EDUCATING PHYSICIANS FOR THE 21ST-CENTURY

The author reviews the fundamental changes that have taken place in th e U.S. health care system since 1935, predicts what that system will b e like in the early part Of the next century, and discusses the implic ations for academic medicine. Specifically, he maintains that physicia ns being trained today will practice within the context of large organ izations, with payment for care being either by employment-based insur ance or by some form of government-subsidized insurance, Care will be delivered across diffuse networks, and most physicians will be paid ac cording to capitation or salary schemes. The role of technology will b e high and will revolutionize the health care system, which will be fo cused on prevention and maintenance of function rather than cure. The success-of the system will be measured by its cost-effectiveness and b y how: well it works to maintain the mental, social, and physical func tions of its participants. Finally, the obligation of the physician wi ll be not only to individual patients but also, to the populations and communities from which:patients come. Training physicians to meet the se obligations and to function effectively in the revolutionized Syste m will involve changes In medical education to more appropriately soci alize students into the next century's medical culture, The author rev iews in detail the various elements of the medical culture that must b e addressed by medical education, gives examples of the kinds of chang es that must be made, and describes efforts at his school-to reinforce . across the curriculum the population-based model of clinical practic e.