Since World War II, multiple changes have occurred in medicine that are now affecting academic health centers and department of surgery chairpersons. None of these changes by themselves were intended to adversely affect department of surgery chairpersons, but the sum total effect constitutes a negative external force. In addition, there are internal forces in the schools of medicine and university hospitals that may negatively affect department of surgery chairperson in fulfilling the stated goals of excellent patient care, teaching, and research. Many of the problems brought about by these negative forces cannot be solved by a single department chairperson. However, individual department chairs can contribute to the solution by returning to the values taught to them by the role models of their surgical training.