Divisions of general medicine: ambulatory care activities and responses to cost containment.

To evaluate caring for the poor and uninsured in divisions of general medicine (DGMs), and to document the impact of recent reimbursement changes on division ambulatory care activity, the authors conducted a survey of DGM directors. Questionnaires mailed to directors of 214 divisions or residency programs yielded 120 responses. DGMs staffed, on average, three ambulatory sites, with a median of 17,000 visits per site. Overall, 66% of visits were by poor, underinsured, and uninsured patients. The majority of directors (75%) considered care of the poor a goal of their divisions. The most commonly reported response to the cost containment environment was implementation of revenue-generating measures (66%); 19% reported reductions in care to the poor; and 20% reported increased service to this group. It is concluded that DGMs care for large numbers of poor and uninsured patients and therefore must carefully evaluate the impacts of current policy proposals on their future ambulatory care activities.