As the managing partner of an eight provider primary care clinic, I am well aware of the challenges that face medical groups today. As with any successful business, a clinic cannot function without the careful coordination of operational effectiveness and service delivery that translates into back office/managerial functions and clinic service. There is, however, another aspect of the business of medicine that gets little attention from most clinics–strategy. Physicians ignore the vital tool of business strategy at their own peril. Business strategy can result in improvements in operations and care delivery. It can also result in innovations that improve the profitability of individual practices and address the economic crisis of health care in general.