A passion for the mundane, and our medical education and threatened teaching hospitals.

Teaching hospitals, a critical component of medical education and a provider of indigent care, are in crisis. Competition from our own well-trained graduates practicing in sophisticated community hospitals, the rapid development of managed care, federal restructuring of funding, and erosion of our public economic base are important factors. The failure of teaching hospitals is likely to adversely alter medical education and threaten our professional status as doctors and educators as we compete to survive. The problem is identified, but the clear solution is not. My treatise began with the idea that the public recognizes that their teaching hospitals are in crisis. Yet there is some element of public optimism reflected in a Time magazine article that states, "Whatever happens, no one doubts that teaching hospitals will survive." Although neither government nor medicine are widely respected as organized entities, we do have the best medical care system in the world and the most trusted politicians and doctors on an individual basis. We may or may not be able to improve things substantially, but we must try. In spite of difficulties in the process, we will ultimately live up to Sir Winston Churchill's expectations: "The American people will...do the right thing, but only after they have tried everything else."