New organizations out of old ones: teaching group practices out of private practice and outpatient departments.

A private group practice and a traditional hospital medical clinic are joined together as a teaching group practice for primary care (Internal Medical Associates). Responsible for revenues as well as costs, the practice is administered by a board of managers composed of physicians, nurses, and administrators in the practice. This decentralization of practice from the clinical department and hospital administration has resulted in (1) a reduction in the numbers of physicians needed for the practice, (2) a greater visit census with increased physician productivity, and (3) a reduced operating deficit and better understanding of transient and educational costs. The matrix organization of the board of managers has resulted in better communication and a commitment of the staff to common goals. Public demand for a single standard of care for patients of all backgrounds, professional aspirations to work in groups, and educators' interest in training outside the hospital converge to make such reorganizations of practical necessity.