Anatomical pathology, especially the clinical subdisciplines of surgical and cytopathology, has a distinguished but relatively short history. Prominent in clinical medicine for less than 80 years, these subdisciplines are currently in the midst of significant change. Visions of the future have been  discussed in several recent articles [1-5]. Many if not most of these have emphasized information technology, methods to ameliorate diagnostic errors, and the value of adopting consensus-based guidelines for processing and reporting. Focused in this way, one might view changes in anatomical pathology as a matter of altered methodology. In my view, something much more fundamental is evolving. The changing paradigm can be considered not so much in terms of how we do things but in terms of who we are and what we are becoming. I believe that these issues have received insufficient emphasis and deserve more discussion. This presentation will use selected elements of pathology practice to emphasize the great paradigm shift in which anatomical pathology finds itself. The discussion is divided into 5 parts: technology, the clinical medical literature, authority, money, and subspecialization.