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History of Medicine |

Issues for American Internal Medicine Through the Last Century

ROSEMARY STEVENS, Ph.D.
[+] Article and Author Information

Grant support: in part by a grant from the Commonwealth Fund, for research on the history of hospitals and academic medical centers.

▸Requests for reprints should be addressed to Rosemary Stevens, Ph.D.; Room 106, E.F. Smith Hall 6310, 215 S. 34th St.; Philadelphia, PA 19104.


Philadelphia, Pennsylvania


Ann Intern Med. 1986;105(4):592-602. doi:10.7326/0003-4819-105-4-592
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The content, role, and purpose of internal medicine, organized as an American specialty 100 years ago, have been marked by ambivalence from the beginning. Nevertheless, molded to a large extent by external events, including the strategic and symbolic importance of surgery in American medicine, the rise of university medical schools, development of other specialties, and, more recently, the demand for primary care and the incentives built into reimbursement schemes and organized health care systems, internal medicine has become a powerful entity in American medicine. Its role in the future is likely to be more influential than in the past, both in policy and substantive areas. Continuing tensions in internal medicine include uncertainties about the relation between generalism and specialism, primary care and subspecialties, and internal medicine and general medicine.

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