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As a physician who has served in all areas of internal medicine for 55 years, I certainly agree with Eisenberg's assessment of the academic hospital problem.¹ Years ago the Macy Report showed that the cost of postgraduate education in academic medical centers was increased by the rush to have large subspecialty programs with full-time staff members and increasingly costly technology. This does equate with the need to cover educational costs with a nationwide universal health insurance system. Medical schools tend to keep the faculty with the largest research budgets and the "golden wands" that bring financial benefit to the university and are of the least direct benefit to patient care. It is difficult to get some faculty members to participate in clinical chores, and, with the exception of the annual outstanding teacher award, the clinician is less rewarded than the investigator and publisher. This parallels the clinical practice problem of . . . [Full Text of this Article]