A family physician was appointed director of the Adolescent and Youth Medicine Service at the Montreal Children's Hospital. He was assigned a leadership role in the adolescent outpatient clinics and the adolescent inpatient ward. As team leader, he coordinates the work of allied health professionals and provides personal ongoing care to patients, fostering a comprehensive care approach in service, teaching and in links with the community. There are of course certain conceptual and practical problems in the situation of a primary care physician in a tertiary care setting; university departments of family medicine must face the challenge of altering consultants' thinking about their role.