The discipline of academic general pediatrics (AGP) has been the foundation of the medical specialty of pediatrics since those caring for children became differentiated from practitioners of internal medicine. Virtually every academic medical center has been populated with generalist physicians who engage in patient care, teaching, research, administration, and advocacy. Often these individuals served as wise mentors who saw the need for further subspecialization in pediatrics and encouraged the development of academic careers that have resulted in advancing care for infants, children, and adolescents. Beginning with the certification of pediatric cardiology in 1961 to the certification of developmental-behavioral pediatrics in 2000, pediatrics has become increasingly subspecialized and focused. Yet however beneficial the forces of medical specialization have been,1 the value of those pediatricians who have maintained a generalist approach to their work has also been recognized. The role of the academic generalist has undergone change and challenge. A consensus conference was held to explore the evolution of AGP and to plan future directions of the discipline.