Medicine has evolved dramatically over the past half century. We have witnessed the emergence of the National Institutes of Health as a driver of the research enterprise, the advent of Medicare and Medicaid paying for care that used to be either nonexistent or deemed charity care, the development of “big pharma,” large hospital companies, venture capital investment in health care, and other similar developments. How has this new reality of health care—the medical industrial complex1—altered the world of academic medicine and the nature of faculty positions?