As social and health trends underscore and support the need for aggregative and problem focused education and research, it is not clear that AHSCs are reacting in an effective way - increased isolation from community and generalist care leaves highly specialized institutions vulnerable to criticism of both irrelevance and sub-optional care. A re-affirmation of unambiguous commitment to both study (research and educate) as well as serve those who suffer provides the most likely avenue to make the 21st century "the best of times" for the AHSC.
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