Numerous trends in the current health-care environment have converged to produce an increased emphasis on the role of the midlevel practitioner. Financial constraints head the list, including a mandate for the best care at the lowest rates and a resulting shift from costly specialists to primary care providers. The desire to conserve human and technologic resources requires a practitioner with advanced knowledge and skills to serve as gatekeeper in terms of facilitating access to health care, establishing efficient referral patterns, and developing a holistic care plan. The midlevel practitioner also is prepared to facilitate the transition from the intensive care unit to the less costly general care areas. In addition, the inevitable reduction in funds for graduate medical education and the dwindling number of first-year medical students choosing internal medicine as a specialty threaten the ability of academic medical centers in particular to provide adequate housestaff coverage to full-time and voluntary faculty members. Physicians eager to provide efficient, seamless care to patients in the acute care setting, while maintaining an office practice and caseloads at several hospitals, find the support provided by a midlevel practitioner an enhancement to their clinical practice and a solution to the continuous management of acute and chronically ill patients. In this article, the authors describe one medical center's experience in implementing the midlevel practitioner role.