[13] Ability to travel on foot.
[14] Preferably 2.
This article was prepared by Edward D. Jones, Director of Course Materials, Employment Management Section of the War Industries Board, under direction of Charles H. Winslow, Chief of the Research Division of the Federal Board for Vocational Education. Acknowledgment is due to Dr. John Cummings of the Research Division for editorial assistance.
A great deal of thought is now being given, by American business men, to the subject of employment management. At one time the labor problem seemed to be solely a matter of the policies of organized labor and the methods of industrial warfare. It now shows itself to be chiefly a question of the intelligent handling of the human relations which result from the normal course of business, day by day. It has to do with a study of the requirements of each occupation, the careful selection of men for their work, their adequate training, the fixing of just wages, the maintenance of proper working conditions, and the protection of man against undue fatigue, accidents, disease, and the demoralizing influences of a narrow and inadequate life, and the opening of a channel through which employees may reach the ear of the management for the expression of any dissatisfaction with its labor policies.
Hitherto, executive control in business has been exercised through three main divisions of administration:
(1) Finance—in charge of a treasurer or president.
(2) Manufacturing—in charge of a general manager or general superintendent.
(3) Sales—in charge of a sales manager.
To these general divisions industrial enterprise is now adding a fourth, i. e., employment management or, as it is sometimes called, supervision of personnel. In the employment department of a business are gathered all those activities which have to do with the human relations—hiring, education, promotion, discipline, discharge, wage setting, pensions, sick benefits, housing, etc. To bring all these matters together under one head, and provide each subsection with specialists, is a great step toward scientific industrialism.
Industrial experience has proved the advantage of a separate department equipped to deal with questions of personnel by themselves. The prompt discovery and analysis of unfavorable working conditions can be made only by a central bureau. Most of the approved methods of dealing equitably with the working force have been devised or brought to notice by the new type of industrial specialist.
Where employment departments have been established under competent executives, the waste of turnover has been uniformly reduced, and employees have been rendered more efficient through proper selection, assignment, training, and supervision. In no case of which there is record has an establishment which once tested the benefits of employment work of this character ever returned to the old methods of permitting employment functions to be handled by a variety of minor executives.
The primary functions of an employment manager are to hire shop employees (and often office employees also), to superintend transfers and discharges, to assist in determining rates of pay, to study the causes of labor turnover and absenteeism and strive to reduce them, to adjust grievances, and to recommend changes in working conditions which will eliminate fatigue and accidents, or will improve the health and spirit of the force.
In performing these functions the employment manager will need to organize a staff and provide himself with proper office aids. He will require a set of labor records, which will reveal for each department of the business the degree of efficiency being attained in the utilization of labor. He will analyze the sources of labor supply and make studies upon which job specifications, which set forth the qualifications required for each task, can be based. He will install such methods of physical and mental examination as will safeguard the force against the hazards of the occupation and the hazard of co-employment with men unfitted for their work.
To the employment manager often falls the function of supervising the training of employees by apprenticeship, in vestibule or shop schools, or by Americanization programs.
The employment manager should be the chief agency of his corporation in forming and executing the policies which may be adopted for keeping the worker up to the standard. These efforts may take any one of a variety of forms. In one case a restaurant may be opened; in another housing may be provided. In one plant a mutual benefit organization may be a success; elsewhere local transportation may be a serious problem, or a recreational or thrift campaign may occupy the most attention. Each industrial situation requires particular study. The prescription of economic and social remedies should rest as strictly upon diagnosis as does prescription in medical practice. This means that the employment manager should know how to make industrial and labor surveys.
Finally, in connection with the government of the shop, the employment manager will have a hand in drawing up shop rules, and will, by means of suggestion systems and control sheets, deduce the significance of complaints and the causes of discharge. He will be in contact with shop committees, should such be formed. And he will be a harmonizer and mutual interpreter in all collective bargaining negotiations with organizations of employees, striving ever sincerely to reach a fair and permanent basis for loyal co-operation.
It will be observed that most of these functions are not new in industry. They are now being gathered together under one authority so that they may be handled in a more expert manner, that they may be harmonized into a consistent policy, and that they may be made the definite responsibility of competent officers.
In such a summary of possible activities as the foregoing, the range of duties indicated is wider than would be actually undertaken in most individual cases. Nevertheless, the employment manager has need of a firm grasp on the technique of his art, and an acquaintance with the successful policies of other employers.
He is called upon to practice human engineering, and he has a leading part in transforming the relation of employer and employee from a mere “cash nexus” into a satisfying human relationship. Before the employment manager there opens one of the finest opportunities American business life has to offer. In proper ratio to these opportunities should be the dominating purpose and the training of the candidate.
The employment officer comes into a business organization as a staff man, to relieve the general executives. The general executive is a correlator. He is a balancer of claim against claim. His business is to define the general aims and to harmonize all lesser activities with them. To do this work well, he must be supplemented by specialists who do not have a wide range of functions, and so can concentrate upon some special phase and, upon demand, can furnish him with detailed knowledge and standardized special agencies.
The line executive in war determines where a battery shall go and what it shall do, but he depends upon staff men to breed a reliable artillery horse, to design convenient gun carriages, and to prepare service tables for sighting guns. In industry, the function of staff departments is already understood with reference to mechanical equipments. The general executive decides to construct a factory or a warehouse; but he depends upon an architect to design a building which will resist the probable stresses. He desires a product; but he organizes a designing department and an inspection department to control the dimensions of parts. He would not pretend to a mastery of all the sciences involved. The analogy between the function of the purchasing agent in a modern organization and that of the employment manager is close. Formerly, factory foremen thought they knew best how to purchase raw materials. The development of the purchasing agent proved the fallacy of this, since his testing laboratory and specialized knowledge made the results far superior to those obtained by the individual foremen. This principle of staff service is now being carried over into the field of human administration. General executives demand well-chosen men, men who are physically examined and pronounced safe for the work they are to do, men who are properly paid, and men who are so handled that they become permanent, contented, and loyal co-operators in the general plans of the enterprise. Of all the standardized agencies which a service department can put at the disposal of a general executive, the supreme one is a first-class man.
When it is recalled that the general superintendent of a modern factory is responsible for general supervision of the purchase, repair, and use of equipment; for the purchase, testing, storage, and accounting of materials; for shop schedules, promises of delivery, and measurement of output; for cost estimates, inspection of product, tool accounting, and all production orders, it can readily be seen that he has little time or energy to consider the interests of the workers in other than a very general way. There is some excuse for his looking upon men as merely the tools of production. With such an administrative blockade already existing, even in small businesses, there has intervened in recent decades the enormous growth of American corporations. This growth has so overwhelmed executives with functions, and so regimented each class in industry by itself, that officers and wage earners have been swept apart, and the friendly elbow-touch of the earlier day of small shops entirely destroyed. The effort is now being made to build a bridge between employer and employed—the chief span in this bridge is the employment department.
From the shoulders of the overloaded superintendent there have slipped down upon the foreman of the shops a mass of heterogenous functions. In establishments where the modern plan of functionalizing the foreman is unknown, each foreman is for his own shop a Jack-of-all-trades, endeavoring to deal directly with the details of a great variety of duties. The inefficiency of such methods has been amply revealed by the analyses of the exponents of scientific management.
The remedy is specialization. This means that groups of related duties are put in the charge of special foremen or service departments, such as the stock clerk, the engineer in charge of repairs, the planning room, and the tool room. From the foreman’s point of view the employment manager is such another functionalized foreman.
In this way the general shop foreman is relieved of hiring friends of employees in his own department who importune him for selected jobs merely on the basis of friendship and not fitness. He is no longer a “bouncer.” He no longer can sell jobs, or hold his pets in soft assignments. He has not the easy device of covering his own incompetence by firing a man. He can ask for the transfer of unsatisfactory employees, but if enough of these transfers show that discarded persons are able to make good in another shop where the foremanizing is different, he prepares a prima facie case against himself. The foreman gets a more even and dependable run of workmen from the employment department than he can provide for himself. And he is freed from many distractions to become an expert in shop manufacturing processes. The employment manager must find a way to secure the enthusiastic co-operation of the foremen with whom he works, and to enlist their sympathy with the policies of the management, and of his own department, as if those policies were their own.
The movement which is developing human engineering is not a temporary nor sporadic demand, but is in response to an underlying trend of our economic life. It has not been dominantly, nor even largely, a product of war conditions, except as the war has made men everywhere appreciate more keenly the social virtues, and has made them long more earnestly for a new justice and comradeship. After the war, the underlying economic forces, which are all based upon the urgency of human wants, will steadily drive forward those economic reforms for which human knowledge has prepared the way.
The distinction between the economics of the war period and of the post-war period lies in this: during the war the competitive struggle was chiefly to save time, after the war it will be to reduce costs. During the war speed outweighed economy. The employment manager was demanded because time was lost by absenteeism and turnover and the training of new men. Time was lost when workers were put at jobs for which they were unfitted; and time was lost by sickness, accidents, and strikes. After the war efficiency will appear to be more a matter of cost. If the losses of this war are not recouped by the efficiency of superior organization, and the only means of making them good is a curtailment of consumption, we may look for the struggle to lessen costs and lower prices to be more intense than has ever been known in modern times. In such an event the employment manager will be demanded by intelligent employers, because sickness and voluntary absenteeism mean idle equipment; because labor turnover means the cost of breaking in new workers; because an antagonistic attitude means waste of materials and tools, spoiled work and soldiering; while strikes mean the entire loss of overhead charges.
The United States Employment Service is a national system of recruiting bureaus operated by the Department of Labor of the United States Government, for the purpose of organizing the general relations of supply and demand on the labor market, and of distributing the available supply of wage earners as efficiently as possible to those localities and to those employers where they are in greatest demand.
The employment manager is the representative of private business, which has the task of selecting such labor as it needs and of utilizing it to the best possible advantage in the actual work of production. If, therefore, the Government assists in finding men for industry, it is the function of the employment manager to use those men with intelligence, to take such steps as are appropriate for private industry to maintain their productive efficiency unimpaired, and to see that no condition which can be remedied throws them upon the labor market to be placed again.
By the new system the employer is brought into contact with public officers, who seek a justification of his demands. It is necessary for employers to state accurately what types of skill they require—a thing which requires job analysis. It is necessary to give advance notice of wants; for this a labor schedule is needed. It is certainly no recommendation for an employer, in the eyes of his community labor board, if he must admit that he still continues the antiquated hiring-and-firing process, or that he has a high labor turnover, or that he has no department charged with responsibility for maintaining proper working conditions.
We have spoken of the underlying forces which are creating a demand for specialists to deal with the human factor in industry. It would be difficult to point to an industrial reform which is more clearly the converging point of a number of progressive movements. Employment management is a result of the evolution of cost accounting, of the idea of supplementing line executives by competent staff departments, and of the movement to specialize the work of foremen. It is an opportunity to apply vocational guidance and industrial training. It provides the expert required for setting wages by investigation rather than by dispute. It gives the needed supervisory agency for safety first, industrial hygiene, and medical aid. And it provides an officer able to deal intelligently with shop committees and collective bargaining.
The personnel officer, as an accountant, applies the methods of cost analysis to the factors which influence labor efficiency. As a hiring officer he has an opportunity to make vocational guidance more definite than it has yet been, because he can supplement the analysis of the individual with a parallel analysis of jobs. He has a powerful motive for competence in industrial training work, for he graduates his pupils in rather than out. His students benefit from the psychology of doing real work for pay in a real shop.
The employment manager is related to recent movements in psychology. He has an opportunity to apply appropriate performance tests and general intelligence tests, for the purpose of sorting out those persons who, although adult in physical development, have still the minds of children. These classes he identifies, not to reject from employment but to place at appropriate work; not to browbeat and terrorize, but to protect and guide by patient and educative foremanizing to insure their becoming happy and permanent members of the productive community.
The evolution of wage systems demands a specialist. The ideal form of reward is that of the man who is in business for himself, whose remuneration rises or falls according to his talent and effort. In the complexity of the modern corporation it is difficult to devise such a wage. In general, it may be said that to take a step toward greater fairness in wage setting, it is necessary to achieve greatness in measuring the basic factors involved in wages. Such are the worker’s talent, the nature of the task, the character of the working conditions; the chances of permanency and promotion, and the local cost of living. There is need of some agency to supervise the prolonged process by which each craft or skill in an establishment is placed at its proper point in the wage scale, with reference to the others.
“Safety first” has exerted a great influence toward personal supervision. Workmen’s compensation laws have enforced responsibility upon employers. Students of accidents maintain that a greater number of disabilities result from the carelessness or ignorance of the working force than from faults of equipment and processes. This puts the matter as much in the domain of the personnel officer as of the engineer.
A great advance has been made in medical science in recent decades. This advance has laid bare the intimate relation between good water, ventilation, digestible food, a reasonable work schedule, and home conditions, on the one side, and accident rates, fatigue, absenteeism, antagonism of mind, and strikes, on the other. The interlacing of these factors accounts for the profitableness of the health work which has been undertaken by progressive employers.
Employment supervision represents a movement in the direction of the democratic shop, in which a voice is given to labor in determining working conditions. It may be said to be a method of applying to the relations of employer and employed those conceptions of “Truth” and “Service” which have revolutionized salesmanship and advertising. As the customer is “sold” a finished product—that is to say, is convinced and satisfied by square and generous dealing—so the workman is to be “sold” his job. The latter must be satisfied as to the task, the working conditions, the wages, the foremanizing, and the general policies, before he becomes a genuine employee.
All of these movements, which have so rapidly shaped the new art of employment management, are functions of a rising level of intelligence, of an increasing power to produce wealth, and of growing interest in ideals of social welfare, as contrasted with ideals of personal luxury or arbitrary power. We may look upon them, therefore, as enduring forces and destined to work a progressive change in business management. Upon them the future of employment management rests. That future is secure.
The employment manager, who measures up to the new standards now being set, is a first-class executive, standing on a parity with the sales manager or the production engineer. He has the more need of talent because of the newness of his position; a circumference which emphasizes flexibility of ideas, the ability to conduct investigations, the courage to be a pioneer, and the power of commanding the confidence of others in his pioneering. Again, his position is difficult, because he stands between parties which have been traditionally opposed to each other, namely, capital and management on the one side, and labor and craftsmanship on the other. He must always perform the functions of a mutual interpreter and often those of a peacemaker.
In considering a proposed occupation it is wise to present a sober view of its conditions, so that persons who lack a sufficient persistency and depth of conviction for success may be early dissuaded. Wherever there is authority there is responsibility; wherever there is reward there is struggle. If the general significance of employment management lies in its accord with the progressive tendencies of the age, the greater part of the energies of the individual employment manager is absorbed by the practical problems of finding enough workmen, of supervising records, and of hearing and adjusting complaints. It may be the lot of an employment officer to deal with a hard-headed proprietor, who is habituated to take the defensive against new plans. He may encounter the open or concealed opposition of foremen who, for the sake of prestige, cling to functions they can not properly perform. He may find organized labor cold to benefits which the unions have not won, and which look toward the substitution of a vertical bond, uniting employer and employed, for the horizontal union of employees of different establishments.
All of this means that the successful employment manager must be a person exceptionally fitted for leadership. He needs good native ability, made serviceable by adequate general and special training. He should possess a well-balanced and absolutely impartial judgment. It is a powerful aid if he possess humanitarian instincts and a sympathetic disposition. These must, however, be real attributes, and not a mere pose or policy, for no deception will long blind those with whom he is associated.
The person who measures himself for this profession should be able to find indubitable testimony as to the strength of his own character, in the quality and amount of his achievements, and in the regard he has been able to earn from responsible persons with whom he has been associated. He should find in himself, also, the ability to understand human nature, not through the absurd practice of some quackery of phrenology and physiognomy, but by having analyzed his own nature, and having found therein the instincts and emotions which illuminate for him the motives and passion of others.
With these endowments the employment manager should couple sufficient education to avoid embarrassment in the oral or written use of his mother tongue. His education should enable him to understand the use of general principles, avoiding the pitfalls into which the so-called “practical” man has usually fallen when he complains of “theories.” And this education should have had a wide enough scope to enable him to meet the minds of others, and cement friendships, in a world of ideas larger than the details of his work.
Finally, the employment manager is perfected for the practice of his art by general industrial experience and (if the position in view be in a manufacturing establishment) by actual contact with shop problems. This shop experience is useful to make the candidate familiar with factory tools, machinery, equipment, materials, and processes. It will instruct him, as no form of systematic training can do, in the meaning of factory life, the significance of its discipline, the meaning of its schedule of hours in terms of fatigue, and in the attitude of the worker to his job, his boss, his fellow worker, and to life in general. Any general social experience which the candidate may have had, which has taught him how to deal with people, not as individuals only but in the various forms of voluntary organization, will have value.
It is not to be expected that every candidate will be ideal in all particulars. Special merits may offset deficiencies, within reasonable limits, bearing in mind always that defects of native endowment are less remediable than those of education and experience. If the employment clerk and the labor scout of the past are to give way and personnel relations in industry be placed upon a new footing by an executive officer who is able to formulate adequate policies and bear large responsibilities a high standard of ability must be maintained for the new profession.
To summarize the matter of qualifications we give the relative weights which a number of successful employment managers have agreed upon for five principal factors:
| Per cent. |
|
|---|---|
| Personality | 35 |
| General industrial experience | 25 |
| Executive experience | 20 |
| Shop experience (for employment managers in manufacturing establishments) | 15 |
| Experience with organized social movements | 5 |
| Total | 100 |
Employment management is a thinking job—a matter of judgment, and organizing ability, and tact, and personality. If a man has lost an arm or leg, but still has a good head and a noble heart, he may become a success in this field. Without a leg, or even both legs, a man may still get about enough within a plant to keep in touch with his shops, and be known by the rank and file as something more than an armchair officer. If he has lost an arm, or even both arms, he may be able to work out, with his stenographers and secretarial aids, such a detailed and searching division of labor between hand and brain as to make a success. Robustness and dependable health may play the same role in this work as in other administrative positions. Nervous poise and stability of temperament are highly essential.
The employment manager’s remuneration is salary and not wages. This signifies that its amount is fixed rather by an estimate of the standard of living of the class of persons with whom the employment manager should associate on terms of equality in the business world than by an effort to measure his exact contribution to the income of the company. At present the salaries of employment managers—the great majority of which probably fall between $2,000 and $5,000—are not equal to those commanded by sales managers and production engineers of equal ability. This discrepancy is due partly to the recentness of the function and to its more subtle and indirect relations to the profit-making process. It is due further to the fact that the work of the employment manager is a form of social service which is deeply satisfying to many natures, and which in itself provides a reward able to compensate for some inadequacy of salary.
It may be remarked concerning untrained candidates for an important position that those who are best qualified by nature and general education will usually possess a certain insight which gives them warning of future difficulties, and makes them willing to take preliminary training, and to work at first in subordinate positions. Those without this insight are likely to argue that training is unnecessary and that they are qualified to take at once responsible posts. Thus the line is illustrated, “Fools rush in where angels fear to tread.”
To indicate the scope of any vocational course of training dealing with the art of employment management a brief analysis of the subject into its major and minor component parts is given herewith.
Organization and equipment of an employment department:
Causes which have produced the need of employment management.
Functions of employment departments.
The administrative organization of a department.
Relations to other departments of a business.
Types of records and reports used in labor accounting—Forms—Office management.
Layout of an employment department.
The employing of the worker:
Job specification.
Analysis of the labor market and its sources of supply.
Problems of dilution.
The selection of employees—Physical examinations—Mental tests.
Discharging, paying off, and the collection of control statistics.
Definition of labor turnover and its calculation.
The law of the labor contract.
The training of the worker:
Apprenticeship indentures and schools—Vestibule schools—Americanization.
The psychology of the presentation of the task to the worker.
The payment of the worker:
Wage setting—Minimum wages and the cost of living—Wage scale formation—Technique of wage paying.
Promotions and deferred benefits.
The control of working conditions:
Health, hygiene, sanitation, medical aid, fatigue, mental strain, motion study.
Working hours and rest periods.
Problems connected with the introduction of women into industry.
Efforts to keep the worker up to standard:
Accidents, accident prevention, insurance, and workmen’s compensation.
Canteen economics.
Local transportation—Home conditions.
Housing—Community efficiency.
Recreation and its effect upon productive energy.
Thrift, loans, relief and legal aid.
Pensions and the problem of the aged worker.
The relation of the employment manager to local and State agencies.
The government of the shop:
Shop rules, rule books, foremanizing, absenteeism.
Suggestion systems and the treatment of complaints.
The organization of shop committees and their functions.
Collective bargaining contracts and procedure.
Associations of employees.
The ultimate bases of discipline and loyalty.
Fortunately, there is now a considerable body of literature available to the person who would inform himself. It should be remembered, however, that mere reading is not study; and that even earnest study only yields correct conceptions. It is experience alone which teaches us the uncommunicable art of applying the powers of our personality in the pursuit of a course of conduct which receives its guidance from our conceptions. There is a great difference between being informed on a group of subjects and being expert in the practice of a profession. If you feel qualified to undertake this training talk it over with the Vocational Advisor of the Federal Board for Vocational Education.
Following is a brief list of references which may be called the employment manager’s 3-foot bookshelf. They indicate the broad range of his interests and activities, and with these any course of training for this new trade or profession must deal adequately.
For the material of this monograph the Federal Board for Vocational Education is indebted to the J. Lippincott Company, Philadelphia, Pa., through its publication “Training and Rewards of the Physician,” and the Collins Publicity Service, Philadelphia, Pa., through its publication “Medicine,” School Edition, Teachers’ Auxiliary, Number One, of which this pamphlet is largely an abstract. The monograph was prepared by Dr. H. L. Smith under the direction of Charles H. Winslow, Chief of the Research Division of the Federal Board. Acknowledgment is due to Dr. John Cummings, of the Research Division, for editorial assistance.
The work of the physician is twofold. It is his duty to cure those who are sick and to keep the well from becoming sick. Usually he is not called upon until there is illness, so that the bulk of his work is with the sick. There are two general fields of activity for a physician, that of the general practitioner, and that of the specialist. Physicians in rural communities and small towns and cities must be prepared to deal with any type of accident or disease. In cities the tendency is to specialize on some particular disease or on disturbances connected with some particular part of the body. Some specialists in large cities are able to confine their activities to office work altogether.
The work of the physician is difficult. There is a great mental strain connected with his work, for often even the life of the patient is at stake. With the general practitioner there is a great physical strain due to irregular meals and sleep, and trips in all kinds of weather. Particularly is this true of the practice of medicine for its curative effects. More and more thought in medical science is being directed in modern times to preventive medicine, that is, to ways and means of keeping well rather than of getting well. The preventive work can be done under conditions more nearly those that the physician himself chooses rather than under conditions forced upon him as is usual in the case of curative work.
Of all the professions the practice of medicine makes the greatest demands along the line of a good sound body. In some professions a man with even severe physical defects can, through careful living, be successful. Good health, however, is essential to the physician in order that he may successfully withstand the long periods of strain, the irregular hours for meals and sleep, the bad weather he is often forced to go out in, and the dangers of infection.
Not only must the physician be practically fit, he must have a natural aptitude and love for his profession. He should care more for medicine than for any other calling in life. By natural aptitude for medicine is meant certain foundation qualities which are essential.
It goes without saying that the physician, because of his close relationship with his patients, must be of the highest moral character in order to gain and retain the confidence of his patients. A kindly and tactful manner are essential also in gaining this confidence. One must be alert, too, particularly at the present time when rapid advances are being made in medicine—more rapid than in many other professions. Self-reliance is essential in medicine because unexpected situations are constantly arising, and emergencies, too, in which the help of other physicians can not readily be gained. To practice medicine successfully one must be constantly learning. Because of the rapid changes in medical science one’s apprenticeship is never completed. Each day some new method or means of treatment must be mastered. Moreover, one’s work is never ended. One great element of success is faithfulness to the patients one already has. This means love for the work and enthusiasm over the idea of service to mankind.
Among the characteristics that lead to failure in the practice of medicine are dislike of the work, inability to decide quickly and definitely, and lack of ability to get along well with other practitioners and with patients.
As a basis for a course in medicine one must have completed not only the eight grades of common-school work, but the four years of high school. Twenty-eight medical schools require two years of college work for entrance, and there is some tendency to require even four years of college work. This tendency, however, will probably not grow very fast. Certainly if the requirement is made it can not be a hard and fast rule, for the simple reason that it would raise the age of graduation from the medical school to a point higher than the age at which it is wise for one to begin practice.
The question of what subjects should be taken in premedical work is very important also. Not long ago some 300 graduates of the Harvard Medical School were asked to fill out answers to questions, giving their opinions in regard to the value of their premedical education. They were asked to state whether they thought it best in this premedical work to have a large amount of general culture—such as history, philosophy, economics, literature, and art—or a large amount of natural science—such as physics, chemistry and biology. Of the 300 reporting, 120 favored a large amount of science, while 110 favored a large amount of general culture. Seventy favored an equal amount of general science and culture. It would seem, therefore, that according to the present opinion there should be an equal amount of general culture and science in one’s college education previous to taking up the special training in medicine.
Available records show that in 1904 there were only 20 States that had made any legal provision for preliminary education to go before the definite education in medicine. Now 26 States have such a provision. At that time only 10 States required four years of high school as a minimum amount of preliminary premedical education and none required college work. Now 30 States require the four years, or an equivalent, and 8 of these 30 require either one or two years of college work in addition. At that time 36 States required that all candidates for license be graduates of legally chartered medical schools. Now 44 States make this requirement by law. At the present time 48 States require an examination to be taken by all those who are seeking license to practice medicine, unless they hold a license granted by some other State.
It is necessary, therefore, that the course of instruction taken in medicine shall include courses that will qualify the graduate to meet the requirements of the examination for license to practice in the State in which he wishes to locate. There is a tendency at present for the examination to consist not only of questions and answers, but of some practical test of one’s ability to practice medicine successfully.
At the present time one can not hope to get a satisfactory medical education without taking a full four-year course in the medical school. The course of study in American schools of medicine at present is definitely laid out, and one can know beforehand just what subjects will have to be taken. Even at the end of the four-year course in medicine it is not advisable to begin the practice of medicine immediately. Those who are looking for good positions in the profession should add to the theory gained in college some actual practice. The best way to get this practical work is to serve as an interne in a hospital. Appointments to such positions are often made on the basis of an examination. Such positions last sometimes for one year and sometimes for two years. During the first period of his work in the hospital an interne is directed to some extent by other physicians, but largely by his senior internes. During the last six months of his experience as an interne, however, when he is usually acting as the house doctor or surgeon, he is shown especial attention by physicians and surgeons who have patients in the hospital. There is generally no pay given the interne aside from board and lodging. The period in which one acts as an interne is considered as a further educational period. It has been said that the experience gained during the two years’ interneship in New York City’s largest hospital is considered equal to that acquired in 10 years of ordinary undirected practice.
But even after one actually begins the practice of medicine his education is not complete. In order to keep up with the times he must do a great deal of reading. He must attend district medical meetings, and also State and national meetings. Moreover, he should visit other cities and thus come in contact with the ideas of other practitioners in other communities.
An ideal standard of medical education is outlined in the following quotation:
“The American Medical Association’s ideal standard of medical education as set forth by the Council on Medical Education, after years of extensive study, research, and investigation, is given herewith:
“(a) Preliminary education sufficient to enable the candidate to enter our recognized universities, such qualifications to be passed upon by the State authorities.
“(b) A course of at least one year to be devoted to physics, chemistry, and biology, such arrangements to be made that this year could be taken either in a college of liberal arts or in the medical school.
“(c) Four years in pure medical work, the first two of which should be largely spent in laboratories of anatomy, physiology, pathology, pharmacology, etc., and the last two years in close contact with patients in dispensaries and hospitals in the study of medicine, surgery in its various branches, and the specialties.
“(d) A sixth year as an interne in a hospital or dispensary should then complete the medical course. Under such procedure the majority of students would begin the study of medicine at about 18 years and graduate from the hospital interneship at about 25.”[15]