Subject Terms Report Classification unclassified Classification of this page unclassified Classification of Abstract unclassified Limitation of Abstract UU Number of Pages 64Internal Medicine GME iii Fisher, for making this project possible by allowing me to research a topic of personal interest and giving me the time to devote to it. I would also like to extend a special thank you to Dr. Karin Zucker, LTC Dawn Smith, and LTC Sandra White for their helpfulness, insight, and many hours spent reviewing this project during its various stages.Internal Medicine GME iv ABSTRACT Brooke Army Medical Center (BAMC) is a 450-bed tertiary care hospital with a multi-fold mission to provide comprehensive patient care, medical education, and research. The implementation of managed care has caused BAMC's focus to shift from an academic role to a primary care role, with increased emphasis on productivity and cost-effectiveness. Successfully balancing managed care programs and graduate medical education (GME) programs has been especially challenging because managed care goals are often inconsistent with the traditional goals of a specialty driven, academic teaching institution.This project studied data on BAMC's Internal Medicine Residency Program (1993Program ( -1999 to identify changes attributable to implementation of managed care. Results showed both positive and negative impacts. It has increased the staff's focus on prevention and on their responsibility to provide a continuum of care to enrolled beneficiaries. This has had a positive influence on the procedure workload for internal medicine because it is a primary care service. However, research and workload data indicate that the environment for training and education is becoming more constrained.Since training and education are not goals directly aligned with managed care, they have taken a back seat to recent efforts that focus on productivity in primary care. Decreases in research and inpatient workload signal a decrease in the overall quality of medical education programs and may be a warning sign of more serious problems to come. It is likely that teaching, an inherently time-intensive and inefficient process, will suffer unless provided for in enrollment and productivity calculations.Internal Medicine GME v BAMC must ensure that measures are in place not only to be productive and succeed in managed care, but also to maintain high quality GME. Recommendations include improving documentation, increasing GME visibility, evaluating surgical and subspecialty training programs, and maintaining a healthy balance between the immediate patient care mission and GME mission.