In the early 1980s cardiology was dominated by “triple threat individuals” – doctors who were the very best clinicians, very best researchers, and very best teachers. This type of individual usually became the director of the division. Now, however, the amount of knowledge and specialisation in each of these three areas of expertise has exploded. It is not certain that triple threat individuals can or do exist today. Instead, we need to be aiming higher, for a “quintuple threat profession”. Not only do we need expertise in clinical care, teaching, and research, but also we now require business leadership and alignment. No single person can be expert in all five of these areas. In paediatric cardiology we need to invest in the right people. Our new “quintuple threat profession” needs to match the expertise and passion of the right people with our current and future needs. Going forward, we should focus on leadership, teams, and alignment. We need to identify, develop, and empower leaders at all levels within our profession, including physicians, nurses, and hospital administrators. Ultimately, we need a profession that remains clinically led, but professionally managed. The second step of the formula is the development of successful teams, and teamwork. Successful “team behaviour” is not a part of traditional medical education. The third step is alignment. Alignment can be defined as representing the degree to which physicians and organisations, such as hospitals, acting out of enlightened self-interest, operate inside a common vision, mutual goals, and the acceptance of a shared destiny. Imagine the benefits to our profession and our kids if we can provide a new level of leadership, teamwork, and alignment going forward.