First, let me just say that managed care means different things to different people. I want to give you my personal perspective on pediatric residency training in community settings based on my own experiences in a nonprofit, physician-directed managed care system, Kaiser Permanente Health Care Plan, that has a 50-year history. My experience is, therefore, probably somewhat unusual and different from that of many other physicians throughout the country.

As I wandered back and forth among the various workshops during this conference, managed care was a prominent theme in most. I am going to restrict my comments to three areas: recruitment, evaluation, and financing.

With regard to recruitment, managed care systems are likely to have a strong interest in developing strategic alliances with academic teaching centers, but this interest is based on a reciprocity of needs. These kinds of alliances can only flourish when there is mutual trust that emerges after a variety of discussions at several levels.

Managed care systems can be encouraged, then, to participate actively in teaching programs, and they may be significant sources for recruiting teaching faculty. Some managed care systems can provide stable, multicultural patient populations that are derived from the communities in which they practice. Continuity experiences provided to residents focus on health and prevention issues as opposed to disease orientation. Managed care systems can be rich resources for population research in which residents can participate.

Another issue has not been raised here to any major extent, as far as I know. Teaching residents in a community setting can also involve inpatient care in a community hospital.

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