Changes in the system for the delivery of health care constitutes a challenge for U.S. academic medical centers (AMCs), which are being called on to produce physicians who can function effectively in the 21st century. This paper discusses issues facing AMCs and suggests some steps that might be taken to deal with the challenges these issues present. There is considerable evidence that the demand for physicians is decreasing as the United States moves from a delivery system based on fee for service to one based on managed care. In addition, there is an oversupply in many specialties, and the oversupply of specialists seems likely to last for many years. Other problems are faced by the geographic and racial maldistribution of physicians. Minorities are still underrepresented in the physician workforce. Still another issue is the concern that current medical education and training programs are not preparing physicians adequately for practice in a health care setting dominated by managed care. The numbers and types of physicians needed in the future will be influenced heavily by developments occurring in other segments of the health care industry. Some steps are already being taken to address some of these issues. Many medical schools are revising their curriculums to incorporate items of importance to managed care. There is also some optimism that the problems of physician oversupply will be addressed in the near future and Congress has requested that the Institute of Medicine develop some options it can consider in revising Medicare graduate medical education programs. (Contains 36 references.) (SLD)