Medical school curricula for too long have ignored the obvious and importan
t changes in the economics and delivery of health care in the United States
. Medical students, who become the practicing physicians of the future, and
their patients have suffered because of this academic malaise. Most new ph
ysicians are even more confused than their patients about how to navigate o
utpatient managed care, how to practice efficiently (after being taught tha
t more is better), and how to uphold their sacred trust with their patients
in the context of institutionally based medicine. After summarizing releva
nt historical events, we discuss how we hope to begin making up for lost ti
me by tackling the issue of necessary curriculum change at the University o
f Pennsylvania Health System.