Changes in medicine brought on by health care reform will increasingly pressure physicians and physicians-in-training to adopt business or trade strategies in the name of cost containment and of competition in the health care marketplace. These strategies run directly counter to the professional standards and are a potential threat to medicine's status as a profession. A challenge for this generation of students is not to let this emphasis on finances erode medicine's professionalism. Medical faculty must ensure that their students properly understand the nature of the relationships that permit medicine to enjoy the benefits of being a profession (rather than a trade) and that they learn the appropriate balance between financial and professional considerations. Faculty can and should place financial considerations in proper perspective. Students should learn the basic components of professionalism, how physicians in the past have not always met the full criteria for professionalism, how the current emphasis on cost containment could threaten medicine's status as a profession, appropriate goals for health care reform, the need to form new alliances to meet those goals, and criteria for forming appropriate alliances. Armed with this knowledge, the generation of physicians now in training can understand the delicate balance that must be maintained between financial exigencies and professional imperatives. They will then be prepared to participate in the reform process, embrace its positive aspects, and argue effectively against its negative ones.