Medicine cut off from its roots: context matters in medical education

The values and rewards that animate community practice are not clearly visible to those in traditional medical training programs. Flexnerian education explicitly chose to exclude practitioners in favor of full-time faculties. Academic health centers today are organized to take maximum advantage of a reimbursement system that has been described as perverse; perhaps one of the perversities is that the values embedded in the reimbursement system (reimbursement driven by discrete services rather than overall health or function) have been internalized by trainees and their institutions, and other things valuable to patients and communities (longitudinal care, coordinated care, and appropriateness of care) have become invisible.