"Halstedian 2" Residency Training

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Abstract
The turn of the century has brought more than a new millennium. It has placed a spotlight on a medical system in crisis. This has not been of sudden onset but an insidious process that has occurred during the last 2 decades for most of the nation. What makes the effect of this crisis so alarming is the fact that it emerged from what was considered a gilded era. A period of overall financial surplus and exponential growth had occurred in practically all aspects of medicine, with increased disbursement of direct and indirect medical expenses, expansion of clinical practices with unprecedented profits, increased medical school enrollment, an increase in the number of residents, and enhanced research programs. Concomitant with this phenomenon were skyrocketing medical costs. With these costs as high as 15% of the gross national product, the medical field became fertile ground for a multitude of managed care initiatives that often promoted goals in competition with the discipline of health care delivery. Many managed care ventures embraced a policy of proprietary issues ahead of service, in keeping with the business motto "There is no mission without a margin [profit]."

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