Kiss a bunch of asses and do your boss dirty work. Imz training, training new grads, a bunch of extra projects, clinical work, top imzer, chime in for "new" ideas and pretend you know more than every one at the meeting/conference call, etc and cross your finger they might just like you enough to promote you. Wait until one of the DM retires. You could be waiting 5-10 yrs, then some new grads manager 2 yrs in, better looking, taller, more charming then you, more likeable to your boss, steal the spot.