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When we think about leadership in trauma and acute care surgery, we are often reminded of the direct impact we can have beyond immediate patient care. Leadership is not just about making decisions; it’s about fostering growth within our institutions, among our colleagues and beyond the four walls of our centers. Importantly, leadership and its influence extend throughout the hospital and impact our trainees, mentees, colleagues, and peers alike. As guest speakers at the 2024 American Association for the Surgery of Trauma Annual Meeting Lunch Session entitled “Directorships, Leadership Roles, and Taking the Lead: Everything I Wish I Knew”, KB, JWS and DMS all shared their journeys and thoughts on the complexities, hardships, and rewards of leadership in their roles as clinicians, educators, researchers, and surgeon administrators. This work represents a summary of the lunch panel and provides insights for surgeons seeking to navigate similar paths in academic surgical leadership.