ABSTRACT
The organizational culture of physicians in the U.S. has been shaped for over a century by the 1910 Flexner Report and the resulting medical education and clinical practice based on a biomedical, find it, fix it, disease-centered, acute care focused approach to health care access and delivery. The biomedical model with its accompanying technology and specialization were the catalyst for physicians acquiring increased autonomy, control, and power in American health care access. With a disease focus, technological advances, and physician specialization—coupled with the passage of Medicare/Medicaid legislation—health care expenditures in the latter half of the 20th century grew enormously. However, Medicare/Medicaid and employer-based third party insurers, in response to the changing national economic situation, instituted managed care policies that resulted in decreased physician autonomy, power, and income. These changes to physician culture, decisions, and revenue, combined with a biomedical approach, contribute to America’s current health care dilemma.
