The teaching hospital and primary care. Closing down the clinics.

Hospitals have become major providers of primary medical care by default rather than design because of the decreasing availability of primary physicians in community practice. In 1972, Beth Israel Hospital in Boston closed its traditional general clincs and estblished a primary-care group practice--Beth Israel Ambulatory Care. The practice is staffed by teams of full-time salaried physicians, other health professionals and paraprofessionals, house staff and medical students. More than 25 per cent of patient visits are managed by nonphysicians. Subspecialty clinics have been relieved of primary-care case loads and limited to referral and consultative functions. In 1973-74, the cost per visit was $20.32. Patient-visit volume in primary care has increased from a figure of 29,144 in 1971-72 to 41,650 in 1973-74. Broken appointments have declined by one third.