The Welfare State

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Brayton College

Santé & Médecine

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TABLE 1-1 Milestones of Medicine and Medical Education 1700–2015 ■ 1700s: Training and apprenticeship under one physician was common until hospitals were founded in the mid-1700s. In 1765, the first medical school was established at the University of Pennsylvania. ■ 1800s: Medical training was provided through internships with existing physicians who often were poorly trained themselves. In the United States, there were only four medical schools, which graduated only a handful of students. There was no formal tuition with no mandatory testing. ■ 1847: The AMA was established as a membership organization for physicians to protect the interests of its members. It did not become powerful until the 1900s when it organized its physician members by county and state medical societies. The AMA wanted to ensure these local societies were protecting physicians’ financial well-being. It also began to focus on standardizing medical education. ■ 1900s–1930s: The medical profession was represented by general or family practitioners who operated in solo practices. A small percentage of physicians were women. Total expenditures for medical care were less than 4% of the gross domestic product. ■ 1904: The AMA created the Council on Medical Education to establish standards for medical education. ■ 1910: Formal medical education was attributed to Abraham Flexner, who wrote an evaluation of medical schools in the United States and Canada indicating many schools were substandard. The Flexner Report led to standardized admissions testing for students called the Medical College Admission Test (MCAT), which is still used as part of the admissions process today. ■ 1930s: The healthcare industry was dominated by male physicians and hospitals. Relationships between patients and physicians were sacred. Payments for physician care were personal. ■ 1940s–1960s: When group health insurance was offered, the relationship between patient and physician changed because of third-party payers (insurance). In the 1950s, federal grants supported medical school operations and teaching hospitals. In the 1960s, the Regional Medical Programs provided research grants and emphasized service innovation and provider networking. As a result of the Medicare and Medicaid enactment in 1965, the responsibilities of teaching faculty also included clinical responsibilities. ■ 1970s–1990s: Patient care dollars surpassed research dollars as the largest source of medical school funding. During the 1980s, third-party payers reimbursed academic medical centers with no restrictions. In the 1990s with the advent of managed care, reimbursement was restricted. ■ 2014: According to the 2014 Association of American Medical Colleges (AAMAC) annual survey, over 70% of medical schools have or will be implementing policies and programs to encourage primary care specialties for medical school students. TABLE 1-2 Milestones of the Hospital and Healthcare Systems 1820–2015 ■ 1820s: Almshouses or poorhouses, the pr.

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