Health care delivery systems, managed care, and the changing practice of medicine.

The declining ability of physicians to make independent decisions regarding patient care, the declining level of reimbursement paid for physician services, the increased availability and use of alternative medicine, increasingly strict governmental regulations, and new questions regarding graduate medical education are just a few of the changes that have confronted the health care industry in the last decade. Physicians must become proactive in all arenas where future health care policy will be determined. We must reestablish the physician as the patient's advocate, provide for independent physician judgment in the delivery of health care, and reestablish our dominant role in determining national health policy.