The great need for effective realignment of medical talent and knowledge for the solution of the health problems of our society is attested to in the reports of recent commissionsl-* and by this conference itself. Shortages of medical and paramedical manpower,l-3 increasing costs of medical care? and lack of effective relationship of various parts of the medical care system to one another' all are matters of conccm. These issues are matters of concern not only to health professionals; for it has become increasingly apparent that maldistribution of physicians, failure to provide equal opportunities for health care to all our people, skewed organizational relationships of various medical specialities and methods of medical practice and education are issues of real concern to society at large. Institutions of learning have begun to respond.Departments of community medicine and other comparable units now exist at several schools;5 major efforts in the areas of medical practice and research in medical care have begun;6 medical school involvement in community sponsored health care programs now is a reality;7-10 and programs for training of new types of allied health personnel are under way.ll-18Determination of the most effective way in which any given medical school can contribute to the solution of such complex and diverse sociomedical problems will vary from school to school. The program we will describe here grew in response to many factors, including those already mentioned, and has as its purpose the development of health care programs with a strong academic base in research and teaching.
BACKGROUND AND GENERAL DESCRIPTION OF THE DIVISIONThere were several immediate stimuli for a program in Health Care Research at Washington University. One was the progressive difficulty experienced in the operation of the out-patient clinics in the member hospitals of Washington University Medical School and Associated Hospitals ( WUMSAH) . To a greater or lesser extent, these clinics suffer from the same problems as do other out-patient departments. A high proportion of patients fail to return for