By 1926, the visiting staff of Laguna Honda consisted of 34 physicians, the staff provided equally by UC and Stanford. In 1946, Stanford and UC jointly took over the professional staffing of the Fort Miley Veteran's Hospital. At each location, including SFH, the two schools administered separate faculties and separate clinical faculties. The two schools were considered the best medical schools in the west. Despite their many similarities, the two medical schools were still parts of public and private universities. Their growing faculties were independent and proud, and often wary of the other's intentions. The two medical schools were intensely separate and distinct.
Both UC and Stanford discussed for decades bringing their medical schools back to their undergraduate campuses. For UC it was a damaging debate that went on far too long. For Stanford, it was quite another story. In 1943, Stanford Chancellor Ray Lyman Wilbur, at his retirement dinner, said, "Stanford is a great university standing on the edge of the Pacific. Look at the chance we would have if someone gave us $5 million to build up an Institute for studies of this area, the people, the lands, the products, all centered in Stanford." He went on to say, "The Medical School should be moved to the campus where it would enjoy all of the campus facilities. A joint County Hospital could be arranged for. There will be a great Army hospital on the Timothy Hopkins property, and there is already the Army hospital for mental cases. There should be retained in San Francisco a school of graduate medical work." The message was not what the medical faculty wanted to hear, but he expressed a popular opinion on the Palo Alto campus.
A Stanford University study of its medical school in 1951-52 found that its most pressing need was for major replacement and renovation of its San Francisco facilities. To rebuild the physical structure would have cost $10-15 million. Add to this sum the cost in endowment, and the required expenditure grew to $30 million. Faced with such a large cost to continue operation in San Francisco, the momentous decision to move to Palo Alto was made in 1953. The move occurred at a time when both Stanford and UC viewed their futures as research campuses as well as health care centers. Stanford's future as a research campus would be greatly strengthened by relocation in Palo Alto. Stanford's decision to move, if anything, strengthened the UC medical faculty's resolve to resist a move to Berkeley. UCSF became an autonomous UC campus at the time of the Stanford move.
In 1958 the Stanford intern service at Hassler Health Home was stopped. In 1959 the service at Laguna Honda Home was discontinued, as was the undergraduate training at San Francisco Hospital. Finally, in 1960, the entire Stanford services at SFH were stopped. UC took over the care of all patients at SFH under a contract with the City and County of San Francisco. The contract stipulated that SFH would provide the facilities, personnel, and equipment, and that UC would provide a staff to render medical and surgical care comparable to that in a medical school. By incorporating some of the Stanford faculty and by increasing the UC staff, all of the internships and residencies formerly assigned to both schools were assumed by UC. For administrative reasons, some of the wards were called Blue and others Gold, but the friendly rivalry with the Red service was ended.
The transfer of Stanford's academic activities was successfully accomplished, but it was impossible to move a large proportion of its clinical faculty. The staff remaining in San Francisco that did not affiliate with UC wanted to find a way to continue their teaching and research interests. Stanford turned over its San Francisco facilities for these purposes to the Presbytery of Northern California. The Presbyterian Medial Center became a hospital and teaching center with a house staff in all the specialties, outpatient clinics, and an extensive research program. It affiliated with the College of Physicians and Surgeons. These events led to what is today the California Pacific Medical Center.
The move of the Medical School from San Francisco to the Stanford University campus represented a major challenge for the clinical departments. It disrupted long-established sources of patients for inpatient and outpatient teaching, and in certain of the clinical specialties and subspecialties it decimated the ranks of the full-time faculty. Support for the medical school from the local medical community helped to maintain Stanford's high standards of clinical teaching. Over the next five years, medical school recruitment doubled the number of fulltime faculty members.
During the 1980s, both Stanford and UCSF engaged in major hospital expansion projects. Subsequent cutbacks of federal funds resulted in the disappearance of traditional profit margins despite sizeable cuts in budgets at both institutions. In 1986, California Pacific Medical Center, Stanford, and UCSF established the California Transplant Donor Network in San Francisco to eliminate competition for transplant organs. This unusual act of cooperation was followed by a meeting in 1993 of Stanford Dean David Korn with UCSF Dean Joseph Martin to discuss other areas of possible cooperation between the two medical schools.
At the 1995 meeting of the California Business Higher Education Forum, the topic of discussion was the decline in federal funding for medical research and for Medicare payments for services. UCSF Chancellor Joseph Martin and Stanford President Gerhard Casper took a walk during an intermission and agreed that the two schools ought to share more and compete less. Not long thereafter, Stanford and UCSF announced that discussions were taking place regarding collaboration with patient care programs, and the formation of other alliances between the two institutions. Both parties made it clear that the medical schools and medical faculties would remain independent.
Despite labor concerns, the Board of Regents voted in July, 1996 that the merged health care system would be a private, non-profit corporation. The Board of Regents approved the merger uniting UCSF Medical Center; UCSF Mount Zion Hospital, with Stanford Health Services, which comprises Stanford University Hospital and related clinics; and the Lucile Salter Packard Children's Hospital. UCSF Stanford Health Care (USHC) began operation in 1997.
There was a significant Increase in clinical activity in the first year of the merger, but the growth was not sustained. The merger produced a profit of $22 million in the first year. Then, largely because of administrative costs, UCSF Stanford Health Care sustained an $11 million deficit in the first quarter of the second year, and is expected to lose $60 million by the end of the second year.
The expectation that the merger would create five multi-disciplinary service lines during the first five years was not realized. The absence of an adequate information base and lack of faculty enthusiasm postponed the creation of service lines except in adult cardiology, pediatric cardiology, and pediatric neurosurgery, and the failure to integrate the transplantation and cancer programs of the two schools was a notable disappointment.
Supporters of the merger saw two distinguished faculties creating a single clinical entity, perhaps becoming the nation's premier academic health center, but this goal was not achieved. After a year and a half, the two faculties failed to come together, and in the first months of 1999 leaders of both institutions became aware of a large financial deficit. In spring of the following year, the merger was officially dissolved.References:
Fluhmann, C. Frederic. "Symposium on Progress in Obstetrics and Gynecology," Surgical Clinics of North America. 42:4 (1962).
Kraus, Shirley. "Stanford University School of Medicine (Medical Schools of the West)," Western Journal of Medicine, 139 (1983):244-247.
"Stanford University Medical Center: 25 Years." Stanford Medicine, (Fall, 1984).
Wilson, John L. Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective. In press.