Interdisciplinary ambulatory education and service in primary care at the University of New Mexico

To compete and survive in a managed care market, academic health centers mu st develop integrated delivery systems in general and an integrated primary care system in particular. However, the departmental-based structure at mo st academic health centers is ill-suited to this purpose. Service and educa tion are usually segregated by department, and the professional activities of of primary care faculty in different departments are fragmented, leaving the weakened as a political force within the institution. The University of New Mexico established a model of integrated primary care education and service by creating three interdisciplinary primary care cli nics staffed by primary care residents and faculty. The clinics united prim ary care providers from different departments as a stronger more unified vo ice in negotiating with the hospital and in fostering needed changes for pr imary care in the institution. Interdisciplinary teams require considerable time and labor both in plannin g (because of joint decision making) and in operation. Better staff structu res and staff developments must be learned through trial and error because there are not established benchmarks for interdisciplinary teams. Governanc e presents problems, primarily because loyalties to departments may superse de those to the clinical practice, and sometimes the departments teaching p riorities are challenged by clinical directors' needs. These obstacles to c ollaboration can be addressed creatively, and ultimately the comprehensiven ess and quality of care convinces providers and the institution.