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George Mixter Jr., MD
JAMA. 1971;218(8):1294-1295. doi:10.1001/jama.1971.03190210148018.
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What is the most important problem confronting medicine today? Among a welter of answers we seldom hear the hidden one—the real one: our diminishing capability to produce good doctors for the future.

The tradition in which most of today's physicians were brought up depended on an overwhelming resource of indigent patients, most of whom were adoringly grateful for whatever care they received at the hands of "house-officers" in teaching hospitals, and from the selfless supervision given without recompense by dedicated volunteer teachers.

With few exceptions, that situation exists no longer. It cannot persist much longer, even where it still does. Our American ethos today implies that every sick person is entitled to the best "private" medical care available, regardless of ability to pay. Federal, state, local, and insurance funds are being poured (perhaps not rapidly enough) into various schemes to recompense hospitals and "private" physicians for such care. But little


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