I recently had the privilege of being part of the faculty for the ACR’s practice leaders’ meeting, and I came away not only impressed by the intellectual bandwidth of the leaders in attendance, but equally impressed by what the college itself is doing on behalf of the profession. It is no secret that these are difficult times for radiology, and practice leaders are being tested in new ways (for which many are, frankly, unprepared). As I understand the mission, this is precisely the reason that the practice leaders’ annual conference was established not that many years ago, and it is why attendees have continued to look forward to its focus on broad contemporary issues and leadership themes. Those whom I met were well aware that they will be greeted by new management expectations as the profession becomes more complex, and they were only too happy to network and exchange ideas with their peers throughout the session. My basic takeaway was this: It’s all about business. Never before have I been so convinced that the business side of the practice of radiology should take (has taken, really) center stage in the real-life drama called the modern practice of radiology. Never before has there been such a need for true leadership, that often elusive quality in managers that transcends mere strategy and, when done well, results in aligned organizations that are better prepared to meet the challenges of the day. In past years, I have often been discouraged as I scanned the pool of available talent, searching for those who would lead the profession into whatever is next, that which is new, and the roads less traveled. Innovation was often nonexistent, and organizations seemed more interested in being process driven than in being truly entrepreneurial. My sense is that it might have been because times were so flush that many people thrived despite their uninspired leadership and complacent attitudes. Don’t get me wrong: We have seen some great leaders through the years. What I am talking about is seeing them more frequently than what might be viewed as exceptional. I give a lot of credit to the ACR for its commitment to developing the business side of radiology and, in the process, helping to nurture and bring to the surface a generation of practice leaders who are reshaping the profession. These physicians are building practices that are more confident, focused, and aligned to meet the multiple challenges that they face: increased competitiveness, fewer resources, closer scrutiny, a restless constituency, and democratic models of practice that are slow to change. The challenge now, for the ACR and the current group of practice leaders, will be to develop plans for succession to the next generation. It was hard not to notice that the baby-boom generation was well represented in the current community of practice leaders, and it will not be too many years before these radiologists are ready to hand over the reins to the generation coming up through the ranks. They will need some help in getting this done, and I am encouraged that the ACR is poised to help with that transition. With a few more such conferences under its belt, the college will have built a strong foundation for what should become the practice leader’s business school of choice. Curtis Kauffman-Pickelle is a strategic business consultant to more than 30 imaging centers and radiology practices, and is CEO of imagingBiz, Tustin, California. He welcomes your comments at ckp@imagingbiz.com.