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The Mammalian Medical Center for the 21st Century

Howard Brody, MD, PhD; Harvey V. Sparks Jr, MD; William S. Abbett, PhD; Douglas L. Wood, DO, PhD; William C. Wadland, MD, MS; Robert C. Smith, MD
JAMA. 1993;270(9):1097-1100. doi:10.1001/jama.1993.03510090081018.
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FOR MANY years, supporters of primary care have been frustrated by the peripheral role assigned them within the institutions that teach tomorrow's physicians and conduct the bulk of medical research. They have tried to deal with this frustration by trying harder to persuade or exhort the academic power stucture about the importance and legitimacy of primary care medicine as an academic discipline.1-4 But primary care advocates have usually failed to draw an alternative conclusion: that the academic medical center, as now constituted, may simply be irrelevant to their agenda and that the rejection of primary care is simply one symptom of that irrelevance.5

The newly announced policy position of the Association of American Medical Colleges (AAMC), calling for medical schools to move rapidly to train at least half of their graduates for careers in primary care, may seem to be an appropriate, if overdue, recognition of what primary


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