August 7, 1987

A Randomized Controlled Trial of Academic Group Practice

Author Affiliations

St Joseph Hospital Chicago

St Joseph Hospital Chicago

JAMA. 1987;258(5):613. doi:10.1001/jama.1987.03400050055023

To the Editor.—  Goldberg et al1 must be commended for their study of alternative methods of organizing the teaching medical clinic. Those of us who are actively involved in supervising teaching clinics know that organization is generally an exception to the rule. Attempts to expedite patient care and satisfaction while maintaining resident participation and education often meet with obstacles. Cleveland General Hospital's system of "firms" within a group practice seems to be a feasible and apparently successful alternative to traditional methods.However, I feel the authors have failed to comment on another important reason to change to a group practice. The major challenge facing medical education in the ambulatory setting is financial: who pays? Good will and philanthropy on the part of hospitals have given way to diagnosis related groups and discount medicine. Thus, the medicine clinic must become more self-sufficient. Many institutions have organized their clinic supervisory staff