Impact of the evolution in health care delivery on the academic medical center.

The academic medical center is currently being affected by major changes in the national health care delivery system. These changes include the rapid growth in prepaid health plans, the emerging surplus of physicians, and the continued escalation of health care costs. The potential effects of these changes are only now becoming appreciated and may have significant ramifications for the entire medical education system. In this article, the author traces the impact of these changes on one major academic medical center. He presents a methodology for pinpointing other centers that may soon be affected and discusses ways to minimize the undesirable consequences of these changes.