This of course created problems. A demand for free care rose, and hospital income drastically dropped. Stevens asked, "Which hospitals would survive? What were hospitals to do?"
They survived when they organized. The focus shifted from medical associations to hospital groups. They took the lead during the Depression, and they made hospitals sustainable.
Voluntarism allowed the hospitals to avoid government intervention and certain ideologies rose up. "Spontaneous community activity, romanticism, and a sense of nostalgia for the vanquished past, the voluntary ethos promised the best of both public and private worlds: public responsibility without government compulsion; private initiative untainted by selfish gain.
The Depression changed the hospital again. Under the increased burden of free care, the hospitals didn't suffer like much of the nation. The Depression caused a consolidation of the hospital system. Hospitals increased the amount of patients they could sustain, and in turn smaller hospitals folded. It's almost economic. The market was over saturated, and the Depression was the regulator that brought it back into place. Every market needs stabilization, and the Depression did the job when it came to hospitals.
As voluntary hospitals took hold of the ever changing face of healthcare. Health administrators suddenly developed a larger role. As their role in voluntary hospitals increased they formed the American College of Hospital Administrators. The college sought to provide a professional association for the non medical admins the hospitals were suddenly relying on. It was an immediate success.
The volunteer played a critical part in the depression era hospitals. The volunteer was a social meaning. "In the depths of the Depression, hospitals were beacons of hope, science, faith, and caring."
Volunteerism stressed the importance of the hospital in the private sector. It was "the glue to hold autonomous institutions together," and it allowed the hospital managers to start to mobilize into politics.