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Describes the strategic opportunities and challenges faced by a medical products distribution company in a rapidly changing market. Physician Sales and Service (PSS), founded by Patrick Kelly in 1983, operates in 20 states in the United States and intends to expand to 50 states by 1997. By charging premium prices for high quality service, training its sales representatives intensively, and professionalizing management, PSS has achieved above-average profit margins, and apparently, successfully coped with the organizational challenges of rapid geographic concentration. But now, in 1992, PSS must cope with the uncertainties of Bill Clinton''s impending election to the U.S. presidency and his promise of sweeping health care reform.; To discuss the challenges of building a self-sustaining business in the face of capital market constraints, industry consolidation, and rapidly changing regulations. Issues to be discussed include the management of radical strategic change, the advantages and disadvantages of going public, the risks and returns of rapid geographic expansion, and the cost- benefits of a strong culture.