A vision type of discussion focusing on how leaders evolve their organizations. However, though thought provoking, a significant difficulty with the premise of a “head buffalo” becoming a “lead goose” is the implementation of the concept in the health care practice setting. Although a practice can have cross training and empower employees to act to help fulfill their personal position mission and advance the organization, the flight of the geese, in my view, appropriately stops there. The doctor must set protocols that in other business contexts could be left to rotating lead goose but in a practice cannot. You might see it otherwise!