Changing environment and the academic medical center: the Johns Hopkins Hospital.

Academic medical centers need strong patient bases and strong financial bases to educate and to support research. After careful delineation of its mission with regard to patient care, research, and education, the Johns Hopkins Hospital expanded its health care delivery capabilities and strengthened its position in the health care marketplace by acquisitions of and mergers with other hospitals and a health maintenance organization in the Baltimore area. The resulting conglomerate, operating under the direction of a holding company, the Johns Hopkins Health System, has achieved its goals of expanding patient care capabilities, broadening the patient base, and enlarging the asset base and cash flow. Half the medical residents at the Johns Hopkins School of Medicine receive training at nontraditional sites, and further expansion of teaching activities is being explored. Potential roles of traditional and nontraditional teachers in these activities are discussed.