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Academic medicine is an ecosystem. Like any ecosystem, critical factors affecting sustainability include diversity, disruptive external forces, and natural selection. Perhaps the most important issue we must grapple with is the extent to which we can proactively shape the future of academic medicine versus being subject to the natural forces of change. In thinking about this question, I am reminded of a quote from Ludwig van Beethoven in response to circumstances beyond his control. Faced with impending deafness, Beethoven said, “I shall seize fate by the throat; it shall certainly not bend and crush me completely” (1). Like Beethoven, the leaders in academic medicine should not only be resilient, but we have an obligation to society to identify creative solutions so that we can fulfill the AAP mission, as stated by Sir William Osler in 1885, “to advance scientific and practical medicine” (2). Never before have we had such advanced tools and the fund of knowledge to solve the ills of society. Indeed, Osler would be stunned to see the resources available to us.

Disruptive innovation as a driver of science and medicine