Abstract: Anne learned quickly when she came to Boston that running a department meant she spent most of her time taking care of the fallout from some troublemakers and less time on productive team players. Anne highlighted the issues surrounding conflicts of interest; they were inevitable and common but difficult to navigate. Hospitals competed for people and resources. For example, Anne told the story of a young woman who was caught in the midst of secret moves by two hospitals to obtain resources from a third hospital all the while setting the woman up for national embarrassment. After being announced publicly that the woman had been appointed to a prestigious position, the offer from the first two hospitals was suddenly rescinded and her boss and mentor at the third hospital was appointed instead. The woman was told by the chief medical officer at the Brigham that she no longer had the appointment because the hospital had decided to appoint her boss at the Beth Israel Hospital to the position. She was shocked.