McAllen, Texas: The Inside Story

By  |  July 22, 2009 | 

Many of you already read “The Health Care Blog” (which sometimes carries my posts). In case you don’t, please check out today’s wonderful father-son interview, which puts a human face on the transformation of McAllen, Texas from sleepy border town into national healthcare icon (at least ever since Atul Gawande placed it on the map with his New Yorker piece).

The son in this case is the writer Ian Kibbe, THCB’s associate editor; his dad is David Kibbe, a family physician who practiced in McAllen in the 70s and 80s and witnessed first hand the cultural transformation that put the town in the Pantheon of Greed in the Dartmouth Atlas. As the President and his team try to nudge the culture of medical practice in the right direction, it’s vital to appreciate the forces that can cause precisely the opposite shift.

Well worth a read. 


  1. Benjamin Littenberg July 28, 2009 at 12:39 pm - Reply

    The NY Times published an essay by Gil Welch today that tells the same story from a slightly different point-of-view. Recommended.

     [Note from Bob:  The essay is here; may require subscription]

  2. exodus August 3, 2009 at 5:03 am - Reply

    Here is an anti-McAllen, Marshalltown in north-central Iowa.

    I worked there earlier this decade. In my opinion, the reason for cost efficiencies in Marshalltown are –

    a) paucity of specialists,
    b) most PCP’s see their patients across settings – office, hospital and long term care,
    c) easily available medical records.
    d) More discussion between patients and PCP’s regarding prognosis and end-of-life issues

    The place only recently added its first cath lab. It will be fascinating to see if this leads to cost escalation in the coming years.

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About the Author: Bob Wachter

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.


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