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December 3, 1997

Uniting Public Health and Medicine

Author Affiliations

Dartmouth Family Practice Residency Lebanon, NH

JAMA. 1997;278(21):1722c. doi:10.1001/jama.1997.03550210017008

The vicissitudes of modern medicine are making many resident physicians apprehensive. Residents can scarcely pass the day without hearing about "changing practice environments" and the "new skills and competencies" needed to practice medicine in the 21st century. A pervasive motif in such discussions is the "doctor-panel relationship;" that is, the set of responsibilities that physicians have to a defined population, or "panel," of patients under their care. The concept of population-based health care is new to many clinicians. It is an interdisciplinary approach to health care that considers a broad range of health determinants within a financial framework. This approach strives to find the most cost-effective means of improving health outcomes at the population level. The growth of managed care is one factor driving the discussion, as large systems of providers look to population-based health care as a way of managing costs.

As population-based approaches evolve in health systems, clinicians