The College is celebrating its 75th anniversary, and we’d like to take you on a walk down memory lane. Step into our time machine and travel back to 1942, the year the College was founded, to see how different the day-to-day operation of your allergy practice would have been.
Have you been frustrated with your EHR and how much time it takes from your interaction with patients? In 1942 there are no such problems; the invention of the first personal computer is still decades away.
There are fewer governmental regulations; the Occupational Safety and Health Administration (OSHA), the American Disabilities Act and stark law don’t exist in 1942. However, the Fair Labor Standards Act, which established the minimum wage and a forty-hour work week, was just passed in 1938, so make sure your practice is in compliance.
The passage of the Health Insurance Portability and Accountability Act (HIPAA) won’t occur until 1996, so you are years away from having to spend time on HIPAA protocols, staff training or worrying about a HIPAA audit.
Insurance reimbursement restrictions aren’t an issue in 1942. Neither Medicare nor Medicaid exists (both begin in 1965). Similarly, there are no managed care plans, no Medicare Advantage programs and very few commercial insurance plans. Most patients pay their health care expenses out of their own pockets. Employer-sponsored health insurance will expand dramatically during World War II when federally imposed wage controls cause employers to look for other ways to attract workers.
Perhaps best of all, there are no prior authorizations! In fact, few prescription drugs for allergy and asthma exist in 1942. Benadryl will begin to be marketed as a prescription drug in 1946.
Since Medicare doesn’t exist, there are no PQRS or Meaningful Use requirements. Fee-for-service is the law of the land; there is no push for value-based care, and MACRA, MIPS and APMs are in the distant future.
Happily, allergists don’t need to learn CPT codes since there are no insurance claims (the first CPT edition will be published in 1966). There’s no ICD-10, but you’ll use the fifth revision of the International Classification of Causes of Death.
Your clinical team also looks different. You won’t work with any nurse practitioners or physician assistants, since they won’t exist until around 1967 (after Medicare is established in 1965 there will be a sudden need for more providers!) Your clinical team consists of registered nurses or possibly practical nurses; only a third of states currently have licensed practical nurses (LPNs). You might also work with homegrown medical assistants, although that term won’t be formalized until the 1950s.
Your medical school debt has dropped dramatically, as medical school tuition is nothing compared to 2017. At the University of Pennsylvania, annual medical school tuition is only $500 compared to $52,210 in 2017.
There are no formal research and training programs for allergists, so to learn the allergy specialty, you will need to work with an existing allergist in something like an apprentice role. If you decide to become an academic allergist, you can become certified, but if not, no certification option is currently available to you.
In either case, there is no Allergy/Immunology certification exam or Maintenance of Certification requirements.
The American Medical Association, which was founded in 1847, continues to play an important role in the development of medicine in the United States. And the American College of Allergists, a professional medical organization that will turn into the American College of Allergy, Asthma & Immunology and will grow to more than 6,000 allergists-immunologists and allied health professionals in 2017, is officially incorporated in November of 1942.
Despite the lack of scientific advances, knowledge and modern technology that will develop in later years, there are advantages to being an allergist in 1942. You can take as much time with patients as you like without worrying about time-consuming forms and regulations. Much will change over the next 75 years, but for now, enjoy this moment in 1942.