Recent growing concern in many quarters over the distribution, costs, quality, and accessibility of health care in the United States has resulted in diffuse and intense pressures for solutions at all levels. As a consequence, a plethora of federally legislated programs has been developed: HMOs, HSAs, RMPs, comprehensive community mental health centers (CCMHCs), PSROs, and others. These have not only affected patterns of service delivery but have had profound, and not always consistent, effects on licensure, accreditation, the regulation of foreign medical graduates (FMGs), and medical education institutions at all levels. We now have a patchwork of extraordinarily complex programs, each with massive bureaucratic appurtenances, that are in many respects poorly organized, overlapping, and inadequately integrated.^1.2 Reasonable, indeed estimable, purposes have become distorted in their translation into concrete legislated programs of dubious feasibility and diffuse impact, partly as the result of political motivations. In that process, the shorthand program