Academic medicine faces unprecedented challenges, especially the impact of the changing and more business-oriented health care system on medical education. There is an inherent clash of values between business and medicine: among key business values are profit and competition, while among the traditional values of the medical profession are service, advocacy, and altruism. Business interests have already gained a central place in medicine, so the challenge has become how to utilize the positive elements of the entrepreneurial spirit to enhance professional values and advance academic medicine's central enterprise. The author maintains that to achieve that synthesis, the leaders of academic medicine must continue to engage in a dialogue with the broader academic community, the government, the public, and the health care industry. The dialogue must emphasize (1) managing change rather than resisting it (such as focusing on the positive aspects of change, keeping sight of the fundamental professional values of medicine and medical education, and maintaining cool, rational judgment in the face of challenges); (2) making academic medicine's case with many constituencies, such as the health care industry, government, and the public; and (3) fostering professionalism by increasing medical schools' emphasis on this task, by ensuring that schools keep an appropriate balance between the science and the art of medicine, and by having faculty model appropriate professional values for their students. The author concludes that while change inevitably brings challenge and a sense of loss, it also brings the opportunity to help reshape medical education to meet the needs of society.