” and he would just see them at any hour. As I got older I would go with him on a lot of these night forays, and I was helping him deliver babies by the time I was 15 years old.
Question: And did you ever consider obstetrics or general practice?
Dr. Bogardus: No, that was enough to cure me right there. I worked in the office with him. I would help him, doing things that today would just be unthinkable, but as a teenager I would help him do drip ether anesthesia while he was doing local procedures in his office.
Question: So you literally came to medicine genetically.
Dr. Bogardus: I came into medicine genetically and learned from the ground up. By the time I hit medical school I already had a pretty extensive clinical career. I was one of the few medical students in my class who had even been an assistant, much less having done a delivery.
Question: You graduated Hanover College in 1955. Can you tell me a little bit about some of those years?
Dr. Bogardus: Hanover College was a small school of about 500 students in the little town of Hanover, Ind., on the Ohio River. It was about 20 miles from where I grew up. The reasons I chose Hanover were: first, it was close, second, it was a liberal arts college and had a lot of things I wanted, and third, and probably more important, Dad was a graduate and supporter of Hanover, so it was all very favorable. When I went there it was with open arms, “here you are and let’s see what we can do for you.” It was a great experience. I enjoyed those four years.
Question: Was it co-ed?
Dr. Bogardus: Hanover was a co-ed school with a broad curriculum. I graduated from Hanover with majors in Chemistry and Physics, and I had a minor in Geology. I took all kinds of interesting courses. From Hanover, I went to the University of Louisville School of Medicine, where I graduated in 1959.
I chose the University of Louisville Medical School again following Dad’s footsteps. He was graduate and long time supporter. I was accepted at Indiana and the University of Louisville.I didn’t apply any place else, in fact I never really thought about applying any place else; I applied to Indiana as a back-up, but there was never any problem. I was accepted at the University of Louisville and thoroughly enjoyed my time there. It was a hard school with the usual tough medical school professors in those days. I worked my way through school without any real problems at all.
I was married in the second year of medical school.
Question: Did you find that difficult for medical school?
Dr. Bogardus: It really wasn’t, about 15 in our class were married. There were three of us who were, and still are, close friends starting out as freshmen, and all three of us got married at the same time and lived within a few miles of each other. We all finished school that way and had kids and did all the things you’re supposed to do. It really worked out very well for us.
My first year in medical school was spent doing the things you had to do to survive the first year. We had two-and-one-half months in the summer to do whatever you wanted to do, you had the summers off. Everybody in med school tried to find some medically-related job. I had a great interest in electronics, mechanics, electrical things and a good background in physics. The professor of biochemistry had inherited an air-driven ultracentrifuge as military surplus, and he wanted that ultracentrifuge for his research work, but there wasn’t anybody who could figure out how to put it together. It was just this giant crate of parts and no instructions. I spent that entire summer assembling that air-driven ultracentrifuge and its optics and got it working. After the summer project I worked during the winter while I was going to med school in Schlieren Optics where we would look at optical interfaces as we were spinning down organic compounds. I never found this particularly interesting as a long-term career, but it was fun work.
In the spring of my sophomore year I still wasn’t sure what I wanted to do. There was nothing else in biochemistry because the centrifuge was running, and so I had worked myself out of a job. I was walking through the basement of Louisville General one morning and went past an open door. I looked at the really neatest machine I had ever seen, and I realized it was doing binary counting. I went in and talked to the professor who was running it and he said yes, you’re right, this is a binary counter. You know what that is? I said yes, he said, do you want job this summer? I’ll hire you because you knew that you must know something about radioisotopes. This was the new science of radioisotopes. A nuclear medicine laboratory had just started at the University of Louisville, and the professor who was head of it was Patrick Cavanaugh, MD. Dr. Cavanaugh was the head of radiation therapy and nuclear medicine (one of the subspecialties of radiology). He said if you want to work with me next summer we can pay you, and I’ve got a project I’d like you to start with; the project was to build a rectilinear scanner.
I built the first rectilinear scanner in Louisville. I even cast the pinhole collimator for it and built the printout device for it and the machinery to make it work. That scanner ran for a couple of years just scanning thyroids, but it worked perfectly for that. Later, they bought a new nuclear gamma camera, and then my machine disappeared into scrap. That was my introduction into radiation therapy, it was fun, and the more I worked with it the more interested I became. There was a hospital in Louisville that had a Van de Graaff generator, and the physics staff at the University of Louisville kept the Van de Graaff running. The Van de Graaf was a very particular machine, and it tended to break frequently. When the Van de Graaff would be down we would have to fix it. That was really fun, taking one of those apart, repairing it, replacing belts, resistors, whatever it took to get it running. At that time, I was really more interested in the mechanics of radiation therapy than I was in treating patients. But, I felt that this was really a breakthrough in cancer treatment, so I took an elective in radiation therapy.
As I worked more and more with Cavanaugh, he said, “You’re a natural; you really need to go into radiation therapy.” I understood the equipment; it was really equipment and physics intensive in those days. Cavanaugh was a graduate of del Regato, and he said he could get me into del Regato’s radiation therapy residency. Initially, I didn’t know who del Regato was, but the more I read, the more I realized that if I was going into a residency I needed to go into this residency. I made an application, got accepted and that was the reason I ended up at Penrose, and just to save myself travel,; I did my rotating internship out there also.
The program was fantastic because what I ended up doing there was working with del Regato, Chahin Chahbazian and the others who were residents at that time:
· Bob Lindberg
· Victor Marcial
· Jerry Vaith
· Frank Wilson
· Jim Cox, just to mention a few
Del Regato was a very clinically-oriented physician, he believed in patient care and the examination of the patient to make your decisions about what you’re going to do. He never allowed us to label a patient a name of a disease or a number. We would never say, I’ve got this prostate patient, it’s not a prostate, there’s somebody attached to that, and he would chastise us badly if we talked about the case related to what it was. We always had to do a full evaluation. Every patient had a total workup, top to bottom, and he always said you will be amazed at what you will find if you start looking outside where the cancer is. I still find this to be true even today. Many physicians don’t look at the rest of the patient. Del Regato always taught us to do that. Those years at Penrose were really fantastic. We had the opportunity to meet with those I consider the big names at the time (Fletcher, Buschke, Kaplan, Powers, Lampe, Kramer); anybody you could name in that era came through Penrose at least one or more times when we were there, and they would spend many days with us, lecturing to us, talking with us, and it was really a one-on-one because in the country there weren’t that many radiation oncologists or residencies.
Question: What kind of equipment did you use?
Dr. Bogardus: When I went there the first year, I was there as an intern, and they were installing the Eldorado cobalt unit. In Louisville it was called a cobalt bomb. Del Regato never like that term: he said that this term is way too destructive, he said this is to cure patients, he said it is a cobalt therapy unit, and he said it was an Eldorado mercury shutter machine. The machine’s shutter mechanism was a pump that moved liquid mercury into a chamber to seal off the beam and when you turned the machine on you would pump the mercury out of the chamber. In my second year of residency one of the hoses broke and all the mercury ran out of the machine, which then left the source exposed and the mercury all over the floor. It was a few weeks before they got that fixed. There weren’t very many of these machines built that were mercury shutter units.
Question: Did you have other equipment?
Dr. Bogardus: We had a GE 250 kvp and a superficial unit, and about the second year, I was there when they put in a GE resonant transformer 400 KEV unit, which was a pretty good piece of equipment.
We had a huge supply of radium; del Regato was a great believer in radium, and we treated many patients, especially cancer of the cervix, skin cancer and head and neck cancers. Radium was used as the boost almost always, no matter what we were treating; if we could get to it with a radium application, we would do it. We had a fantastic radium experience.
Question: Do you think del Regato or any of you at that time had any sense of where the specialty was really going?
Dr. Bogardus: Del Regato was a visionary, and he was one of the early pioneers who actually came into radiation therapy as a radiation therapist. He did not come in as a general radiologist, which many of the other “dinosaurs” did; many were general radiologists who specialized in radiation therapy. Del Regato always felt that this was a true specialty and it should be treated that way.
Question: So he had a sense of where it was going?
Dr. Bogardus: He knew exactly where the specialty was going. He was instrumental in forming the American Club of Therapeutic Radiology, which was the first gathering, officially, of as many radiation oncologists from North America as were practicing at that time. He was instrumental in making those club meetings occur because he knew, from the beginning, that this would be a driving force in organizing radiation therapy as a specialty.
Question: 1963-1964, you were a fellow at the Mallinckrodt Institute of Radiology in St. Louis. Why did you do that, and tell me a little bit about your experiences there?
Dr. Bogardus: In those years the residency in radiation therapy was three years, and you could go out and work after three years. Del Regato said you should take an extra year but you can’t take it here, you need another experience. So, I went to The Mallinckrodt Institute of Radiology in St. Louis. Mallinckrodt was an interesting experience; St. Louis itself was not where I really wanted to go after living in Colorado Springs, but it was a fun place for a year. I went there on the recommendations of Bill Powers. Bill had talked to us many times, and Bill was a gadgeteer like I was; he liked to build equipment. He liked to build new machines. A lot of people don’t realize this but Bill was probably the person who was instrumental in developing the multileaf collimator, the first MLC that I ever saw Bill Powers had developed and was using in Detroit. It had eight moving leaves on each side of it. He was predicting what a great device this was going to be someday. He and I both enjoyed building things and building appliances, so I thought this would be a great year. So I accepted the fourth year fellowship. Shortly after I got there Bill resigned and went someplace else, so I was left wondering, what am I going to do now? Fortunately, Michael Ter-Pogossian was there, and he was a superb physicist, and it didn’t take me long to gravitate to physics. I spent the first six months of my fellowship doing radiation physics. We developed some new scintillation probes for central body reading of radiation doses primarily around the cervix. We designed the first computer program to actually calculate radiation doses instead of doing them by hand, then Bill came back, and I spent the rest of the year doing clinical radiation therapy. Carlos Perez was a fourth-year resident when I was there, and Carlos and I became good friends. We shared a lot of patients together.
Question: Who were some of the other people there at that time?
Dr. Bogardus: Actually, Carlos is the person I worked with the most in radiation oncology. There were other general radiology residents going through there, but none of them stand out in my mind.
Question: The philosophy of patient management, cancer management, was significantly different at Mallinckrodt than it was at Penrose?
Dr. Bogardus: Penrose was a very clinically-oriented program, whereas at Mallinckrodt, it was you take care of the patient, get the work done and get on to the next patient. There was a lot of basic radiobiology research being done. Bill was really big on killing mice. I mean we killed thousands of mice the year I was there. A lot of good basic radiobiology work was done.
Question: Now, following your experience with Mallinckrodt, you turned up at the University of Oklahoma. Tell me how that happened.
Dr. Bogardus: As I was finishing my year in St. Louis, Bill was in the process of resigning, again, and I wasn’t so sure that I wanted to stay there. It was up in the air as to who actually was going to be running the department. They wanted me to stay on and they offered me a salary of 16,000 dollars a year to stay there on faculty, coming from 9,000 dollars a year from the fellowship, this was a good raise. Then the University of Oklahoma was looking for faculty, and they offered me 18,000 dollars a year, so I moved. I was just that simple. At the time, it seemed like a much better offer. Sy Levitt was Director of Radiation Therapy at the University of Oklahoma, and we had previously met at RSNA, so I came to Oklahoma, spent a couple of days here and liked it. The University of Oklahoma was a very friendly school. I met the dean, who said, “We’ll support you and do whatever we can do for you.”
My first year in Oklahoma, I was an assistant professor, an associate radiation therapist and a section chief of radioisotopes and nuclear medicine. When I arrived, the University of Oklahoma did not have a nuclear medicine program at all. One of my expertises was nuclear medicine; I had worked in nuclear medicine in medical school. As a resident, I helped develop the nuclear medicine program at Penrose; Mallinckrodt already had a very good isotope program. So I designed the first radioisotope program at the University of Oklahoma as the section head of nuclear medicine.
The Radiology Department at the University of Oklahoma was called the Department of Radiological Sciences, made up of sections; nuclear medicine, radiation therapy and diagnostic radiology. I headed the section on nuclear medicine, which I did for quite a few years, until it eventually got to be such a big operation that I could not do that and radiation therapy together. I eventually turned the nuclear medicine duty over to an internist as the chief of nuclear medicine.
ASTRO: As a resident of del Regato’s we were associate or junior members of the American Society for Therapeutic Radiology; we couldn’t become a full member until we became practicing radiation therapy physicians. All of us were expected to become members of ASTR (as it was then called). So we all became members of ASTR during its formative years. It was del Regato, myself and a few other people who organized that first meeting at the Mountain Shadows Resort in Scottsdale, AZ. In 1968, I was the secretary of ASTR at that time and was responsible for making sure all of the arrangements for the meeting were in place and everything worked out. Del Regato was a major driving force behind organized radiation therapy. As Del Regato was trying to get that first meeting together, everybody who was really doing radiation therapy in the U.S. was invited to that meeting. This first meeting was very, very informal. I remember the scientific sessions were held around the swimming pool, and there was no real structured program at all that first meeting. There were topics that were suggested, and we talked about breast cancer and head and neck cancer. Simon Kramer was there talking about a new project that he was trying to get off the ground called RTOG. Dr. Fletcher and Del Regato would always get into arguments because they would never see things the same way and the more heated the argument got the more they spoke French, but it always ended up that we came to conclusions. I think a tremendous amount of interchange took place, and the residents and faculty who were there really profited by our experience.
The meeting was both clinical and scientific. People talked about some of their new research projects they were doing. Dr. Kramer was talking about what he was doing with methotrexate, the RTOG and all of the new techniques we were trying with radiation. We heard new and exciting ideas regarding the treatment lymphomas from Kaplan and head and neck cancers from Fletcher. We talked about residency programs and what ought to be included in them and how the training should go. Reimbursement was never an issue. Nobody ever talked about how they were going to be paid for all we did because almost everybody there was from an academic institution and didn’t worry about that. Del Regato was not interested because we never charged for anything we ever did in Penrose. It was all supported by Penrose Hospital and donations. You never sent a bill for anything, it just wasn’t done.
Question: Fifteen years later you became the president of ASTRO.
Dr. Bogardus: ASTR grew to ASTRO. The meetings got bigger every year, each bigger than the last, and each one of them became more of a project. In those years I became very actively involved with the ACR much more so than with ASTRO. As ACR was growing, ASTRO was a piece of the ACR. As a piece of the ACR, ASTRO was carried right along with them. I know and remember Nick Croche, Otha Linton and Sheila Aubin and others who would blend the ASTRO meeting with the ACR. All of the arrangements for the ASTRO meetings were done through the ACR, as they were managing ASTRO. So, we were basically wed at the hip for a long period of time until the ACR and ASTRO finally went their own way.
Question:In 1991 and 1992 you were president of the American College of Radiology, now how did you feel in that position as a radiation oncologist?
Dr. Bogardus: My working with both the ACR and ASTRO put me in a unique position. It was unique because I was one of only two radiation oncologist (Roy Deffenbach was the other one) who has been president of the ACR, and I am the only one who was president of both organizations. It was challenging and hard work, but very rewarding.
I could see that there were problems on the horizon. In my presidential address at ASTRO I really pushed hard that as radiation oncologists we need to stand firm with the ACR. I felt that we could not go forward by splitting these two societies apart at that time. I realized that if we lost the clout of the ACR, radiation oncology simply did not have enough political horsepower to be able to carry some of the key elements forward in terms of reimbursement. It was clear to me that reimbursement was going to be the key to survival of radiation oncology and, in fact, it has been and still is.
ACR: In 1973 I was president of the Oklahoma State Radiological Society; I then formed the Oklahoma State Radiation Therapy Society and was president of that group also. I was very politically active in the state. I pulled all of the general radiologists, diagnostic radiologist and radiation oncologists together as the Oklahoma State Radiological Society. I formed the first of our scientific meetings, put the programs together, brought in national speakers and brought in diagnostic radiologists and therapeutic radiologists to speak at these meetings and as a consequence became more and more politically involved. I was elected as councilor for the ACR from Oklahoma in 1979. T.J. Brickner and I had known each other since he moved to the state, and we worked together through those years trying to make the meetings work and working on the socioeconomic aspects of radiology. All this led me into the inner circle of the American College of Radiology going in as a councilor and then on to the council steering committee and just working my way up through the ranks of the ACR until I finally became president.
Question: Now the American College of Radiology created the relative value system tool in radiology before it was created for the rest of medicine. Can you give me a little bit of the background of why that happened, how that happened amd what the philosophy was of sort of leading way?
Dr. Bogardus: RVS:My earliest involvement with the financial aspects of radiology and radiation oncology started with the ACR supplement number two published in 1975. That was the first of what now we now call the user’s guides for radiation oncology. In the fall of 1973, Morris Wizinberg, Dale Fuller, Robert Moreton, myself and a few other others met in Chicago and devised the first codes that we thought would be appropriate for radiation therapy. Earlier that year, HCFA had contacted the ACR and said, “You are wasting an enormous amount of time doing billing a hundred different ways, and we’re spending way too much money trying to figure out what you’re doing. You need to standardize what you’re doing or we’ll standardize it for you.” That was a challenge. This committee met, and we developed those first codes. That was my intro into putting together the whole system. Once that had happened, every year as more and more procedures developed in radiation oncology, our committees developed more codes. We worked with everybody that we needed to work with. When Chaio, MD, came on the scene, he was just someone we needed to work with to develop the RVS system.
Working with Dr. Chaio was an interesting experience. It was obvious to us that when Chaio got into the RVS problem. the more he realized he was in a lot deeper that he really wanted to be. I think he was set up to put together the relative value system the way the Feds wanted to put it together. Chaio finally took everything almost verbatim that we had designed and made the relative value system fit that. It was very fortunate for us, and for all of radiology, because we had done our homework upfront, and what we put into the RVS was very accurate and actually was what we wanted. I think the system worked better than any of us would have anticipated in the beginning. Jim Morefield and I had these discussions many times; Jim was worried about the diagnostic side, I was worried about the therapy side of it, and we were all worried about what was going to actually happen to reimbursement. We knew we (radiology) were the first group that was going to be the test group to fill out the relative value system, and we actually came out in pretty good shape value wise. We were able to develop a system that worked internally really quite well. We compared the work of a simulation to a chest X-ray to an IVP and were able to come out with values that we felt realistically valued all the procedures. We put a huge amount of work into that process.
Jim Morefield and our colleagues on those committees were clearly visionaries and even prophets. There was some opposition within the profession in radiology and radiation oncology. In the beginning there was opposition because people were billing on the usual and customary system, some were making a lot of money off the UCR system because they had gotten in early and were billing high values. Medicare would establish your profile, then they would literally pay whatever you were billing. There were others who had no idea how to bill and realized the RVS would probably help them. Many groups and individual physicians were sharing numbers (illegally under the rules of the FTC) with those of us on the committee, so we were able to see huge differences in what people would bill from one practice to another. What the RVS was designed to do was equalize payment, so everybody across the country was billing the same amount and receiving the same amount of payment for services. I think it has worked out very, very well; we came out far ahead of where we would have been if it had been left up to the government to design the system. The RVS system has been fully accepted, and new physicians coming into the specialty probably will never realize where it would have been if it hadn’t been worked out this way.
Question: Now 40 years in retrospect after those glorious days at Penrose, how do you see the specialty? How do you see training programs, practice, and what are some of the important issues you think are facing us today?
Dr. Bogardus: The specialty of radiation oncology has grown phenomenally over the past 60 years; all you need to do is go to an ASTRO meeting, it is a huge international meeting, unbelievable. None of us could have foreseen this trend of growth when we were sitting at Mountain Shadows. I can remember a few years into our early ASTRO meetings there were heated discussions about whether we should have vendors come to the meeting. We now realize meetings wouldn’t be near the magnitude they are now if we didn’t have the vendor participation. They are an integral part of radiation therapy, and vendor scientific support is very valuable. This is really where the specialty should be.
TRAINING PROGRAMS
Question: Do you think there’s anything significantly different we should be doing in training programs or in development of our practices at this point?
Dr. Bogardus: I think we lost sight of programs with strong clinical emphasis. Most of the training programs now place heavy emphasis on research and radiobiology. All of this is very important, but there are a lot of physicians who want to be clinical-based; they don’t care that much about basic research and radiobiology, they just want to take care of patients. That’s one of the reasons why the program at the University of Oklahoma is strongly clinical-based; we didn’t have the resources to invest in enormous research activities. You need physicians to train physicians to take care of patients. I would like to see more of these type programs.
Question: Can you, off the top of your head, give me names of five or six people who had the most impact on you, radiation oncology, your career and on the specialty?
Dr. Bogardus: The past leaders … if you started at the top of the list, the following are the fathers of modern radiation: Juan del Regato, Gilbert Fletcher, Henry Kaplan, Bill Moss, Mort Kligerman, Simon Kramer, Bill Powers, Franz Bushke, Edith Quimby, Harold Johns and Phil Rubin, and then you just go down the list. From there, you begin to find people who are my generation, and here we’ve got a list of about 20 or 30 people who have continued what these first individuals started. A handful of physicians really began this specialty and pushed it where it needed to go. These are the people that drove the specialty; they’re the ones who trained the residents and set the standards.
HOBBIES AND OTHER INTERESTS
Question: Now in going through your CV, you have what I think would surprise many people: in addition to a significant body of scientific, academic publications and presentations, one of the things that fascinated me was a number of articles on model railroading and socioeconomic issues.
Railroading, tell me a little bit about that.
Dr. Bogardus: I’ve always loved railroads. My first recollection of a train was when I was just over a year old, Dad was in practice in rural Kentucky, and the back side of our house abutted the main line of the L and N Railroad, and I can honestly remember seeing trains go by. I’ve always liked trains, and I’ve always had trains. I still do model railroading; I am certified to operate full size trains at a number of railroad museums across the country. It’s my hobby. I don’t play golf or tennis. Everybody has to have something where you can go and retreat to that place and leave the world behind. And yes, I’ve written numerous articles on railroading.
I have always had a very strong interest in the socioeconomic aspect of radiation oncology. Starting from the first ACR Supplement in 1973 and the Users’ Guide in 1980, through the tumultuous years of RVS, to the present day, continued stress on documentation and correct billing. This has been my passion. I have written extensively about reimbursement issues, and my present Users Guide was first published in 1995 to fill in a void in information during the 10 year hiatus between the early ACR user’s guides and today’s ASTRO Guide. The ACR published three versions of the earlier Users Guide, the last was 1989, and a further guide was never published, but drafts were widely disseminated as User Guide 1993. The ACR/ ASTRO Guides and my cause now have taken on a life of their own.
IN SUMMARY
Question: Now we’ve sort of freewheeled over a lot of issues. Is there anything else you would like to add, anything specific that we haven’t talked about or advise that you can give young people in radiation oncology or who are considering radiation oncology? Or where do you see us going within the next generation?
Dr. Bogardus: I really think that radiation therapy is a marvelous specialty and looking back on my career I would not have done anything differently. I always knew what I wanted to do, which is unusual. By the time I was a junior in medical school, I knew where I was going. Many people don’t find out until later, and so I was blessed with the fact that I never wasted time doing another specialty. I would not change what I do now. I have always really enjoyed taking care of patients, and I still do. I’ve got a very active practice and, hopefully, I can go on for a few more years. I am 76 years old this year, and I still carry a full clinical load.
Question: Do you have any sense at all, premonition, where we’ll be in 10 years or 20 years?
Dr. Bogardus: I don’t think there’s any doubt that radiation therapy will always remain a key element in cancer therapy. Time and science may provide the magic silver bullet. We know there are over 120 different kinds of cancer, and you’re not going to find a way to cure all cancer. It’s like saying you’re going to cure disease. Radiation therapy is still the most cost effective treatment that we have today to treat malignancy and still preserve natural function. It’s a specialty that is critical to cancer management. What we’re doing will always be needed. It’s a method of treating a disease (cancer) that is going to be this nation’s number one health problem in another few years. Modern medicine is combating so many other diseases that patients will live long enough to get a malignancy and often more than one. It’s going to be up to us, radiation oncology, to cure these people.
Question: Do you see any significant problems for the future?
Dr. Bogardus: Problems have always been with us, and this won’t change. The problems will be new and different, but solutions will be found. There may not be enough radiation oncology physicians over the next few years completing training. Right now, there are many openings for staff, but it is hard to find good, qualified staff to work with. Most people are finding good jobs. Part of what I’m doing now in my career is looking at programs, looking at individual departments and practices. Good people will always gravitate into this field, but to do quality radiation oncology you’ve got to be a little bit smarter than the average physician.
Question: OK, anything else you’d like to say for the record?
Dr. Bogardus: I’d really like to see us go back to the family practice bedside manner of taking care of our patients; to take the time to see a patient the day they’re referred to you. To spend the time with the patient; to take 20 minutes, take an hour, take two hours, whatever it’s going to require; talk to the patient, talk to the family. When you’re done, you know what the problem is, and the patient bonds with you and knows that you’re a doctor who is going to take care of them. The patient is not just a number, not just a disease but a real person with a big problem that you may be able to fix. That’s a feature that we cannot lose track of, and I think probably, overall, radiation oncologists do this very well.
Question: Well, thank you very much. I want to especially thank you for your graciousness and hospitality and more importantly to thank you for your unbelievable contributions to the profession. We are where we are today because of people like you and especially because of you, and thank you for taking this time and for all your work.
Dr. Bogardus: I appreciate it very much. Thank you.
