Depression, War and a Population Explosion
Like the rest of the nation, Palo Alto in the 1930s suffered through the Great Depression. Palo Alto Medical Clinic physicians often waived their fees – $3 for an office visit, $4 for a house call and $10 for a night house call – because patients simply could not afford to pay.
"You just didn't think of sending them bills. Some would run out to their garden and pick some lettuce for you, and sometimes you hated to take it," Dr. Esther Clark said. After World War II, many patients returned spontaneously to pay off old debts, though the doctors had long since written off the charges.
The Clinic was organized as a partnership, and in the early years, each partner was assigned whatever percent of income seemed appropriate for his or her services. A separate corporation, in which each physician held stock, owned the real estate, medical equipment and office furniture.
Governance decisions were made informally, with each partner's vote carrying equal weight. Although Dr. Lee was a dominating presence, other partners recalled that they sometimes outvoted him.
With few other hospitals or medical providers on the Midpeninsula, the Clinic cared for patients from San Carlos south to Sunnyvale, and west to the coastal communities. As the patient base grew, Dr. Dunn and Dr. Harold Sox, an internist who specialized in diabetes, joined the group in 1937. Though all the doctors had their own specialty areas, the Clinic was still small enough that they would assist each other as needed.
"When they brought me down [from San Francisco], it was because Roth was going on his sabbatical. There was nobody else to scrub in surgery, so while I was an internist, I also had two hands and was a doctor," Dr. Sox said. "The next year, Esther Clark went on sabbatical and I became a pediatrician for six months."
War and the Post-War Boom
The outbreak of World War II caused dramatic changes in Palo Alto. Though the town had grown little during the Depression, the war brought an influx of military personnel and their families to the Peninsula. At the same time, about half the physicians in Palo Alto joined the service.
Those who stayed behind handled a remarkable caseload. "During the war, I was the only obstetrician between San Mateo and San Jose," said Dr. Dunn. "To show how busy we were, in one year I delivered 1,000 babies – roughly three a day."
Dr. Lee was among the first area physicians to go to war, becoming chief of professional services at Santa Ana Air Force Hospital. After two years, he was appointed chief of preventive medicine for the entire Air Force (a rank of colonel), a position in which he traveled around the world to every fighting front.
He became the personal physician for the Secretary of War and the Commander in Chief of the Air Force, and became known as the Air Force's "general practitioner" because he treated so many men of that high rank. "It was," he said, "an exceedingly interesting job."
After the war, Palo Alto saw rapid growth. Many families who had been stationed on the Peninsula by the military chose to stay, and the baby boom began. Palo Alto's population more than doubled from 16,774 in 1940 to 33,753 in 1953.
The demographic shift put a strain on city resources, including health care. Palo Alto Clinic leaders concluded they needed to bring more doctors into the practice to keep up with demand. "We held a clinic meeting and decided to ask the most qualified specialists in Palo Alto to join us," Dr. Lee said.
By this time, some doctors had experienced and enjoyed group practice as part of larger medical military units. Others had been displaced from solo practices while serving overseas. Whatever the reason, many independent physicians were receptive to the Clinic's offer. In 1946 alone, 12 new doctors came on board.
Surgeon Ralph Cressman was one of them. Returning from war, Dr. Cressman initially joined forces with internist J. Sewall Brown to start another group practice in Palo Alto.
"Come along December, Russ Lee approached us and said he would like us to join the Clinic and we would join as full partners at $1,000 a month," said Dr. Cressman, who is now retired. "Sewall and I figured that to start another group and get very far would be a little difficult and this would be better, so [we] joined the Clinic."
Dr. Lee's personality helped win people over, remembered Dr. William Clark, a retired internist who joined the Clinic in 1947 (and who is no relation to Esther Clark). After the war, Dr. Clark was guided toward the Clinic by Dr. George Barnett, the Stanford professor who had been Tom Williams' original partner and trained many of the Clinic's early doctors.
"It was really due to Barnett's spirit that we came. And then, we fell under the spirit mainly of Russ," he said. "I think [the doctors who joined] saw that the Clinic was a main act in town. And Russ had an eye for good doctors, he had persuasion and he was really dedicated to multispecialty practice."
The growth brought in doctors from new specialty areas, such as radiologist Sydney Thomas and ophthalmologist O. Ralph Tanner. For the first time, the Clinic was truly capable of handling a full range of health care needs. The group began to organize more formally into specialty divisions and dealt with growing pains both small and large, from learning to centralize record-keeping to the continual need for more space.
An expansion to their office building, which had been built for just 12 doctors, provided only short-term relief, and by the end of the 1950s, the group had acquired or constructed several new buildings in the downtown area.
Medicine was changing too during this time, with the major development being antibiotics. Penicillin, sulfadiazine and similar drugs helped eradicate diseases in ways impossible to imagine just a few years earlier. Still, in some ways the doctor's life was little different from what it had been, with house calls and hospital rounds still customary.
"The Clinic knew where we were, and if they needed us they would call ahead to our next stop," said Dr. William Clark. But driving between patient houses was "our quality time, to look at the blossoms in the Los Altos orchards and so on. Very different. Thank God there weren't cell phones."
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