Lecture Ten: Specialization and Compensation

American Medical Reform

1. 1844-1846: AMA, allopaths only need apply
2. Mid-century medical incomes: ~$600/year -- a skilled trade
3. 1890: American Association of Medical Colleges
4. 1901: AMA Reform, inclusion of homeopaths, eclectics, county, state medical societies
5. 1888: Dent v. West Virginia
6. 1893: Foundations
   • Johns Hopkins Medical School
   • Rockefeller General Education Board (GEB)  2/3 to 7 schools
   • Carnegie Flexner Report #4 of 1910

Results of Reform

1. The new sects: Chiropractic, osteopathy, Christian Science
2. Decline in medical supply
   • 1906: 161 medical schools
   • 1910: 131 medical schools
   • 1915: 95 medical schools
   • 1922: 81 medical schools

Specialization: "Practice Limited 100% to..."

1. Old Specialities (c. 1800)
   • Physician
   • Surgeon
2. Middle Specialities (c. 1850, from Germany)
   • Man midwife
   • ophthalmologist (1916)
   • ear and throat (1924)
   • dentist
   • mad doctor
   • neurologist
   • veneralogist
3. New Specialities (c. 1900)
   • Technology-related: clinical pathologist, radiologist, anesthesiologist
   • Society-related: pediatrician, psychiatry, psychology
   • Science-related: varieties of surgery, urology, podiatry