Despite exhortations made by some of our most able leaders about the need for leadership 1-4, this need continues to be unmet. Of increasing concern is our belief that orthopaedic surgery is falling behind in the creation of new leaders for our specialty. The relentless intrusion into the practice of medicine by industry, government, business, and insurance companies, especially in the last twenty years, has created a need for a substantially larger number of individuals who will donate a considerable portion of their time to management, organizations, and leadership to serve the specialty. Furthermore, as the number and complexity of institutions and organizations increase, the number of orthopaedic surgeons who are needed to donate their time to the organizations seems enormous. In addition to the time spent in clinical practice and personal life, our specialty is asking individuals to use their valuable time to do volunteer work in orthopaedic organizations. Given the increased pace of life and the demands of the profession and/or family, it is no wonder that there is concern about the diminishing voluntary participation of individuals in organizational activities, as described by Putnam et al. in the masterpiece, Bowling Alone: the Collapse and Revival of American Community 5. In the past, the few individuals who were needed to lead the small number of relatively simple orthopaedic organizations usually came from academic backgrounds. These few individuals became department chairs, and many went on to become organizational leaders. Now, however, not only has the number of leaders that are needed increased exponentially but the necessary skill mix of the leaders has changed dramatically. In the past, leaders were skilled in clinical practice, surgery, teaching, and research. They were chosen for leadership positions because of their excellence in the traditional triad of academic medicine: teaching, research, …