How internists founded a hospital and the evolution of the hospitalist

Gainesville Internal Medicine Physicians

Written by Robert “Bobby” Slaton, M.D.

A little over 50 years ago, Dr. Richard Cunningham from Jennings, Florida and Dr. John Andrews from Cedar Key, Florida left the University of Florida College of Medicine and entered private practice in Gainesville. Both had received training in internal medicine, with Dr. Cunningham receiving additional training in neurology and Dr. Andrews in cardiology. Dr. Cunningham was actually in the first graduating class of University of Florida College of Medicine, and Dr. Andrews was the first chief resident in internal medicine. Their initial goal in private practice was to deliver the highest quality of primary care.

They practiced at Alachua General Hospital, which was owned and run by the Alachua County commission. Drs. Cunningham and Andrews soon learned that they were practicing in a hospital setting that could not fulfill their initial goal. It came to their attention that a new private hospital company out of Nashville, Tennessee, called the Hospital Corporation of America, was interested in expanding into the state of Florida. This evolved, a few years thereafter, into North Florida Regional Hospital, a primary care internal medicine group, known as the Gainesville Medical Group and the beautiful Doctor’s Park, which surrounds the hospital grounds. The initial focus of the Gainesville Medical Group was providing primary care, as was the focus of the hospital which they had founded. Primary care and internal medicine was the backbone of North Florida Regional Hospital when it initially opened its doors.

It was also appreciated that back in the 1970s, specialty medicine was rapidly evolving, and this new hospital was prepared for rapid change and expansion. Programs in interventional cardiology were established along with cardiovascular surgery, neurosurgery, neurology, while keeping with their initial goal of providing quality primary care. I joined Gainesville Medical Group during its early years in 1976.

Initially, we practiced in two hospitals, five miles across town. We covered two emergency rooms with different call schedules: there were no cell phones, and we jingled when we walked with pockets filled with quarters to use in pay phones as needed. Practice was not easy. There were no CAT scans, blood sugar fingersticks and patients were often admitted for preparation of a colonoscopy and to perform a comprehensive physical exam.

In the late 1980s, it was evident that change had to take place in providing primary care. Dr. Chuck Wilson, a new graduate in internal medicine, was employed by Dr. Terry Fletcher in 1987 to cover his hospital practice. Dr. Wilson’s services were required by others and within a year, Dr. John Nelson joined, forming the first Hospitalist Group in the United States. Over the next 10 years, most of the physicians practicing primary care in both internal medicine and family practice transferred both hospital and emergency room responsibility to the rapidly evolving subspecialty of Hospital Medicine.

The evolution of hospitalist, nocturnist, comprehensive emergency room physicians, satellite emergency rooms and walk-in clinics has totally changed the practice atmosphere of primary care/internal medicine over the last 50 years. I am about to turn 79-years-old and would have been forced to retire years ago without these changes.

I look back now in amazement at the advances in technology, particularly in the fields of cardiology, oncology, diagnostic medicine and realize that on average my patients are living 10 years longer than when I started in the 1970s. North Florida Regional Hospital has been my second home and family for almost 50 years. I have often referred to this campus as “Doctor Heaven.” The spirit of primary care internal medicine remains — just like the magnificent oak tree between my office and the hospital.