Higher Education and the Nations's Health: A Review of the Carnegie Commission Report on Medical Education

Abstract

THE Carnegie Commission's report is . . concerned with the serious of professional health manpower, the need for expanding and restructuring the education of professional health personnel, and the vital importance of adapting the education of health manpower to the changes needed for an effective system of delivery of health care in the United States.' The Commission, to put matters succinctly, finds that a deplorable state of affairs exists with respect to the production and delivery of medical care and that the output of physicians ought to be increased by fifty per cent in the next decade.2 With few exceptions, this report implicitly views the current state of affairs with respect to the supply of medical care as if it were a consequence of a natural event such as an earthquake or hurricane. Therefore, the Commission's report contains virtually no analysis of how the current state of affairs came into existence. This omission constitutes a serious deficiency; it is usually necessary to understand the cause of a social problem in order to deal with it effectively. Generally it is a mistake to ignore the causes of a social problem. For the Carnegie Commission to largely ignore the causes of our present difficulties in the medical field is self-serving. It is our thesis that most of our present difficulties, in particular the so-called shortage of physicians is attributable to the Carnegie Foundation's previous endeavors in the field of medical education-that is, the famous Flexner report on medical education and the widespread implementation of its recommendations.3 The focus of the Commission's recommendations is .. the contributions of university health science centers and they report they know of . . no