Several key points will facilitate the success of mid-career surgeons as they join the military. First, they have assured themselves that they can align their goals and objectives with the goals and objectives of the military health system. Second, the direct accession surgeon maintains patience as they are incorporated into the military health system, which moves at a different pace and has different pressures. Third, the mid-career surgeon remains flexible. The military health system will provide opportunities that may not be immediately apparent to mid-career surgeons as they take their oath of office. Mid-career surgeons will likely identify opportunities to positively impact the military health system. After gaining knowledge of the military health system, the direct accession surgeon can be an agent of change. Even before assuming formal leadership positions, the newly onboarded surgeon can be an informal leader by using leadership techniques that have proven successful in their civilian careers. After gaining tenure and formal leadership positions, the direct accession surgeon can be a powerful influence to enhance the military health system.