Medical Leadership: Doctors at the Helm of Change

INTRODUCTION Since the beginnings of the modern era, medicine has evolved tremendously. Merely two hundred years ago, American and European medical treatments were generally provided by independent physicians who went from home to home to offer their services. From this form of medicine, often referred to as " bedside medicine " , (1) Western countries started to move towards a more centralized form of medical care provision: hospital medicine. During the 20th century, as cities steadily grew larger and more populated, numerous hospital supercomplexes with complicated hierarchal structures emerged. Employing hundreds and sometimes thousands of health care professionals, hospitals became increasingly difficult to manage and required the presence of a well organized management staff. With the current aging of Western populations, developed countries now face major problems within their healthcare systems concerning economics and efficiency. Having to deal with the consequences of a strong movement of medicalization over the past few decades that has brought more and more elements of everyday life under medical jurisdiction, (2) Western governments are now struggling to restrain the rising costs of their national healthcare coverage. Seeking new venues and solutions, many countries like Canada allocate an increased importance to practices such as preventive medicine, surveillance medicine and homecare treatments. (1) All three of these practices tend to reduce the role played by hospitals in healthcare. However, hospital treatment remains an essential part of Western healthcare programs, and the development of parallel structures does not eliminate the management issues that health ministries are faced with.