Functional group practice in a national health program.

Dick Weinerman was a great medical care teacher. His thoughts had the clarity and far-sightedness of a panoramic view from a high mountain top on a bright day. It is all there. From the top of the mountain one can see the rest of the range, the peaks, the slopes, the valleys, the trails, and the roads. One also sees what is close at hand-the rocks, the trees, the berries and the shrubs. One knows that there are things still hidden-toads, chipmunks, fish, birds, or things yet unknown and only sensed. So it was with Dick Weinerman. His thoughts were always far-ranging, clear but never monotonous. He always tried to comprehend the vastness of the universe, but he grappled with its specifics. He imparted an exhilaration in his writings and in his remarks. This quality is especially evident in his views on group practice, and specifically on how group practice would fit into a national health program. He saw group practice as essential to quality and economy in health care, and wrote about it for 20 years, beginning in 1950, with "Medical Group Practice in California" (13 & 21).t His articles on prepaid group practice began in 1951 (20), especially influential analyses being published in 1956 (30), '60 (34), '62 (40), '64 (48), and '68 (74). In "Group practice revisited," an editorial in 1969 (88), he called for a new model of group practice. It would emphasize primary health care, supplement, soon outnumber, and largely replace, what he called the "Noah's Ark" model of group practice. In that model, he saw a tendency to collect two of every species of medical and health specialty under one roof, resulting in giant centers such as the Mayo or Cleveland Clinics, the Kaiser Hospital specialty clinics, some garment workers' union health centers and some European polyclinics. He called them "Large assemblies of medical specialists in imposing modern edifices (representing) an inverted pyramid design, (which) balance an array of specialists on the relative pinpoint of a few generalists, who function largely as admissions officers." His last major paper dealt with functional group practice as a key component in the "Organization and Quality of Service in a National Health Program." (See preceding paper.) Written just three months before his