I made the difficult decision to become the leader of a department of dermatology approximately 1 year ago. At that point, it immediately became incumbent upon me to begin my education in the financial aspects of managing a clinical department in an academic health care delivery center (AHDC), a job of increasing complexity and challenge due to the financial constraints imposed on such institutions by the managed care (managed cost) revolution in medicine. This was an especially daunting process because until that time, I had actively avoided involvement in the murky swamp of departmental finances and personnel management. Even as a vice chairman of a clinical department for 9 years, I was for the most part spared from such swamp lurking by the benevolence of a highly supportive chairman (Paul R. Bergstresser, MD, University of Texas Southwestern Medical Center at Dallas).