Fathers Day in El Salvador
“If there’s one thing that has motivated my career… it is to work with people who feel like other people see them on the margins …”
William (Bill) Ventres, MD, MA is a family physician and medical educator. He spent more than 25 years as a community-based family doctor working in both ambulatory and hospital settings, focusing on the care of underserved and minority populations in safety-net clinics and correctional health settings. He taught medical students throughout his clinical career and was a community-based academic until 2017, when he joined the faculty in the Department of Family and Preventive Medicine at the University of Arkansas for Medical Sciences (UAMS) in Little Rock.
Bill contributed greatly to development of global family medicine, physician-patient communication, cross-cultural practice, and the use of qualitative methods in generalist research. A member of the Society of Teachers of Family Medicine since 1988 he has been closely associated with the STFM Annual Conference as a presenter, mentor, Foundation Trustee, Editorial Board member, and colleague. He retired from UAMS in 2023 as the Ben Saltzman, MD, Distinguished Chair of Rural Family Medicine in the Department of Family and Preventive Medicine. He currently lives in San Salvador, El Salvador, where he is enrolled as a doctoral student in Latin American Philosophy at the José Simeón Cañas University of Central America.
Watch the video of the interview below or on Youtube or listen to the podcast on Spotify and all the major platforms
“I quickly became quite disillusioned with the medical education system at that time, and having returned to the medical education system as a teacher of family medicine later in my career, I’m not so sure that things have changed that much.”
Welcome to MedicsVoices.com where we talk to the key opinion leaders in health and medicine around the world. Today we’re talking to Professor Bill Ventres. You lead a very exciting life so, first tell us where you are?
Bill and his wife Esthela in San Salvador
Bill Ventres: I’m in La Palma in El Salvador and I live here now. I came here in 2010 for a one year teacher exchange fellowship sponsored by the U.S. State Department. It may not exist anymore after this administration, but it was a wonderful experience. I met my wife, and I made my life here for five years. Then we were in Arkansas for about six years. And we came back again a couple of years ago to El Salvador, to La Palmas in the mountains. I think you can see them behind me.
UAMS College of Medicine. William Ventres, M.D., Invested in Ben Saltzman, M.D. Distinguished Chair in Rural Family Medicine
DMacA: Let’s bring you back to the very beginning. Tell us where you grew up and where interest in medicine came from?
BV: I grew up in Minneapolis, Minnesota, home of the ‘Vikings’ and I went into medicine for family reasons. People go into medicine for many reasons but the big three, I think, are family, service and money. Mine was family reasons. My dad was an attorney and I was expected to become a professional of some kind which meant that I could be a minister, a professor, an engineer, a doctor or a lawyer. I certainly didn’t want to be a lawyer so medicine seemed the place to go. I was a good student and a very good boy…
DMacA: You went to Duke University, tell us about that.
BV: Well, I went to Duke as an undergraduate. The system here in the United States is a little different, where you do a primary degree. There are a couple of medical schools in the United Kingdom and in Australia that are similar, but usually you have six year programme after High School. We have four years of college and I was a history major which was very interesting, and even more interesting now, as I mostly studied modern German history before the Second World War. You can imagine what I studied…
DMacA: … that’s pretty topical at the moment. So after your first degree, you went to medical school in Minnesota…
BV: I was a state resident of Minnesota and they give preference to state residents. I quickly became quite disillusioned with the medical education system at that time, and having returned to the medical education system as a teacher of family medicine later in my career, I’m not so sure that things have changed that much.
Also, I would say that history, while a wonderful preparation for practice, was not the best preparation for the first two years of medical school. The thing that really started me on my so-called career was that there was a large Hmong population. This was in the years after the Vietnam War. You might remember that there was U.S. involvement in Southeast Asia that did not quite go so well, at least from the US perspective. And, there were many refugees at that time. The Hmong were a hill tribe group from Laos that fought for the United States and after the war they were, we could say, persecuted. There were about 50,000 Hmong in the Minneapolis Saint Paul area and I became involved in sponsoring one of the families. That was an eye opener for me- in the wake of the Vietnam War, seeing the disruption, seeing people from a really a different part of the world, from a different world altogether.
DMacA: What was the context of looking after these families, this sponsorship?
BV: The husband in the family had died of a medical problem and I babysat on Saturday mornings while my girlfriend at the time taught the mother to drive. The US is a very car centred culture and if you can’t drive, it’s very hard to do stuff. But, the important part was that I saw a different perspective on life that I had never understood before, never seen before and, I would also say, not paid much attention to. And that gave me a different perspective. After medical school and before my residency training I went to Thailand to work in a camp for Vietnamese refugees. After four somewhat difficult years in medical school that was what I wanted to do.
I had already decided to go into family medicine, because late in my medical studies, I met a wonderful family doctor, a medical educator, Dr Tom Altemeier, and he opened my eyes. He had worked in a rural practice before going into teaching, and he opened up my eyes to what it meant to be a family doctor in a community with a population of patients. It was very different from what I had then learned.
“It was an unlearning of the medical model. It was clearly unlearning for me, as it was bringing in a new kind of humanistic approach- how do we look at people from a humanistic perspective?”
Bill with friends at the 2023 RCGP meeting in Glasgow
DMacA: You’re also are a medical anthropologist. Tell me about the anthropology and where that comes in.
BV: I did my residency in Tucson, Arizona, after having worked for six months in this refugee camp and I was still looking at how we incorporate community into this family medicine model. I did a fellowship in family medicine research and teaching and as part of that, I studied medical anthropology. That was another tremendous opportunity that opened my eyes to a different way of seeing family medicine. It was an unlearning of the medical model. It was clearly unlearning for me, as it was bringing in a new kind of humanistic approach- how do we look at people from a humanistic perspective? And that’s medical anthropology. I’m not an academic medical anthropologist but I saw it as a way of enriching my family medicine practice.
DMacA: You have a very different vision of family medicine at this stage when you went into practice, and I understand you were in urban practice to begin with.
BV: I was in urban practice in, what we call, a safety net clinic. And I don’t know if there’s even an equivalent in the UK because you have universal health care but we don’t. And so we have safety net clinics. Ours was a very small, private, not for profit on the edge of the community, and in a Latino community. So that was another area where I put my medical anthropology, my view of family medicine, to use. It was an urban underserved area and, at the beginning, I did a lot of maternal and child care because that was who came to this clinic. It on the wrong side of town, the poor side of town, the other side of the tracks.
DMacA: You then came to another crossroads in your life when you were awarded a Fulbright Scholarship. Was that a major step in your life?
BV: It was. Working in the Latino community is essentially doing global health. Basically, it was at least half of my practice. And for me it was in a foreign language, in Spanish. I wanted to teach and a senior Fulbright is for teachers. I had some contacts from the United States who had worked in Venezuela. This was before the Venezuela of today and it was much more open. I had the opportunity to teach in a family medicine residency program and the two things I focused on were- just observing and talking about doctor patient communication. And then I led a Balint group. It was tough because it was in Spanish, but I found you could do a Balint group by asking four questions. Who has a case today? We’d like you to present the case. Who has any questions about the case? How has it touched you? And then- I think it’s time to go. Just letting people share their own personal experiences. I was not an experienced Balint group leader but it was a wonderful experience. And I think that, in a more hierarchical culture, it opened people up to talking about the kind of work that they really wanted to do.
DMacA: You brought this experience back to the US and you went into rural practice?
BV: Not yet. I worked in Portland, Oregon for 15 years, in two different practices. One was a large, not for profit, and then in the county health care system. I left the large not for profit for issues of values- margin before mission. I think we should look at health care as a mission, not in a religious sense, but certainly in a faithful sense. The faithful sense in that we believe in what we do to help people. After seven years it just was clear that the values were different. So I went to work with the county health department, which had a lot less money, but a lot more humanistic values. I did that for several years, mostly working with immigrants from Africa, and from the Ukraine which was well before the war. When I say immigrants from Africa, I mean refugees. Africa continues to have wars and people are not stupid, they leave because they want to stay alive.
After that, I had another Fulbright in El Salvador, and that’s how I ended up here. I’ve had the opportunity to make my life here. I wrote, I worked at the National University, I taught in public health. There are plenty of physicians in El Salvador, but the issues are the same as in many other parts of the United States and perhaps even in Ireland or the UK. Doctors go where there’s money and they stay away from those underserved communities, rural or urban, where it’s tough to make the practice work. It’s worldwide.
So, I made my life here. I also went back to the States to work in correctional health in the same health department that I worked with. But that’s a whole different practice altogether.
“There are thousands of family docs who do the work of genuine family medicine using a bio psychosocial model, whether they’re in areas of social need or not, who are anonymous… let’s honour them.”
Bill talks about the importance of STFM in his professional life
William “Bill” Ventres, MD, MA, a member of STFM since 1988 and a former STFM Foundation trustee, talks about the importance of donating to the foundation. Giving “was a way I could connect with my people.” If you are one of the people who cares about the future of family medicine, please consider donating to celebrate the foundation’s 50th anniversary:
At the annual meeting of STFM, Bill has been the “comic” host welcoming people to the STFM party at the end of the meeting.
DMacA: To use an analogy, you found your tribe in the Society of Teachers of Family Medicine…
BV: Absolutely, I had several teachers like Tom Altemeier, or like a history professor in college, that I really admired and I wanted to teach but I ended up in practice and I practiced for 25 years. I always had a student in my office but I wasn’t an academic. Nobody paid me to do that work, it was volunteer work and I really enjoyed it. I always asked for students who were interested in some aspect of cross-cultural medicine or medicine for underserved in the universities with whom I was affiliated. I had some wonderful students.
I came back to teaching in 2017. My wife wanted to learn English and to get a master’s degree in the US so we came to Arkansas for family reasons, but it was a tremendous experience. And there I became involved with rural family medicine. My job was to go around the State to help support residents who were training in rural sites, not in the capital of Little Rock, but eight sites around the country in mid-size cities of 12,000 to about 40,000. It was not the most rural of rural, but the idea was that they might then go out to smaller towns around the State. And that was the best part of my job.
DMacA: Having lived the dream, as teaching was your dream, there must have been a great satisfaction to have been recognized by the STFM in 2020.
BV: That was the Gabriel Smilkstein Memorial Award (from the Society of Teachers of Family Medicine Global Health Educators Collaborative) It was really an honour. I had the chance to meet Gabe in Seattle, Washington when I was interviewing for residency in the 1980s. What he did in his career was just exemplary so that was a great honour. But, I’d say two things. One about Gabe and then one about that award. The thing that I really most appreciated about Gabe is that he wrote an article in about 1975 on how to examine an infant and a child in the mother’s lap, and I used that all the time in practice. And the second thing was that, while I was honoured by this award, more importantly, there are thousands of family docs who do this work of ‘ global family medicine’, who are anonymous. There are thousands of family docs who do the work of genuine family medicine using a bio psychosocial model, whether they’re in areas of social need or not, who are anonymous. And I think I would like to turn this around and say, let’s honour them.
“… it’s the same thing I learned over and over and over again from my patients, from people of colour, refugees and immigrants, people who for a variety of reasons are on the social margins of society. Life ain’t fair.”
is a series of 99 illustrated mini-essays, written by over 100 authors, collected in 12 thematically linked articles. The essays in this article speak to the purpose of the series, the foundational history of the discipline and some of the key values and rationales that support the activities of family physicians in their day-to-day work. In that these articles examine the paths family medicine has taken in the past to arrive at the present, they offer a point of departure for students and residents beginning to learn the ‘ins and outs’ of family medicine. They also set the stage for the future of family medicine, one many readers of this series will likely help shape.
BMJ: FMCH Storylines of Family Medicine Collection
John Frey and Bill Ventres recorded a series of interviews as the “Voices from Family Medicine Project” for the Family Medicine Oral History Project of the American Academy of Family Physicians Foundation
DMacA: In recognising so many of your colleagues and their huge contribution to family medicine, tell me about “Storylines”.
BV: When I was in practice about 20 years ago I was speaking with a student and I had this idea. I don’t know if other family doctors are the same, but at the end of the day, I was always tired. Family medicine is a challenging area. I’m acting all the time, using my brain and my heart and all this stuff in between to come up with a way to think of how I can use my, what I like to call, my signature therapeutic presence to help the patient move toward health. So it’s exhausting. But when I was truly an academic and was getting paid to do these things, I came back to that idea. And that idea was to focus on the values, the themes of family medicine but I wanted to include other people because every family physician has their own unique style of practice. It’s not the medicine per se, but it’s the style. And so “Storylines” was the culmination of many years, about five years after I actually started the project, although Covid intervened. In total, 136 authors from around the country, from all continents except Antarctica, wrote short essays on their values, their beliefs, the tenets from the history of family medicine, to actually looking at how family physicians diagnose and treat problems. It was a wonderful way to finish up my relatively short academic career. I’m not dead yet. I’m back in school in El Salvador studying Latin American philosophy, which interestingly, although the context is different, it’s the same thing I learned over and over and over again from my patients, from people of colour, refugees and immigrants, people who for a variety of reasons are on the social margins of society. Life ain’t fair.
“Look at me. Hear my words. Nobody listens to me.” I remember words from a movie many years ago “The Elephant Man.” I think he had a severe case of neurofibromatosis and he felt trapped, and I think my patients are similar. He said, “I am not an animal. I am a human being.” If there’s one thing that has motivated my career, and I know it’s from a movie, it is to work with people who feel like other people see them on the margins, excluded as animals.
DMacA: When you talk about the motivation for your career, and I’ve seen it as a title of one of your lectures, you’ve said that for global health the key is leading by example.
BV: What I mean by leading by example has to do with the United States. We don’t have universal health care, we have a very mercantile health care system. In terms of global health it means that rather than exporting our commercialized health care systems we need to work on our health care system in the United States to make it at least a little bit more fair for all. I don’t think there’s any perfect system around the world. I don’t think it exists in Europe. It certainly doesn’t exist in Latin America. But, I think we can all contribute in our own little ways to make it a little better, and little by little put it together. That’s what family medicine is; putting it together, little by little, and I think we can we can lead by example.
DMacA: Bill, thank you very much. That’s been absolutely fascinating. Thank you very much for sharing your vision and your life, and we must recognize your immense contribution to family medicine and to the whole philosophy of family medicine. Thank you.
Bill with his children Roby and Cory
