The Rip Van Winkle Clinic

Seventy-five years ago, following the end of World War II, the Rip Van Winkle Clinic was established in rural Columbia County in upstate New York. The region was economically depressed with inadequate and unaffordable medical care for its residents. In this setting, Caldwell B. Esselstyn, MD conceived of a group practice model to serve the region. The model featured prepaid health insurance, multiple locations, and salaried practitioners, which was controversial at the time. Independent local practitioners and the local hospital were at odds with the Clinic's policies. These issues led to in-print criticisms and justifications of the model reflecting opinions of organized medicine at the time. The Clinic often faced dire financial straits and as Medicare legislation was progressing, it disbanded in July 1964. However, as a prototype of a health maintenance organization a generation ahead of its time, it deserves to be remembered for its pioneering efforts.