Twenty years before the term “hospitalist” was coined, and not long after serving as a battlefield surgeon in Vietnam, Tracy Spencer III, MD, selected a path few—if any—had chosen before.
Fresh from his combat experience, he became chief resident at the University of Colorado School of Medicine in Denver in 1975. He dreaded clinic hours but enjoyed the hospital. The flash, dash, and adrenaline of battlefield medicine were still in his blood; he wanted challenges.
“I didn’t want an outpatient practice with the overhead of an office,” says Dr. Spencer, 63, “I wanted to do internal medicine in a hospital setting. I had tons of energy to deal with the unassigned patients who came in the ER, and [I liked] the idea of being a hospital-based physician.”
He began searching for the right setting for his skills and temperament. Eventually, the third-generation physician made a bold leap—he started a hospital-based internal medicine practice in Everett, Wash.
In 1976, Dr. Spencer knocked on lots of doors and convinced scores of Everett’s primary care physicians that his caring for their hospitalized patients would free them to build their practices. Although many of those physicians thought it bizarre that Dr. Spencer had no outpatients, they readily turned over their inpatients to him.
“I believe he was one of the first, if not the first, hospitalist in the state of Washington, and perhaps the country,” says John Cramer, MD, MBA, an intern at the University of Colorado 1974-1975 when Dr. Spencer was chief resident. Their relationship has endured more than three decades—with a twist. Now the former intern, who joined Dr. Spencer as a hospitalist in 1979, supervises his former boss in the growing 32-physician hospitalist group at Providence Everett Medical Center.
“Tracy is a member of the team, dispensing wisdom to the younger docs,” says Dr. Cramer. “I have never seen him happier professionally than he is now.”
Dr. Spencer’s medical training and early experiences shed light on how he came to be an inpatient physician two decades before hospitalist medicine formally emerged.
Theodore Woodward, MD, nominated for a Nobel Prize in 1948 for his work on typhus and typhoid, was Dr. Spencer’s professor at the University of Maryland, Baltimore. He impressed Dr. Woodward with “an old-fashioned, knowledge-based, and holistic approach to patients.”
Later, Thomas Petty, MD, an eminent pulmonologist who headed a respiratory team at the University of Colorado Medical Center and became chairman of the National Lung Educational Program, introduced the young physician to a team-based approach to hospital care. During his 1968-1969 internship at the University of Colorado under Dr. Petty, Dr. Spencer found he enjoyed working on a hospital team and the discipline of the hospital hierarchy.
After graduating from medical school, Dr. Spencer was drafted in 1970 by the Marines and was sent to Dà Nang, Vietnam. As a regimental doctor, he worked alone—and didn’t like it. “There was no collegiality for field combat docs,” he recalls. “There were ship-based specialists who didn’t even talk to us. The most serious cases we triaged were [taken] to the ship, and I didn’t see them again. I was dissatisfied and felt that the doctors in the field deserved more respect.”
Maurice Ramirez, DO, an emergency physician and federal medical officer with the Department of Homeland Security, suggests the military’s command structure may have influenced Dr. Spencer more than he realizes. “Before hospitalist medicine, physicians were like British aristocrats in their fiefdoms, ordering their lessers about,” explains Dr. Ramirez. “[The] hospitalist movement has changed all that.”