Search Results

Throughout its history, the American medical school, like the rest of the country's system of higher education, had been shaped by social, economic, and political developments in the larger society. Thus, it was hardly a surprise that many of the pressures experienced by academic health centers in the 1970s and 1980s arose from outside events. Yet, academic health centers encountered additional dilemmas that could not so clearly be related to external pressures. A number of traditional challenges to medical education grew more intense: the problem of teaching bedside medicine as biomedical research became increasingly molecular, the perpetual difficulty of achieving a suitable institutional balance between teaching and research, and the ongoing dilemmas of residency and fellowship training. These frustrating problems arose mainly from the evolution of medical knowledge and the institutional development of academic health centers rather than from the challenges imposed by a hostile external environment.

Goldstein describes how the prior personal experiences—political, physical, and emotional—of individual physicians were instrumental in the introduction of complementary and integrative medicine into medical school facilities and curricula. He applies parallel arguments to past research on patient‐driven movements, which has emphasized the effects of personal experiences on involvement and leadership for those at risk for or affected by a particular condition or disease in the study of professionally driven movements. From eight of the medical schools currently belonging to the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), fourteen individuals, including five deans and nine other integrative medicine advocates, attended a key organizational meeting during the summer of 1999. Goldstein interviews a number of these participants about the extent to which attendees conceptualized their actions at the time of the meeting as part of a social movement and the degree to which personal experiences of participants were significant factors in their participation. The chapter findings indicate that most participants were conscious of being part of a social movement and recalled this as quite important. Additionally, many respondents reported self‐perceptions as “wounded healers” and saw movement participation as a means to address this status.

Between 1950 and 1980, state and federal funding made higher education a major component of American society in terms of the number of institutions, students, and faculty members; the range of academic and professional programs; and the capital investment and expenditures. Medical schools also grew from small, narrowly based institutions that educated undergraduate medical students to large academic medical centers that provided a wide range of educational, research, and patientcare activities. The schools changed their internal structures by replacing part-time faculty members with full-time faculty and restricting clinicians’ private practices to the medical school. Their independent sources of funding and autonomy affected relations with their parent universities, affiliated health schools, and the community. The most distinctive feature of higher education after mid-century has been its greater accessibility to students. The number of degree-credit enrolled college students increased from 2.7 million in 1949 to 5.9 million in 1965, 11.2 million in 1975, and 12.4 million in 1982. Between 1950 and 1982, the proportion of the 25- to 29-year-old population who had completed four or more years of college rose from 7.7 percent to 21.7 percent, even though the number of persons in that age group increased by two-thirds. The most rapid growth in higher education occurred from the late 1950s to the mid-1970s, when total degree-credit enrollment tripled. From 1975 to the early 1980s, three-fourths of the growth has been due to part-time students. The greater accessibility of higher education has especially benefited those groups of students who had low rates of college attendance at mid-century. The number of women students increased from 0.8 million in 1949 to 6.4 million in 1981, while the number of men increased from 1.9 million to 6.0 million. Between 1950 and 1982, the proportion of blacks 25 to 29 years of age who had completed four or more years of college increased from 2.8 percent to 15.8 percent. In 1979, blacks accounted for 10.5 percent of high school graduates and 10.0 percent of college enrollees. In the same year, hispanics accounted for 4.3 percent of high school graduates and 4.2 percent of college enrollees. Changes have occurred in the academic status of many students.

In 1986, the Rockefeller Foundation and the Pew Charitable Trusts decided to encourage the academic health centers (AHCs) to modify the curriculum of their medical schools. They launched the Health of the Public (HOP) program, issuing a call for proposals that was answered by 89 medical schools, representing about 7 out of 10 of U.S. allopathic schools. This chapter discusses the objectives and major accomplishments of the HOP program. It also assesses the implications for future changes in the curriculum of the AHCs resulting from this effort.

An academic health center (AHC) consists of a medical school and one or more health professional schools. These schools are joined to one or more affiliated teaching hospitals that are under common ownership or closely aligned with the medical school. This book focuses on the academic health centers (AHCs) that provide medical care to the urban poor. The urban poor belong to a group of people with income below the federal level of poverty and people who are uninsured. The book centers primarily on the relationship between AHCs and the urban poor subsequent to the passage of Medicare and Medicaid.

This chapter provides a brief account of the important changes in the structure and function of U.S. medicine as a result of the World War II. It begins by identifying key interactions between the leading urban academic health centers and their low-income neighbors. It then discusses the changes to the health care system brought about by the participation of the United States in World War II. These include the GI Bill, private health insurance, biomedical research, and the passage of the Hill–Burton Act.

This concluding chapter evaluates potential developments for the year 2000 to 2010. It examines the transformations that occurred during the last decade of the twentieth century in restructuring the functioning of academic health centers (AHCs). It also assesses changing relations between the AHCs and the urban poor from the implementation of Medicare and Medicaid through the end of the twentieth century and then examines their potential pattern of interaction for the next ten years.

This chapter examines the rise and growth of managed care plans and their impact on the academic health centers (AHCs) and the urban poor. It begins by exploring the rise of the independent physicians association (IPA)/network system that emerged in southern California. The impact of managed care on the revenues of AHCs is also examined. Finally, the chapter discusses the growth of Medicaid managed care and the efforts to enroll low-income persons not previously eligible for public coverage.

This chapter examines the overall impact of Medicare in the U.S. medical care system. It first provides an overview of the passage of Medicare and then describes how Medicare expanded the financing of the nation's leading research-oriented academic health centers (AHCs). Medicare's reimbursement policies helped improve the financial position of AHCs. One of the most important of the new financing arrangements under Medicare was the payment that the federal government made to hospitals for the direct and indirect costs connected with the operation of residency and fellowship training programs.

This chapter discusses the importance of physician supply issues in the evolution of U.S. health care policy. It first looks at the consequences resulting from the 1963 initiatives to provide financing of medical and other health professional schools. It then discusses the impact of the Medicare and Medicaid statutes on physician supply in terms of numbers, specialization, practice locations and incomes. Medicare provided multiple sources of graduate medical education (GME) funding to the academic health centers(AHCs) and other teaching hospitals to cover the costs of training and employment of residents. The chapter also discusses the factors involved in the expanding and changing character of the physician supply in the United States since the passage of Medicare.