Pediatric residency: The first 50 years
“…Relative to the appointment of an interne and resident physician at the Hospital,” the chief of staff at Children’s Hospital wrote to his Board of Lady Managers in 1916, “we beg leave to submit the following report….his duties would be service to all patients in every department… service in the clinic, and the administration of anesthetics.” The proposed salary would be $50 per month, and he would reside in the adjacent Auburn Hotel.
This is the first mention of a resident physician serving pediatric patients in Cincinnati. Children’s Hospital, then located in Mt. Auburn near The Christ Hospital, was independent of the university at this time. It was a privately run institution affiliated with the Episcopal Church, serving both charity and private patients, and it was here in 1919 that the first resident physician served. Her name was Ethel Winston.
However, Cincinnati had no academic pediatric residencies at that time, because the field of pediatrics did not yet officially exist. It had begun to develop in the late 1800s; the local pioneer in this effort was Dr. Benjamin Knox Rachford, who established the first pediatric wards at General (now University) Hospital, as well as the Baby’s Milk Fund, which quickly expanded into a community-wide system of mother-baby clinics.
In 1909, the merger of two medical schools created the UC College of Medicine. Medical training in the US became standardized a year later, following the publication of the Flexner Report. UC’s Department of Pediatrics, named in honor of Dr. Rachford, was endowed in 1920, and the stage was set for the accreditation of its first pediatric residency program. When Dr. A. Graeme Mitchell took the helm in 1924, six trainees began serving their two-year pediatric residencies at General Hospital.
Two years later, thanks to the vision of Board Chair William Cooper Proctor, Children’s Hospital relocated next door to the College of Medicine (where Locations S and T now stand), formalizing its affiliation with the university and paving the way for a multifaceted pediatric residency program using the facilities of both Children’s and General Hospital, the Babies Milk Fund Clinics, and the privately run Convalescent Hospital for children in Mt. Auburn.
Gaining momentum
By the 1930s, the residency program was accepting eight residents per year. About 8 percent of these were women, who at the time accounted for only 5 percent of medical school graduates. The application form asked questions about religious affiliation and marital status, including, “If not (married), do you plan to marry?” and “If married, will your wife live in Cincinnati?” The class of 1936, by way of example, included two married and four single men; four were Protestant, one was Jewish, and one was “non-sectarian.”
First-year residents were paid $300/year, including room, board and laundry; second-year residents received $600. First-year rotations included two months each on the following services: H-2, the general pediatric ward and the Contagious Disease unit at General Hospital; “Surgery,” “Private plus Orthopedics” and “ENT plus 3-4 West” (the older children’s ward), all at Children’s, and the Convalescent Hospital. Second-year residents also rotated through ‘Xenia,” and got their outpatient experience at the Baby’s Milk Fund clinics. “H-2” and “Contag” were typically each staffed by one chief resident, two junior residents, and a rotating intern from General, Jewish, Christ, or Good Samaritan Hospitals. Then, as always, the challenge was to balance the service needs of the hospitals with the residents’ need for academic training and teaching.
World War II wreaked havoc with the residency program and medical education in general. Although medical students could be granted deferments, interns and residents had no such protection and were often called up in the middle of their training. In a desperate attempt to produce more physicians, year-long curriculums and training programs were condensed into nine months. Chair Dr. Ashley Weech spent much time recruiting to fill unexpected holes in the rotation schedule. When even members of his faculty were called up, community pediatricians filled in, supervising wards and giving lectures. Fortunately, in 1943, Weech was able to hire Dr. Katie Dodd, universally acknowledged as the hospital’s finest teacher, who apparently also served as a super-chief resident during those chaotic times.
The one group that benefited from this manpower shortage and rapid turnover was women. During the war, they accounted for 30 percent of the hospital’s resident physicians, and for five years in a row, women also served as chief residents.
When the war ended, the residency program once again became male-dominated. Many of those hired were now in their 30s, married, seasoned veterans, with that positive “can do” attitude that characterized the post-war years. “Catch up” courses were created for those whose training had been interrupted by military service. The program expanded to 14 positions per year, and residents continued to rotate between the two hospitals. Dr. Jim Englert, who trained in the early 50s, recalled the terrible polio epidemics of those years, when the Contag Unit would be packed full of iron lungs, and of sleeping in the call room above it, which was equipped with a tennis racket to ward off flying bats!
Yet, there was a special camaraderie among pediatricians, Englert recalled, and this sentiment was echoed by Drs. Kurt and Mary Bofinger, who trained in the 1960s. Residents, faculty and community physicians all ate together in the doctors’ dining room on the ground floor of the west wing; residents’ spouses and children received free meals in the cafeteria, which further enhanced the familial atmosphere. Traditional “town/gown” tensions did not exist within the Pediatric Department.
In the 1960s, unmarried residents still boarded in one of two houses, the “Ranch” for men and the “Annex” for women, located along Elland Ave where Location E now stands. They were paid a whopping $150 a month. When Kurt Bofinger and Mary Kessis wed halfway through their residencies, he received the $50 per month “married resident supplement.” She did not.
Residency redefined
The most significant development of this era was the beginning of a three-year pediatric residency program. It began with a “straight pediatric” internship in 1964, consisting of five months of pediatrics at Children’s instead of the customary two. These rotations included 2C (infants), 4W (older children), and Pediatric Surgery at Children’s, plus Newborn, H-2, Ped ER and Contag at General Hospital. Second-year residents looked forward to a six-week “away” elective in Haiti.
A typical day began with drawing the morning blood work; followed by senior and attending rounds, then X-ray rounds with Dr. Fred Silverman; then morning conference. Afternoons were spent carrying out orders and working up new admissions. Call remained every other night for interns but moved to every third night for senior residents. Residents worked 48-hour shifts in the ER, but opportunities for sleep and rest were frequent: in those days, the ER only saw about 100 patients per week!
The pediatric residency program facilitated the integration and standardization of pediatric care at Children’s and General Hospital. Many of its graduates remained in Cincinnati, entering private practice or staying at the hospital to found pediatric subspecialties. One such grad was William K. Schubert!
The next 50 years would see the development of pediatric subspecialty training, the consolidation of pediatric care at Children’s, and the emergence of women as the majority of pediatric providers. But that’s another story!
-- M. Elaine Billmire, MD, December 2017
