American medicine is undergoing public scrutiny with an intensity never before experienced by a profession. The immediate cause for this scrutiny is the recent perception of a "crisis" in the health care system. The factors that cumulatively contributed to this sense of crisis are multiple and interdependent and some are probably at least 100 years old.
During the past century, medicine has changed from an empiric art toward a research-based, quantitative, technologically oriented, specialty-dominated scientific discipline. The 19th-century advances in microbiology and anesthesia, which transformed the disciplines of surgery and public health, were previews of the remarkable 20th-century achievements in physics, biochemistry, physiology, and pharmacology that were to transform the practice of clinical medicine.
The Flexner report of 1910 encouraged the development of scientific medicine by integrating medical schools into universities and helped to effectively eliminate proprietary medical schools. In addition, Flexner urged that the clinical teaching of medical students