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May 12, 2015

The Transformation of US Physicians

Author Affiliations
  • 1Stanford University, Stanford, California
JAMA. 2015;313(18):1821-1822. doi:10.1001/jama.2015.2915

The current transformation of physicians in the United States—from self-employment to salaried employment, from fee-for-service to “bundled” or capitation payment, from providing acute care to providing chronic care, from inpatient to ambulatory settings, and from solo or small group practice to “team care”—complicates the future of the medical profession.

The current transformation was preceded by 2 other major changes for US physicians. An early transformation, usually associated with the 1910 Flexner Report, began around 1900 by the Johns Hopkins School of Medicine and the activities of the American Medical Association.1 Criteria for admission to medical schools were raised, length of training increased, and standards for faculty were tightened. These innovations, plus stricter licensure laws, resulted in a decline in the number of physicians per 1000 population from 173 in 1900 to 125 in 1930. Hamilton summarized the results of the transformation in 1932, reporting that “An ancient and honorable craft had become a profession; the profession has lived on into an epoch in which it has had… to respond to the incentives of business [emphases added].”2

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