In the current health care environment of competition and market forces, concern has arisen that the classic principle of serving disadvantaged persons may not be fulfilled due to pressures from managed care. Reach Out, a $12 million national program of the Robert Wood Johnson Foundation, was developed to recruit leaders from among practicing physicians to organize projects to care for the uninsured and underserved. Physician volunteerism was a key component of all projects. Thirty-nine Reach Out projects were implemented and carried out across the United States, with average funding per project of $300000 distributed over a period of 4 years. Seven model types emerged, the most common of which, the free clinic and the referral network, accounted for two thirds of the total. At the program's conclusion, 199584 patients were enrolled and 11252 physicians recruited. Project execution was more complex than initially supposed, and major progress commonly was not evident until the third or fourth year, but at least two thirds of the projects are likely to continue with local support. With strong physician leadership and a funded administrative core, organized community efforts can develop and sustain an effective program. Programs such as Reach Out cannot solve the national problem of access to health care, but they can make a small but important impact on the number of uninsured and underserved persons without access to health care.