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On November 10, 1993, the annual meeting of the Society of University Otolaryngologists (SUO) was held in Washington, DC. The purpose of that meeting was to discuss issues relevant to academic otolaryngology, health care reform, and the training of otolaryngology subspecialists. The proposals by Congress (S.1315,H.R.2804 by Rockefeller, Durenberger, Waxman, and Cardin, and S.1215 by Kasselbaum and Simpson) and the Clinton Administration to alter the health care delivery system in the United States are likely to profoundly alter American medicine. These proposals include specific mandates for postgraduate medical education (GME) that should be of concern to both academic and private practice otolaryngologists. Although the proposals change nearly daily, they share a common theme. The most important of the various GME proposals is the Administration mandate that, by 2002, at least 55% of all residents should be enrolled in generalist training programs. Generalists are defined as practitioners of family medicine,