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Numerous forces are presently deployed which threaten to produce largescale changes in medical practice and the systems of providing medical care. Some of these changes may be advantageous but others are likely to have deleterious effects on the quality of care, on the physician-patient relationnship and on the physician's freedom to practice as he sees fit. While certain of these pressures cannot be easily diverted, much can be accomplished with a modicum of effort to sway public opinion, the news media, the legislators and the bureaucratic regulation makers. Physicians, both individually and through their societies, must make this effort or suffer the pain of seeing immense decisions made without their leadership or intellectual guidance.