ABSTRACT
One difference is the presence or absence in the various locations of other medical schools. Four of the cities—Boston, New York, Philadelphia, and Chicago—contain multiple academic health centers. There is one other dimension that may throw some light on the evolution of the varied paths that the seven academic health centers are taking, specifically the length of time that they have been actively engaged in the process of altering their institutional strategy and tactics. Academic health centers are under added stress because they have depended increasingly on practice plan income to help support educational and research activities that operate in the red. Managed care plans are placing increasing responsibility for the direction of their enrollees' health care utilization on primary care physicians, with whom most specialty-oriented academic health center staffs have not interacted effectively, if at all, in the past.
