Payment systems are driving many of the changes in the health care system and those payment systems will continue to change in the years ahead. Cost containment pressures have already brought physicians and administrators together in efforts to reduce length of stay and diagnostic tests. Increased competition, fiscal restraints and prescribed patient care protocols will continue to influence tomorrow's physicians. Hospitals must find increased opportunities for physician participation in continuing education, management decision making, and business ventures such as development of ambulatory care centers, preferred provider organizations (PPOs) or health maintenance organizations (HMOs). Only by working together can physicians and administrators achieve their ultimate goal of providing quality health care that is also cost effective for both the hospital and the patient.