A difference that is perhaps even larger than these 2 differences is the organizational structures of hospitals and clinics. Take the not-so-simple matter of implementing an electronic medical record. In most hospitals, a team of computer experts would handle this problem aided by clinicians with specialized expertise in informatics and time carved out of their clinical schedules. Although the process would engage “user groups,” no one would expect a rank-and-file doctor to double as “the IT guy.” However, in all but hospital-associated or huge ambulatory practices, a clinician must take the lead role when an office practice transitions to an electronic medical record (14). Similarly, hospitals can afford to have staff with specialized expertise in various types of errors (such as pharmacists for medication errors) or in human factors, root-cause analysis, and legal medicine. The hospital cross-subsidizes these positions, which do not generate revenue, with profits from the clinical operation. Contrast this lavish staffing with the 3-person ambulatory practice, in which the physician (or nurse) is likely to also be “the human factors guy” (or woman), “the root-cause guy,” and “the malpractice guy.” And what profits are available for cross-subsidy? Get serious.