Many different programs define themselves or are defined as residential treatment centers (RTCs). These range from small, freestanding, private, nonprofit programs to subacute units within large, for-profit health care systems. This article focuses on the role of the physician leader in community-based, nonmedical institutions. First, the physician’s role in an RTC is to optimize clinical outcomes through direct service, teaching, training, coaching, and consulting with the child and family and the child care, multidisciplinary, educational, and administrative staff. Physician leaders are needed to integrate and translate the various assessments of the child’s needs and strengths into a coherent narrative that can be used for treatment planning within the RTC and in the child’s home and community. Second, physician leadership can help ensure that programs remain family-centered and that they use the best available evidence-based practices. Third, physician leaders must help the RTC to develop and sustain its unifying theory of treatment and to use this theory to guide its practice, mission, and vision. Physician leaders in RTC must be “trilingual and tricultural” and adept in the mental health, special education, and child welfare systems to be effective advocates for youth and their families.