12/01 Specialization and Medical Education Technology, Transformations, and Tensions Jokes about medical specialists: e.g. duck hunting Specialists and Generalists in the 19th century Generalist ideal: comprehensive knowledge of medicine, and of patients Specialists (e.g. oculists, dentists): lower prestige Rise of Specialists Changing theories of disease: local pathology, local expertise Specialize by organ system: neurologists, dermatologists Specialize by disease: syphilology, oncology Emergence of new technologies: radiologists, cardiologists (EKG) Urbanization, population density, and medical hierarchies Specialists and Tensions Urban-rural disparities in access to specialists Who makes the diagnosis -- clinicians or technicians? Sources of confidence How is responsibility for a patient divided? Challenge of integrating treatment Reforms in Education and Licensing Should Hopkins be an elite school, or the model for all schools? Flexner Report, 1910 Improving status and restoration of medical licensing by states AMA, state licensing boards, and standardization of medical education Rise of postgraduate training: internships Specialties and the rise of residencies and accreditation exams Consequences Improved status, prestige, and income for the profession High barriers to access: limited access for minorities and women Portable credentials Costs: do doctors require 12 years of training (vs. Europe) Does Boston require more cardiologists than England?