Despite a lack of governmental legislation, health care reform in the United States will continue secondary to market (insurer) forces. Various motives underlie the forces driving this reform, with patient care issues (sadly) being absent from the top of most lists. One can strengthen a rheumatology practice in concert with these reforms through various means. Continuous quality improvement, expanding your patient base, improving efficiency, decreasing overhead, increasing knowledge of your worth, and expanding your roles are key points discussed in this article. Rheumatologists have the tools needed to be successful and to make important contributions in the present health care era.Musculoskeletal diseases will continue to increase in prevalence, and the need for ongoing care, education, and research will expand. Rheumatologists can not only strengthen their practice but are also well positioned to be leaders in delivering costeffective, quality care to patients with musculoskeletal diseases in the United States and other countries.