Significant changes are taking place and continue to take place in U.S. health care and medicine. Many of these changes are not, and will not be, to the benefit of physicians. Reduced personal autonomy, probably lower compensation than expected, fewer and less adequate resources, and overall significantly reduced power are some of the likely outcomes of the changes underway. Perhaps of greatest personal interest is the high likelihood of lack of employment in medicine for upwards of 200,000 physicians over the next 20 years.