Even after 30 years, he relishes teaching and remains a role model for many internal medicine residents who trained in Rochester.
By Michael Wentzel
Ask almost any graduate of the internal medicine residency program of the University of Rochester School of Medicine and Dentistry about Donald R. Bordley, M.D. (R ’81), the program’s director, and the answers will leave little doubt about his importance in the careers and lives of many.
“His passion for his work is infectious, and I have tried to apply the same outlook in my career,” said Brandon J. McMahon, M.D. (R ’05), now an assistant professor of medicine at Northwestern University Feinberg School of Medicine.
Jennifer Barton, M.D. (R ’05), assistant professor of medicine at the University of California at San Francisco, said Bordley’s “high standards created an atmosphere where everyone was expected to perform at their best and expect excellence from one another and Dr. Bordley fostered that environment.”
Alec B. O’Connor, M.D., M.P.H. (R ’00, MPH ’07), an associate professor of medicine at Rochester’s School of Medicine and Dentistry, called Bordley “in many ways the ultimate role model and the doctor I'd want my loved ones to see if they were hospitalized.”
Bordley has shaped the careers of hundreds of physicians, mentoring residents in Rochester for 30 years and directing the School of Medicine and Dentistry’s internal medicine residency program for almost 15 years.
During those years, Bordley demonstrated the value of having an internal medicine residency program director who viewed the position as a rewarding and sustaining career.
He also is a determined advocate of an intimate style of education that places the teacher, the learner and a patient together at the bedside or in the examining room. Technology, simulations, lectures and research all have value. But Bordley looks to the “triangular encounter” of physician, patient and teacher for the lessons that ultimately create the best physicians.
“Where you really find out how people can function as doctors is with real patients,” he explained. “All of my most memorable experiences, both as a physician and as an educator, have been around interactions with patients.”
Bordley has preached his belief in these educational encounters nationally. From 2007 to 2010, he served as president-elect, president and then past-president of the Association of Program Directors in Internal Medicine, which has more than 2,000 members from 380 medical schools and teaching hospitals. He was on the board of directors of the Alliance for Academic Internal Medicine during the same period. He now chairs the Alliance’s Governance Task Force.
A graduate of Johns Hopkins University School of Medicine, Bordley came to Rochester in 1976 for his internal medicine residency training during the tenure of William L. Morgan, M.D., as director of the program. Along with George Engel, M.D., Morgan wrote The Clinical Approach to the Patient, the influential textbook that had a humanizing effect on medical teaching.
“Of all the people I have worked with professionally, I respected him more than anybody because of his clinical excellence, his integrity, his advocacy for residents,” Bordley said. “I wanted to be like him. The best way to be like him was to wait for an opportunity to have the job he did with such distinction.”
Today, Bordley not only directs the residency program, he is the first William L. Morgan Professor in Medicine.
“Don Bordley is one of a very few who revolutionized the position of residency program director,” said Mark B. Taubman, M.D., dean of the School of Medicine and Dentistry. “He has built a rewarding and distinguished career for himself but his skills and dedication to the training of residents have rewarded us with better physicians who provide excellent care at our Medical Center and other institutions across the country.”
Medicine in the genes
Don Bordley comes from a Maryland family with five generations of physicians. His father, James Bordley III, was a Hopkins graduate who had a prestigious career at the Baltimore institution before becoming chief of medicine and director of Bassett Hospital in Cooperstown, N.Y.
Bordley, now 64, grew up in the village by Otsego Lake that is the home of the National Baseball Hall of Fame and Museum. His father, at one time, served on the Hall of Fame’s board. He has many memories of meeting famous baseball players, including once, when he was quite young, of sitting on the knee of Hall of Famer Ty Cobb, the famous Georgia Peach.
In spite of the deep family history in medicine, Bordley initially decided to go into a completely different field. He was an English teacher at Baltimore’s Gilman School for two years.
“I entered into it with the expectation that it was something I thought I could do for the rest of my life. I was a very happy English teacher. I really enjoyed my job,” Bordley said. “What brought me back to medicine was spending time with my father and my brother, who graduated from medical school and began surgical residency while I was at Gilman. Whenever we would get together, they would be talking about medical topics. I was very energized by the conversations. I thought if I did not give this a try, in five or 10 years, I would be disappointed.
“I had done well in college, but I did not have the kind of GPA you have to have, especially now, to get in med school. I was a solid B student but I didn’t think it was a sure thing getting in med school. I felt all along if I was unsuccessful in getting in med school, I would be happy coming back to English. I loved the teaching.”
Bordley, of course, was accepted in medical school, graduated from Hopkins and came to Rochester for his residency.
“I knew I still wanted to teach. By the time I was chief resident, I knew I wanted to teach residents,” he said. “I came here knowing very little about Rochester. I would not have anticipated spending my whole career here. Seeing the impact Bill Morgan was able to have on the program as a whole and on every resident who went through it influenced me. Not every resident liked Bill Morgan, but no resident wanted to disappoint him. I don’t think there is a single person who went through the program who would say they were unaffected by him.”
When Bordley completed his residency in 1981, he went to Rochester General Hospital as the internal medicine residency program director. He remained there until 1994, when he was recruited to the Medical Center to direct the internal medicine clerkship. He took over as residency program director in 1997.
“Under the current rules, I would not be allowed to do the job at Rochester General if I wanted to and someone wanted to give me the job,” Bordley said. “You have to have been a faculty member in internal medicine for at least five years before you can be a residency program director. Residency training has gone through quite a bit of evolution.”
Unwavering commitment to education
Thirty years ago, the medicine residency program director’s job went, in most cases, to junior faculty as a way to provide extra financial support. The director routinely held the position for about three years when it would be handed off to another junior faculty member. But over the years, more and more departments wanted to invest in someone who viewed the position as a career option.
Two fundamental responsibilities of the positionâ€” recruiting and preparing for accreditation site visitsâ€”are extraordinarily challenging but get much easier as the director accumulates experience, Bordley said.
“Recruiting in internal medicine 30 years ago was relatively easy because 60 to 70 percent grads from some med schools were going into the field,” he said. “Now it is unusual if 20 percent choose internal medicine. You get better at recruiting with experience. People get to know you. You make connections, especially if you are active nationally. I make recommendations to our medical students for residency based largely on my knowledge of the people in leadership. You won’t build these connections without staying in the job.”
Site visits can risk a department’s or hospital’s accreditation and reputation, another reason experience counts.
“In 1981, my first year as director, we had a site visit. The internal medicine requirements were 2 Â½ pages and all were vague,” Bordley said. “It is now 28 pages of specific, externally imposed expectations of the competencies the residents must demonstrate and how the curriculum should be designed to allow them to achieve those competencies.”
Residents, as well as program directors, have changed during Bordley’s 30 years.
“When I was a resident, if the program director said jump, you said how high,” Bordley said. “It was not that Dr. Morgan was not receptive to people telling him what was not working well. He was receptive. But then there was a much more authoritarian style and hierarchical structure. That’s not the way now. The residents today expect and deserve more control over their lives than we had. My interactions with residents are much more collaborative and involve negotiated changes. It’s not my telling them what to do. The effort to be fair is no greater on my behalf than on Dr. Morgan’s. You just didn’t challenge him.”
The evolution of residency and residents is one of the elements adding to Bordley’s job satisfaction and appreciation of the Medical Center and School of Medicine and Dentistry.
“A critical element of this institution is the commitment to the educational mission at the highest level of leadership. It is genuine and unwavering, in spite of the fact that it is not always the cheapest way to go,” he said. “I have never had any trouble over my years of running this program in getting support from institutional leadership for any changes we need to make, even when they have been costly to the hospital. Because of my involvement in national organizations, I know how unique it is to have such support and how fortunate I am to have accomplished what we have.”
The bedside teaching experience
Bordley, usually wearing his trademark bow tie, is most in his element when he is teaching.
Morning report, when residents discuss patients admitted to the Medical Center during the past days, is held at 7:15 a.m. five times a week throughout the year. Bordley attends three times each week. The residents work through their differential diagnoses and clinical reasoning during the meeting that runs for one hour.
“It is conference room teaching, but it’s based on real patients and it’s not lectures,” Bordley said. “I love morning report but conference room teaching is not my favorite.”
His favorite moments happen during the 10 weeks each year he is on-service in the Medical Center. Bordley and a team of senior residents, interns and a number of medical students care for more than a dozen patients.
“We go around together and see the patients every day,” Bordley said. “We examine them and talk about them. So the teaching is about patients we care for together while at the same time I try to have the senior resident be the real leader. I get to see whether they are doing careful and thoughtful physical exams and whether their technique is correct. This is by far the most rewarding teaching because it happens at the bedside.”
These bedside teaching and learning experiences should be multiplied and enhanced, Bordley believes.
“If there is an area of residency education that really needs to be re-emphasized and made a more prominent part of resident experience it is the teaching at the bedside or in the ambulatory examining room by experienced clinicians,” he said. “The proportion of the time the residents physically spend with patients is shockingly small because they have so much else to do. They spend more time with the computer than they do with a patient and we need to move them back. I certainly believe residents spend less time physically with their patients than I did when I was a resident. The job of caring for hospitalized patients has become so complicated that there is a lot of work they have to get done that does not require direct patient contact. They do the charting, the documentation, and the discharge paperwork. It is all important but it takes a lot of time and it is not quality time with a patient.”
Although Bordley cherishes his traditional approach, he supports innovation in the training of residents. The School of Medicine and Dentistry has moved much of the resident experience to an outpatient setting and is redesigning the resident’s outpatient practice as a patient-centered medical home. Bordley also is overseeing a pilot program that will give residents longer blocks of time in ambulatory primary care practices and selected subspecialty practices.
“This will allow a resident to see a patient multiple times and that means a more meaningful and a better learning experience,” he said.
Bordley also is a proponent of controlling a resident’s duty hours.
“To ask someone to work more than 80 hours a week is unreasonable,” he said. “Our program is nowhere near that on average, more like 60 to 65 hours. We do have some rotations where residents work 80 or a bit over. We also have rotations where they only work 40 hours. That’s healthy.”
Bordley’s worries about the future of internal medicine and internal medicine education revolve around time.
“It comes back to the demands that push residents away from the bedside and physicians from their patients,” he said. “Health care and health care delivery have become so complicated that physicians don’t have enough time to spend with their patients and don’t have enough time to reflect on what their patients have told them and to learn from the process. The pressures of time force us to react quickly and do the best we can and move on. That is not nearly as satisfying as gathering the information, spending time with the patient, making sure you have all you can from that experience and taking time to reflect on the experience and deciding whether you need to find out more. We end up practicing and approaching diagnosis in a shotgun way because we don’t have time to narrow things down and to think and process.”
The movement to focus more on preventive health care and the team-based approach to medicine in the outpatient sector could allow physicians more time to reflect and “practice at the top of their license,” he said. These changes also might make for happier residents.
A time to retire
Bordley says he detects no signs of personal burnout. An avid bicyclist, he rides to the Medical Center six months out of the year. He still enjoys downhill skiing and hiking. The father of three, Bordley and his wife, Priscilla S. Martin, M.D. (R ’84), clinical assistant professor of medicine, are known for their love of dancing, especially at the departmental holiday parties.
Over the years, Bordley has received offers of attractive positions from other institutions. He even has gone through the interview process a couple times. But he says he can’t imagine leaving the field of internal medicine education at the Medical Center and School of Medicine and Dentistry for at least five years.
“I will retire from here,” Bordley said. “I am extremely happy at this institution. There is no place like this for someone like me that combines the institutional support for the educational mission at the highest level with all the other positive things about Rochester. I love the people I work with and I love the institution that supports what I do so enthusiastically.
“There is great satisfaction in staying in this position and succeeding academically. But the real satisfaction for me is making the program work for the individual residents and having them feel they are being treated both rigorously and fairly. We have high expectations but we provide them the opportunity to reach those high expectations without over-burdening them. As a professor of medicine with an endowed chair, I feel very fortunate.”
Match Day 2012
The drama of Match Day moved to Whipple Auditorium this year, where both tension and spirits were high.
The Future of Medical Education
Philip Pizzo, M.D., dean of the Stanford School of Medicine and a Class of 1970 graduate of the University of Rochester School of Medicine and Dentistry, discussed the future of medical education during a January visit to Rochester.
Power of Posters
Intrigued by a poster about preventing AIDS that he saw on a Boston subway car in the early 1990s, Edward Atwater, M.D. (M '50), began collecting AIDS education posters to track how different societies viewed and responded to the epidemic.
Praising and sustaining the Rochester model
(Best viewed on a PC using Internet Explorer. Mac users need to have the Silverlight plug-in.)