To the Editor.
—The Editorial by Drs Blumenthal and Thier1 addressed the important issue of managed care and medical education. While they speak of the "new health care paradigm," I'm afraid they have addressed this new paradigm with the old paradigm. Their comments are based on maintaining the academic medical center essentially the way it was. While they acknowledge the need for ambulatory education, they have not suggested the real step that is needed: moving academe into the ambulatory arena. Not only are educational placements for learners needed in the ambulatory setting, the ambulatory setting itself needs to evolve and become part of the fabric of academic medicine. Ambulatory settings need to be places not only of education, but of research and of patient care excellence that can be transmitted to future physicians. In the same way that hospitals became the academic setting more than 100 years ago, it
Katz LA. Where Will Managed Care Fit in Medical Education?. JAMA. 1997;277(13):1038. doi:10.1001/jama.1997.03540370028028