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Financial management is often an area that physician leaders have not yet developed experience prior to assuming their leadership role. The complexity of clinical reimbursements, research funding sources and institutional compensations has greatly increased the management demands for physician leaders. Fortunately, department chairs, and most division chiefs, often have an administrator available to share this responsibility. In this conversation of members of CareerPhysician’s Child Health Advisory Council, experienced leaders reflect on the nature of this relationship and how it might be maximized.