Change is no stranger to academic medicine. A century ago, medical education recreated itself as a scientifically based discipline.1 Unfortunately, this fundamentally sound approach to the training of physicians was never adequately extended to teach disease prevention and health promotion, nor did it train physicians adequately to deal with the consequences of success in managing acute illness: an expanding aged population, the increasing burden of chronic illness, and explosive growth in health care costs. The last of these has been enormously accelerated by an insurance system that rewards treatment over prevention and a health care system that is constructed around the hospital and technologically sophisticated care.
See also pp 667 and 672.
Managed care is society's current response to existing trends and oversights in the US health care system. The rapid expansion of managed care arrangements in the United States has been widely chronicled.2 In 1995, 54 million
Blumenthal D, Thier SO. Managed Care and Medical EducationThe New Fundamentals. JAMA. 1996;276(9):725-727. doi:10.1001/jama.1996.03540090071015