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American Medical Schools and the Practice of MedicineA History$
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William G. Rothstein

Print publication date: 1987

Print ISBN-13: 9780195041866

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195041866.001.0001

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Hospitals and Health Care

Hospitals and Health Care

(p.207) 10 Hospitals and Health Care
American Medical Schools and the Practice of Medicine

William G. Rothstein

Oxford University Press

The use of hospitals for medical care became more varied after 1950. More patients were admitted for a wide variety of conditions and more different types of treatments were provided. Many new technologies were adopted that have raised costs considerably. Hospitals employed more residents, foreign medical graduates, and nurses. Between 1946 and 1983, hospitals grew both in size and importance in the health care system. The number of short-term nonfederal hospitals increased by only one-third, but the number of beds and the average daily census doubled and the number of admissions increased 2.6 times, while the U.S. population grew by only two-thirds. Much of the additional use was for nonsurgical care. During the 1928–1943 period, 74 percent of all hospital admissions were surgical. This declined to 60 percent between 1956 and 1968 and to 50 percent between 1975 and 1981. Outpatient care grew even more rapidly than inpatient care, with the number of hospital outpatients doubling between 1965 and 1983. The hospital system has become dominated by large hospitals, practically all of which have affiliated with medical schools. In 1983, the 18 percent of nonfederal short-term hospitals that had 300 or more beds admitted 50 percent of the patients, carried out 59 percent of the surgery, and had 55 percent of the outpatient visits and 61 percent of the births. They employed 72 percent of all physicians and dentists employed in hospitals and 90 percent of all medical and dental residents. At least 60 percent of them had nurseries for premature infants, hemodialysis units, radiation therapy or isotype facilities, computerized tomograhy (CT) scanners, and cardiac catheterization facilities, and almost one-half had open-heart surgery facilities. Most also offered types of care not traditionally associated with hospitals. Practically all of them provided social work services and physical therapy, at least 75 percent provided occupational and speech therapy, and 40 percent provided outpatient psychiatric care. On the other hand, fewer than one-third provided family planning, home care, or hospice services, or partial hospitalization for psychiatric patients. The expanding services of nonfederal short-term general hospitals has led to the employment of larger numbers of workers.

Keywords:   Foreign Medical Graduates (FMGs), Massachusetts General Hospital, Medicaid and Medicare

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