• A S Relman.
• Brigham and Women's Hospital, Channing Laboratory, Boston, MA 02115-5804, USA.
• Acad Med. 1998 Dec 1; 73 (12): 1229-33.

AbstractThe corporate transformation of medicine raises questions about the basic purposes and values of the profession and the physician's social role that have not been adequately considered in medical school and residency curricula. Medical schools and graduate programs need to make students and trainees more aware of the conflict between traditional professional values and the imperatives of the market, so they will be better prepared to defend these values in the new business climate. Otherwise, medical schools and teaching hospitals could simply become trade schools, turning out sophisticated technicians, future entrepreneurs, and managers. As a starting point for educational reform, the author suggests that students (1) learn the social and political history of the medical profession of the United States over the past 200 years; (2) be introduced to the economic dimensions of health care--where the money comes from and how it is spent; (3) learn the history of health maintenance organizations, and understand the different forms of managed care and how they work; (4) become familiar with the health care reforms proposed by the Clinton Administration in the early 1990s, and understand why they were defeated and what has happened to health care reform since then; (5) examine the conflict between the culture of business managers and that of practicing physicians, and consider the recent efforts to achieve "quality control" as a balance to the emphasis on price; (6) be challenged to think about the important ethical, legal, and professional issues raised by the industrialization of health care; and (7) consider the political and professional options that might preserve the most important principles of medical professionalism while still addressing the social objectives of cost control, community service, and universal access. The author concludes that to prevent medicine from becoming merely a technologic business, the medical profession will have to become more actively involved with other policymakers and representatives of the public in efforts to improve the health care system, while preserving professional and social values. To do this, physicians will need a better knowledge of the health care system and its problems than most of them possess. This is a challenge medical educators must now address.

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