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Health-care organizations have recognized the need to prepare physicians for various leadership and management positions within their own institutions. The demands of a dynamic health-care environment have created increased pressure for institutions to develop a larger cadre of physician leaders and managers among their staff, and this must be done cost-effectively and efficiently. In the past, physicians who wanted more education had to look beyond their practice to fulfill this need. Institutions have begun to create tailor-made programs for their physicians in order to meet the various needs of their staff regarding leadership and management. Herein we describe the educational initiatives undertaken in 1995 and 1996 to provide Mayo physicians with in-house leadership and management programming. A substantial number of institutions are answering the challenge for increased physician expertise in leadership and management through the development of their own in-house programs.