Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care / Edition 1

by Kenneth M. Ludmerer

Overview

The recipient of extraordinary critical acclaim, this magisterial book provides a landmark account of American medical education in the twentieth century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, self-centered professional interests.
Kenneth M. Ludmerer describes the evolution of American medical education from 1910, when a muck-raking report on medical diploma mills spurred the reform and expansion of medical schools, to the current era of managed care, when commercial interests once more have come to the fore, compromising the training of the nation's future doctors. Ludmerer portrays the experience of learning medicine from the perspective of students, house officers, faculty, administrators, and patients, and he traces the immense impact on academic medical centers of outside factors such as World War II, the National Institutes of Health, private medical insurance, and Medicare and Medicaid. Most notably, the book explores the very real threats to medical education in the current environment of managed care, viewing these developments not as a catastrophe but as a challenge to make many long overdue changes in medical education and medical practice.
Panoramic in scope, meticulously researched, brilliantly argued, and engagingly written, Time to Heal is both a stunning work of scholarship and a courageous critique of modern medical education. The definitive book on the subject, it provides an indispensable framework for making informed choices about the future of medical education and health care in America.

Product Details

ISBN-13:	9780195181364
Publisher:	Oxford University Press, USA
Publication date:	01/01/2005
Edition description:	New Edition
Pages:	544
Product dimensions:	9.00(w) x 6.10(h) x 1.60(d)
Lexile:	1590L (what's this?)

About the Author

Kenneth M. Ludmerer, M.D., is Professor of Medicine and Professor of History at Washington University in St. Louis. He is a member of the American Academy of Arts and Sciences and a recipient of the Distinguished Alumnus Award of The Johns Hopkins University.

Table of Contents

Preface		xi
Acknowledgments		xv
Introduction		xix
Part I Fulfilling the Social Contract: Medical Education as a Public Trust and the Capture of Public Confidence
Creating the System		3	(23)
Progressive Medical Education
Fund-Raising
Medicine and the University
The Emergence of the Teaching Hospital
Establishing the Social Contract
The American Medical School Between the World Wars		26	(33)
Education
Research
Patient Care
Faculty Culture
Diversity and Development
The Rise of Harvard Medical School
Undergraduate Medical Education		59	(20)
Admissions
Training for Uncertainty
The Hidden Curriculum
Student Life
The Limits of Education
The Rise of Graduate Medical Education		79	(23)
The Creation of Internship and Residency
From Supervision to Responsibility
Selecting House Officers
Stresses and Support
Graduate Medical Education and the Public Interest
Teaching Hospitals		102	(12)
Joining the University
The Presence of Time
The Ward Service
Academic Medical Centers and the Public		114	(11)
Town and Gown
The Care of the Poor
Medical Education and the Nation's Health
World War II and Medical Education		125	(14)
Mobilization for War
The War Against Disease
The Apotheosis of Medical Optimism
Part II Medical Education in the Era of the Multiversity: The Growth of Research and Service in a Period of Abundance
The Ascendancy of Research		139	(23)
The Age of Federal Beneficence
Changing Intellectual Directions
The Decline of Academic Gentility
The Expansion of Clinical Service		162	(18)
Academic Medical Centers and the Rising Demand for Medical Care
The Persistence of Academic Values
The Preservation of the Learning Environment
The Maturation of Graduate Medical Education		180	(16)
The Democratization of Residency
The Rise of Subspecialty Training
The Changing Life of the House Officer
The Forgotten Medical Student		196	(25)
The Evolving Curriculum
The Changing Medical Student
Producting More Doctors
The Devaluation of Teaching
Part III Breaking the Social Contract: The Erosion of University Values, the Decline of Public-Spiritedness, and the Beginning of the Second Revolution in Medical Education
Medicare, Medicaid, and Medical Education		221	(16)
The Escalation of Faculty Practice
Toward a One-Class System of Care
The Inversion of University Ideals
Medical Education in an Era of Protest and Civil Rights		237	(23)
Student Activism
House Staff Militancy
Minorities
Women
Academic Health Centers Under Stress: External Pressures		260	(28)
The Decline of the Cities
Competition for Patients
The New Adversarial Relationship with Government
The Dawn of the Age of Limits
Academic Health Centers Under Stress: Internal Dilemmas		288	(39)
Molecular Medicine and the Disappearance of Teachers
Reform Without Change
The Dilemmas of Graduate Medical Education
Internal Malaise		327	(22)
Rudderless Ships
The Decline of Academic Health Centers as Public Trusts
Medical Education in an Era of Cost Containment and Managed Care		349	(21)
Vassals of the Marketplace
The Loss of Time and the Erosion of the Learning Environment
Proactive Words; Reactive Behavior
A Second Revolutionary Period		370	(31)
The Reemergence of a Proprietary System
The Declining Relevance of Medical Education
Restoring the Social Contract
Notes		401	(94)
Index		495

Editorial Reviews

"We must not let the future [of medicine] happen, we must make it happen. Ludmerer's extraordinary book provides the foundation—and inspiration—for doing this."—Jerome Kassirer, New England Journal of Medicine

"Its writing is sufficiently riveting and its message important enough to capture any reader.... Before you or your loved one checks into an American teaching hospital for critical care, read this book."—Newsday

"Persuasively written and meticulously researched, providing an exceptional foundation for understanding the problems American health care and medical education face in the next century."—St. Louis Post-Dispatch

"No consideration of the future of health care in the United States can afford to overlook the historical facts laid out by Ludmerer."—The New Republic

"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."—Publishers Weekly

"A superb book, perhaps the most significant work of American medical history to have been published in the last quarter-century."—Choice

"A magisterial book, bound to attract more than the scholarly attention...this book will make Ludmerer the most eminent historian of American medicine of his time and a notable figure in the medical profession into the bargain."—Donald Fleming, History Department, Harvard University

"This brilliant historical account...is more than a work of breathtaking scholarship. It is also a work of great social and moral stature...The message of the book is not that medical education and the health care system are beyond redemption. Quite the contrary, it is a challenge for their redemption."—Renee C. Fox, Social Sciences, University of Pennsylvania

"Ludmerer's book will replace the Flexner report as THE book on American medical education."—Gerald T. Perkoff, Curators Professor Emeritus, University of Missouri-Columbia School of Medicine

From the Publisher

Reviewer: James A. Pittman, BS, MD (University of Alabama at Birmingham School of Medicine)
Description: This is a clear, fascinating, exhaustive, and telling book describing the development of medical education in the 20th century.
Purpose: The author, one of the leading historians of medicine in the world and practicing physician at Washington University Medical Center in St. Louis, has divided the century into thirds for heuristic purposes, but there are really two objectives: first, to discuss the heroic build-up of the system of teaching physicians in the first portion of the century and second, to alert readers to the changes in medical education affected by the massive rise in research and practice, including recent restrictions imposed by managed care. His thesis is that the emphases on research and earning money from practice have nearly crowded teaching out of the academic medical centers and their medical schools, and that some sort of denouement is occurring with restrictions now being imposed by governmental and private funding sources.
Audience: The thesis put forth by the author is likely to be received well by the intended audience — those working in academic medical centers, other interested physicians, insurance companies, policy makers in and out of government, and interested laymen.
Features: The author appears to have visited a huge variety of medical institutions and their archives, and to have read nearly everything pertinent to his subject and digested it. This is reflected in the narrative, tabulations, anecdotes, and the nearly 100 pages of closely packed references and commentaries in the notes at the end of the book (well worth reading by themselves).
Assessment: This is an attractive, well-referenced, and authoritative book. There is no other historian of medicine so well situated to write this book, which will become the definitive work on the subject.

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