There has been a growing recognition over the past 25 years that it is increasingly difficult for physicians to develop careers as physician-scientists. This commentary reviews the traditional culture of academic medicine, factors that are altering that culture, and several grassroots suggestions for revitalizing academic medicine in our departmental programs. It is based on a presentation, "Basic Scientist or Translational Scientist? Changing Roles of Physician-Scientists in Biomedical Research," delivered in the President's Symposium at the Thirty-First Midwinter Meeting of the Association for Research in Otolaryngology on February 17, 2008.