In preparation for this talk, I reviewed the addresses of some of our previous presidents. I was impressed with their concern with both the social and economic influences of American surgery. Their talks collectively trace the evolution of the certifying boards, the appearance of the Joint Commission on Accreditation of Hospitals, the Residency Review Committee, and the early worries about the fragmentation of general surgery. Later, they described the intrusion of the regulatory agencies, with the passage of the Medicare laws, the Professional Standards Review Organization legislation, and then the appearance of the Health Planning agencies. These earlier addresses are a wonderful source of information about influences that society and government have had on American surgical training and practice. This year there is a new array of influences that we must understand and deal with.
For some time, I have been fascinated by the relationship between the quality of medical
McCurdy RE. Changing Physician-Hospital RelationsLife in the Fast Lane. Arch Surg. 1984;119(5):505–507. doi:10.1001/archsurg.1984.01390170005001
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