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In July 2000, Dr. William Hazzard published an article in the Journal of the American Geriatrics Society entitled “So you think you want to lead an academic geriatric program?” My answer to that question the same month was “Yes,” as I agreed to become the chief of the newly established Section of Geriatrics at the University of Chicago. With about 3.5 years on the job now, I offer a more complete reply to Dr. Hazzard's query. Although his paper covered many important and practical issues to consider in looking at becoming a chief, this article provides a perspective on the academic geriatric leadership position based on a new chief's observations. Topics covered include pressures for and against becoming a chief, changing perspectives on goals and rewards, good help, mentoring, money problems/issues, support for the chief, and communication and relationships. It is hoped that these observations will be of use to geriatricians considering leading an academic geriatrics program and to other newly appointed chiefs. [ABSTRACT FROM AUTHOR]