Even sky isn't the limit for Fischer's optimism
By TIM RAUSCH
Augusta Chronicle
Published on: 06/03/2008
Who hasn't gone to college with the idealistic self-promise to come out and make a difference in the world?
Paul Fischer actually did it.
His landmark research into the effects of cigarette advertising on children sparked one of the early battles in the tobacco wars that raged throughout the 1990s. It ultimately got restrictions on cigarette advertising.
The Augusta physician didn't change the world, though, without the influence of his children.
The tobacco advertising study was inspired by his son, Tariq, who as a toddler said he wanted to smoke cigarettes.
When Dr. Fischer decided to leave academia, it was his daughter, Shireen, who persuaded him to stay in Augusta and go back into doctoring, and he started what is now the area's largest physicians group.
"He's a free thinker. He believes anything is possible," said Benjamin Hamilton, the president of ImagineAir, an Atlanta-based air taxi service that Dr. Fischer is bankrolling.
When Dr. Fischer's patients found out he was starting that airline, they were worried it signaled an impending retirement. Not for this baby boomer who briefly dropped out of college to lounge with hippies on the beaches of Greece.
"He was bored," said Julie Anne Lacey, who became Dr. Fischer's research assistant at the Medical College of Georgia in the 1990s and is now the chief financial officer of his Center for Primary Care. "He's a pretty intelligent fellow ... Seldom do you find someone with a great business mind and doctor mind."
Yet, he admits that he can't speak a lick of Urdu, the language of Pakistan, where his wife, Asma, was born.
"When I met my wife, I embraced Islam," said the former Baptist. That was 25 years ago.
Dr. Fischer is one of the instrumental people involved in the construction of a new mosque that the Islamic Society of Augusta wants to build in Columbia County. Not just because it is his faith. Not just because the society has outgrown its mosque in Martinez.
"After losing my son, I realized how important it was for me to help people," Dr. Fischer said of Tariq's car accident in 2005. "I want to do something valuable every day."
Difficult diagnosis
In the Evans office of Center for Primary Care, the walls are white - except Dr. Fischer's office, where it is solid red. Hanging there is an original Doonesbury strip, signed by Garry Trudeau, taking a satirical pot shot at Joe Camel. Another wall holds up his certificate of achievement for being elected to the Institute of Medicine in 1999, an elite group that testifies to Congress.
Next to the door is a picture of Shireen sitting at her dad's desk, above the caption "The doc is in."
"We used to sit around the table at night and play Difficult Diagnosis," Dr. Fischer recalled.
The Fischer family game was one that would not spark an interest by Fisher-Price. When Shireen and Tariq were of middle and high school age, their doctor parents would bring home symptoms of a disease to see whether the children could figure it out.
"It is a lot more fun than it sounds. It sounds kind of nerdy." Shireen, now 23, said with a laugh. "It was a fun way to give us insight into what he did on a daily basis."
The game introduced her to medicine and is one of the reasons she chose to go to medical school.
Dr. Fischer said the uncertainty now is whether the second-year student at MCG will choose family practice to follow in Dad's footsteps or a specialty to follow in Mom's. Asma is a pediatric neurologist.
Dr. Fischer didn't have physician parents. His father was a Navy engineer who took care of the engines on nuclear-powered aircraft carriers. His mother was a homemaker who moved the family from port to port.
He was born in Oregon during the baby boom. He spent most of his early childhood on the move until the family roots took hold in Connecticut after his father's retirement from the Navy.
"My mother is a very amazing woman. She would just get in the station wagon with five kids, three dogs, two cats and all of our worldly possessions in a U-Haul behind her. She knew how to go cross country and end up where we were supposed to go," Dr. Fischer said.
He hardly set foot inside a doctor's office while growing up, but when it came time to pick something to do with his life, medicine was the choice.
"It was a profession of high esteem. You get the chance to help other people," Dr. Fischer said. "In the '70s, everybody wanted to change the world. I figured that would be one way to do it."
He started his pursuit of a chemistry degree at a Quaker-founded institution in Richmond, Ind., called Earlham - and then quit.
"There was a time in college when I thought, 'I'm not going to do this because everyone's always wanted me to do it,'" Dr. Fischer said.
He dropped out of Earlham at a time when he was supposed to be in Sweden and Denmark as part of a foreign study. Instead, he spent four months in Greece, sitting on a beach on the isle of Crete.
"All the hippies were going to Crete back then," he said.
He started to think about what he was going to do with his life after he got home, realizing he wasn't meant to just sit on a beach.
"That was the point where I committed as an adult to being a doctor," he acknowledged.
Knocking out Joe
Dr. Fischer started his campaign to make a difference in Weeping Water, Neb., situated between Lincoln and Omaha. He was the only doctor in the county for the two years he was fulfilling a commitment to the National Health Service Corps.
He already had met Asma Qureshi and married her while attending medical school at the University of Connecticut. After residency at the University of North Carolina, it was off to the Great Plains, where Asma was able to get on the faculty at the University of Nebraska.
The Fischer family, now with Shireen, moved south, as Dr. Fischer said, because of the weather and the people: "I hate snow. It is one of the reasons I'm in Georgia."
The Fischers were on the faculty of Medical College of Georgia.
It was in a restaurant in North Augusta that the MCG department head would get an eye-opening comment from a 2-year-old Tariq. The toddler picked up a soda straw, pretended to smoke it and told his father that he wanted to smoke cigarettes and drive fast cars when he became a man.
"When my son said that, I understood things in a new way," Dr. Fischer said: The message of smoking as being a glamorous adult practice was infiltrating the minds of little kids.
When his study came out in the Journal of the American Medical Association, a person wouldn't think "Recall and Eye Tracking Study of Adolescents Viewing Tobacco Advertisements" to be very controversial. It was. Joe Camel, the cartoon character for R.J. Reynolds' Camel brand cigarettes, was as recognizable to 5-year-olds as Mickey Mouse. Dr. Fischer was soon talking to reporters from major media operations.
He knocked out Joe Camel, Mrs. Lacey said.
"I don't think history is going to remember me as having done it, but I got some personal satisfaction," Dr. Fischer said. "That study was in part responsible for the change in our country from a smoking country to one that wanted to stop smoking. There were a lot of studies about cigarettes being harmful, but that study on targeting children really changed the feelings people had toward the companies."
He is being honored for his efforts with a mention in the introduction to Harvard medical school historian Allan Brandt's The Cigarette Century, which was released in March.
Not long after Dr. Fischer's 1991 study, R.J. Reynolds was sued by a smoker citing Dr, Fischer's research. Joe Camel's attorneys then came calling and tried to get their hands on his research, specifically the names of the preschool children who were used for the study. Dr. Fischer said he thought the company was going to use the information to discredit him.
R.J. Reynolds ultimately got its hands on Dr. Fischer's research. He said attorneys for MCG told the tobacco company attorneys that they could get it through a public records request. With R.J. Reynolds' "harassment" completed, Dr. Fischer became an expert witness for the state attorneys general suing the tobacco companies.
"He handled it with a lot of grace, even though it was a pressure-packed situation," said Dr. Edwin Scott, then a student at MCG while Dr. Fischer was the head of the family medicine department. "He didn't know what was going to happen to him ... He never panicked, and stuck to his guns and prevailed."
It cost him his job, though. When MCG President Francis Tedesco sided with the tobacco company in trying to get the research released, Dr. Fischer said he realized he couldn't stay at the medical college any longer.
He looked around for other department chairman positions.
"My daughter at the time was 7 or 8, and she said, 'Well, Dad, you can go practice wherever you like and come see us in Augusta on the weekends.' That was the first time I really thought about the fact that my family was wedded to Augusta."
Carving a new niche
The Center for Primary Care is now centers - plural - five locations with a sixth in the planning west of Evans. In 1993, however, it was just Mrs. Lacey and Dr. Fischer in an office at University Hospital.
"In a city with 100 cardiologists, there was not a well-developed primary care system. This was a good setting to start a multisite family medicine group," Dr. Fischer said.
Mrs. Lacey, who had a business degree, joined Dr. Fischer's research team because she was burned out on business. He hired her as his assistant for the private practice. Mrs. Lacey said the doctor always has the vision, but he needed someone to handle setting up the business.
Mrs. Lacey said she was told it wasn't going to be that busy. "We had 20 patients on the first day."
Now the practice is one shy of having 20 doctors. One of the first to join Dr. Fischer was Dr. Scott.
On graduation, he, along with others who were leaving MCG to go into family practice, got a copy of Dr. Fischer's textbook.
"He wrote inside my copy, 'I hope we get to work together again someday,'" Dr. Scott said.
Someday was a year later. Dr. Scott returned to Augusta from North Carolina for a meeting and had breakfast with Dr. Fischer. The conversation turned to how unhappy Dr. Scott was with the situation and how he was thinking of leaving Fayetteville.
"The next thing I know, I'm getting called to my boss's office in North Carolina because he got a letter from Paul saying that I was going to leave and move back to Augusta and go into practice with him," he said. "Paul doesn't burn the bridges behind you; he sets fire to them while you're standing on them."
Dr. Scott said Dr. Fischer has used a similar recruitment technique on others. Dr. Fischer performs at a high level and expects that out of everyone else.
"He has a low tolerance for people who don't," Dr. Scott said.
As a way to foster leadership, Dr. Fischer gave up his power in the medical practice and its real estate corporation. Dr. Robert Clark is the chief executive of the medical group. Dr. Scott will get the mantle next year.
Turning over power is one of the ways Dr. Fischer lifts people up, Mrs. Lacey said.
"He's the type that will empower you. This is what I want done, now go do it. He knows you can though you're scared to death. ... He does that with anyone that is willing," Mrs. Lacey said.
She said Dr. Fischer also operates with a "work with me" attitude, not a "work for me" attitude.
Though Dr. Fischer doesn't have the power any more, he is still the father figure in the board room, Dr. Scott said. The business runs smoother with the blessing of the parent. Letting others run the businesses is a blessing on its own for him.
Ratatouille
Asked about hobbies, Dr. Fischer said: work and starting companies.
"My practice is my hobby. There's a fine line between what I enjoy doing and what I do."
That isn't far from the truth, Dr. Scott said: "He spends most of his time trying to make money. That comes close to his real hobby, starting businesses and making profit."
Still, there is the doctor who is also a "frustrated farmer," spending time in the residential garden.
The produce from the garden ends up in the doctor's ratatouille: tomatoes, onions, zucchini, eggplant and peppers.
"It is his specialty dish," Shireen said.
The doctor's specialty might be making lemonade from the lemons handed him throughout his life.
"Throw lemons at him," Mrs. Lacey said. "He'll come out on top. He always does."
The sourest lemon was July 13, 2005.
Tariq, a sophomore at Swarthmore College in Pennsylvania, was driving on Interstate 20 near Thomson when his vehicle hydroplaned. He and two occupants died after it hit a truck.
"It crushes you as a parent when you watch the book of life of your child unfold and then it comes to an end at the third chapter," Dr. Fischer said.
Mrs. Lacey said it was the lowest she had ever seen Dr. Fischer - and it was the first time in their work relationship that she didn't know what to do for him, how to fix it.
"I had this older couple, in their late 80s. I saw them after Tariq died," Dr. Fischer said. "I could tell when I walked in the room they had something they wanted to tell me. They had lost their son, who was a law student and had just gotten married.
"He and his wife were in a car accident 60 years before. The pain they had in their eyes was the same pain I was feeling. I knew it was pain that never goes away."
The Fischer family gave $1 million to Swarthmore College in Tariq's memory. There is an Islamic tradition that people are encouraged to set up educational facilities or programs that will continue to benefit people even after the donors are gone.
Donations made after Tariq died became the Panacea Fund, which paid for the plans for the mosque.
Shireen said one of her father's main assignments in the Islamic society is to raise money for the new mosque.
"People are naturally hesitant to give," she said. "He shows them that it is worthwhile."
What was also worthwhile was an idea on how to make business travel easier, a company that Dr. Fischer was going to form and then turn over to someone else to run. This one was going to go to his son.
"That's why he's so passionate about ImagineAir. If it were not for Tariq, I don't think he would have kept pursuing it. He wanted to do it for Tariq," Mrs. Lacey said.
Imagined wings
As a researcher with MCG, Dr. Fischer spent a lot of time in the air. The hassles of air travel versus the lack of hassles with private jets while he was flying as the expert witness in the tobacco lawsuits was a stark difference.
He said private jets changed the world in much the same way cars made the world smaller for those using horses.
When the medical partners wouldn't go for a private aircraft for the company ...
"I decided to start an airline. My son at the time was ready to go to college. I figured it would be a good project for him for when he graduated college," Dr. Fischer said.
Shireen said she warned friend Aaron Sohacki, a Georgia Tech student and pilot, before he sat down beside her father that he might get a hard time.
"People think he's very intimidating because he's successful. He gets things done and has vision on how he wants things to be," Shireen explained. "He's so nice and he's so funny. After the first five minutes, he's the life of the party."
The conversation turned to the discussion of starting an airline.
Mr. Hamilton, ImagineAir's president, was pulled into the picture in a subsequent meeting.
Dr. Fischer bankrolled the airline and turned it over to Mr. Hamilton and Mr. Sohacki.
"He wanted to put us in charge. He wanted to give us the opportunity because he saw the value of taking kids right out of college with open minds like himself," Mr. Hamilton said.
Dr. Fischer's role now is to simply sign the checks, but he still has his visionary moments.
"Sometimes he comes out with the crazy ideas that Aaron and I chuckle at sometimes. But really, those are the ideas that make things possible," Mr. Hamilton said.
What's possible is that the air taxi service team is planning for 100 percent growth annually for the next few years, an intense scenario for a doctor who has enjoyed 20 percent annual growth with the medical practice.
"The economics of business travel have become so high, flying your own personal plane becomes much more reasonable," Dr. Fischer said.
The engines for the new ImagineAir jets, he said, come from Pratt & Whitney, the company his father joined after retiring from the Navy.
Augusta cardiologist Abdulla Abdulla said he was surprised that Dr. Fischer went in the direction of an airline, but isn't surprised by the man's entrepreneurial spirit.
The former hippie beach bum is acutely aware that people now look at him as the white-haired 53-year-old baby boomer.
"Boomers think about retirement. They all want to not work and travel and have a house on the beach," Dr. Fischer said. "I don't think I'm going to have an abrupt change in my life.
"My patients are worried that I'm going to retire (based on starting the airline). The truth is, there's nothing I'd rather do in retirement that I don't do every day."
Mrs. Lacey scoffs at the idea of Dr. Fischer's retiring.
"He can't sit still," she said.
Reach Tim Rausch at (706) 823-3352 or timothy.rausch@augustachronicle.com.
