The paper by Lozon and Fox in this issue outlines the opportunities and challenges for AHSCs as we move forward. This commentary expands on some of these issues from the perspective of the university. At present, both partners at times feel that the other organization makes decisions that have important implications, but without proper consultation or reflection on impact. This is no greater a problem for the healthcare system than for the university and underlines the urgent need for a new definition of this strategic partnership we refer to as the AHSC. Canadian AHSCs have been impacted negatively during the past decade, and particularly so in those provinces that developed regional governance models.To assure that this does not continue to happen, AHSCs must be redefined to be both more responsive to societal needs and more recognizable by their stakeholders, not the least of which are the public and governments.

The lead paper by Lozon and Fox provides a comprehensive overview of the Academic Health Sciences Centre, its origins, complexity, resilience, costs, value to society and challenges. Although I agree with most of Lozon and Fox's perspectives, in this commentary I will offer an additional viewpoint on a number of issues: the definition and role of the AHSC, relationships within (rather than with) the university, the impact of regionalization on the AHSC, and some thoughts on the future. These comments are primarily from the perspective of the university, although some reference to the healthcare delivery system and the need for fundamental change is also provided.

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