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The Mexican Medical Movement from 1964-1965 constitutes an important event from the rising urban middle-class, besides it was the first time medical doctors claimed for fair working conditions. The background of this movement is the so-called Crisis of 1958, which included the Movements from the educators union, oil workers union, telegraph workers union and the railroad workers union. The conflict began because interns and residents from the "Hospital 20 de Noviembre" would not get a payment at the end of the year, so on November 26th, 1964, the movement started. The Asociación Mexicana de Médicos Residentes e Internos (AMMRI) was created and their demands were the following: 1) Full working site restitution without retaliations, 2) Legal examination of the scholarship-contract terms, in order to get annual, renewable and progressive contracts, and a fixed salary with the usual working-hours and characteristics of each institution, 3) To have preference to get an adscription at the hospital where the resident studied, 4) Active participation from the resident in the elaboration of the academic plans, and 5) Resolution of each hospital's problems. This movement had social impact for Mexico's contemporary life, nevertheless some of the demands are still unchanged among medical residents.

El movimiento médico mexicano de 1964-1965 constituyó parte del primer despertar de la clase media urbana, además de haber sido la primera vez que los médicos reclamaron condiciones de trabajo justas. Como antecedente se tiene la llamada crisis de 1958, la cual incluyó los movimientos: revolucionario del Magisterio, del Sindicato de Trabajadores Petroleros, de la Alianza de Telegrafistas, y del Sindicato de Trabajadores Ferrocarrileros de la República Mexicana. El comienzo del conflicto médico se debió a que los residentes e internos del Hospital 20 de Noviembre del hoy Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) no recibieron su aguinaldo, por lo que el 26 de noviembre de 1964 inició el paro, a partir del cual se formó la Asociación Mexicana de Médicos Residentes e Internos (AMMRI), cuyas demandas fueron: 1) Restitución total en sus puestos, sin represalias, 2) Revisión legal y cambio de los términos del contrato-beca, en el sentido de lograr contratos de trabajo anuales, renovables y progresivos, con el horario y características acostumbrados en cada institución además de determinación de sueldos base, 3) Preferencia para ocupar plaza de médico adscrito a los residentes egresados de las propias instituciones, 4) Participación activa del residente en la elaboración de los planes de enseñanza, y 5) Resolución de los problemas de cada hospital. Este movimiento, aunque tuvo repercusiones sociales para la vida contemporánea en México, a 50 años de su inicio, algunas de las demandas siguen sin ser resueltas para los médicos residentes.

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One of the major complaints often voiced by healthcare organization administrators is that physicians do not seem to cooperate when it comes to reducing costs. This article presents several techniques designed to involve medical staff more actively in the financial management of a healthcare facility.

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This paper views quality assurance costs as appraisal costs. We used cost accounting techniques to estimate the cost of quality assurance activities in a large university affiliated Veteran Administration Medical Center. In addition to the personnel employed full-time for quality assurance activities, all other employees in or directly in support of clinical services were interviewed in order to determine the per cent of their work time devoted to specific quality assurance activities. The per cent time committed was multiplied by the salary and benefits package for each employee and the total computed for the facility. In addition, non-salary overhead expenses were estimated by multiplying the salary and fringe benefit costs to the ratio of total medical center non-personnel costs to total medical center costs. We found that 3.39 per cent of the total budget or $4,884,775 was devoted to quality assurance activities. The highest costs aside from the designated quality assurance personnel were for pharmacy, Laboratory, extended care (including nursing home), psychiatry, and nursing services. We did not attempt a formal benefit analysis. We concluded that quality assurance activities in a major medical center are not free. Careful cost accounting studies should be performed both to determine the cost of quality assurance and to identify its specific benefits.

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