The American College of Obstetricians and Gynecologists (ACOG) Presidential Task Force on Changing Practice in the 21st Century developed a list of practical goals or recommendations that ACOG or our members can implement, to improve practice satisfaction and ensure survival in the twenty-first century. Three areas of focus were 1) Patient Safety and Risk Management; 2) Practice Economics and Efficiencies; and 3) Workforce Changes. Recommendations in each area were subdivided into what ACOG might implement and what members can do themselves. Recommendations for ACOG to consider include enhancing the ACOG Web site; developing model protocols, informed consents, and electronic medical records templates; continue lobbying for tort reform, but also work on alternative concepts; help develop "reentry" guidelines; expand the Practice Management division to provide more tools for practices; and help develop models to allow more practice style diversity. Recommendations for ACOG members were to reduce variation in practice patterns, using standard tools; automate routine tasks with electronic tools; work cooperatively with other providers and practices; participate in emergency drills, "time-outs," and other risk reduction training; mentor new associates; and learn from them too.