Relations between departments of internal medicine and their cardiovascular divisions are strained in many U.S. medical schools at this time, sometimes to the serious detriment of all concerned patients, trainees, and faculty. The editor of this Journal has invited me to comment on this problem, and to offer suggestions as to how a solution might be approached. It is necessary first, particularly for the non-American readers of this Journal, to review briefly the organization of departments of internal medicine in the U.S. These departments are large always the largest in the hospital and medical school and often the largest in the university as well. Their size is commensurate with their broad missions and responsibilities, which consist of: (1) the transmission of knowledge (education) to (a) undergraduate medical students (preclinical and clinical); (b) postgraduate trainees (residents in internal medicine and subspecialty fellows); (c) practicing physicians (continuing education); (2) the generation of new knowledge, i.e., the conduct of basic and clinical research; and (3) the application of medical knowledge, i.e., clinical practice. While these responsibilities are shared by other clinical departments in medical schools and teaching hospitals the breadth of internal medicine. encompassing virtually all non-surgical, non-obstetrical conditions of adults accounts for the large size of departments of medicine. The departments are organized into a number (generally 10 to 20) of divisions, which constitute the working units of the department; these divisions correspond to the organ-system oriented subspecialties of internal medicine, such as cardiology, nephrology, gastroenterology, etc., as well as diseaseor discipline-oriented divisions such as oncology, immunology, infectious diseases, human genetics, gerontology, primary care, clinical pharmacology, etc.