Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care

This important critique of U.S. medical education from WWI to the present makes painfully clear that the training of the nation's doctors could be vital to your health. Ludmerer, professor of medicine and history at Washington University, argues that the primary commitment of medical schools and teaching universities to education has been severely compromised. The main culprit, in his diagnosis, is managed care, especially HMOs, with their emphasis on cost cutting through limited use of medical services and the substitution of nurse practitioners for M.D.s whenever possible. Today's ultracompetitive corporate environment, asserts Ludmerer, has left medical schools reeling, with a sharp decline in teaching standards due to a fundamental shift toward increasing the volume of patients, doing research that will bring in federal funding and aggressive expanding of private practice by faculty members. Things were not always this way, he insists, in this sequel to Learning to Heal (1985). From the 1920s to the '40s, American academic health centers were, by his reckoning, congenial places marked by a disdain for commercialism and a willingness by clinicians and pathologists to expose errors--though he admits such shortcomings as the old round-the-clock work ethic and the barriers to minorities and women seeking advancement in medicine. While this dense scholarly study offers few prescriptions, it should be read by anyone concerned about the vitality of the U.S. health care system. (Oct.)