Turning Point
Dr. Spencer returned from his tour of duty and began his chief resident stint at the University of Colorado in 1975.
That year, Boyd Bigelow, MD, “a maverick with a plane” by Dr. Spencer’s account, hired him to admit and manage patients at Denver’s St. Anthony’s Central Hospital, which had no house staff. “To compete with big hospitals, we’d fly referrals into Stapleton [Air Force Base],” Dr. Spencer says. Dr. Bigelow became medical director of Flight for Life, the first civilian airborne emergency medical service, which has flown more than 65,000 patients to critical care facilities. He would swoop down from the sky through Colorado’s whirling snow, delivering patients to Dr. Spencer.
In 1976 Dr. Spencer took stock of his career and recognized he wanted to be a hospital-based physician. He contacted John Hoidal, MD, from his University of Colorado days, expecting to buddy up, move both of their families to Everett, and cover inpatients at two hospitals 24/7. But Dr. Hoidal chose not to go.
“It would have been easier if the two of us had started the hospitalist practice together, but it wasn’t right for him,” says Dr. Spencer. “I saw that I could do it on my own. I had energy to burn and ambition to succeed.”
Undaunted, he soldiered on to Everett.
“It is an absolutely gorgeous place to live,” he says. “When we arrived I found Everett loaded with GPs in their busy offices, and I had the expertise they needed to manage their inpatients. I hooked them with my three A’s: availability, affability, and ability.”
Everett Hospital hired him to provide 24/7 coverage for respiratory care, the intensive care unit, medical/surgical consults, and overall inpatient management. He worked solo for more than a year and grew exhausted. He hired a second physician in 1977, then Dr. Cramer in 1979.
Also in 1977, Dr. Spencer forged what has become a 30-year professional relationship with Eric Larson, MD, MPH, executive director of the Center for Health Studies Group in Everett.
“In 1977 I was chief resident at Providence General [which merged with Everett Hospital to become Providence Everett Medical Center in 1994],” Dr. Larson says. “Tracy introduced himself as a hospitalist and said he took care of patients in the hospital for GPs. It seemed like an interesting solo practice model.”
What struck Dr. Larson at the time was the contrast between the commotion of a teaching hospital with medical students, interns, residents, and attendings “tripping all over each other” and Dr. Spencer’s approach.
“He embodied the principle of keeping things simple and was organized and methodical in his approach to patients,” Dr. Larson says. “He was superb in pulmonary medicine and the ICU.”
Challenging Times
The hospitalist practice and Everett’s medical community kept growing through the early ’80s, with specialists joining general practitioners in using Dr. Spencer’s group for consults and co-management. Then came managed care in the mid-’80s, and the hospitalists’ gains seemed threatened. “Managed care’s tight controls and preauthorizes of inpatient services were terribly frustrating,” says Dr. Larson. Dr. Spencer found himself competing for managed-care contracts rather than seeing patients.
By the time managed care loosened its grip in the 1990s and the hospitalist movement was officially launched, there were new challenges and frustrations. Dr. Spencer felt worn out administrating rather than doctoring. Dr. Larson felt something else: futility. “One of the hardest things about being a hospitalist is dealing with the futility of treating old people with multiple co-morbidities who shouldn’t even be in a hospital,” explains Dr. Larson. “Hospitals are now so protocolized. Once a patient gets in the hospital he’s almost on automatic.”