Largely stable over the last three years, the Syracuse health care market continues to grapple with the challenge of finding the right level and mix of hospital capacity. The community has long had four general acute-care hospitals—one public academic medical center and three private, nonprofit hospitals—serving a relatively small population. Previous attempts to trim inpatient capacity through consolidation all ended in failure, with merging hospitals unable to resolve differences in physician cultures, business philosophies and management styles. The most recent proposed merger—public Upstate University Hospital’s acquisition of private Community General Hospital—did come to fruition in mid-2011, as most observers had expected. If this merger proves successful, it will allow Upstate University Hospital to relieve acute capacity constraints and Community General Hospital to reverse the recent exodus of physicians and patients—thus remaining a viable service facility.