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May 17, 1995

The Academic Health Care SystemPreserving the Missions as the Paradigm Shifts

Author Affiliations

From the Department of Medicine, University of California, San Francisco School of Medicine.

JAMA. 1995;273(19):1549-1552. doi:10.1001/jama.1995.03520430085053

BALTIMORE & OHIO; Atchison, Topeka, and Santa Fe. Whether the source of reference is the Monopoly board or an old western movie, nearly everyone recognizes these railroad giants of a bygone era. For more than 50 years, railroads dominated industrial America and built many fortunes. Then, by the mid 20th century, the trucking industry captured most freight transportation and the airline industry revolutionized passenger travel. The railroads, whose capital and expertise should have been ideal for developing new forms of transportation, instead made a fundamental error: they thought they were in the railroad business when they should have been in the transportation business. Railroads competed against each other for an ever-shrinking portion of the transportation dollar, while new companies emerged to move cargo and people more quickly and less expensively. If the railroad companies had diversified from trains to trucks and airplanes, their integrated transportation systems would have rewritten US

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