BACKGROUND Little is known about the relationship between academic medical centers (AMCs) and community physicians (CPs). We examined this relationship for an individual specialty-dermatology. METHODS South Florida dermatologists were queried regarding their practice and referral patterns, as well as the effect of managed care on these patterns. RESULTS On average, the respondents see 7,342 patients annually. Ninety-eight percent refer one or more patients for aid in therapy (39%) and diagnosis (27%). Most were satisfied with the amount (63%) and quality (77%) of the service provided. Overall, only 0.2% of patients are referred. Sixty percent reported that managed care caused alterations in referral patterns. CONCLUSIONS We found that, although community dermatologists diagnose and treat the vast majority of patients with skin disease seen by dermatologists, they also use and are satisfied with the AMC's services. Changes in referral patterns have occurred but have not negatively affected the relationship between the AMC and the CP.