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Historically, a generation of pediatric psychologists was trained and expected to function effectively in the roles of clinician, researcher, and mentor. There have been significant changes in the delivery of health care and in the competition for grant funding that have made it challenging to function at the highest level in each of these domains. The metaphor of the “triple threat” needs to be reexamined in the context of these changing demands. Further, there are potential directions in the area of clinical program development, including focus on health promotion and integrated primary care, and in the area of research, which may allow us to maintain our leadership role in delivering health care to children. Important directions in both clinical and research arenas are to develop truly integrated teams of care deliverers and scientists and demonstrate both the effectiveness and the cost effectiveness of our interventions. We would be well served by collectively taking on the missions of advancing research, developing effective clinical programs, and providing outstanding mentorship for our students, without relying on a single pediatric psychologist to excel in each of these domains.