[Skip to Content]
[Skip to Content Landing]
January 22, 1982

The 'Growth Disease' in American Institutional Medicine: An Open Letter to Physicians and Hospital Board Members

JAMA. 1982;247(4):469-470. doi:10.1001/jama.1982.03320290015019

THE MEDICAL system has become huge, having followed an explosive industrial-type growth pattern. Hospitals and medical centers have been oriented to expansion, and medical administrators—both lay and physician—have been bred according to the growth concept. The rule has been that growth equals progress and, hence, success. Hospital leaders are loath to give up this measure of achievement, which they have learned from industry, although it is a concept that leads to great costs in money and efficiency and that runs contrary to our social needs.

The growth-oriented administrators of our medical institutions are generally supported by strikingly passive governing boards, almost always consisting predominantly of businessmen, who casually provide their legal authority and psychological support to the administration. The resultant growth includes more buildings, more facilities, larger staff, more support personnel, more administrators, and more power concentrated in a central administrative office. Ironically, the boards of these institutions allow the