PacMed is a multi-specialty, regionally distributed system of clinics that is at the forefront of managed care. It is one of the larger providers of primary care to a diverse multicultural population throughout the region, and offers methods of diagnosis and treatment of gastrointestinal illness in a managed care setting. Large numbers of ambulatory patients with a wide spectrum of illnesses are seen in consultation, along with a smaller number of acutely ill, hospitalized patients. It functions as a highly structured and efficient HMO, but staffed by physicians who are faculty members of the University of Washington.