For physicians in internal medicine, a new era has begun. Those of us who have made a large investment in the past for the establishment of the present soon will be bankrupt if we do not make some sweeping changes for the future. The status quo is no longer defensible.
Those sweeping statements are the consequence of many long-term reflections and provide an opportunity to present some ideas concerning the future of internal medicine. Where are we going? How are the medical manpower needs of the American community to be defined and fulfilled? What are the universities, the practicing physicians, the governing and licensing boards, the legislators and the voters going to do?
Let us start with a quick assessment of the problems of the present. Wherever you turn (medical journals, daily newspapers, weekly news magazines, pharmaceutical company journals, the Atlantic, Harpers, etc), there is this current refrain: "American medicine
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