Academic medical centers link three critical functions: training physicians and other health professionals; delivering state-of-the-art medical care; and Carrying out laboratory and clinical research. The linkage of these three functions has enhanced each. Now, many AMCs report severe financial distress. Some allege that this distress is from a dramatically worsened financial environment-increased market power by managed care plans, reduced reimbursements by Medicare and Medicaid, and technological change that has reduced demand for in-patient hospital services. Others claim that the problems are more of the AMCs' own making, arising from sloppy administration sanctioned by years of relatively unconstrained reimbursements and from unwise business decisions made in response to an increasingly competitive environment and excess capacity. The purpose of this conference is to review available evidence and hear first hand from participants. Because of lags in data collection, it is important to get even rough intelligence from those who are in the trenches. Which of these views is nearer to the truth should have an important bearing on public policy. The product of this conference will take two forms: the direct exchange of views by those who attend, and a conference discussion paper and conference summary that Brookings will publish shortly after the conference.