This book serves as an insiders guide to careers in academic medicine. The author shares his 45 years of experience as a clinician, teacher, researcher, and administrator. His journey has often taken unpredictable turns and the book offers practical guidance to becoming a successful physician scientist in academic medicine, or to become a successful clinician affiliated with an academic medical center.  Divided into four parts, the book begins by focusing on academic medicine as a complex system. This is followed by parts on academic duties, academic life, and concludes with words of wisdom. These sections and subsequent chapters are tied together by the scholarships of discovery, teaching, application, and integration. To pursue research, practice, teaching, and administration, scholarship should be the core value of every physician.