May you live in interesting times. Academic medical centers, academic societies, and the coming dominance of government and business in American medicine.

The coming changes in the organization and financing of medicine will lead to dominance of government and business in the American health care system. These changes will have a profound effect on academic medical centers (AMCs). To compete for managed care contracts and maintain their patient bases, AMCs will have to compete with private providers on cost, something they are ill-equipped to do because of their high cost structures. The AMCs are likely to have lower patient care revenues and alter the makeup of their faculties to reduce the number of specialists and increase the number of primary care physicians. Undergraduate and graduate medical education and research are also likely to suffer adverse consequences as a result of these changes. With the number of specialist residency positions decreased, it will be difficult for faculty to replace residents with physicians' assistants or nurse clinicians. Faculty may have to devote more time to patient care, and research and education may suffer. The decreased revenues of AMCs will affect the Surgical Infection Society and other academic societies. Society members may limit the number of societies to which they belong as their incomes or those of their departments are threatened.