Community Health Legend Dr. Carl Lecce: Lessons Learned

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Mark Masselli ( 00:04 ):
This week we present a special edition of Conversations on Healthcare. We talk with one of our own,
our beloved Dr. Carl Lecce, who has just retired after four decades with Community Health Center here
in Middletown, Connecticut. I think through this chat you'll learn more about the history of community -
based primary care for the underserved. Enjoy this conversation.
( 00:34 ):
Welcome to Conversations on Healthcare. I'm Mark Maselli and I'm joined by Margaret Flinter. And we
are here interviewing one of our heroes, Dr. Carl Lecce. And, today is his last day after 45 years of
service at the Community Health Center. And, we couldn't be prouder of our relationship and
partnership with Carl. He started back almost 45 years ago in a week or so. But, you and I met for the
first time back in July 1978, when you were just finishing up residency. But, I do want to just go back and
ask a couple of questions. Tell us, you were born in Pennsylvania, whereabouts?
Dr. Carl Lecce ( 01:18 ):
Williamsport, Pennsylvania.
Mark Masselli ( 01:20 ):
Williamsport, Pennsylvania. And, went to high school?
Dr. Carl Lecce ( 01:24 ):
In a smaller town about five miles away from there called Montoursville, Pennsylvania.
Mark Masselli ( 01:30 ):
Okay. And, from there off to Columbia University for?
Dr. Carl Lecce ( 01:35 ):
Undergraduate -
Mark Masselli ( 01:37 ):
I should note, I heard recently on a football scholarship. I don't know if, Margaret, you heard that?
Dr. Carl Lecce ( 01:42 ):
I mean, that's how I got interested. I didn't pan out to be a star on the football -
Mark Masselli ( 01:52 ):
Well, Not on the football field -
Margaret Flinter ( 01:55 ):
But, you got into Columbia and became a star.
Mark Masselli ( 01:56 ):
And, then you went off to University of Pennsylvania at Hershey, for medical school?

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Dr. Carl Lecce ( 01:59 ):
Yeah. Actually, Penn State, at Hershey for medical school.
Mark Masselli ( 02:04 ):
Hershey for medical school. Was Hershey new then?
Dr. Carl Lecce ( 02:07 ):
It was about one or two years old.
Mark Masselli ( 02:10 ):
One or two years old.
Dr. Carl Lecce ( 02:11 ):
And, the reason supposedly that it existed was to train primary care physicians.
Mark Masselli ( 02:20 ):
That's right. It was really a remarkable innovation that the Hershey family put a lot of money in, built
that beautiful hospital, large medical school out there. And then, from there, how did you hear about ...
You came to Middletown three years before you started, so 1975. How did you hear about the
Middlesex Family Practice program?
Dr. Carl Lecce ( 02:41 ):
Again, that was only one or two years old at the time, and only because a bunch of my friends from
medical school were coming to New England to do residencies and various things. And so, I just started
looking in New England and Middletown. It looked like maple trees in the autumn, with congregation -
Margaret Flinter ( 03:10 ):
[inaudible 00:03:10] Beautiful. Who wouldn't want to come? Yeah. Yeah.
Dr. Carl Lecce ( 03:12 ):
[inaudible 00:03:12] ... college town. A good friend of mine from Middletown went to Wesleyan, or from
Hershey went to Wesleyan. And so, I met some people there that had been at Wesleyan. And, it seemed
like a nice New England town, so I picked it.
Margaret Flinter ( 03:33 ):
But, Carl. Timing wise, this is really the dawn of family medicine as a specialty. Right?
Dr. Carl Lecce ( 03:38 ):
It was pretty close.
Margaret Flinter ( 03:39 ):
Tell us a little bit about that. It had gone from general practice to family medicine with its own specialty
residency training.

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Dr. Carl Lecce ( 03:47 ):
They carved out their own specialty, their own certification, just to make it a more credible way to work
and specialty. It was an interesting thing. When me and my colleagues were applying for residencies, the
dean of students at Hershey told us all ... And, we were thinking of where to go to residency programs.
And, the big divide was do you go to a academic medical center, or do you go to a community hospital?
And, those of us that were interested in family medicine leaned towards community hospitals. And,
even at Hershey, the dean of students who was an academic, said, "That's the biggest mistake of your
career. You really need to be in a tertiary care hospital with other residents." And so. It wasn't
encouraged, but most of us disregarded it and went anyway to community hospitals.
Mark Masselli ( 04:51 ):
Well, you were real pioneers -
Margaret Flinter ( 04:53 ):
Absolutely.
Mark Masselli ( 04:53 ):
... because that was a whole new area. So, you come to Middletown. For those of us in Connecticut,
where in Middletown did you end up living?
Margaret Flinter ( 05:03 ):
Portland.
Dr. Carl Lecce ( 05:05 ):
I ended up on Ridge Road, which was about five minutes from the hospital. Rented an apartment there.
Mark Masselli ( 05:13 ):
Oh, that's great.
Dr. Carl Lecce ( 05:14 ):
And I remember exactly, it was $90 a month.
Mark Masselli ( 05:17 ):
Oh, my God! Well, times have changed. This might be the daily rate.
Margaret Flinter ( 05:23 ):
That's right.
Mark Masselli ( 05:24 ):
But then, you come to Middlesex, very creative initiative. D. Brown. I forget who was the lead at that
point.
Dr. Carl Lecce ( 05:33 ):

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I think he was the head of the residency.
Mark Masselli ( 05:36 ):
Yeah. That's right. Yeah. And, you had local practitioners who were all engaged in that? Pediatrics,
internal medicine. What was the mix there?
Dr. Carl Lecce ( 05:48 ):
Yeah. I mean, it was three years. Most of it was in the hospital, except for our model family practice
unit -
Margaret Flinter ( 06:01 ):
As part of the hospital.
Dr. Carl Lecce ( 06:03 ):
Yeah. Which was next door to the hospital, but owned by the hospital.
Margaret Flinter ( 06:07 ):
Yeah. Still going today.
Dr. Carl Lecce ( 06:08 ):
Yep. Actually, I think, well, not quite in the same place, but very close to the same place. And then, we
did some training in various local practitioner's office. I remember there was a dermatology rotation in
the dermatologist's office and general surgeon in the general surgeon's office. And, that's how it went.
Mark Masselli ( 06:37 ):
Did it have OB at that point? Or was that something that came later?
Dr. Carl Lecce ( 06:40 ):
It had OB. The OB department at Middlesex wasn't wildly enthusiastic about family doctors doing OB.
And, I mean, it wasn't a tradition in New England with Yale and Harvard. And, they dominated how
medical care was conceived.
Margaret Flinter ( 07:03 ):
Well, one of the things that was unique was, you weren't competing with other residents for intensive
care experience or for pediatrics, newborn nursery or any of that. The dean back at Hershey maybe
didn't fully appreciate what a challenge that is in the academic medical centers. And, family medicine,
trying to do that at Yale would not have been a possibility, at least at that point in time. So, you had
great insight.
Dr. Carl Lecce ( 07:26 ):
Yeah. And, it was decent training. I don't have any qualms about it.
Mark Masselli ( 07:32 ):

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Yeah. For those of you who follow Conversations on Healthcare, and follow the work that we've been
doing, obviously you hear now about the health center. Our work not only in Connecticut, Margaret, we
have 200 locations, care for 150,000 people. We have offices for our training program, NIMAA, the
National Institute for Medical Assistants in Denver, in Southern California. The consortium, which is a
program that Margaret started as the first nurse practitioner residency program 15, 16 years ago and
now an accrediting body. And then, we also do specialty care around the country to about four - and - a -
half million lives through our ConferMED. And then, in our DC office, we have Weitzman Institute, which
is our policy arm. But, the reality was when Dr. Lecce came to us, we were one small hallway.
( 08:25 ):
And, I think we had an opportunity to be with Carl yesterday. And he told this interesting story about
the advice as he was thinking about where he should go. I want to sort of say that there's bookends to
what his dean told him or advisor to what advice he got coming to a community health center. I think
many of our listeners, Margaret, are from the federally qualified health center world, of community
health center world. They will appreciate this. One of the challenges that we all faced when we were
much smaller about, is this the right decision to make? And Carl, maybe you could just tell that story one
more time.

Dr. Carl Lecce ( 09:03 ):
Yeah. When I finally had decided to go and I was telling people at the hospital where it was, "I'm going
up the street." And, at that time the relations with the hospital community and the Community Health
Center were not the best. And, it's interesting. The social workers at the hospital said, "Great. Sounds
like a good idea." And then -

Margaret Flinter ( 09:03 ):
Always listen to the social workers.

Dr. Carl Lecce ( 09:29 ):
And I told this one cardiologist and he said, "Hmm. Well, that's fine. But, what are you going to do when
you grow up?"

Mark Masselli ( 09:38 ):
And, you can see what Carl helped us grow over these many, many years. And, maybe just put a little
finer point. Those of you who remember back to your origin stories, probably some of this reflects. So,
Carl comes in '75 to Middletown. '72, we start as a free clinic, offering dental services first. And, we're in
a small, second - floor walkup. And, the state comes knocking on our door saying, "Where's your
license?", and we asked the question of, "Do we need a license?" Of course we did and they did an
inspection. Turned out our hallways were one inch too narrow.
( 10:20 ):
And, we find out later that probably 35 local providers, local physicians, had all signed a letter to the
state saying, "How's it possible?" So, when Carl talks about there was a struggle, certainly we all faced
this at some point. But, I say, today we have great relationships, in part because of the pioneer work you
did -

Margaret Flinter ( 10:43 ):

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That's right.

Mark Masselli ( 10:44 ):
... in terms of building a relationship, by which we got known for more than just be rabble - rousers, but
really for a great practice of medicine, which you did. And I think physicians who are listening here, this
is a true champion, seven days a week, Margaret?

Margaret Flinter ( 11:00 ):
And, I think it's important to note how Carl earned that respect. Of course, you were already known to
many people from doing the residency. But, if we dial back the arc of time thinking on these bookend
days of the beginning and where we are today, that was one of the big differences, right? Carl? Sorry.
Carl was on call 24/7, but he managed all the admissions, newborn nursery to ICU, to wherever in the
hospital somebody needed to be. And that was the beginning, I think, of the creation of the community
connection between the medical community and Community Health Center, because real relationships
developed out of that. And they became, when I joined a few years later, they were friends.
( 11:44 ):
Institutionally, there might be challenges, but in terms of the individuals, the specialists, they were
friends and colleagues, who appreciated enormously that that patient seen in the emergency room had
some place to be sent to for follow - up. Right? The people who weren't attached. This is pre Medicaid,
except in a very limited way. It's the days of city welfare, where you had to go to the town clerk's office
and get a little ticket to go see somebody if you wanted to get healthcare. It was a radically, radically
different world. But, the medical community at the hospital level really counted on Carl, Dr. Lecce as the
person they could then send patients to, and to the Community Health Center.

Mark Masselli ( 12:25 ):
And, Carl, we've moved to the hospitalist program, but I can remember you telling us and we run
ConferMED, which does eConsults ... But, I remember Dr. Lecce coming back and say, "I go to the
hospital, I have an opportunity to pull the specialist aside, ask them questions and really have a
conversation with them." Sort of lost with the hospitalist world. But talk about the opportunities you
had just to go back and consult with colleagues, pull them aside and get some feedback.

Dr. Carl Lecce ( 12:53 ):
Yeah. I mean, one of the positive aspects of working in the hospital ... I mean, one, you got to know the
specialist, and so you got to know who you would prefer to send your patients to and who not. And, it
was a lot easier just to pick up the phone and call them up and say, "Hey, can you give a -

Margaret Flinter ( 13:13 ):
Advice.

Dr. Carl Lecce ( 13:14 ):
Tell me what to do here. Now, most of the specialists are just names, so I don't know them. So, that was
one of the things that was lost. The other thing that was lost was, a lot of people then and now, they go
into the hospital, end of life. And so, we lost the end - of - life part of care. I'm not saying I would really,
really want to go back, but I think that was one loss of not going to the hospital anymore, of taking care
of patients at the end.

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Margaret Flinter ( 13:53 ):
Right. Yeah.

Mark Masselli ( 13:54 ):
Yeah. Absolutely. Margaret, I want to dial back a few more years from that. And, maybe you could just
walk through the background of what was happening in 1980 with the HIV, and what we uncovered and
the work. And, maybe hear from Dr. Lecce about the work with the HIV patient.

Margaret Flinter ( 14:12 ):
Sure. Well, as everybody here knows, I came along a few years after Carl in 1980 as a National Health
Service Corps scholar, assigned to the Community Health Center, my great good fortune to be assigned.
And, Mark accepting me for an assignment down on Main Street in that one hallway that I always call
the original team - based care model. Though we didn't quite call it team - based care, but we had
everything, dental, behavioral health, medicine, and a home visitor. The forerunner of the home
visitation programs for new parents.
( 14:45 ):
And, I would say those first few years were tremendous learning family practice, pretty much what one
might have been expected to do. And then, we were in the mid - eighties reading the weekly monthly
morbidity and mortality report from CDC about Pneumocystis Carinii identified in a small group of
people in San Francisco. And, Carl and I were saying, "What is this?" And, it was very, very short period
of time before the AIDS crisis arrived full - blown. And Carl, you so stepped up to the challenge on that.
Tell us about that, how you remember it unfolding, and the work that you did to try and provide the
very best that we could for people with limited options.

Dr. Carl Lecce ( 15:28 ):
Yeah. I remember we didn't have large number of HIV patients, but we had some and we did the best
we could. At the time, it was basically there was one drug which was AZT.

Margaret Flinter ( 15:46 ):
That's right.

Dr. Carl Lecce ( 15:48 ):
And, we used it. And, retrospectively it didn't do anything, except make people anemic. And, I
remember making some home visits on HIV patients. And, I remember one young guy, he was 17 or 18
caught HIV, because he used drugs with his father, and got progressively sicker from the usual HIV stuff.
And, ended up dying and told me when he was alive, "I don't want my family to know about this." And
so, the family kept questioning me, "Why is my son not getting better? Why are you not making him
better?" And, I couldn't really tell them. And, he eventually, I think died in the hospital. Anyway, but that
was a hard case. Young. I think maybe 18, 19 when he died, something like that.

Mark Masselli ( 17:02 ):
And, probably out of those experiences we formed the OASIS program -

Margaret Flinter ( 17:06 ):

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That's right.
Mark Masselli ( 17:06 ):
Really had the support of [inaudible 00:17:09] down on Ferry Street, also close to the hospital. Right?
Margaret Flinter ( 17:13 ):
Yep. Yep. Preston Street.
Mark Masselli ( 17:14 ):
So, how was it to have that support network as well?
Dr. Carl Lecce ( 17:23 ):
Yeah. That was very helpful to have other people being on the team, helping the patients. And, they had
groups and all kinds of stuff. So, yeah. That was helpful.
Margaret Flinter ( 17:35 ):
Yeah. And then, we had a first line seat on the advent of testing that was reliable, though a little
complicated, of treatments that began to be effective, of the ability to engage with public health and
infectious disease. But, really led to our developing the specialty here to be able to fully manage HIV
care. And, of course, we saw the advent in women as well very quickly.
Dr. Carl Lecce ( 17:59 ):
Yep. Yeah. Then, I mean, from the single ineffective AZT drug, then it became much more complicated
with multiple drugs, multiple regimens, resistance. And, at that point, I personally handed off to ID
people in town, because it became a little complicated for me. And, then we had a couple of infectious
disease people that would come up every week and discuss patients and care. So, that was actually a
good program at that point.
Margaret Flinter ( 18:41 ):
Right. Right.
Mark Masselli ( 18:41 ):
It's interesting you say that, it was complicated regimes that we had to deal with. Margaret and I just
had the opportunity to be at the Aspen Institute and we had a sit down with Dr. Fauci on the anniversary
of PEPFAR. And, one of the stories he told us was the regimes were so complicated. And, he was off to
Africa. The President Bush had asked him to go and he said, "I'll go. And I'm just worried that they just
won't be able to keep up with the regimen of medicines and the timing that had to be used -
Margaret Flinter ( 19:20 ):
Five times a day, at one point.
Mark Masselli ( 19:21 ):
Yeah. It was just really incredible. And, he came back and said, "Oh, my God! They can manage this," and
PEPFAR got born. It was an interesting story.

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Margaret Flinter ( 19:30 ):
Just needed the resources.

Mark Masselli ( 19:30 ):
Just needed the resources. And, he came back and sort of said, "Well, here's the amount I think we
need," and the president said ... After everybody left a room, he said, "Tony, come over here." He said,
"That's a small number. Let's really go all in." And, he told Fauci, "Let me worry about the money. You
just make sure the program works." And, it saved millions and millions of lives -

Margaret Flinter ( 19:56 ):
Millions and millions of women and babies and men and everybody else.

Mark Masselli ( 19:59 ):
But, it wasn't easy. It was complicated and then things got better. On the parallel track. We're also
engaged in domestic violence and we start a battered women's shelter and really having that
relationship of New Horizons, again, not in the facility, but a shelter for them. Obviously, over the years,
lots of domestic violence issues. As a practitioner, what were the struggles that you faced. And, how
were having the resources of a battered women shelter helpful?

Dr. Carl Lecce ( 20:38 ):
Having the resources was great. Before that, there was very little that, at least as a single practitioner or
in a small group, that you could do. So, having both the physical shelter and the shelter personnel that
would come to the office, make contact with the patients. If it needed to go through the court system,
they would help them with the court system. So, that was terrific. Otherwise, it was just very frustrating,
because a single person in an office couldn't really deal with it.

Margaret Flinter ( 21:21 ):
Right. Yeah. Yeah. And, gave us a much deeper understanding of the issues. And, I think, made us better
at just recognizing it in primary care, which is a big challenge. Those few years march on, so much
happened. I marked the late '80s, beginning of the de - institutionalization of people with chronic mental
illness. We are in a beautiful community up on the hill. Overlooking it is a classic state psychiatric facility
that had been there since the 1800s.

Mark Masselli ( 21:50 ):
On the other hill is Wesleyan University.

Margaret Flinter ( 21:51 ):
On the other hill is Wesley. Got some similar architecture there, divided by the Connecticut River and
Main Street. But, it was born of the desire to stop the isolation and stigmatization of patients, which was
all very positive. And yet, the preparation at the level of the community was not quite so. And, I think
much fell to primary care and much fell to Community Health Center in terms of responding, and
suddenly having the challenge of integrating healthcare with psychiatric care and homelessness. Tell us
about what you remember about those days.

Dr. Carl Lecce ( 22:30 ):

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Oh, do I remember? Yeah. It was a challenge. A lot of the folks would come out of the institutions and
they would end up homeless. They would end up using drugs, they would end up that their psychiatric
illness would relapse. There was a community mental health center affiliated with the hospital in town.
I'm not sure it was up to the total challenge of the times, but they were there. And then, at some point,
we developed our behavioral health.
Mark Masselli ( 23:10 ):
That's right.
Margaret Flinter ( 23:10 ):
We expanded.
Dr. Carl Lecce ( 23:10 ):
I don't know when exactly.
Margaret Flinter ( 23:13 ):
Right. Well, we added our child guidance clinic in '86, '87, with filling a real need and became the
designated child guidance clinic. But, our behavioral health services, which had pretty much served our
patient population, with a few, one or two therapists -
Dr. Carl Lecce ( 23:31 ):
I mean, we had Elaine -
Margaret Flinter ( 23:33 ):
[Inaudible 00:23:33] ... from the very be beginning -
Dr. Carl Lecce ( 23:33 ):
... very early. A social worker.
Margaret Flinter ( 23:35 ):
But, they really expanded in order to embrace the full range of behavioral health services and really
became, I think, one of the foundations, which allowed us then, so many years later to expand into the
schools in such a way.
Mark Masselli ( 23:48 ):
And, it's interesting, we now talk about warm handoffs, but there was a warm handoff in the hallway -
Margaret Flinter ( 23:53 ):
Oh, very warm.
Mark Masselli ( 23:54 ):
Back when you came in '78, that you were able to do that. But, team - based care is really something.
And, when we moved over to our newer building and across the state, as we built out facilities, trying to
move from what you experienced when you came. You had a solo office, you didn't really have a solo

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office, but you had a closet. But, how was that transition? Because that was really the beginning of this
choreography of care delivery, that really changed. And, geography was important in terms of bringing
people together. So, you had that older experience of a single office moving into the pods. Talk a little
bit about that transformation.

Dr. Carl Lecce ( 24:37 ):
Yeah. The single office, looking back on it was brilliant. I mean, it may have just been born out of, that's
all we had. But, the dentist was there and the social worker was there. And then, I think we had
somebody to sort of help with entitlements and stuff like that. And then, we got bigger and just by what
was available, we had to be in different buildings. So, the behavioral health moved to a building that was
about 100 feet away. They needed the space, because we didn't have enough space originally to house
them all. And, it made a little bit of a difference as far as access and communication and coordination.
And then, after that, we got our current building, where everything then came back together, so it sort
of full circle.

Mark Masselli ( 25:36 ):
I forget. There was some phrase that we had, a parking lot gap between medical and behavioral health.
There was some chasm that happened, even though it was 100 feet away.

Margaret Flinter ( 25:47 ):
So, we did. I do remember, we did in what we call the bowling alley, which there was the one hallway.
Then we moved to the bowling alley. We did take a crowbar to the walls between a few offices and
create pods as an experiment. So, that was our intermediary step before moving to our piece in health
building as we call it, which really took pods to a very intentional design. And, I think one of the things
I've always admired about you, Carl, is territoriality is not part of your culture. Willingness, eagerness to
communicate with everybody and to share your knowledge and always have time for questions from
people in the pod, really took away any apprehensiveness people had about, "Can I knock on the door?
Can I go in?" There is no door to the pod. So, "Yes, you can."

Mark Masselli ( 26:41 ):
Carl, maybe we talk a little bit about the expansion of the health center and the pluses and the minuses
of that. We have big fixed facilities, from Stanford to Groton, from Clinton up to Enfield, and we're
adding new staff. And, yet probably in the site that you're in, that means there may be diminished focus
of sometimes. But, it also additive of new colleagues that have come in. How has that transition for you?
Happened over many years, where you saw the expansion and you developed new colleagues, new
medical directors at different sites. But, what's your reflection on that? Particularly for so many of the
health centers across America are small, mid - size health centers. Actually, the vast majority of them are
smaller and might be facing this experience. Any advice for medical directors, as you think about the
opportunities?

Dr. Carl Lecce ( 27:36 ):
I don't know. I think it went pretty well for me. I mean, we pretty much stuck to our local team. We have
one meeting a week of the onsite medical directors, so we can talk to each other. Just with the
pandemic and everything, I personally think we lost something with Zoom meetings, as opposed to in -
person meetings. But, I understand there's lots of advantages to the remote Zoom meetings. But, I think

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it was okay. I mean, I just sort of settled in blindly, "Okay. This is where we are now. And this is who
we're working with, so we'll go forward."
Mark Masselli ( 28:27 ):
That's right.
Dr. Carl Lecce ( 28:27 ):
So, I don't think there was a lot of negative stuff. I mean, I think probably one thing I would've liked
more is, "Oh, how are you doing this in Stanford?"
Mark Masselli ( 28:40 ):
Sure.
Dr. Carl Lecce ( 28:41 ):
"How are you addressing this problem in New Britain?" I think we lost a little bit of that. But, anyway.
Mark Masselli ( 28:49 ):
Yeah. Let's shift to what you said was a difficult time, which was the pandemic itself. And, it really just
changed the entire way we did business and probably will be with us for a long time in terms of how
care is. But, what were some of your early reflections on March of 2020. I think in February we had Dr.
Fauci on telling us about COVID. Is it here? We were all focusing on Seattle, was it Seattle? And Dr. Fauci
said to us, "20,000 people from China come to America every single day of the week on an airplane."
And we said, "It's everywhere, right -
Margaret Flinter ( 29:34 ):
Warning. Warning.
Mark Masselli ( 29:35 ):
But, we're all out in, "Is there another case in Seattle?" But it was really, it was everywhere.
Dr. Carl Lecce ( 29:40 ):
Right. At the beginning, it created lots of anxiety among the medical staff. And, one of our colleagues
would get a stuffy nose or get a fever and everybody would be worried. And, the testing and the mask
and weren't quite sure should be we wearing gowns and gloves and masks? So, lots of uncertainty, lots
of anxiety. And then, we flipped over to doing everything remotely. So -
Margaret Flinter ( 30:15 ):
For a while.
Dr. Carl Lecce ( 30:15 ):
... I spent a year at a building across the street. Huge building, beautifully -
Mark Masselli ( 30:22 ):
Beautiful office.

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Dr. Carl Lecce ( 30:23 ):
20 desks. One person talking to people on the screen. And, it was doable. Wouldn't be my preference to
do that all the time, but -
Margaret Flinter ( 30:35 ):
We used to send people over to visit you, to keep you from getting too lonely.
Dr. Carl Lecce ( 30:40 ):
So, yeah. There's a year sitting alone in front of a computer screen. We got through it and then things
eased up. But, yeah. The beginning was anxiety producing, for sure. Yeah.
Mark Masselli ( 30:57 ):
Margaret, as we wrap up with Carl, maybe talk a little bit about his role as a preceptor -
Margaret Flinter ( 31:05 ):
Oh, of course.
Mark Masselli ( 31:05 ):
And just -
Margaret Flinter ( 31:05 ):
Of course.
Mark Masselli ( 31:05 ):
... I think what's important probably to many of the medical directors listening, just training the next
generation.
Margaret Flinter ( 31:12 ):
Right. And, I will say speaking as somebody who arrived as a brand new nurse practitioner in 1980, I
want to thank you for being the best mentor anybody could have. And again, the level of collegiality,
mutual respect, but also just your willingness to share your vast knowledge and all that you had seen,
was incredible. And, I think pretty much from the time I was here anyway, we always had students. We
had students from different schools, we had nurse practitioner students, we had some medical students
for a while. Developed a great relationship with Middlesex family medicine residency for the OB
prenatal program. They are here and run that. So, that's been a nice updating of that relationship. But,
when we made the decision to start the nurse practitioner postgraduate residency program here at CHC,
you along with many providers became a preceptor. But, you have been absolutely instrumental as a
preceptor. And, I wonder if you could talk with us a little bit about your experience? Been doing it now
for 16, 17 years. Generations have been trained by you.
Dr. Carl Lecce ( 32:27 ):
Yeah. I generally enjoyed it. Teaching people, sharing knowledge. I mean, I think it happened fairly
seamlessly. A little bit prior to that I would take medical students. An interesting thing about one of the

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very first medical students I had, they were from Yukon. And, one of the perks of taking a medical
student is ... That was so long ago, they gave you free Yukon women's basketball tickets -
Margaret Flinter ( 33:04 ):
Wow!
Dr. Carl Lecce ( 33:05 ):
... because nobody wanted them.
Margaret Flinter ( 33:07 ):
That would be a heck of an incentive today!
Mark Masselli ( 33:09 ):
UConn Huskies.
Dr. Carl Lecce ( 33:11 ):
But, it started with a few medical students and then went into the nurse practitioner residency. And, I
don't know, it seemed fairly natural to me. I don't remember it having a lot of, "Oh, I have ... " Self -
consciously do this ... It's just, "Yeah. Okay, we'll do it." And, it seems enjoyable. I enjoy it, they enjoy it.
It works out four hours you don't have to deal with patients a week.
Margaret Flinter ( 33:44 ):
Interesting for you. You can go back and look up the things yourself. But, we can tell you, and we were
just at the consortium conference in Washington earlier this week, and part of the buzz were alums who
are all over the country now, several of them running their own programs. L.A. Whitejack out in Seattle,
Jessica Horseman in Hawaii, Tanya Theroux starting up a program in New Orleans. Of course, our own
Nicole Seagriff, who's here at CHC. She is the clinical director of the program. But everybody talked,
they'd all gotten the note that you were leaving. Everybody talked about how important you were to
them as a preceptor. And again, the same things that I look back on as formative, the collegiality, the
mutual respect, the willingness to share the incredible font of knowledge, because you truly have seen
just about everything we think. You never know in healthcare, but we think you've seen just about
everything and great gratitude and also role modeling for what it means to serve in that capacity.
Dr. Carl Lecce ( 34:44 ):
Thank you.
Mark Masselli ( 34:46 ):
And, Carl. As you said the word "enjoy." And, retirement's ... Or this new chapter. I'm not sure how we
define it once -
Margaret Flinter ( 34:52 ):
There were several requests yesterday. They expect you to come back in, so they can ask their
questions.

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Mark Masselli ( 34:57 ):
[inaudible 00:34:57] ... leave or badge activated. But, what are your plans? I know you're involved in
some environmental issues in town, or thinking about those?
Dr. Carl Lecce ( 35:05 ):
Yeah. I don't have a real structured set plan. My tongue in cheek is, I'm going to talk to my dogs and they
will reveal it to me. I've talked to people that were retired and I said, "Oh, how did you figure it out?
How'd you work it out?" A lot of them said, "It took two or three years to get into it." Other than that ...
And, if you're a medical practitioner, your day is really, really structured.
Margaret Flinter ( 35:37 ):
Structured. Right. And, very full.
Dr. Carl Lecce ( 35:40 ):
Every 15 minutes. So, going from that to unstructured, I think, there'll be a challenge.
Mark Masselli ( 35:50 ):
Well, for those of you who follow our work at the Weitzman Institute and know that we're shameless
about taking any opportunity, you might see a webinar on what to do in retirement. Because I think -
Dr. Carl Lecce ( 35:50 ):
A lived experience, perhaps?
Mark Masselli ( 36:04 ):
A lived experience. So, we may see more of Dr. Lecce. And, I want to just, again, on behalf of the family
of individuals who work here and who've been part of our history. And, patients in the community and
civic leaders throughout the community, thank Dr. Lecce for his service. And we wish him well, but we
will see him on Main Street often.
Dr. Carl Lecce ( 36:27 ):
Thank you.
Margaret Flinter ( 36:28 ):
Thank you, Carl. Thank you for everything.
Dr. Carl Lecce ( 36:30 ):
You're welcome.
Speaker 5 ( 36:35 ):
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Inc. The views expressed by guests are their own, and they do not necessarily reflect the opinion of
Conversations on Healthcare or its affiliated entities.

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