The Ecology of Medical Care Revisited

Since its publication in the Journal in 1961, “The Ecology of Medical Care,” by White et al.,1 has provided a framework for thinking about the organization of health care, medical education, and research (Figure 1). This conceptualization, inspired in part by careful reporting on the part of British general practitioners,2 suggested that in a population of 1000 adults, in an average month, 750 reported an illness, 250 consulted a physician, 9 were hospitalized, 5 were referred to another physician, and 1 was referred to a university medical center. These data have been used repeatedly by investigators, authors of textbooks, task . . .