Governments and the policy-making bureaucracy are faced with all of the challenges currently facing academic health sciences centres (AHSC). Traditionally, AHSCs and their faculty partners were key players in the development of policies that defined the directions of the healthcare system. A better understanding of the determinants of health, demands for new community services and an inflexible workforce are forcing governments and policy-makers to re-evaluate the role and responsiveness of AHSCs as directions are set for the system of the future. AHSCs must engage policy-makers f they expect to continue as a major influence in the direction of a Canadian publicly funded health system.