The future of academic healthcare will bring changing legislative requirements, increasingly complex business structures, and new modalities of care. The administrator will balance these while finding funds to support furthering education and research in an era of declining reimbursement. Change is likely our only constant in the foreseeable future. This presentation looks at the attributes of an administrator and of administrative structures in the years leading into the era of health reform. It assesses trends likely to continue in the coming years and explores ways that administrators and administration are responding to the growing need for specialized skills maximized for limited resources and essential efficiency.