An academic medical career traditionally revolves around patient care, teaching, and scholarly projects. Thus, when an opportunity for a leadership role arises, such as division chief, the new leader is often unprepared with little or no formal leadership training. In this focused review, academic leaders of the Association of Pulmonary, Critical Care, and Sleep Division Directors describe several leadership concepts adapted from the business sector and apply their years of experience to aid new division chiefs with their first day on the job. The first 90 days are highlighted to include achieving early wins; performing a division-wide Strengths, Weaknesses, Opportunities, Threats analysis; establishing division rapport; redefining the division infrastructure; avoiding conflicts; and managing the relationship with the department chair. The five levels of leadership applicable to academic medicine are discussed: position, permission, production, people, and pinnacle. Finally, emotional intelligence and behavior styles crucial to leadership success are reviewed.