For the guidance of the prospective student, the American Medical Association publishes annually classified lists of medical colleges in which these institutions are rated according to the standing of their faculty members, their teaching and administrative organizations and the extent and character of their equipment and facilities for practical work. These lists should be consulted in selecting a college.

Success in the acquisition of knowledge and in its organization in the minds of the students for practical work presupposes that the student knows something about the nature of the mind and of the thinking and learning processes, and although professional courses do not usually prescribe anything nor do professional schools generally recommend it, it will increase the practical value of what the attendant gets out of any courses if he first reads or studies, with some care, some of the accessible books bearing upon the laws of mental operations and the principles of the efficient life. A list of these books is given at the end of this chapter.

REFERENCES.

Bennet, E. A. The Human Machine. Doran, 1910. $.75. The Learning Process. Macmillan, 1915.

Colvin, S. S. Gulick, L. H. Locke, John. Meumann, E. 1913. $2.00.

The Efficient Life. Doubleday, 1907. $1.20.
An Essay on the Human Understanding.

The Psychology of Learning. Appleton,

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CHAPTER IX.

A GENERAL SURVEY OF THE FIELD.

It has been shown that we have in the entire country about one physician to every six hundred and fifty of the population; in country districts, one to about every two thousand people. Many of these physicians are old and have practically retired; some are giving their time chiefly to business; others, again, are devoting their time to public service; and many are engaged in research work.

The same motives which lead persons of other trades and professions to crowd into cities, lead medical men to locate in the great centers of population. The physician must go where the people are. Moreover, there are opportunities in the cities which are not found in the country districts; there are chances for hospital and dispensary work; the better educational and social advantages; the privileges of meeting specialists in the professional organizations; better fees; and opportunities for part-time salaried work.

The practitioner in the rural communities, on the other hand, does not lose his identity, as too often does his brother in the crowded cities; he is generally one of the influential members of his community; he commands a more permanent clientele and has less competition. He becomes by force of necessity more self-reliant, and although his fees are smaller his percentage of collections is larger.

The first puzzling problem of the physician who would devote his time to private practice is the selection of a location. Those who follow other trades and professions may sometimes change their locations to advantage; but the fate of the physician depends in a great measure upon the prosperity of the community with which he first casts his lot, for it is rarely possible for him to make a change of location without risking considerable loss.

The student of this problem would suppose that the distribution of the three thousand or more annual graduates of our medical schools who expect to enter private practice would be regulated according to some well established principles. Inquiry was made to learn what instruction was given by the medical colleges to aid their students in this important matter of choosing a location. It seems that the colleges as a rule overlook this matter of giving instruction in regard to the best methods of marketing the capacities for service which their students developed through the long and expensive years of study. A careful reading of some three hundred answers to a thousand letters of inquiry seemed to indicate that the matter of selecting a location has heretofore been largely a matter of accident and chance and that the method of trial and error resulted in the aggregate in a very large amount of waste.

One man replied that the final choice between several localities which he had under consideration was determined by a study of the directories of practicing physicians in those places. In one city he noted that half of the names which appeared in the directory for 1900 were not in the list for 1910. He concluded that because an unusually large number of those who tried

practice in that city abandoned it for some reason or other, the place was to be avoided. Another replied that while debating with himself about the relative advantages of two places he consulted a banker friend who pointed out to him that the figures of the state banking department showed that the average per capita deposits in the saving banks by the people of one of the cities was much larger than in the other and that therefore it was safe to infer that the first city was more prosperous. Another reported that he was deterred from locating in a manufacturing city when a friend showed him a copy of the census bulletin which indicated that the average annual earnings of factory workers who formed a very large proportion of those gainfully employed, was relatively small. Another investigated a new industrial city which seemed to be undersupplied with physicians to turn away from it because a very large proportion of the inhabitants were foreigners from a country in which the laboring classes had never been educated to make any considerable outlays for medical services and because as a rule these people were clannish and suspicious of those who did not speak their own language. One man reported that by accident a copy of the atlas of the U. S. census had fallen into his hands and that in looking over a map showing the relative value of farm lands for the entire country the thought came to him that a moderate sized town in a good farming country in which a large proportion of the people were retired or living on their investments and in which those who were gainfully employed were engaged chiefly in commercial pursuits would be a good place in which to find a permanent location, he added, however, that "in such places collections are confined

almost entirely to the time of the annual payment of rents and the settlement days which follow the sale of crops."

Not a few sharpers seem to be lying in wait for those who are looking for a location. A favorite dodge of real estate promoters in boom towns is to advertise desirable openings for physicians when they mean that they have offices to rent to desirable tenants. There are also rumors that there have been physicians who built up records of crowded consultation rooms in order to sell to advantage their practice and office equipments.

Sooner or later the insistent students of the medical colleges will demand that the faculties undertake an investigation sufficiently extensive to enable them to work out the sound underlying principles with which to make the approach to this problem and that instruction in these matters will form a part of the regular work of the colleges.

It must also follow sooner or later that all medical schools will follow the example of other professional schools and the more progressive colleges and universities and open for their graduates appointment offices. and bureaus of counsel and advice through which trained and experienced men will make available for the use of graduates well indexed and up-to-date information for their guidance so as to minimize the waste of time and energy and discouragement which is incident to the slack period between graduation and full employment as a partial compensation for the lengthening of the period of medical study and preparation, nor is it too much to expect that before long the medical societies will awaken to the fact that it will be to the interests of their mem