We present the results of an environmental analysis by the American Medical Association Council on Long Range Planning and Development to determine the key factors that are likely to affect the pediatric specialty in the future. Three factors were identified that are particularly salient to future pediatric practice: demographic trends, decisions by third-party payers, and public attitudes toward services for children. Less than half as many children per pediatrician is predicted for the year 2000 compared with 1970. Pediatricians are likely to face future constraints on reimbursement, particularly for cognitive services and for providing care to the growing number of children in poverty. One moderating effect may be laws enacted at the state or federal level mandating basic insurance coverage for child health supervision services. The public interest in children's services will influence future access to pediatric care for children and the compensation that pediatricians receive for children in poverty. In light of these issues, organized medicine may seek means to adjust to and also to shape the environment in which pediatric practice is to occur in the future.