The Medical Service at the UCSF Medical Center is the hospital’s largest service, averaging 5500 admissions per year.  The service cares for a diverse patient population, acting as the primary hospital for the western third of San Francisco and as a referral center for hospitals throughout Northern California. Although UCSF’s Medical Service has a long tradition of excellence, it stands as the nations’s first academic hospitalist program.  The motivations for creating this service (and the origin of the term “hospitalist”) and the ongoing successes and challenges have been described in several articles published in the peer-reviewed literature [see references].  Currently, 85% of the attending months on the service are staffed by the Division of Hospital Medicine.  The remainder of the months are staffed by a highly qualified group of non-hospitalist attendings. The UCSF Medical Service is dedicated to excellence in clinical quality, patient safety, and education of residents and students.  Members of the Division of Hospital Medicine work closely with care coordination, nursing, pharmacy, and the Medical Center to provide the highest quality care possible. Although UCSF's Medical Service has a long tradition of excellence, it has received considerable attention over the past few years as the site of the nation's first academic hospitalist program. The motivations for creating this service and some of the key issues and outcomes that relate to it have been described in several articles published in the peer-reviewed literature (NEJM 1996, JAMA, 1998, Am J Med 1999). Presently, the members of the hospitalist group staff approximately 65% of the attending months on the service, as well as 100% of UCSF's Medical Consult Service. The remainder of the months are staffed by a highly qualified group of non-hospitalist attendings. The Medical Service is committed to excellence in clinical quality, patient satisfaction, referring physician satisfaction, efficiency, and education. Several initiatives related to quality improvement have been completed and others are underway.