Ethical issues faced by a department chairperson

There are numerous ethical dilemmas faced routinely by department chairmen. Herein, we attempt to describe the responsibilities of a chairperson and then discuss some exemplary ethical issues that they are often required to handle, including. (1) How should a chair deal with the potential undermining of established doctor-patient relationships when a patient comes to the tertiary medical center? (2) What demands can a chair require of volunteer faculty to ensure the success of the department? (3) How should a chair deal with promotion issues and mentorship? (4) How should a chair deal with performance issues? We offer opinions and cite existing data, but we ask the reader to recognize that very few peer-reviewed publications are available on these topics. We hope that in the future these ethical conundrums will be addressed more frequently in medical journals.