Health care, and the organizations of physicians involved, is in transition. More and more, the terms of an overall policy depend on the largesse of business. As Victor Fuchs1 has pointed out, employers will offer a defined benefit to employees, thus shifting the burden of health care costs. When and if the political system allows, and only then, will there be a real change toward universal health insurance. Until that time, it is important to absorb very carefully the message of Drs Schwartz and Tumblin, ie, that we must develop leadership that is transformational, situational, and servant in style so that the health care we offer can be adaptable, flexible, team driven, communicative, knowledge creative, and consumer loyal.