Many of the problems currently facing the U.S. health care system are similar to what emergency medicine pioneers faced in the 1960s – increasing ED visits, lack of access to primary care, a high number of uninsured patients. That correlation was evident this summer when ACEP and others celebrated the 50th anniversary of the Alexandria Plan – the model for current emergency care.
In America back in 1961, change was in the air. President Dwight D. Eisenhower had just handed over the reins to the much younger John F. Kennedy, and across the Potomac River change was also brewing at Alexandria Hospital. There, the president-elect of the medical staff, a respected general practitioner named James Mills Jr., had been handed a perplexing problem.
The Alexandria Hospital ED was reeling from a nearly 300% increase in patient visits from 1950 to 1960 – up to 18,000 per year. Complaints and wait times were rising. Staffing the ED was a big problem, as consigned medical staff objected to working in the ED, housestaff (primarily foreign medical graduates) had declined by 50%, and a plan to use Georgetown University medical students to cover the night shifts had failed.1
Dr. Mills had worked shifts in the ED and he liked the pace and variety, and was committed to helping the poor, as demonstrated by his numerous volunteer activities. Dr. Mills was also finding his general practice less than satisfying. His idea for solving the problem in the Alexandria Hospital ED came to him early one morning.
“One night I came home after 1 a.m. from working a day that had started that morning at 7,” he noted in a 1965 Reader’s Digest article. “I remember thinking that as a chronically tired and overworked GP, I wasn’t being fair to myself, my family or my patients. It came to me that in emergency service, with regular hours, I would be able to practice much better medicine. If I could get three other good men to join me, we’d have a team that could provide top-notch treatment.”2
Dr. Mills did find three good men to help him: John McDade, M.D.; C.A. Loughridge, M.D.; and William Weaver, M.D. These four general practitioners all gave up their private practices and entered into a contract with Alexandria Hospital to establish a new, revolutionary type of practice that was unheard of in the 1960s.