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A Legend of Change: Abraham Flexner

in The Roots, Rituals, and Rhetorics of Change: North American Business Schools After the Second World War

This chapter examines the influence of Abraham Flexner and his Flexner Report, published in 1910 as a critique of medical schools in the U.S., on the reform of business schools in North America. It ... More

This chapter examines the influence of Abraham Flexner and his Flexner Report, published in 1910 as a critique of medical schools in the U.S., on the reform of business schools in North America. It explains that while the Flexner Report led to far-reaching reforms in medical education, Flexner believed that the practice of management was radically different from the practice of medicine and that the contents of the Report may be not applicable to management education. Despite Flexner's view, this chapter argues that the Flexner Report provided both the optimism about what could be done and the support for the theme of the reformation of business schools.Less

Regulation of Physicians and Other Health Care Professionals

Robert I. Field

in Health Care Regulation in America: Complexity, Confrontation, and Compromise

This chapter presents the regulatory structure for health care professionals with an emphasis on physicians. It traces the history of the formalization of the medical profession, initiated by the ... More

This chapter presents the regulatory structure for health care professionals with an emphasis on physicians. It traces the history of the formalization of the medical profession, initiated by the American Medical Association (AMA). This organization successfully induced every state to adopt a licensing process, and it standardized medical education based on the findings of the Flexner Report, issued in 1910. Regulation of the medical profession, including granting licenses to practice and imposing discipline, remains at the state level but with several federal and private organizations providing elements of national coordination. Oversight is also imposed by various other governmental and private bodies, including the federal Medicare program, specialty boards, health maintenance organizations, and hospitals. Similar regulatory arrangements govern osteopathic physicians and many allied health professions. The chapter concludes with a review of perennial policy conflicts, including that between licensure and consumer information as arbiters of professional quality.Less

Medical Education, 1900–1950: General Trends and Basic Medical Sciences

William G. Rothstein

in American Medical Schools and the Practice of Medicine: A History

During the first half of the twentieth century, American medical education underwent drastic changes. Greater costs of operation and the requirements of licensing agencies forced many medical ... More

During the first half of the twentieth century, American medical education underwent drastic changes. Greater costs of operation and the requirements of licensing agencies forced many medical schools to close and most of the others to affiliate with universities. The surviving medical schools were able to raise their admission and graduation requirements, which was also made possible by the rise in the general educational level of the population. The growth of the basic medical sciences led to the development of a new kind of faculty member whose career was confined to the medical school. During the first half of the twentieth century, the educational level of the population rose significantly. The proportion of the 17-year-old population with high school educations increased from 6.3 percent in 1900 to 16.3 percent in 1920, 28.8 percent in 1930, and 49.0 percent in 1940. The number of bachelors’ degrees conferred per 100 persons 23 years old increased from 1.9 in 1900 to 2.6 in 1920, 5.7 in 1930, and 8.1 in 1940. Between 1910 and 1940, the number of college undergraduates more than tripled. Because the number of medical students did not increase, medical schools were able to raise their admission standards. At the same time, many new professions competed with medicine for students. Between 1900 and 1940, dentistry, engineering, chemistry, accounting, and college teaching, among others, grew significantly faster than the traditional professions of medicine, law, and the clergy. Graduate education also became an alternative to professional training. Between 1900 and 1940, the number of masters’ and doctors’ degrees awarded, excluding medicine and other first professional degrees, increased from 1,965 to 30,021, or from 6.7 to 13.9 percent of all degrees awarded. Colleges and universities decentralized their organizational structure to deal with the increasingly technical and specialized content of academic disciplines. They established academic departments that consisted of faculty members who shared a common body of knowledge and taught the same or related courses. Departments were given the responsibility of supervising their faculty members, recruiting new faculty, and operating the department’s academic program. By 1950, departments existed in most of the sciences, social sciences, and humanities. Less

Behind the Hype: Unproven, Experimental, Herbal, and Innovative Remedies

Daniel J. Wallace and Janice Brock Wallace

in All About Fibromyalgia: A Guide for Patients and their Families

Advocates of practical though controversial lifestyle approaches have always found a sympathetic ear in the United States since the time folk practitioner Sylvester Graham’s principles of health, ... More

Advocates of practical though controversial lifestyle approaches have always found a sympathetic ear in the United States since the time folk practitioner Sylvester Graham’s principles of health, nutrition, and fitness (in addition to inventing the Graham cracker) achieved cult status in the 1840s. Heroic, misguided therapies were administered by allopathic (mainstream) physicians throughout the nineteenth century. This created fertile ground for promoters of patent medicines and nostrums to those escaping organized medicine’s use of leeches, cupping, phlebotomy (blood drawing) knives, and brutal laxative regimens. During the Progressive Era, medicine started to improve with the establishment of postgraduate training programs at Johns Hopkins University just before the turn of the century and the regulation of medicines as part of the Pure Food and Drug Act of 1906. The final revolution occurred when two-thirds of the medical schools in the United States closed following revelations of their inadequacies by the investigative Flexner Report funded by the Carnegie Foundation in 1910. Despite these changes, however, the appeal of alternative therapies to the American public continues unabated. The previous two chapters have described how mainstream, organized, conventional medicine approaches fibromyalgia. Even though their therapies usually provide significant relief of symptoms and signs, traditional physicians to some extent must regard themselves as failures. In the United States, one person in three has consulted a complementary medicine practitioner. These individuals spend $23 billion a year on this approach, $13 billion of which is out-of-pocket and not reimbursed by insurance. This exceeds all expenditures on hospital care in the United States. A 1996 Canadian study found that of several hundred fibromyalgia patients, 70 percent purchased unproven over-the-counter rubs, creams, vitamins, or herbs; 40 percent sought help from alternative medicine practitioners such as chiropractors, massage therapists, homeopaths, reflexologists, or acupuncturists; and 26 percent went on special diets. Since it is logical to believe that people who are tired and hurt want to get better, it follows that some fibromyalgia patients will try anything that is not harmful to improve their medical condition. This chapter is dedicated to patients who wish to “look before they leap” into nontraditional therapies. Less