Public hospitals in America are closing at a much faster rate than hospitals overall. The number of public hospitals in major suburbs declined 27% (134 to 98) from 1996 to 2002. Much research has proven the increase in uninsured and Medicaid enrollment entwined to unmet needs for disproportionate share subsidies to be associated with the challenges faced by public hospitals to maintain their financial viability as they compete with the private sector for paying patients. Since the creation of the Affordable Care Act (ACA) in 2010, 15 million of the 48 million previously uninsured receive Medicaid. It is projected that this number will grow to about 33 million by 2018. The provision of good quality ambulatory specialty care for these uninsured and Medicaid enrolled patients has particularly been a challenge for many urban public hospitals. This accounts for many factors ranging from a shortage of specialists who are more likely to practice in the more profitable sectors than in the safety-net, to the lack of clinical space. To overcome this challenge, some public hospitals have adopted disease prevention methods, the increase of specialty providers and clinics, deployment of nurse practitioners and physician assistants in specialty clinics, asynchronous electronic consultations, telehealth, the integration of Primary Care Providers (PCP) in the specialty clinics, and referral by PCP's to specialists.