The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900-1940

Chapter 1: The Primacy of Private Practice

15 In a small, well-worn memorandum book, young Dr. DeForest Porter Willard Jr. (1884–1957), kept track of the highlights of his life and career in Philadelphia in the early twentieth century (table 3). His parents began the memo book to record childhood milestones, such as first words spoken, but Dr. Willard assumed authorship during adolescence. Apart from jotting down personal triumphs, such as winning golf championships in 1912 and 1913 and purchasing a Fiat roadster in 1916, Dr. Willard devoted most of his entries to career achievements, such as deployment dates for his medical service during World War I. Many of Dr. Willard’s early career achievements had become typical by the early twentieth century and probably appeared in the personal papers of many of his peers. For example, after graduating from the University of Pennsylvania and earning his license in 1908, Dr. Willard undertook a voluntary hospital internship—in his case at the University of Pennsylvania Hospital. After completing his internship in 1910, Dr. Willard established his private medical practice. Dr. Willard’s next career steps warrant closer inspection as they reflect some of the new opportunities available to young doctors in the early twentieth century. He quickly secured a number of institutional appointments, including staff positions at several Philadelphia hospitals and teaching positions at his alma mater. In addition , Dr. Willard limited his private practice to a single medical specialty— orthopaedic surgery—only a few years after graduating from medical school. The example of Dr. Willard begs the question: how common or accessible was his career path to specialism? The Primacy of Private Practice Chapter 1 Table 3. Selected Events from the Memo Book of Dr. DeForest P. Willard Jr., 1908–1917 1908 May Earned M.D. from the University of Pennsylvania (Univ. of Penn.), third in class. July Began internship at University Hospital (in West Philadelphia). 1910 April Finished internship. September Did “some work” at St. Mary’s Hospital (Kensington). October Started private practice at 1901 Chestnut Street (Center City). November Assistant Surgeon in Pathology, Univ. of Penn. Staff in Surgical Dispensary, University Hospital (West Philadelphia). Private assistant to Dr. Ed Martin (Clinical Professor of Surgery at Univ. of Penn.). Consulting Surgeon at the State Hospital for the Insane (West Philadelphia). 1911 February Assistant Orthopaedic Surgeon at University Hospital (West Philadelphia). March Consulting Surgeon at Haddock Memorial Home (a small hospital for infants in Center City). July Bought a new automobile. October Lecturer in Anatomy at University Hospital’s School for Nurses (West Philadelphia). Gave two papers at the Clinical Congress of Surgeons of North America. November Published first article, “Beck’s Bismuth Paste Treatment” in the Therapeutic Gazette. December Assistant Instructor in Orthopaedic Surgery, Univ. of Penn. 1912 January Clinical Assistant at the Orthopaedic Hospital (Center City). April Assistant Instructor in Surgery, Univ. of Penn. May Consulting Surgeon for the Home for Consumptives (Chestnut Hill). July Won golf championship. Took fishing trip. August Moved private practice office to 1933 Chestnut (Center City). September Gave paper at the Pennsylvania State Medical Society Meeting. 1913 March Published article on “flat foot.” April Ordained elder in 2nd Presbyterian Church. May Gave paper on “Splenic Anemia” at Academy of Surgery— later published. August Won another golf championship. (continued) The Primacy of Private Practice 17 This chapter examines the significance of private practice for the medical careers and livelihoods of Philadelphia doctors. As institutions played everlarger roles in medical education and training during the professionalization of medicine in the early twentieth century, did private medical practice begin to decline in its importance to doctors? Had getting institutional appointments replaced setting up a private practice as the ultimate career objective? In order to ascertain the enduring significance of private practice, the chapter begins with an explanation of the growing role of medical institutions, especially September Gave paper with Dr. Dickson at the State Medical Society Meeting—later published. October Assistant Surgeon, Home of the Merciful Savior for Crippled Children (West Philadelphia). 1914 June Presented paper on “Results of Treatment of Scoliosis by Abbot Method” before the American Orthopaedic Association (AOA) Meeting in Philadelphia. Elected Fellow of the College of Physicians of Philadelphia. August Vacation at the Lake Placid Club. September Gave two papers at the Pennsylvania State Medical Society Meeting. 1915 January Assistant Surgeon at Orthopaedic Hospital (Center City). May Presented on “Association of Static Deformities in Children” at AOA meeting in Detroit. October Assistant in Orthopaedic Hospital...