On April 8 and 9, 2006, District I of the American College of Obstetricians and Gynecologists (ACOG) held a retreat to assess the future of the specialty. The retreat leaders were Dr. Fredric D. Frigoletto Jr, MD, and Dr. Michael Tesoro, MD. Dozens of issues were identified, analyzed, and prioritized for action. The participants identified the twin goals of continuing professional development and improved patient care as critical and central to the healthy evolution of the specialty. The participants also identified nine major issues that greatly influence our ability to realize these twin goals. The nine issues include 1) ensuring career longevity, 2) balancing family life and work life, 3) optimizing residency training and medical student recruitment, 4) developing the careers of a cadre of physician-scientists, 5) enhancing competency-based continuing professional education, 6) supporting practice development, 7) improving patient safety, 8) securing patient access to care, and 9) advancing our legislative agenda, including tort reform. The retreat leaders identified the need for the specialty to develop a “road map” to constructively address these key issues.