Advances and New Directions

By Silvano Arieti; H. Keith H. Brodie | Go to book overview

CHAPTER 34

MEDICAL FACULTY,
ORGANIZATIONAL PRESSURES,
AND SUPPORT
Pamela J. Trent H. Keith H. Brodie
¶ Introduction
MEDICAL EDUCATION in the United States has not faced such careful scrutiny since Abraham Flexner published his report in 1910. 9 Whereas that report disclosed the need to organize medical education, present studies of the issues reflect the overwhelming complexity of that organization. The recent report, The Organization and Governance of Academic Health Centers14,24 makes this abundantly clear. Academic health centers (AHCs), direct descendants of post-Flexnerian efforts to improve medical schooling, are now complex and diverse institutions "consisting of a medical school, at least one other health school, and a teaching hospital (owned or affiliated)."14 Note the historical factors leading to this complexity, as delineated in the report :
1. There has been an overwhelming increase in the operating and capital budgets for programs, staff, students, and faculty.
2. There has been a tremendous growth of new medical knowledge in the past forty years.
3. There has been a large and steady increase in federal support for health care, medical education, and medical research since 1945, adding to the administrative complexity.
4. Since the 1960s, there has been pressure to provide more and better health care to all members of society.
5. There has been a major increase in external regulation from all levels of government.
6. There has been increasing competition from nonphysician professionals who seek to improve their status, capabilities, and credibility in health-care delivery.

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