Health Care Hall of Fame - 2009

Charles and William Mayo’s legacy: creating the multispecialty group practice concept

They pioneered the concept of multispecialty group practice, and one that paid physicians a flat salary, giving doctors every incentive to stay true to the oft-repeated mantra: Put the needs of the patients first.

They developed aseptic surgery techniques that led to low mortality rates. They launched one of the early medical fellowship programs at a time when a few years of education after high school was enough to begin a medical career. They lived next door to one another with their families and shared a single bank account.

Their professional and familial descendants say William and Charles Mayo, brothers and co-founders of the Mayo Clinic, left legacies that continue to flourish as their namesake organization enters its second century.

“Those values come directly from the Mayo brothers and the Mayo family,” says Shirley Weis, the clinic’s chief administrative officer. “We see very much that those values need to stay the same while the world around us changes.”

“It is an extremely unique environment. It is uplifting how the physicians work as a team,” says Bob Walters, senior administrator and former chief administrative officer in the Jacksonville, Fla., satellite of the Mayo Clinic, and the great-grandson of William Mayo, who worked elsewhere for many years. “The primary value of, ‘The patient comes first,’ is enduring. It is what attracts the staff, both the physicians and allied health staff, to Mayo.”

The dedication to patients was passed down from their parents, William and Louise Mayo, who once mortgaged their house to purchase a $600 microscope for the elder Mayo’s practice, where the brothers received their early training, says Nina Schwenk, vice president of the clinic and an internist. “Will it benefit the patient?” she says. “Yes, so they did it.”

Undivided loyalties

After frequently accompanying their father on professional visits and attending medical school themselves, the brothers returned to Rochester, Minn., to practice. They joined their father, first in private practice and then in helping to open St. Marys Hospital in 1889, inspired in part by a disastrous tornado.

Their surgical section of the hospital became known as the Mayo Clinic in 1903 and spun out as a full-service medical center in 1915. That same year, they created the Mayo Foundation for Medical Education and Research affiliated with the University of Minnesota to which the brothers donated a significant chunk of their considerable personal fortune.

The philosophy of putting patients first had heft partly because of the system of paying physicians a salary, says W. Bruce Fye, a cardiologist at Mayo and a medical historian. “You didn’t have divided loyalties,” he says. “There was no competition between doctors to take care of patients.”

The teamwork among doctors helped the notion of group practice to take root, Fye says, as the Mayos added to their own surgical expertise with other specialties. “The Mayo brothers are responsible for that concept,” he says. “There’s no question in my mind that the group practice model is that absolute ideal way to practice medicine. But it can’t be replicated in most places.”

Schwenk describes how doctors of different specialties are able to reach one another by phone on a moment’s notice for consultations. “This person has a strange murmur. I don’t know what test (to order) because I’m not a cardiologist,” she lists as an example. “Our financial and administrative structures as such that those walls are very porous, so we can make an effective decision.”

“When you change how people are paid, you change incentives,” Walters says. “Mayo’s incentive has always been, ‘Don’t worry about the number, or what generates revenue. You do what needs to be done. If someone needs something, pick up the phone and talk.’ Those are some of the cultural things in place.”

The Carillon Clinic in Roanoke, Va., has looked to the Mayo brothers and the clinic’s legacy as it has been trying to move toward such a system for the past three years, says Edward Murphy, president and chief executive officer.

“Doctors are good at focusing on the patient in front of you, moment to moment, but we’re not as good as we could be at handoffs, and the collective management of patients with chronic diseases with a bunch of different doctors with a bunch of different specialties,” Murphy says. “The approach is meant to be much more of a team approach than an individual approach, which I think is better for patients.”

At a rural hospital without a medical school affiliation, the Mayos had the opportunity to become surgical experts. “They weren’t teaching anyone to do it, and they had no competition,” Fye says. “They did high volumes. The incredibly low mortality rates attracted attention from around the country.”

Over time, the Mayos did begin a fellowship program that helped lead to the current structure of post-graduate, formal specialty training, Fye says. “There were no residency programs when they started the fellowships. I can’t tell you we were the only one, but I know we were very early educators,” Schwenk says.

There were other contributions to the field: An early hire, Henry Plummer, a physician, developed a system that set a new standard for medical records storage and retrieval, while an intricate conveyer system carried those records from floor to floor. Case studies the brothers wrote proved invaluable to their contemporaries.

On a personal level, Charles and William Mayo are remembered as inseparable yet distinct. A DVD called “My Brother and I,” produced by the clinic and narrated by radio host Garrison Keillor, recalls that they lived next door, but their wives put the kibosh on building a connecting passageway between their homes—so they constructed a window-to-window speaking tube.

Walters remembers hearing about the brothers’ spirit of togetherness, captured in their frequently used phrase, “my brother and I,” from his grandmother, William Mayo’s daughter Phoebe, and his grandfather Walt, a staff surgeon at Mayo throughout his career. “Everything I’ve read in the various biographies or histories of Will and Charlie seemed to be validated by my grandmother,” he says.

Distinct styles

Charles Mayo was the more relaxed and rumpled of the two, while William Mayo, who became president of the American Medical Association in 1906, was the more driven. “Charlie smoothed the feathers that Will sometimes ruffled,” the DVD notes.

Those who work at the clinic today describe the brothers’ presence (both died in 1939) extending from large portraits in public areas to continuous references to their aphorisms during lectures and meetings throughout the facility.

Weis notes that the clinic has annual “heritage days” during which staff and physicians spend a week talking about a particular aspect of their heritage. “We try to find some fun facts to tie this all together, to make it relevant again, to put those values into place in contemporary times. It’s not a worship of the past. It’s taking those core values and understanding who we are and how we want to change.”

“It’s surprising how much their legacy and their culture really does affect us on an everyday basis,” Schwenk says. “One of the joys for me is knowing that what the Mayo brothers started really carried forward.”

Ken Ackerman, chairman of Minneapolis-based consulting firm Integrated Healthcare Strategies, who has worked at similarly structured Henry Ford Health System in Detroit and Geisinger Health System in Danville, Pa., sums up the Mayo Clinic philosophy: “Putting the needs of the patient first—it’s that seven-word phrase that all 50,000 people in the Mayo system know. And they walk the talk,” he says.