Change is an ongoing phenomenon that accompanies progress. However, the tempo of change is rarely constant; advances usually occur in starts and bursts. Unfortunately, in these periods of rapid change, not all aspects of the progress are embraced with enthusiasm. The practice of medicine is in ongoing upheaval, with many forces acting to produce a significant change in the way medical care is provided in the United States. These forces include, but are not limited to, technological advances, the method of surgical education, generational differences, increased expectations from the consumer, and health care economics (both the available monies as well as the allocation of these financial resources). Claude H. Organ, Jr, MD, editor emeritus of the ARCHIVES, asked for the perspective of a young surgeon (I finished my training in 1998) on the influence of these forces on the changing culture of surgery. The following discussion is purely my opinion and is inherently biased by my experiences, my lack of knowledge of the details involved in the forces at work, as well as my limited foresight of the future.