The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900-1940

Unevenly distributed resources and rising costs have become enduring problems in the American health care system. Health care is more expensive in the United States than in other wealthy nations, and access varies significantly across space and social classes. James A. Schafer Jr. shows that these problems are not inevitable features of modern medicine, but instead reflect the informal organization of health care in a free market system in which profit and demand, rather than social welfare and public health needs, direct the distribution and cost of crucial resources. The Business of Private Medical Practice is a case study of how market forces influenced the office locations and career paths of doctors in one early twentieth-century city, Philadelphia, the birthplace of American medicine. Without financial incentives to locate in poor neighbourhoods, Philadelphia doctors instead clustered in central business districts and wealthy suburbs. In order to differentiate their services in a competitive marketplace, they also began to limit their practices to particular specialties, thereby further restricting access to primary care. Such trends worsened with ongoing urbanization. Illustrated with numerous maps of the Philadelphia neighbourhoods he studies, Schafer’s work helps underscore the role of economic self-interest in shaping the geography of private medical practice and the growth of medical specialization in the United States.