The health care industry is in the middle of a disruption. For the first time in decades, less than 50% of practices are physician owned. This is despite the fact that the research shows better patient outcomes with physician led systems. While there are many reasons for this, one of the major reasons is because physicians lack business skills and so avoid the business of medicine altogether. Physicians need to add business skills to their clinical skills in order to no only take great care of their patients but to also build the thriving systems needed.