THE CHANGING HEALTH-CARE ENVIRONMENT - IMPLICATIONS FOR RESIDENCY TRAINING

Throughout the United States, the growth of managed care is forcing pe diatric providers (physicians and hospitals) to reconstruct and integr ate the health care delivery system with a focus away from the academi c center and toward the community. Managed care also is forcing new fi nancing approaches geared toward the assumption of economic risk for p atient management and utilization of services. Radical changes in pedi atric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving m arket forces. These changes, while disruptive, will strengthen the bre adth and diversity of graduate medical education and will better prepa re trainees for the new delivery system in which they will practice. I n this article, we examine how the evolution of managed care is redefi ning the basic financial and organizational framework for pediatric ca re and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our e xperience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.