Washington Heights-Inwood is a multiethnic community in northern Manhattan served by an academic medical center, the Columbia-Presbyterian Medical Center. Two random, stratified household surveys were carried out in 1989-1990 and 1992. Results were compared with institutional utilization data to identify major changes in patterns of utilization of primary care since 1989. A total of 629 households completed interviews for the first survey, and 544 completed interviews for the second survey; respectively, 33% and 14.5% of the dwellings contacted did not complete interviews. During 1989-1990 the last physician visit for most people in this community was not provided at the academic medical center. Off-site, community-based services reached far fewer patients than did private doctors without local affiliations and out-of-area hospitals. Changes in utilization in the early 1990s considerably altered this picture. Many people who previously had received care outside the area either shifted to care in the area or went without care by 1992. Despite a rapid rise in services provided at community-based facilities associated with the Columbia-Presbyterian Medical Center, unmet needs continue to be great. A model for provision of service by academic medical centers in underserved urban communities is examined.