The future of group practice

Abstract

LTHOUGH it is generally believed that group A medical practice originated in the western hemisphere and particularly in the United States, actually group medicine was practiced in Europe many years ago. According to Thompson [I], “In Europe the great pioneer medical teachers, like Vesalius, gathered groups of physicians around them in places like Padua, and these were undoubtedly the forerunners of the modern medical center and medical school. In Germany and Austria, group clinics of a kind evolved around outstanding clinicians in the 19th Century. Some of these originated in connection with the universities, some with private hospitals and some with mineral spas.” Although group medical practice originated in Europe, it has had its greatest impetus in the United States where, through the years, it has become progressively more prevalent and developed to a highly refined degree. Will group practice become more widespread or will it gradually retrogress to individual practice? The general practitioner undoubtedly plays an extremely important role in the practice of medicine, and I sincerely hope that his image will continue to be strengthened. With rapid expansion of medical knowledge and great improvement in medical technology, however, specialization has become even more refined, and the information that the trainee in a medical specialty must acquire is much greater than ever before. The tremendous advances in medical science are making it increasingly difficult for the medical student today to master them all, and the need for physicians to be well informed of these new developments is obvious. In fact, today there is such a demand on the time of medical students that medical education is undergoing tremendous changes. Many educators believe that it is undesirable for all physicians to have the same basic medical training, but that because of the years now required for specialty training, courses in medical specialization should be introduced early in the undergraduate medical school curriculum. As emphasized by the Report of the Endicott House Summer Study on Medical Education [Z], serious consideration must be given to shortening the premedical course to three and possibly two years, to beginning the study of clinical medicine during the first year of medical school, and to starting specialization early in the medical school curriculum. These suggestions have considerable merit, but they have the inherent weakness that the future medical specialist will have such highly specialized knowledge that he will be poorly trained to evaluate the patient as a whole. Indeed, even today physicians must constantly strive to overcome the tendency to think about the disease rather than the patient. For these reasons, I believe that group practice will become more necessary and, therefore, more widespread than ever before. After the second World War the number of medical specialists multiplied rapidly, primarily because the income of the medical specialist was so much higher than that of the general practitioner that most young physicians wanted to specialize. In contrast, before World War II, this ratio was two general practitioners to one specialist. I am not implying that specialization is undesirable, but the fact remains that there are considerably fewer general practitioners today than there were twenty-five years ago. Although the practice of medicine has be-