Departments of Medicine — 1973

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Abstract
During the review of four departments of medicine, certain common problems that these departments face were recognized. These included a major increase in teaching load, primarily owing to curricular revisions, a dispersion of house staff through several affiliated hospitals, and a lack of time or resources to make meaningful commitments to continuing education. Simultaneously, there was an increasing demand to provide personalized service, and a schizophrenia concerning the department's mission to tertiary subspecialty-oriented medicine as opposed to primary or general medicine. The size of departments of medicine leads to certain organizational difficulties and gaps in communication. Although the chairman continues to have a central role in the department, his job is becoming progressively more difficult. Tenure, financial support and relations with affiliated hospitals, the dean and the university all pose interesting challenges. The major issue confronting departments of medicine is a solution to the problem of health manpower, particularly the training of general internists. (N Engl J Med 291:440–446, 1974)

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