The electrical system wouldn't coordinate with the plumbing. Sometimes you need specialty contractors to come in, but you still need a general contractor to take care of the project, manage most aspects of the job directly, and make sure it's organized. With the growth of managed health care in the 1980s and '90s, health maintenance organizations helped bring back the primary-care generalist as a physician who knows and understands the patient and who can coordinate care effectively, perhaps avoiding unnecessary tests and trips to specialists. Medical schools scrambled to set up family medicine departments starting in the 1970s and early '80s, Streiffer says, with public schools leading the way in response to pressures from state legislators. In July 1998, Tulane University Medical Center formed its Department of Family and Community Medicine, building on groundwork laid by the decades' old Program in Community Medicine led by J.T. Hamrick, now professor and vice chair of the department.
Clinical clerkships are a turning point in medical school.
At Tulane, students perform the majority of their clerkships in the university's own hospital and outpatient clinics and other hospitals and clinics in New Orleans. At the start of the third year, students are eager to see, talk to and assess real patients. Although they've practiced clinical procedures with Tulane staff members who act as patients in the school's standardized patient program, interacting with an actual patient brings the medical students one step closer to becoming doctors. Levine says one of the reasons he volunteered for the clerkship was to have closer relationships with patients and his physician-teacher, who program organizers call a preceptor. I was looking for more of a mentorship than being one of a bunch of students and residents with an attending.