A few weeks ago, I wrote about William Osler and his quote about knowing syphilis meaning knowing medicine. He was one of the fathers of modern medicine.
In the nineteenth century most physicians did not do specialty training. They did their internship and then went out to practice. Osler and William Halstead were responsible for forming the first residency programs in the country. They started them at Johns Hopkins Hospital in Baltimore in 1889.
New residency programs began to sprout up elsewhere after that. However, most physicians continued to only do what was called a rotating internship. That meant working a few months in each specialty. They would then go into practice as a general practitioner.
That remained the situation until after World War II. In 1940 there were 6,000 residency positions in the entire United States. By 1970, that number had grown to 40,000.
By the time I graduated medical school in 1972 most of my classmates entered residency programs. I went to Boston for my pediatric residency.
The rotating internship still existed. However, the name changed to transitional year. The implication was some individuals would still work a few months in each specialty. However, it was just a prelude to selecting a residency program.
General practitioners had just one year of internship. New residency programs developed in Family Medicine. As might be expected by the title, the emphasis was on treating the family unit and the interactions of the individuals in that family unit.
Physicians who finished their residencies would go into a practice of their specialty. However, in many places that meant taking night calls for emergencies. It also meant taking care of patients in the hospital.
The next logical step was the rise of emergency medicine residencies. Most emergency rooms began to be staffed by individuals who had done a residency program in emergency medicine. Prior to that, emergency room physicians were often individuals who had completed a rotating internship and then went to work in ERs.
The most recent change occurred in the late twentieth century. An article in the New England Journal in 1996 pointed out how hard it was for physicians to have to split their time between the office and the hospital. In addition, night calls to the hospital often made office hours the following day difficult.
Out of this came the initiation of the hospitalist. These physicians do not see patients in the office. They do their work entirely with inpatients. Much like emergency medicine physicians, they work a standard shift without the responsibility for additional call duties.