Managed care is not a new concept to a majority of the health care professionals in the United States. However, certain health care markets historically are more competitive than others, particularly on the West coast and in the Southwest. These areas were the proving grounds for a now well established national trend. Managed care is now beginning to make strong footholds in eastern seaboard communities. As managed care companies gain market share in the East, orthopaedic offices must learn to successfully cope with numerous changes to their office routines, patient populations, and reimbursement levels.