Three easy pieces.

The author provides information about and analyzes three issues confronting academic medical centers in the realms of education, patient care, and research. (1) In the educational realm, he indicates why medical centers must play an expanded role in training primary care physicians, explains the dangers of not doing so, and describes ongoing and proposed approaches and reforms for achieving this goal. (2) In the arena of patient care, he explains why modifying physician reimbursement policies is essential for more physicians to develop careers as generalists. Other more controversial physician payment reform measures and their implications for health care and academic medical centers are discussed; the author urges that benefit to patients always be the first concern of such reforms, even at the expense of more narrowly based interests such as limits in faculty salaries or reduced overages to institutions. (3) Regarding research, he discusses various facets and implications of conflict of interest for biomedical scientists--both the reality of misconduct and the appearance of it--especially as they apply to the growing number and forms of university-industry relationships, and urges that such conflicts be managed within guidelines that clarify expectations and standards in an atmosphere of appropriate disclosure and oversight. He concludes by urging academic medical centers to rise to, rather than avoid, the three challenges he has described.