If you attend a medical meeting or read an article about healthcare in a magazine or newspaper, you are immediately reminded that our country is in the midst of a healthcare crisis.

The proof is extensive and varied. For example, think about how often you hear the phrases the malpractice crisis, the Medicare reimbursement crisis, the plight of the uninsured, the shortage of physicians and nurses and so on.

In short, there is a crisis in access, cost and healthcare delivery in the system that has long been considered the best in the world.

But is our healthcare system truly broken? If so, how do we explain the tremendous advances in technology and the amazing improvements in the quality, efficiency and outcomes of our care? Our patients are living longer and we are conquering diseases with simple, unobtrusive and minimally invasive forms of medical and surgical therapy.

Still, a paradox exists. Despite the many positives above, physicians and patients are, at the same time, victims of the growing crisis in the healthcare system.

How we got in this situation is easily explained by doctors who talk about the "good ol' days" and blame a litany of outside influences: the government, the insurance companies, managed care, and of course, the trial attorneys.

But our real concern should not be how we got here, but rather, where we want to go, and most importantly, how we are going to get there.

In order to solve a problem, we must first recognize the nature of the problem and then develop strategies leading to a solution.

In essence, we physicians, as members of the medical profession, have been divided and almost conquered. We have been reluctant to take the leadership role in recognizing how we must adapt to the rapid onslaught of advancements, developments and changes in medicine. Our strength as individuals has not held up against the corporate powers that have taken control of certain aspects of our profession. However, physicians' most powerful tool and core responsibility remains-healing the patient. From that aspect, we will muster our collective strength.

We physicians must ask ourselves three questions:

WHAT do we need to do?

HOW are we going to do it?

WHO is going to do it?

Here is how I would answer these questions:

WHAT--Physicians must assume the responsibility for creating the vision of the healthcare system we believe would be the most effective for all concerned.

HOW--Physicians must put aside our varied and self-serving interests and align ourselves into a cohesive and functional force that fosters trust and regains respect.

WHO--In a word, everyone. In order to achieve any modicum of success in this effort, it is imperative that all physicians either commit to the early adoption of significant changes, or at least, support their colleagues in their efforts to effectively deal with the adversaries who will fight to maintain control.

Our strength and power to do this will actually be enhanced by the existing positive aspects of healthcare mentioned above and by the support of our patients, who will be the true beneficiaries of the changes we bring about. This is our challenge.