ABSTRACT
New York is on the eve of what is likely to be a wrenching transition in its renowned health care system, a system unmatched for the volume of care and for the research and teaching it performs in a setting of pervasive poverty and societal ills. New York is usually seen as a bellwether for the rest of the country, but in this case the situation is reversed; New York is playing catch-up. Our job at the Health and Hospitals Corporation is to see whether we can manage the abrupt transition. New York City is a mecca of medical education but it is also about to become the most competitive health care arena in the country. Shifting medical education in this direction means more than just steering students into different courses. Preparation for practice under managed care means teaching students very different ways of thinking.
