Director of Diagnostic Laboratories and Pathobiology, St. Michael ’ s Hospital, Toronto

Academic Health Sciences Centres (AHSCs) are an enduring feature of health systems in all developed countries. In Canada, despite the lack of precise definition and standard-ized organizational arrangements, the educational services and programs in health sciences offered by AHSCs, and the caregiving organizations they embrace, are critical components of the national health system. Yet, the past decade has been a period of profound change in the Canadian health system. The pace of this change and the nature of the demands on the system are unlikely to abate in the near future. Given that many of these changes have directly impacted on AHSCs, or their component parts, it is timely to review these entities and to understand more fully how these organizations have been, or may be, affected in the future. This paper identifies many of the unique attributes of AHSCs that have arisen from their threefold mission of patient care, teaching and research. The authors describe many of the most critical issues confronting AHSCs in the current era: diminishing financial support;increasing demands on the system, with little prospect of new resources; new forms of care delivery such as regional models; alternative plans for physician compensa-tion; and new models for research funding