Beware! Reengineering has arrived in health care.

This latest management fad can bring dramatic cost savings, but the savings often are through reduction in head count. Experience in other industries shows that the damage too much downsizing can cause occurs in short-term benefits, as well as over the long run. Readers are advised to participate actively in reengineering rather than to be content with others doing it for them. Research now underway in a number of New York City hospitals is exploring the effects of greater labor-force participation as a cost-effective and humane alternative to downsizing.