Faculty practice plans. Profile and critique.

In 1910, the Flexner report signaled the end of commercialism in American medical schools, only to have it reappear in 1931. Between 1960 and 1985, access to federal, state, and private-sector funds paid to medical service plans in all 127 medical schools led to almost a 20-fold increase in faculty practice plan (FPPs)--from six to 118. All 127 US medical schools were surveyed. Wide swings in federal funding policies left medical schools with a defective management model, particularly for FPPs. Disposition of collected revenues, the role of for-profit FPPs, the personally lucrative nature of FPPs, an unwieldy number of fairly autonomous departments, ineffective governance, and hostile opposition from other parts of the university have raised questions of conflict of interest and accountability. Some 75 years after the Flexner report, a thorough evaluation of the effects of commercialism on medical education once again appears to be warranted.