Permanente in the Northwest

About the Author: Ian C. MacMillan, MD has never authored anything before. He was born and raised in Regina, Saskatchewan where he was influenced by his physician father to become a doctor. He received his MDCM from Queen’s University, Kingston, Ontario and interned at University of Alberta Hospital where he met his future wife Shirley on the pediatric ward. A Fellowship in Internal Medicine at the Mayo Clinic convinced him of the desirability of group practice and, after a pathology residency in Victoria B.C. where he was impressed with the beauty of the Pacific Northwest, he joined The Permanente Clinic in 1961.

© 2010 by The Permanente Press

Published 2010 by The Permanente Press Oakland, California • Portland, Oregon

The Permanente Press is owned by The Permanente Federation, LLC Oakland, California

PERMANENTE IN THE NORTHWEST

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ISBN: 0-9770463-3-8
Library of Congress Control Number: 2009937531

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, without permission in writing from the publisher. Permissions may be sought directly from The Permanente Press Publishing Office, 500 NE Multnomah Street, Portland, Oregon, 97232 USA; phone 503-813-4387, fax 503-813-2348.

Every effort has been made to trace the copyright holders of material reprinted in this book. The editors and publisher request that any copyright holder not listed here contact the publisher so that due acknowledgement may appear in subsequent editions.

Book design by Lynette Leisure

Printed in the United States of America

Dr. MacMillan chronicles the growth and development of Northwest Permanente from the birth of the idea of prepaid medical care to the large multispecialty medical group of today. He provides a thoughtful, well-researched account of the clinicians, leaders, and innovators, along with the challenges, triumphs, and near disasters along the way. — H. Raymond Blair, MD, Northwest Permanente Pediatrician for 43 years

A superbly chronicled account of the Northwest Permanente Medical Care Program from its humble beginnings to its evolution into a nationally recognized model. This book captures the true spirit of dedication and commitment by many talented individuals, professional and administrative, who contributed to the growth and advancement of the organization, while dealing with various challenges and conflicts. The text is easy reading, captivating, and fascinating. — Bhawar Singh, MD, Northwest Permanente Anesthesiologist for 42 years

Permanente in the Northwest is an accounting of a rich legacy of physician leadership, clinical excellence, and medical politics that serves as the foundation of Northwest Permanente, P.C. The early years through the turn of the 21st century demonstrate how Northwest Permanente has become the leader in the deployment of an electronic medical record, the application of evidenced-based principles, and in the delivery of integrated care in the Northwest market. I have confidence that we are well equipped to lead our community in health care reform. — Sharon M. Higgins, MD, Northwest Permanente Executive Medical Director

“The history of this Northwest physician group parallels that of 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. The author of this account, Ian MacMillan, for many years confined his writing to notes in medical charts as an internist and rheumatologist with Kaiser Permanente. For 14 of those years he was the well-regarded Chief of the Department of Medicine at Kaiser Sunnyside Medical Center. … In his narrative covering six decades of Kaiser Permanente Northwest history, MacMillan exploits the opportunity to tell the stories of physicians and others in both major and minor roles. Testament to his broad curiosity, he enriches his archive with historical detail and context. 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, 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 of health care reform.” — From the Foreword by Arthur D. Hayward, MD Successor to Ian C. MacMillan, MD, as Northwest Permanente Chief of Medicine