Dr. Felton Wayne, the chief medical officer for North Carolina operations at Valley Health (VH), had been working incredibly hard for the past nine months trying to motivate and empower his medical staff, who had become disillusioned by VH's management practices. But he had little to show for his efforts. He felt unappreciated and ineffective in his role. After a tense meeting with his director, during which Wayne was called a "cowboy," he wondered whether he should just go back to doing what he was good at?taking care of patients. This A case is accompanied by a B case (UVA-OB-1075).