Interview by Dinah Miller, MD
[Fall 2003; Vol. 30, No. 1; Pg 6, 10]
Last night, shortly before dusk, Bob Roca went running. It may have been hot and muggy, and he probably had worked a 12-hour (or longer) day as Vice President & Medical Director of Sheppard Pratt Health System, but when he got home, more likely than not, he went running. It may have been just a quick six-mile run around his Towson neighborhood, or it may have been a 28-mile journey up and down the NCR trail, but chances are, he ran somewhere.
Dr. Roca slips in and out of a variety of roles in the course of a day and in the course of a career. After graduating from Occidental College in 1974, he went on to UCLA where he simultaneously received an M.D. from the School of Medicine, and an MPH in Epidemiology from the School of Public Health. He completed residency training at Johns Hopkins, first in Internal Medicine, then in Psychiatry, and went on to receive Special Qualifications in Geriatric Psychiatry. He spent seven years as Director of Consultation and Geriatric Psychiatry at Frances Scott Key, and has worked at Sheppard Pratt since 1993. Currently, he is Sheppard’s Vice President & Medical Director, a position he’s held since fall of 2000. Dr. Roca is a member of eight professional organizations; he is, or has been, on 43 different professional committees, sub-committees, and task forces. He has authored or co-authored 21 book chapters. Aside from the professional, he has been married for 24 years to his wife, Breon, who also pursues a multi-faceted life as a nurse and a sculptor. They have two children, Peter, 20, who is studying neurophysiology at College Park, and Julia, 19, who attends Skidmore College. If that's not enough, Dr. Roca has run in 11 marathons—his “best ever” time was 2:52 in the 1982 Marine Corp Marathon, with a more recent “best” time of 3:12 in the 2002 Baltimore Marathon. And now he's President of MPS.
I met with Dr. Roca one afternoon in July. The Sheppard campus was swarming with activity-- there were construction crews in the midst of erecting the new hospital, and party tents with hot dog vendors were set up for the employees' Summerfest. Dr. Roca was pleased that I'd managed to find his office in all the chaos, and didn't hesitate to let me know that he was a bit uneasy talking about himself.
He is a slim man, with deep set eyes, chiseled features, and a purposeful manner. His voice is melodious--soothing even, and he speaks with just enough volume to be heard. He talks slowly, and it's obvious that he cares which words he uses. Nothing about his manner is rushed, or heedless, and only the fact that his lunch –stolen bites of naked tuna fish with string beans and black olive slices—brought to his desk on a white styrofoam carry-out tray, belied the fact that he might have all the time in the world. And so we talked.
It's the moment you've been waiting for: the latest issue of The Maryland Psychiatrist arrives in the mail. What would you like to know about the new president?
I think about questions like this when I'm interviewing job candidates. Usually I get them talking about something they're interested in and we move on from there. It's not so much things like their hobbies that interest me, but I guess what I want to know about people is how they got to be where they are and what had impact on them along the way.
How did you get to be where you are and what had impact on you along the way?
I remember being a child and having my father say to me that he thought the worst kind of pain anyone could have was anxiety and depression. This idea that emotional suffering could be so painful stuck with me. So, when I finished my medical residency I decided to apply for pulmonary fellowships and psychiatry residencies at the same time. I remember walking into a pulmonary lab at Hopkins to interview, and there was this preparation of dog lung being inflated and deflated. It struck me as very bizarre-- it wasn't something I was drawn to. And then I met with Paul McHugh, and we had this great conversation. He gave me an early draft of The Perspectives of Psychiatry to look at, and I found it so clear. Psychiatry had always been a mystery. I thought, “I’ve found what I want to do.”
What do you see as important issues for the MPS in the coming year?
I have two themes in mind. One has to do with our infrastructure as an organization and our connections with our membership. We have already started a new committee for Academic Psychiatry, to enhance our connections with an important MPS constituency. We have also started to look at ways of more effectively linking the efforts of the MPPAC and the Legislative Committee. The other theme involves enhancing our affiliations and connections with critical partners outside the MPS. This includes other professional and advocacy groups. Last year we did a lot of work with NAMI with respect to changing the Emergency Petition criteria. We also worked with ER docs to examine the problem of protracted ER stays for patients needing psychiatric admission. It’s important for us to continue doing this kind of collaborative work with other groups.
In terms of legislation, it's a little early to tell what's going to be on our table. The Legislative Committee is a very lively group--they look at over one hundred bills a year. We're always prepared to deal with issues of scope of practice--like the psychologist prescribing. But that's a negative issue, and there are other important and more affirmative issues. For example, we're working on how the Preferred Drug List will be implemented for Medical Assistance patients. We tried to get the legislature to exclude all psychotropics-- a number of us testified, but they elected not to exclude them. So, now we're trying to work with the DHMH in terms of the implementation.
Another perennial issue is reimbursement for treatment of the dually eligible, those with Medicare and Medicaid. Medicaid picks up only a small fraction of the co-pay, and this is a burden for clinics and clinicians caring for these patients. During the most recent session, the legislature passed a bill that might provide a remedy; we’ll be monitoring its implementation.
Tell me about your running. Why do you run?
I came to running a little late. I was a medical resident, and some of my friends were running marathons, and I thought, “If that guy can run a marathon, I can run a marathon.” I started training, and I ran five marathons in a little over two years. Then I stopped doing marathons and thought I wouldn't run one again. But several years ago one of my colleagues at Sheppard – Susan Wait - started running marathons. I thought, well, why not? So I ran the marathon on the North Central trail and managed to qualify for Boston. I’ve run the last three Boston marathons, and another two in Baltimore over the last three years. It’s not altogether easy to say why I run, but it’s partly that I like the sensation of effort, and partly that I like the sensation of stopping. It’s also an amazing feeling to think “I’m going to run 26 miles; can I run 26 miles?” and then manage to run 26 miles. It’s completely unnecessary and very exhilarating.
Is there something else you like to do?
Fishing. When I was a kid, I got this idea that I wanted to fish, but no one would ever take me; it was something no one was interested in. I even started reading books about fishing. Do you know anything about fly fishing? There's a lot to it--the entymology, the technique. Then, one day it hit me that I was a grown up, and I could go fishing.