Abstract
My daily reading of the Washington Post newspaper invariably leads me to the business section where I find, more often than not, articles about how companies in the business world are in a constant state of change. They are either merging, downsizing, reengineering or reducing in force their employees to stay competitive and, more importantly, survive. This is an example of how the change environment has permeated all areas of our lives and it is, in fact, not a passing fancy but a reality. The health care industry has not been immune from this mindset although few would have believed that medicine in the 1980s would follow this path.

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