The education of the physician

Although the quality of U.S. medical care is at an all-time high, thanks largely to the education and training of American physicians, the nation is in a health care crisis, especially in rural areas and the inner cities. To meet this challenge, change in the education of physicians is required. An important reason for the present crisis is that the selection and education process has encouraged only science- and high-technology-oriented individuals to enter medicine, even though social and behavioral factors are the basis of a majority of today's medical problems. The author realizes that there is little motivation for frequently overburdened faculties and underfunded medical schools to undertake the needed changes; he describes various problems that challenge the existence of the health care system, including the increasing (and well-meaning) involvement in educational matters by legislators and bureaucrats. The author then explores various options for bringing about reform of physician education, including changes in premedical education, in the criteria used for identifying and admitting promising students, and in various aspects of medical education. Such reform could encourage some of the best, brightest, and more broadly educated students to enter the medical profession and could maintain high standards of physician education while fulfilling a public trust and meeting a public need.