The New York herald., 1921-09-25
COUNTRY DOCTORS
BECOMING SCARCER
Higher Standards of Profess
si0nal Training Seen as
Cause of Decline.
FACILITIES LACKING
Modern Healing Science Re-
quires Use of Hospitals
and Laboratories.

The passing of the country doctor
as one of the suits of the raising OF
standards in medical training is for
seen by DR.. George Vincent, president
OF the Rockefeller Foundation, in an
article which he has contributed to
The October number of The Forum. A
doctor, he insists. who has had modern
training is unwilling TO be exiled from
laboratory and hospital, and the coun-
tryside can compete for his services
only by developing a system OF hos
pitfalls and laboratories
The modern medical school, DR.. Vin~
cent declares, has developed in re-
sponse to changes which compelled
recognition. The discoveries in the use
Of serums and vaccines. the rapid de-
velopment of bio-chemistry, the adj
vancement in surgery and the con-
stant multiplication of diagnostic re-
sources and other products of the last
half century have made it necessary,
he says, for medical education to be
completely revised, adding:
while these many changes have been
rightly welcomed as signs of progress
they have involved a number of new
problems. Under modern conditions
greater demands are made upon bedside
teachers, the length and cost of a medi-
cal education have been increased. the
number of doctors who are being grad
uated has diminished. the curriculum
has been overcrowded, new subjects, es-
pecially preventive medcires, are de-
manding recognition. recently trained
physicians are showing reluctance to
practise in rural districts, the resources
II modern medicine are unequally avail
able for the various groups In the
country. The new system Is displaying
the inevitable resistance to further
modification.
THE dimnution in the nuraber of well
trained doctors has been a source of
anxiety. 1t Is probable that very soon
the lowest point will be reached and an
increase in the number of graduates
will be reported. The real problem is
not, however, with respect 10 the num-
Der of doctors, but with regard to their
geographical distribution AMI their re-
lations with laboratories and hospitals.
Modern medicine insists that diagnosis
and treatment cannot Re effective unless
there Is the closest cooperation between
the doctor, the labore .ory and the hos
pital. Unde. exising conditions in the
United States only small percentage OF
physicians have access to these indis-
spensable facilities.
working In isolation from the resources
which they ought to command. 1t is
cynically said that only the millionaire
and the pauper receiv. the best medical
treatment. In this exaggeration there is
a measure of truth. The rich and well
to do and the very poor are received in
hospitals and attended by the ablest
and hest trained men The great ma
jority of the population are treated by
physicians who have no contact with
laboratory and hospital and who do
not keep abreast. of progress. on meth
ods Of diagnosis and treatment
an order TO meet this situation vari-
Gus experiments are being made and
many proposals are suggested. dag
nostic pay clinics, to which all doctors
may take their patients, health centres.
community hospitals with resident ply
sicians and nurses are among the solu-
tions that are proposed. The resistance
which the mass of the medical profess
sion offers to some of these proposals is
natural and to be expected. Only a
as a change comes about in medical per-
sonnel and ideals.
zone of the most disquieting results of
the raising of standards in medical
training is the reluctance of young doc
tors to settle in rural communities. This
Is sometimes attributed wholly to the
hardships of country life and the small
income of the rural doctor. These in
fuences are doubtless potent. but they
alone cannot explain the situation. A
doctor who hae had modern training is
unwilling to be exiled from laboratory