In recent decades, departments of medicine have grown enormously. More recently, however, there have been suggestions that certain subspecialties (that is, cardiology and oncology) reconfigure as categorical disease centers with an eventual weakening of ties to departments of medicine. Recent trends in health care make such a change undesirable. More and more, general internists will direct and coordinate the care of patients, and fragmentation of departments of medicine will make this task more difficult. The need to practice and teach cost-effective medicine and analyze patterns of care will require a closer working relationship between general internists and specialists. To accomplish these goals, a unified, rather than a fragmented, department of medicine is required.