Founding Chair, University of South Alabama

Founding Chair, University of South Alabama

In the 1970’s, health care reform was happening. Medicare and Medicaid had been established by President Johnson and expanded by President Nixon. The WWII veterans were well established in their jobs, all of which came with extensive health care benefits thanks to wage and price controls. Everyone was clamouring to use their “insurance” cards. A massive expansion of the physician workforce was going to lead to medical happiness and longevity. The “directional” medical schools were founded to facilitate this These were medical schools at such universities as East Carolina, East TTennessee State, and South Alabama. Since the “big name” schools were putting out specialists, it was assumed that these schools would put out generalists, with an emphasis on Family Medicine.

South Alabama was founded with this primary care focus. moon Mullins, our founding chair, had been in private practice in Fairhope Alabama for 19 years when he was asked to create the department as a part of the new medical school. In the case of South Alabama, Family Medicine was incorporated in the fabric of the school.

It turned out that incorporating a social movement into an establishment instution was not good for the social movement. As early as 1989, Gayle Stephens was warning that we (as a specialty) “should never become so indolent, smug, or arrogant that we take the interest of medical students in family practice for granted. That would be a fatal mistake.”

The 1990s brought about that mistake, and it has proved to be almost fatal. Between the Clinton health care reform proposals and the managed care “gatekeeper” movement, we believed that the benefits of primary care were self-apparent, and we were valued. The next decade proved to those of us in academic medicine how wrong we were.

The 2000’s were characterized by a belief in the “market”. Healthcare “consumers” (those with insurance) were given almost carte blanche access to providers, technology, and were told that any long-term damage done by poor lifestyle choices could be undone. Uninsured “consumer” were given access to heroic care through EMTALA. In fact, the President George W Bush was quoted as saying  “The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America, after all, you just go to an emergency room.” So, clearly by the end of the tenure of the last administration, “primary care” was out and consumer driven care with the Emergency Department safety net as a unfunded mandate was in. So much for controls on consumption, prevention, or any other attempt to have grown-ups in charge.

This is the system President Obama is trying to fix.