Stanford School of Medicine. I. Problems over more than money

Since World War II the American medical school has become a highly complex institution and, like other American institutions today, the medical school is being challenged to respond to diverse and often conflicting demands. In part the pressure comes from activists who insist that the medical school more fully meet the needs of the community by reforming both training and the delivery of medical care. But another sort of pressure is exerted as a result of changes in internal relationships that have occurred in the last two decades in large measure because of the federal support of biomedical research. As in most institutional conflicts the dispute is expressed in contests over power and money, but, at a more fundamental level, what is involved is the value and reward system of academic medicine and the question of how the medical school is to be governed. This is the first of three articles which will attempt to discuss these issues in the context of the development of one medical school-Stanford's. The first article will describe the pattern and policies of expansion since World War II, and the other two will examine the effects of internal and external pressures for change.