practice, calls for general practitioners were about four times more frequent than for internists or gynecologists…”14
Medical schools, for their part, by fulfilling their Flexnerian mission, had become more
divorced from the realities of everyday clinical practice than at any time since the 1920s.
Responding to the new call for practitioners to relate to their patients’ real-world health problems, medical educators tried to improve “the educational process, largely from the standpoint of better and more effective learning, but also with regard to increased relevance of medical practice to social needs.” Education reformers called for increasing the role of the behavioral sciences in
an expanded curriculum that stressed comprehensive care of the “whole” patient. For example, the new field of family medicine was authorized to grant board certifications in 1969 and
had campaigned for specialty status most intensively from the mid-1960s; the concept of the
“biopsychosocial model” also emerged in the 1960s and ’70s, becoming a conceptual bulwark for both psychiatry and family practice.15 Among the most prominent proponent of modifying the
goals of medical education to reconnect it more directly to the public’s needs and to incorporate
more of what might be called “doctoring” was Ward Darley, Executive Director of the AAMC from 1959 to 1965. Others, too, began expressing concern over the dearth of small-group teaching and
“active” learning rather than the still common reliance on large lectures and memorization during the first two years of medical school.16
By the time of the Surgeon General’s Report in 1959, in short, both the AAMC and the AMA
were cognizant of a growing mismatch between the kinds of physicians entering the profession
and those that the general population actually needed: primary care doctors. According to “The Future Need for Physicians,” a statement adopted at the 67th annual meeting of the AAMC in
1956, “In the ten-year period [1945-46 to 1955-56] the number of medical schools has increased from 77 to 82, the number of entering freshmen from 6,060 to 7,686, and the number of
graduates from 5,655 to 6,485…It is possible that some existing schools can, with new and larger facilities, accept additional students, but the need cannot be met completely in this manner.
The larger contribution in the number of students will have to come, as it has in the past, by the
establishment of new schools.”17 But Ward Darley of the AAMC came closer to the real problem, noting that, “The availability of physicians for general care has been threatened by the growth
of specialism…The availability and adequacy of continuing, comprehensive health and medical
care for individuals and their families is, I believe, one of the most important questions facing the future of American medicine.”18
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