THIS IS MY 15th year as the chair of an academic department of surgery. Much has happened to surgical departments as we know them and to the delivery of health care during these tumultuous years. Unfortunately, the tumult is not over; it is increasing. To accomplish the mission of teaching, research, and patient care, the comfortable model with which we all grew up will no longer work. The rules have changed. Departmental organization and financial issues are different and the differences will continue to evolve. The following comments focus on these differences. If one guesses correctly and plans properly, a viable, successful department can continue. Conversely, if one guesses wrong (or is unable to respond to change) the opposite might readily occur.
Orthopedics was the first to separate from the department of surgery; a new department was created 6 months before my appointment as the department of surgery chair.