F i h c i p he average tenure for chairs of departments of internal edicine at US medical schools has decreased from .272 years in the 1970s to 3.997 years in the 2000s 2000 to 2006). During the past 4 decades, the average ength of an interim (or acting) chair’s tenure increased rom 1.353 years to 2.355 years. These trends indicate hat the leadership of departments of internal medicine s becoming increasingly destabilized. Becoming chair of a department of internal medicine t a US medical school has shifted from the capstone of successful career to a stop on the way to other posiions, such as dean of a medical school. The chairs of esterday are now running centers and institutes, servng as vice deans for research, or leaving academic edicine to pursue other professional opportunities. cademic medicine has become more corporate: deartment chairs run “business units” rather than build cademic programs in education, research, and patient are; mentor students, residents, fellows, and faculty; or each, conduct research, or care for patients. This shift raises fundamental questions about the kills, knowledge, and attitudes necessary for chairing epartments of internal medicine in the future as well as oncerns about the amount of money medical schools pend to replace chairs. These costs include retaining earch firms, involving faculty and staff in the search, nd providing packages to entice the most appealing andidates.