Pat Cawley, MD, MBA, FHM delivered a speech outlining in broad strokes how we have flourished as a professional society, even during the short stint that he has been President, including the Fellowship and several multi-site QI efforts (such as project BOOST). Challenges to be forewarned about include balancing workload and workforce, and fixing operational issues (such as patient discontinuity and readmissions). There is only 1 way to fix these problems, by thinking about new and different ways to care for patients to balance out the discrepancy between workload and workforce. We will need to get creative in the ways we spend our time and how we allocate responsibilities (to multi-disciplinary care team), to maintain quality while improving efficiency. It is up to hospitalists to be proactive in re-designing care delivery, and ensuring that appropriate outcome measures are tracked longitudinally to make sure we designed it well. We all need to gain the skills (leadership skills) and emotional commitment to lead this charge.