Background: Changes in health care delivery and funding have placed strains on academic medical centers' ability to meet their multiple missions. To gain insight into how this new academic landscape is affecting academic primary care, this study examined the current status and perceived challenges at nine departments of family medicine at allopathic and osteopathic medical schools.

Methods: Site visits were made to nine academic departments of family medicine where key informant interviews were conducted with several individuals in key leadership positions. Sites were chosen to maximize diversity among departments along a variety of factors, such as location, size, mission, and type of school (private versus public). Interviews were transcribed and analyzed by a three-person multidisciplinary team for key themes.

Results: Analysis of interviews revealed five major challenges for academic departments of family medicine: 1) adjusting to new clinical demands in the academic health center, 2) organizing and administering new initiatives in community-based education, 3) recruiting and retaining faculty, 4) developing and maintaining research capacity, and 5) serving multiple missions (education, clinical care, and academic pursuits) in times of financial restraint.

Conclusions: Significant challenges face academic departments of family medicine. The success or failure of departments of family medicine to meet these challenges could serve as a bellwether for how primary care fits into the future overall scheme of academic health centers.