Medicine: No More Interns?

Why should every U.S. medical-school graduate spend one or two years as an intern in a hospital before entering private practice? Answering his own question last week, Dr. William Lee Hart, dean of the University of Texas' Southwestern Medical School, suggested that it was time to do away with the whole "outmoded" internship system. Instead, said Dr. Hart, a fledgling doctor fresh out of school should put in a year's practical training as assistant to a small-town doctor.

Because most medical schools are now closely linked with hospitals, Dr. Hart argued, the young doctor no longer needs further practical experience on hospital wards. At Southwestern, for example, students spend seven out of their twelve terms in Dallas hospitals—"which ought to be enough." In fact, said Dr. Hart, the intern system sometimes does more harm than good. Under a "hierarchy of hospital staffers" the intern comes to depend on continuing supervision, which may make his transition to independent practice more difficult.

Internships also work practical hardships on the many students who are married and have dependents. Under his plan, Dr. Hart suggested that general practitioners pay their assistants $300 a month (compared with the average of about $50 paid to interns). Given such a start, said Dr. Hart, many of them would stay on in the towns where they broke in, thus helping to distribute doctors more evenly through country districts.

Dr. Hart did not expect the American Medical Association, which regards such views as heresy, to accept his suggestion without a stiff fight. There was sure to be bitter opposition from those hospitals which now depend on interns for virtually free labor.