Deep currents of cultural change are having an effect on the medical profession, beginning with gradual decreases in membership numbers in county, state, and national organizations that influence education, training, policy making in the health care sector, and political lobbying, and with gradual increases in membership numbers in specialty organizations that provide educational materials and meeting venues for physicians to remain current in their specialties and to develop and maintain professional relationships. Concurrent with the demographic changes, medical professionalism has become a growing movement to organize accepted professional behaviors into ten commitments, two of which, improving access to care and just distribution of finite resources, are consistent with Russell L. Gruen's concept of civic mindedness. There are also increasing numbers of physician-activists who are emphasizing the need for greater civic engagement. Medical institutions have the opportunity to build on these commitments to inculcate strong social skills and civic attitudes and behaviors at all levels of education, training, and medical practice for the betterment of patients and for the greater public health of the community and the country.

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