The Reform of Medical Education

Prologue: The nation's medical education system has grown dramatically over the past several decades, a consequence of society's abiding commitment to the medical model Through the particular encouragement of federal subsidies, the number of medical schools increased from 88 to 127 and total enrollment rose from 21,379 to a peak of 67,443 in 1983–1984; enrollment in 2986–1987 was 66,142. During the 1980s, when many other sectors of the health sphere were being subjected to dramatic change, the status quo largely prevailed in medical education, although pressures for reform began to build. In this lead essay, Robert Ebert and Eli Ginzberg discuss the evolution of medical education and offer a prescription for its reform. Ebert is a particularly appropriate figure to survey the changes he believes are necessary to prepare medical education for the twenty-first century. His career spans the deanship of Harvard Medical School, the presidency of the Milbank Memorial Fund, and now a post as an adviser to the president of The Robert Wood Johnson Foundation. Ebert has maintained a long interest in generalist training of physicians, arguing that medical education must achieve a more appropriate balance between primary care and tertiary, specialty-oriented teaching. Ebert was instrumental in the creation of the Harvard Community Health Plan, one of the first health maintenance organizations with an affiliation to a medical school He also fostered the recruitment of minority students to Harvard Medical School, a standard the school has largely maintained. Ginzberg, a professor emeritus of economics at Columbia University, is the long-time director of the Conservation of Human Resources, which is affiliated with the same institution. Ginzberg was among the first national figures to question the notion that the United States faced a physician shortage. In a letter published in The New England Journal of Medicine, Ginzberg said that increasing the supply of physicians would not automatically achieve the policy goals of improved health or better distribution of physicians.