The Challenge to Local Medicine
The Challenge to Local Medicine
This chapter begins outlining historical changes in medical practice in rural communities in the region and illustrates how the language of competence became the discourse through which new specialists and residency-trained family physicians challenged older general practitioners, established alternative forms of medical practice, and promoted new criteria of medical competence. It is a story in progress, filled with intermittent fits and starts and often poor medical service for some communities, while other communities have experienced extraordinary developments in the quality, complexity, costliness, and diversification of medical and hospital services. It is a story about what competence means to community physicians and how local “discourses on physician competence” were generated and shaped by structural changes in the organization and practice of medicine in rural America in the 1980s.
Keywords: medical practice alternatives, medical residency, medical competence, rural America
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