It is more than 25 years since movement in rebates for pathology have been adjusted by negotiations based on the movement of the costs of provision of services. The pathology industry has relied on growth in demand and industry restructuring to deliver an efficiency dividend to the community and profit to providers. The industry faces decreasing opportunity for efficiency gains and continued growth in demand is not guaranteed. The public sector suffers collateral damage as those services provided by them to private or community based patients are delivered without the opportunity to achieve the efficiencies of the private industry. With an increasing range of tests and an increased emphasis on preventative medicine, the challenge is to provide sufficient funds to underwrite the current and future appropriate use of pathology. The Commonwealth, as the major underwriter of health services, needs our input to decide how to get best value out of the available funds and be confident that the money spent delivers necessary services of an acceptable quality and that they are affordable and accessible to our community. They do not readily invite our strategic involvement and are wary of those inputs which appear to be based on self-interest. The enviable quality of Australian pathology is threatened by the absence of an effective strategic interface between laboratory professionals, funders and the community.