Our compact with tomorrow's doctors.

In recent years, the image of medicine as a caring profession has been badly tarnished by a rash of critical reports in the media. In the face of this negative publicity, do young people still want to be doctors? The author reviews conventional reasons given for the declining applicant pool (e.g., issues of declining income, loss of autonomy, etc.) and posits that an additional reason may be perceptions that doctors no longer command respect and that they are being oppressed by, rather than being guardians of, the health care system. Such views challenge academic medicine to broadcast to the world a realistic picture of the fabulous opportunities and gratifications that lie ahead for the next generation of physicians. However, academic medicine must also address some current realities within medical education, such as the admission process (where at present there is a tendency to overemphasize indices of academic achievement and underemphasize the personal characteristics sought in applicants) and the acculturation process in medical school (which can often dehumanize students and convert idealistic ones into cynics). The author acknowledges that these are tough challenges. He suggests as a first step that leaders of academic medicine prepare and disseminate an explicit statement of their commitments, a kind of compact between teachers and learners of medicine. He outlines these commitments, and states his hope that by fulfilling them, the academic medicine community can make clear that medicine-which at its core is still about the doctor-patient relationship-is a true calling, not just beleaguered occupation.