Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care

$29.95

A comprehensive look at American medical education in the 20th century, Time to Heal takes the reader on a historical journey from Abraham Flexner's famous report on the state of medical schools in 1910 through the dawning of managed care.

Dr. Kenneth M. Ludmerer, author of the book, spoke to the History of Medicine Society at Baylor College of Medicine in February. Dr. Ludmerer is a professor of medicine in the School of Medicine and professor of history in the Faculty of Arts and Sciences at Washington University in St. Louis.

In an interview with the Texas Medical Center News, Dr. Ludmerer described the book's beginnings as "a moral passion" driven by the effects the early stages of managed care were having on academic medical centers, a term which collectively refers to medical schools and their affiliated teaching hospitals.

Time to Heal is divided into three parts, marking what Dr. Ludmerer describes as the three eras in the evolution of medical education. He refers to the period between World War I and World War II as the education era, in which academics were the primary focus of medical education. The time between 1945 to 1965 is classified as the research era, a period during which the federal government began making funds available for research efforts. The establishment of Medicare and Medicaid in 1965 brought about the third era, one in which clinical practice became a dominant force. From 1965 to the present, medical schools have expanded considerably and clinical activities account for approximately 50 percent of medical schools' budgets.

"The challenge has always been to get the right balance of education, research and clinical care," says Dr. Ludmerer. "If any one dominates, the others can suffer from it. So the task is to strike a balance, and there has always been tensions among them."

Dr. Ludmerer gives readers the benefit of a historical perspective in Time to Heal and then challenges them to alter the present course American medical education is taking under managed care. His book suggests American medical education is at a critical point in the beginning of a revolution when opportunities still exist to create a new model, one that will preserve the quality of health care at academic medical centers while remaining mindful of the rising costs that led to managed care.

"I think we can identify components of it [a new model], but we are not yet at the point where we have that crystal-clear answer," he says. "We are working toward that. It is important to recognize where we are today and where Flexner was. It is going to take work."

Time to Heal has been nominated by Oxford University Press for a Pulitzer Prize in the nonfiction category.

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©2006 Texas Medical Center

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