Seventy percent of physicians are now employed by hospitals or corporations. Health care systems based on primary care have better quality of care, better population health, greater equity, and lower cost. There is a national trend toward maximizing clinical productivity of faculty, which reduces the amount of time available teach and to meet administrative responsibilities and accreditation requirements. This may reduce the ability to train needed new family physicians. It is critical that family medicine educators understand the drivers of health system decisions in order to effectively partner with health system leaders to advance excellence in family medicine education and practice. This interactive workshop will provide participants an inside look at how health systems financing, structure, and culture impacts decisions made at the health system level that impact primary care models, family medicine scope of practice, and investment in family medicine education. A variety of didactic and hands-on teaching strategies will deepen participants’ knowledge of business and cultural factors that drive health system decisions and prepare them to lead strategic conversations to advance family medicine at their own institutions.