The study and practice of medicine in the twenty-first century: ask not for whom the bell tolls.

Economic forces are rapidly transforming the profile of medical practice. Many of these changes will be beneficial and are long overdue. A number, however, have the potential to adversely affect both physician and consumer. At present, consumers are expressing few concerns; the concerns of physicians are receiving little attention. Consumers are quite content with the possibility of further decreases in medical costs and are relatively unconcerned with the potential decrease in the quality of care that may result or the diminished numbers of physicians entering research careers. If a decrease in quality of care occurs, it will be subtle, not recognized by the public for a number of years. Although the demographics of those entering practice may change, physicians as a group will adjust and survive, and the study of medicine will continue to attract those committed to the provision of health care. Ultimately, it will not be the physician who will "suffer" but the consumer.