Medical schools in the United States have approximately 166,000 faculty members (Fig. 1.1). The vast majority, about 121,000 (73%) individuals, are physicians, but faculty appointments are also held by many other health professionals .These clinicians have chosen academic practice despite the many career opportunities available in health care. In addition to the individual faculty member, many others including patients, learners, colleagues, institutions, and society have investments in clinicians enjoying long and productive careers in academic medicine. Unfortunately, the evidence points to widespread and deepening dissatisfaction with academic careers. While escalating demands for patient care and educational services are major factors in faculty dissatisfaction, the systems for academic promotion are part of the problem.