Guardian of America’s health
How Jack Colwill shaped family medicine
Professor Emeritus Jack Colwill, a member of the prestigious Institute of Medicine, led MU’s Department of Family and Community Medicine for 25 years and raised the visibility of family medicine throughout the nation.
MU doctors who work with Professor Emeritus Jack Colwill understand fully why he was elected to membership in an institute established for the good of the nation.
For decades Colwill has asked difficult questions in his role as a leader in family medicine, nationally and at Mizzou — questions such as: Will we have access to the physicians we need? How can rural family medicine be improved? What lifestyle changes should physicians ask patients to make?
Colwill is an elected member of the Institute of Medicine, a small club of 1,700 medical professionals who represent the epitome of achievement in and service to their profession.
IOM is the health branch of the prestigious National Academy of Sciences. Members become advisers to the government, accepting an obligation to ask and answer pressing questions about health.
Colwill’s motivation was and is the need for a larger number of generalist physicians, particularly in rural America. He is known nationally for his persistent efforts to expand the health-care workforce.
For 25 years, from 1972 to 1997, Colwill led MU’s Department of Family and Community Medicine, elevating it to a ranking among the best in the nation. He began the department with a half dozen faculty members. Today there are 60.
“As a leader, Jack developed a national reputation, but he brought the attention home to Mizzou. He genuinely wanted this department to have a national presence,” says Hal Williamson, vice chancellor for health sciences and professor of family and community medicine.
When Colwill charted the path of family medicine at MU, the specialty was in its infancy and suffering from a lack of respect.
Medical students were avoiding general practice. Faculty at the nation’s medical schools typically viewed family medicine as a continuation of the old general practice — doctors with the least amount of training.
Colwill realized that if family medicine were to make its mark nationally, it had to train physicians to be teachers and researchers as well as clinical practitioners.
“Internal-medicine doctors were being sucked into subspecialties. There was a need for primary-care physicians, and there was a huge shortage of doctors to prepare physicians for medical careers,” he says.
In the early 1990s, the Robert Wood Johnson Foundation asked Colwill to lead its Generalist Physician Initiative. Of 36 medical schools applying, he chose 11 to receive grants for curriculum changes that could increase the number of graduates in primary care.
Colwill directed the program for 10 years, making MU the national office. He recruited IOM member Professor Gerald Perkoff (now Curators Professor Emeritus) as associate chair of family medicine and director of the MU fellowship.
“Starting that fellowship did more for the reputation of the department than anything else. We were training people who became faculty members in other departments. It had a great impact on family medicine nationally, and it gave our department academic credentials,” says Steven Zweig, current chair of MU’s Department of Family and Community Medicine.
The primary-care physician shortage is infinitely better now, and family medicine units are becoming lead departments in many medical schools nationally, Colwill says. But he worries about future shortages. That’s his job as an IOM member. Without changes, he predicts, the nation will experience a shortage of 50,000 primary-care physicians by 2025.
Rural health care
Colwill recognized early on that the number of physicians serving rural communities was inadequate and that the only doctors in rural communities were family-medicine physicians.
It became clear to him that by creating educational experiences in rural communities, MU would help its medical students and residents feel more confident about practicing there. “If we educated our residents in an ivory tower, it wasn’t the same as in a natural setting,” Colwill says.
So Colwill opened family-medicine residencies in two small Missouri communities. He chose Fulton in 1975 and Fayette in 1980 — college towns that might appeal to physicians and their families.
Those clinics continue today as residency training sites, and they provide important health services to underserved areas.
“It’s one of Jack’s legacies. I can’t imagine there are any residencies in the country that are longer-lasting rural training sites than those two places,” Williamson says.
Colwill could have left MU for career opportunities elsewhere several times, but he chose to stay.
“He had a real commitment to this department and our medical school. It’s the combination of having good ideas and a very strong commitment to place that enabled him to have a significant impact,” Zweig says.
Despite his growing administrative, research and teaching duties, Colwill always practiced medicine. He coordinated the care of his patients and made sure their needs were met. “If you’re a chair, you’re also a model,” he says.
In his view, patients need a personal physician who sees them as the highest priority.
Colleagues are family
Research remains a priority for Colwill. Last year, when he was 75, his papers were published in the New England Journal of Medicine, in the Annals of Family Medicine and in Health Affairs, a general health policy journal. Zweig says it’s remarkable for someone in his “mature years” to be on the leading edge of his field.
“There were people in family medicine I wanted to emulate. They were concerned about patients, had a broad view of health care and liked what they were doing. Jack was one of them,” Zweig says.
With no retirement plans, Colwill still practices medicine. He continues to ask and answer the hard questions, but now he has help from the doctors he mentored.
“The best part (of this profession) is to see the success of your graduates and to work with them,” he says. Colwill meets his former students in leadership roles at national conferences, and he works with them every day at Mizzou.
Colwill is especially proud that while he led MU family medicine, 40 percent of graduates entered rural practice and 20 percent became academicians. Three of those graduates are members of IOM; nine have chaired family medicine departments; three head health-care systems; one directed Missouri’s Department of Health; and one, Williamson, is a vice chancellor for health.