Is this article present a strong argument? Conflict can, of course, happen anywhere within an integrated system. The nature and seriousness of the conflict are dependent to a considerable extent upon the sponsorship of the integrated system and the stage of development of the system. When the integrated system is developed by a hospital, then all of the well-worn pathways by which conflicts have been expressed in the past can be opened up. Enormous pressures can be exerted by physicians upon the hospital board and management of the hospital. Either or both may be unequal to their task. The board will have to make sure that its members have the necessary financial expertise and general understanding of the new relationships involved in integration. The board must understand and be committed to the plans for integration and have the courage to stand its ground in the face of opposition. Management will need to be very clear about their goals and avoid being caught and pulled into competitive and exclusionary issues between physicians while yet maintaining a serious leadership role--no easy task. Physician members of the board will have to examine their competing and conflicting interests and when appropriate abstain from the decision-making process. It may be impossible for actively practicing physicians to participate in many of the fundamental decisions without being involved in conflicts of interest. It is among physicians that the most severe conflicts seem likely to occur