Kenneth Ludmerer's Let Me Heal is the first comprehensive history of US graduate medical education; it is an authoritative work from the preeminent scholar in the history of American medical education and a much-needed resource in the rapidly evolving medical education landscape. Let Me Heal is the third offering in Ludmerer's triptych on American medical education, which began with the publication of Learning to Heal in 1985 and continued with Time to Heal in 1999. The first two works provided a definitive history of American medical education, focusing primarily on undergraduate medical education (medical school). Until now, the historical underpinnings of graduate medical education (residency) have received little scholarly attention, even though, since at least the 1970s, it has been key to American physicians’ professional development. Let Me Heal traces the transformation of the residency from that of an educational opportunity for an elite few to an obligatory training system for all physicians practicing independently in the United States.

The first six chapters, covering the eighteenth century to the 1930s, trace the development of the residency as well as its antecedents (“institutionalized apprenticeships” at hospitals as early as the eighteenth century) and alternatives (such as apprenticeship with a specialist or graduate study at a university). The modern residency began at Johns Hopkins in 1889 and ultimately served as a model for residencies around the country, just as its medical school served as a model for American medical schools in the early twentieth century. Hopkins set out to create “scientific practitioners,” who “employed the same methods of reasoning as scientists in the laboratory” (p. 26). The early Hopkins residents were a privileged bunch who became academic leaders and spread the Hopkins model nationwide. In Ludmerer's telling, they underwent an ideal residency experience in that they were trained by luminaries of the profession (such as William Osler), they were singularly devoted to the profession (were unmarried, lived at the hospital, worked long hours, and were unpaid), and they found joy in the ideal of putting the needs of others above their own. Since their inception, residencies served the dual purpose of providing education for residents and service for hospitals; the service function included providing a medical staff for hospitals as well as a workforce that, not infrequently, performed additional duties that did not require medical training. It was many years before it became commonplace for physicians to pursue additional hospital-based training after medical school. However, by the 1930s, most medical school graduates were undergoing an internship that served as preparation for general practice. A few went on to further training via a residency (p. 45–46); during this decade, the residency became the sole route to medical specialization (p. 117). The residency, as it developed at Hopkins and spread nationwide prior to World War I, started as a training period for future researchers and academics in particular specialties, but after World War II, its purpose had shifted to producing clinical specialists (p. 58).

Chapters 7 through 9 focus on the 1940s to the 1970s, when specialization became the norm in medical education and practice. This era roughly correlates to what others have termed the “golden age of medicine,” in which the medical profession experienced a relatively high degree of autonomy, prestige, and resources. Fueled by an expansion in the number of hospitals, the concomitant need for increased medical staffing, and demand from medical school graduates who desired specialty training, the number of residency programs increased rapidly. Ludmerer notes that during this period, as medical knowledge and practice became more complex and the residency transformed from a “privilege” for a few physicians to a “right” for all, residencies became less personal, the pace of work increased, and medical practice styles became increasingly wasteful in their use of increasingly available resources such as tests and procedures. This period also saw the rise of third-party payers. The resulting increased clinical revenue meant that residents began caring for “private” patients as well as “charity” or “ward” patients and that, by the end of the period, house officers were paid a living wage (pp. 188–89). Chapter 10, focusing on the 1970s, argues that changes during the post-War War II era, in which residents felt increasingly underappreciated and overworked, made residency less satisfying as an educational experience.

In chapters 11 and 12, covering the 1980s to the present, efforts to reign in health care costs made residency increasingly more challenging for residents, as they were expected to care for higher numbers of more complicated patients in less time, with resulting negative impacts on the educational value of the experience as well as concerns about the safety of patients being cared for in this system. Residency reform efforts focused primarily on curtailing duty hours, as opposed to ensuring adequate supervision for residents. The focus on duty hours led to the creation of nationwide standards for duty hours in 2003; the standards have subsequently undergone multiple revisions, including one that went into effect in the spring of 2017 that is in line with Ludmerer's recommendations for more flexible standards.

The concluding chapter presents Ludmerer's prescription for what he views as the comorbid ailments of the American health care system and medical education. He argues that inculcating physicians during their residencies in “parsimonious medical practice”—that is, an actualization of the Hopkins ideal of the “scientific practitioner” whose “approach to patient care was … efficient and cost-effective. … Scientific physicians … could be stewards for the nation's resources as well as outstanding doctors for their individual patients” (p. 27)—would be a significant step in making American health care better for patients and physicians, and he expresses the hope that such a change is in the purview of medical educators (p. 332).

For Ludmerer, a physician, historian, and medical school professor, the professional is personal in myriad ways, and his allegiance to and long engagement with medical education are key to the strengths and weaknesses of Let Me Heal. The work is subtitled “The Opportunity to Preserve Excellence in American Medicine” and is dedicated to “the Ideals of the Johns Hopkins Medical School and Hospital” (p. v). It is a history that is painstakingly researched, lucidly written, and, considered together with Ludmerer's prior work, provides a comprehensive and essential picture of American medical education over the past two centuries (although the inclusion of a bibliography would have been helpful). For Ludmerer, the early years of Hopkins (Ludmerer's alma mater) are not only foundational in the actual development of American medical education but serve as an exemplar. In his narrative, what was is at times conflated with what could be. If Hopkins did indeed serve as the bedrock and model for American medical education, then in many ways we have what Hopkins wrought, for ill and for good. Ludmerer is dutifully critical of ways in which American medical education and professionals have been wanting (e.g., the impact of class on the treatment of patients), but there is more conviction behind his admiration for “great” physicians and institutions and regret about the loss of professional cohesion that accompanied the burgeoning demographic diversification of the profession that began with the “protest era” of the 1970s (pp. 218, 223, 230). In this book, the phrase “Let Me Heal” translates into “let me practice my profession”; an alternative reading of the phrase, in line with the convictions of activist physicians of the “protest area” and beyond, would acknowledge that residencies at times produced professionals that not only sought to heal, but who needed healing.