"Physicians must abandon the illusion of autonomy . . ."

Radical changes are occurring in medicine which are impacting the practicing physician. This is especially true for specialists caring for very acutely ill patients such as those with congenital heart disease. This article explores developments such as the reversal of fiscal and medical paradigms, risk-averse behavior, price-based costing, and competing physician priorities. Special emphasis is directed to issues in pediatric cardiology. Suggestions for action are made, the primary of which is that physicians must abandon the illusion of autonomy in order to acquire the reality of collective influence on the practice of medicine.