When I arrived at a regional military hospital, it wasn’t a mere dispensary or community clinic. It served as the referral hospital for the northern tier missile and bomber bases, just beneath the larger medical centers. We were classified as second tier, but the implications were global.

Within this environment, I introduced the medical home and a mini-developmental clinic. Thanks to a program for exceptional family members, families from across the globe found their way to my practice. For a humble captain succeeding a major lacking leadership skills, it was exhilarating. Patients were enrolled in pediatrics 24/7/365. At-risk children were safeguarded from insufficient care. Operational truths were prioritized over hierarchy.

What was paramount was speed. In just two and a half years, the medical home became fully functional. While national organizations debated the approach for years, we executed it in real time. Children couldn’t wait for ideal models; they required care immediately. That sense of urgency became the defining rhythm of my professional journey.

Broadening the vision

At a national conference in 1996, with past national presidents and state health leaders present, I shared a colleague’s narrative of the medical home in Hawaii and illustrated its potential to expand globally. The developmental-behavioral pediatrics clinic, interdisciplinary clinic, and family programs served as evidence.

I acted as a mediator among four conflicting groups: state chapters, federal agencies, early intervention programs, and parent educators. Like a former president facilitating peace without the instant recognition, my role was analogous: The honest broker, broadening vision, yet overlooked by my own “hometown” leadership.

I received no acknowledgment from national leadership because recognition would have diverted attention from the founders and the academy itself. Operational truth was awkward for those who favored theory and hierarchy.

An observer of innovation

One moment stands out vividly. The surgeon general descended from the dais to position himself directly in front of me as I recounted how one pediatrician utilized a modest planning grant to listen to Appalachian families and providers, translating it into millions of dollars in funding.

One individual built it. Two men dismantled it out of jealousy and resentment. This contrast, creation through empathy versus destruction through envy, encapsulates the fragility of progress in our field. The surgeon general’s presence served as validation, a testament to what grassroots innovation could accomplish.

Acknowledgment and rejection

There were instances of acknowledgment: national delivery awards and presentations of significant drug studies. Yet regarding specific lifetime achievement awards, the leadership opted against nomination. Not due to a lack of merit in the work, but because operational disruptions rarely garner insider support.

The denial was not oversight. It was political. It aimed to preserve a slower, aspirational system that felt threatened by a rapidly operational model. This created a prophet dynamic: Celebrated abroad, dismissed at home.

Linkage: Muscle to bone

Guess who led Air Force medicine during the critical launch of the primary care optimization model in 2001, the patient-centered medical home in 2007, and the family health initiative in 2009? My former commander, who had previously honored an overweight chief of pediatric service and remembered who assisted him in winning a significant leadership award.

Unlike present leaders, he recognized what operational truth entailed. He had witnessed it firsthand. The foundations laid in that second-tier hospital bore fruit years later in the institutional acceptance of the military medical home. What national organizations took decades to define, and the Air Force years to formalize, was already operational in my clinic in less than three years.

This doesn’t happen by chance; it’s lineage. My prototype was the muscle; his subsequent adoption was the bone. Together, they created the connective tissue of the medical home.

Clinical studies and community care

My leadership education model in neurodevelopmental disabilities remains a primary framework. Initially, there were only a handful of programs; Congress expanded it to every state, including those without a developmental pediatrician. Many of those expansions were superficial, lacking pediatric training. At the university, the program eventually eliminated its medical director, removing the productive tension with the children’s hospital. That choice weakened the connection, detaching muscle from bone.

I also helped develop the template for double-blind, placebo-controlled studies in autism spectrum disorder. This design became the gold standard for evidence-based medicine. Certain behavioral therapies have never engaged it because true randomized, controlled scrutiny would reveal their weaknesses. It’s a live wire that would fry them like an egg.

And I took a van into Appalachia, hearing families where they resided. I brought occupational therapy, physical therapy, and speech therapy into the base hospital to conduct preemie follow-ups in an interdisciplinary manner. My colleague operated as one doctor with one patient. I coordinated care as a team, not in isolation. That connection between grassroots listening and interdisciplinary delivery turned into the model for subsequent programs, although many forfeited their pediatric core.

Final cadence

Ultimately, the work was never