Medical Practice: Then, Now, and in the Future

In spite of the phenomenal progress in the science of medicine and the many contributions of Utah physicians, the art of medicine nationwide took a step backward in the late twentieth century. Prior to the initiation of Medicare in 1966, physicians felt responsible for taking care of all patients, regardless of their ability to pay, either in tax-supported hospitals or in their offices. Even many private hospitals had charity services.

Medicare certainly had a profound effect on the practice of medicine by removing the elderly and many widows from the medically indigent group, while high inflation during the 1970s and 1980s, rapid progress in medical technology, and further implementation of technical procedures boosted the cost of medical care. A significant increase in the number of medical school graduates with an even higher percentage training in the subspecialties rather than the primary care areas (internal and family medicine, pediatrics, and obstetrics) contributed to rising costs.

Three further events had a devastating effect. First, a ruling by the Federal Trade Commission in 1979, supported by a Supreme Court decision in 1982, declared medicine (as well as law) a "business" rather than a "profession." This opened the floodgates to advertising by physicians and hospitals, which fostered excessively luxurious buildings and facilities to compete for physicians and their referrals. Second, administrative costs skyrocketed because of government regulations and insurance requirements, eating up more than twenty percent of the medical dollar. Third, the abandonment of the tightly controlled "certificate of need" in 1985 deregulated local decision-making regarding requirements for new facilities and equipment and allowed a very wasteful duplication of hospitals and expensive machines. Six new psychiatric hospitals were quickly built in Utah, whereas, only a short time before, a few wards had filled the need.