By M. Rudolph Brody MD and Sam Sapin MD Kaiser Permanente Southern California
First of Two Parts
Permanente’s pioneering physicians started out in the 1940s with the idea of developing an academic environment in which to practice medicine. Accustomed to the university-based hospitals in which they got their training, these not-so-traditional doctors relished the idea of keeping their strong connection to academia. Group practice, which allowed for convenient consultation with colleagues, was the perfect vehicle.
In the late 1940s, Southern California Permanente Medical Group physicians presented interesting and challenging cases for their peers twice per week at the medical centers. More in-depth discussions took place at half-day departmental educational activities that included organized rounds at various hospitals, teaching and research. Often the medical group hosted visiting professors who presented and led discussions.
In Northern California, The Permanente Medical Group physicians were taking a similar route. Doctors were given a half day a week to pursue academic opportunities, including teaching, learning and research. By 1969, San Francisco and Oakland medical centers had graduate medical education programs, and each facility had a chief of staff for education.
Beginning in 1955, SCPMG invited medical experts renown in their fields to lead specialty symposia and share new clinical information. Research, mainly on clinical topics, flourished. Without knowing it, SCPMG physicians were practicing in an environment that met the definition of an academic medical center.
Cross-pollinating medicine and academia
What is an academic medical center? Let us take you back one hundred years in American medicine to explain:
In 1910 the Carnegie Foundation asked educator Abraham Flexner to review the quality of the 155 medical schools then operating in the United States and Canada. Flexner visited each one of the schools and prepared a voluminous report that would result in all but five of the schools being declared deficient and forced to close.
The Flexner Report spurred a revolution in medical education, and the academic standards set at the time of its release are still pertinent today. In his investigations, Flexner identified Johns Hopkins University School of Medicine as the model for all institutions qualified to train new physicians.
The Johns Hopkins model set down three must-haves for an institution qualified as an academic medical center: 1) a clinical setting where new physicians can gain experience treating patients, 2) high quality teaching and 3) a research program.
Academic bent attracted like-minded colleagues
Starting out a few decades after the Flexner Report’s release, Kaiser Permanente pioneers understood the value of high-quality physician education. Our early physician leaders created educational opportunities at the medical centers and encouraged all doctors to participate. Many physicians taught at local medical schools. With this academic mindset, SCPMG attracted many new physicians who had recently finished their post-graduate residency and/or fellowship training.
With a large clinical practice and excellent continuity of care, Kaiser Permanente medical centers also began to attract medical students looking for a clinical rotation. Next, residents from local university residency programs came to Kaiser Permanente for an elective experience. This led to residents affiliated with medical schools rotating through the Fontana and Los Angeles Kaiser Permanente medical centers.
In the mid-1950s, SCPMG physicians began to ask themselves: Why not develop our own independent residency programs? The three assets that Johns Hopkins University saw as vital to an academic medical center – opportunities for clinical experience, education, and research – all existed within Kaiser Permanente Southern California.
First SCPMG residency program launched
Led by OB-GYN physicians T. Hart Baker and Jack Halett, the first independent residency program was begun in 1955 at Kaiser Permanente Los Angeles. Dr. Baker, who later became the Southern California regional medical director, had a strong academic background and proven administrative abilities. He teamed up beautifully with Dr. Halett, who had an upbeat personality and a passion for research.
During the early years, a number of the graduates of our OB/GYN Residency Program stayed on after their residencies and devoted their professional careers to SCPMG. These included Ruth Nicoloff, MD, Fred Miyazaki, MD, Harry Richards, MD, and Doug Taguchi, MD.
Started in 1971, the pediatrics program initially had one resident, Richard Mittleman, MD, then added Daisy Dolorfino, MD, Jim Heywood, MD, Mary Ellen Friedman, MD, and Phil Mattson, MD. All but one of these pioneer pediatric residents continued their careers at what later became the Baldwin Park Medical Center. Dr. Mattson continued his career at SCPMG in San Diego.
Graduate physician education expands
In the ensuing years, residency programs were started in several other KP medical centers: family medicine at Fontana; internal medicine, general surgery, pathology, urology and pediatrics at Los Angeles; internal medicine at West Los Angeles; and family medicine programs in Orange County, Riverside and Woodland Hills.
Vince Roger, MD, was key to the development of the Family Medicine Residency in Fontana. Dr. Roger also oversaw the launch of the Sports Medicine Fellowship in Fontana, which Aaron Rubin, MD, and Bob Sallis, MD, have directed since 1990. Our sports medicine program was among the first 20 that were accredited in the United States in 1993.
Today, SCPMG trains more than 300 residents and fellows in 27 independent residency and fellowship programs in six of Kaiser Permanente’s Southern California medical centers. About 150 residents at various GME programs in Southern California, including UCLA, University of Southern California, UC Irvine and Loma Linda Universities, rotate through our medical centers for a portion of their training. We can afford to be highly selective because we receive more than 7,500 applications each year for 100 available positions.
Many people have contributed over the decades to the success of our residency programs. Our list includes our longtime Los Angeles residency program directors: Jack Braunwald, MD, Steve Woods, MD, Ted O’Connell, MD, Thomas Tom, MD, Jimmy Hara, MD, Aroor Rao, MD, Craig Collins, MD, and Scott Rasgon, MD.
Also deserving recognition are: Tim Munzing, MD, program director, Orange County; Walter Morgan, MD, program director, Riverside; Dennis Kim, MD, physician director of the Center for Medical Education; and A. Robert Kagan, MD, an internationally known radiation oncologist.
The growth and prestige of our educational programs result from the work and support of many professionals. We have mentioned some of them in this article, but we realize that many more deserve credit and praise for their contributions.
Next time: Southern California Kaiser Permanente residents take their care to the community.
M. Rudolph Brody, MD, is the retired director of the Center for Medical Education at the KP Los Angeles Medical Center. A pediatrician, he helped create and develop SCPMG’s Pediatric Residency Program and was the first pediatric residency program director (1970-1990). He was the regional coordinator for all the Southern California Residency Programs from 1983-1992.
Sam Sapin, MD, a retired pediatric cardiologist, was SCPMG’s associate medical director for Clinical Services from 1982 to 1990 and consultant for Clinical Services until 1994. Sapin was SCPMG’s first director of Education and Research, taking on that position in 1972. Sapin was also a major influence in the development of quality assurance methods.