David Druker, president and CEO of the Palo Alto Medical Foundation and a key architect of the nonprofit organization's expansion in the South Bay and coastal communities, is near death at his Los Altos Hills home following a battle of several years with lung cancer.
But he took time recently to speak of his vision for health care in America.
Druker, a non-smoker, said in what he acknowledged was a final interview June 29 that he has been scaling back his duties as he has grown less able to handle the physical demands of overseeing both the medical foundation operations and broader responsibilities for Sutter Health, of which Palo Alto Medical Foundation is an affiliate. He resigned a regional vice presidency for Sutter last year.
But he emphasized that his vision for providing high-quality outpatient health care remains as strong as his belief in the "multi-specialty group practice" model for providing health care. He believes that it should become a national pattern for efficient but thorough community-based health care contrasted with single-specialty referral groups or hospital-based and solo-practice models.
Druker said he would like to see the group-practice model of the Palo Alto Medical Clinic, founded in 1930 by the late Dr. Russel van Arsdale Lee, coupled with two components: innovations in how groups are organized and self-monitored; and modern communications technology among providers and with patients.
Under Druker's leadership, the medical foundation has grown from about 120 physicians to more than 950. It now includes the Sunnyvale-based Camino Medical Group, a Santa Cruz medical group, the Fremont Center, the Los Altos Center, the Redwood City Center and more recent affiliations in San Carlos and Burlingame.
Druker was a key participant in designing the 1993 affiliation with Sutter Health, then a predominantly hospital-based organization in Sacramento and the Central Valley. He said one of his regrets was the failure of two years of affiliation talks with Stanford University Medical Center that preceded the Sutter linkage.
Druker has pushed for creation of a "Center for Innovation" within the foundation, and there is talk of naming it in his honor.
The foundation is planning a $500 million campus in San Carlos that includes a community outpatient clinic and 95-bed hospital. (The project has been delayed by the economic recession, however.)
Druker said the concept for the San Carlos facility is to further the foundation's longtime research into improving outpatient care, as opposed to the more common "bed counts" to measure the success of hospitals.
He has long envisioned such an integrated facility where treatment methods could be integrated, tested and refined.
"It's actually been my dream. When we first joined Sutter, in 1993, I laid out a vision. First we would build a physician infrastructure so we would be in a position to provide care for the communities we're in.
"For decades we've been learning how to keep people out of the hospital while providing quality care."
He said when he was named executive director of the clinic in 1989 he confronted a rapidly increasing demand for primary health care in the region, due to growth and an aging population.
"The implications were that we had to have many more primary-care doctors versus specialists, and we began to work on how to achieve that," despite a national shortage.
"This took us back to the vision of expanding the primary-care infrastructure. Then we would have the luxury of deciding whether to build or buy beds," depending on whether there were existing hospitals in various communities. His vision includes building health care teams of physicians, physician assistants and registered nurses tightly integrated through electronic medical records and communications.
Despite his illness and declining health, Druker said in a comfortable den in his Los Altos Hills home that he still counts his life as being one guided heavily by good luck. In an interview shortly after he was named executive director of the Palo Alto Medical Clinic in 1989, he described his life as "one big accident. So much of what happens to us is the result of good luck and timing. I've been blessed with a lot of both."
He was raised in Marshalltown, Iowa, and went to Harvard University believing he would follow in his father's footsteps and become a lawyer. He was accepted at the University of Michigan Law School but abruptly changed his mind.
"Since I liked people, and the idea of being my own boss really appealed to me, I decided to switch to a career in medicine."
He was admitted to the University of Iowa Medical School on condition he complete required undergraduate courses. He spent a full year catching up on science classes, cramming 90 percent of the pre-med requirements into that year.
"It was a fun year," he recalled ruefully.
He and his wife, Karen, were married in 1966, and have two children, Daniel and Ellen, and five grandchildren. He has two sisters, Hannah and Leah.
He spent two years in the U.S. Army at Fort Leonard Wood, Mo., then completed his dermatology residency at the University of Oregon in the early 1970s. He was in private practice in Portland when he heard of an opening at the Palo Alto Medical Clinic then a private physician partnership and not yet a component of the nonprofit medical foundation.
He said that, too, was luck. His sister Leah lived in Palo Alto, and when visiting he drove past the clinic's former large blue building at 300 Homer Ave. and thought, "Gee, that looks like a nice place to work." He joined the clinic in 1975, later serving as head of the Business Affairs Committee and vice executive director, before being named executive director. He was later named chief operations officer for the foundation and finally was named president and CEO following the retirement of Dr. Robert Jamplis.
For years, Druker continued to see a normal full load of about 30 patients a day, declaring "I would never want to give up my dermatology practice. That's the thing I enjoy most. It's what I'm trained to do."
But he also derived satisfaction from "being able to contribute to something I believe in," such as multi-specialty group practice and innovation.
He has been a clinical professor of dermatology at Stanford School of Medicine, has written several books on dermatology and medical administration and has held state and national offices in professional organizations.
In his June 29 interview, Druker noted that he has been a Republican but nevertheless supports the underlying notion of some form of universal health care in President Barack Obama's reform package. Most physicians support that notion, also, he believes.
He is pessimistic about reform overall due to its complexity, cost and politics: "As a whole it is destined to fail," he said.
Yet he believes the most promising aspect of the reform package is embodied in the term "accountable-care organization," replacing the older "managed care" term that people often interpret as rationed care. Accountable care means "aggregating doctors into some kind of functional group that takes responsibility for providing a broad range of health care services to a community or region."