History

The history of medical care in Erie County has been an organic process of change. The last book written about Erie’s medical history was published in 1990 by John S. Chaffee M.D. “Reflections on Erie County Physicians“.

As suggested by the title, it is a story told through the perspective of Erie county’s past physicians. Through this collection of individual physician stories, we can get a flavor and understand how medical care was delivered and the history of medical care in Erie County.

The book starts with the very first practicing physician John Culbertson Wallace in 1803 and ends with biographical sketches of multiple physicians who practiced well within the 1960s. It’s a book about individual practices and practitioners delivering care throughout the years in Erie County. It showed how medical care relied on the skills, knowledge and empathy of those individual physicians. In the last 65 years much has changed in the science of medicine and medical care delivery.

In 1950 less than 40% of doctors were considered full-time specialists within a decade, 69% of doctors considered themselves full-time specialists. This trend was also evident in Erie County with physicians changing from general practice to specialties and even subspecialties. The main reason for that change was economics. Physicians would group together to share expenses, office space, medical personnel, equipment and “on call” obligations.

Eventually, like-minded physicians of different specialties would coalesce together to form multi-specialty groups.

By the 1970s in Erie County, the concept of specialty groups had significantly matured.

The evolution didn’t stop with just physicians. The hospitals saw the opportunity in the 1980s to manage and own physician practices. Initially in the fields of primary care and in some instances, hospital-based physician practices were acquired.

In 1960, 89% of physicians practiced in independent offices. In 2022 less than half of physicians practice independently.

This trend also occurred in Erie County with a gradual progression from independent practice to hospital owned and eventually health system owned physician practices.

Looking back and researching the 1960s There is a world of difference surrounding delivery of medical care. In 1960 the government paid only 12% of all medical expenses. There were no Medicare, Medicaid, TRICARE, healthcare exchanges, or other miscellaneous government programs. Of the 260,000 MDs and DO practicing in the United States in 1960 only 30,000 got a payroll check from an employer. Half of that 30,000 were physicians in training getting payroll checks from hospitals and universities and the others were military physicians. Currently, more than half the practicing physicians in the United States are employed by a non-physician entity, such as a hospital health system, university, and private equity groups.

In 1960 per capita spending all medical expenses in the United States were $146. As of 2022 per capita spending in the United States was $13,493. On a sidenote, I was born in 1953. (I saw my total delivery cost at Buffalo General Hospital was $27 for hospital maternity care and $17 for the obstetrician.)

In 1960 there were approximately 700 health insurance companies in the United States with almost even market dominance. As of 2022 there are over 900 insurance companies, but five insurance companies command over 44% of the market.

Before World War II in the 1940s less than 9% of the populous had healthcare insurance. After World War II, there was a marked increase with 2/3 of the populace having employer-based hospital insurance but not for physicians’ services. The major patient group excluded from the insurance coverage were individuals that were retired or disabled. The country recognizes that gap in healthcare coverage for the elderly, therefore in 1965 President Lyndon Johnson signed Medicare into law. It is of note that the American medical association was initially opposed but then became involved in its design and enactment. An Erie physician, Russel B. Roth M.D. was one of the AMA representatives to worked with the Johnson administration in the design and construction of Medicare.

Russel Roth MD is on the right Dwight Wilbur MD is on the left. This photo was taken at the house of delegates meeting in New York City in 1969. Dr. Roth is speaker of the house and Dr. Wilbur is president of the AMA.

On the scientific front in 1960 there were no vaccines for rubella and mumps very limited number of antibiotics and Polio was still present. There was no warning on cigarettes and cancer treatments were quite limited. Imaging was in some cases barbaric such as a pneumo-encephalograph. There were no MRIs CT scans or ultrasounds. We did not do open-heart surgery, or angioplasties. Cardiac pacemakers were invented in 1958 and we’re not readily available. There was no such thing as laparoscopic surgery. We did exploratory laparotomy for diagnostic purposes. We treated most peptic ulcer disease with open surgical intervention. We did not have synthetic insulin, ACE inhibitors, or beta blockers. other things we think of as standards of care today. There were no such treatments as kidney and liver transplants, component therapy for blood transfusions, artificial joint replacement or DNA technology. As one can see there were massive scientific and technological changes in medical care for patients not only nationally but here in Erie County.

It was the physicians of Erie County that fostered, advocated, and promoted extraordinary advancements in medical science technology and delivery of care.

Despite all these changes, what did not change is the physician’s dedication to their patients, to their skill set, to the advancement of their medical knowledge and their empathy.

I am hoping that today’s physicians can help us preserve and highlight some of the individuals and events over last 75 years that shaped medicine in Erie County. A small group of us physicians have taken on that task, but we need your help. Please come forward with your treasured memories of the medical experience otherwise they will be lost.

Peter S Lund MD