The department chair has a broad sphere of influence in which to promote diversity. The most immediate sphere of influence is on the department physicians(faculty, residents, and fellows) as well as administrators and support staff. The chair also can potentially influence this same group of individuals throughout the medical school as well as throughout the hospital. In addition, the chair can be extremely influential in her or his interactions with the community. Effectively promoting diversity can be accomplished by terminating the employment of individuals who discourage or minimize diversity, educating those who ignore diversity, and cultivating and encouraging constituents who value and manage diversity. If our goal as orthopaedic surgeons is to provide the most effective care to our diverse patient base, we must expand our level of care beyond the "three A's" that have for so long determined clinical success-affability, availability, and ability-to the "four A's:"affability, availability, ability, and awareness.