The effect on academic health centers of tertiary care in community hospitals

Increased competition among hospitals is a potential threat to teaching hospitals. The growing cost of medical education and the provision of care to the indigent can be endangered by the dilution of revenue sources which traditionally have been available to the academic health centers but which now are being taken over by suburban hospitals. As an example of such a threat, the authors in this paper relate a case study regarding the expansion of open heart surgery programs in St. Louis, Missouri.