Permanente in the Northwest

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Ian C. MacMillan, MD with contributions from Kitty Evers, MD & Allan J. Weiland, MD -- Edited by Judy Hayward
What would later become Kaiser Permanente began as something of an afterthought for Henry Kaiser and as a job opportunity for young surgeon Sidney Garfield: Kaiser, the industrialist who drove himself and others to “Think Big”, couldn’t afford to let illness and injury among workers drain productivity on his big projects. Medical care had to be readily available in remote sites and capable of keeping workers healthy and on the job. For his part, the recently trained Garfield imagined a job that offered key features he’d enjoyed in his training: predictable pay, camaraderie with fellow physicians, and reliable cross-coverage during off hours.

Kaiser’s emphasis on productivity became even more critical in World War II, when he was assigned important projects in the Pacific Northwest. At his Portland and Vancouver shipyards near Portland, Oregon, Kaiser sought to replicate his previous arrangement with Garfield to assure medical service to workers. The collaboration between the two led to the 1945 hiring of internist Ernie Saward, who became chief of medicine and assembled a team of physicians for the task.

Permanente in the Northwest relates through small stories how a change in financing medical care, implemented 60 years ago, created a rationale, and drove physicians to collaborate to deliver care to a population that included both the sick and the well. In telling this story, Dr MacMillan has made the book relevant not only to past and present physicians who will find their names in the text, but also to the current national discussion on health care reform.

The history of this Northwest physician group parallels that of Dr Sidney Garfield’s physicians in California; two groups with separate beginnings shared a template and later became affiliated as geographic Regions in a national Kaiser Permanente.

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