Benchmarks

CELP
CareerMed

14

PART 1 / PLANNING YOUR MEDICAL CAREER

tending to become general practitioners (GPs). Very few completed much postgraduate training. After graduating from medical school, they spent 1 to 2 years in an apprentice-like internship with a more experienced physician. Just like today's family practitioner, the GP took care of patients of all ages, from infants to the elderly. They treated medical problems, delivered babies, and performed surgery. As respected members of the community, they even made house calls on their patients. Because there was a limited amount of clinical knowledge to master, general practitioners could capably manage most medical and surgical problems.

Although GPs dominated the medical scene, several specialties were in the early stages of development. But additional formal training in these areas—like ophthalmology and otolaryngology—was practically nonexistent. The postgraduate internship prepared new physicians for general practice only. If an American doctor wanted to gain more expertise in a narrow field of medicine, a few nonstandardized options were possible. Some worked as apprentices to the small number of established specialists. Others took formal coursework at freestanding graduate medical schools or entered one of the few available residency programs. This path represented the culmination of training through the pursuit of specialized knowledge. The majority, however, went to Europe, where they learned the latest skills in established medical centers, particularly those in Germany. Because there was no uniformity or consistency across the different forms of specialty training, some specialists received better preparation than others.

Specialists were initially met with a great deal of skepticism by the well-established GPs, who viewed them as “quacks.” Although GPs outnumbered the small but growing cadre of specialists, more doctors were returning from abroad with new knowledge and technology. They also brought with them the research skills for making life-changing medical discoveries, which further hastened the trend toward specialization. Patients now had new drugs, chemotherapy, insulin, and vitamins in their treatment regimens, which meant that general practitioners were competing with specialists for mastery of these agents. By the early 1930s, there were roughly 10 areas of specialization within medicine: general surgery, orthopedics, otolaryngology, internal medicine, pediatrics, psychiatry, dermatology, urology, ophthalmology, and obstetrics-gynecology. ² The growing use of x-rays, electrocardiography, and blood transfusions added to the tension between specialists and GPs. Making matters worse for the GP, new surgical specialties and procedures developed with the introduction of anesthesia and sterile operating conditions.

As the United States prepared to enter World War II, the medical commu-