Rationale: The supply of research-oriented physicians is declining. Objectives: Define barriers to successful career development in academic pulmonary/critical care medicine and discover strategies that promote the recruitment and retention of research physicians. Methods: Focus groups and web-based survey of fellows and junior faculty in pulmonary/critical care and neonatology divisions in 2002. Primary survey areas were educational debt, mentoring, institutional resources, information needs, and academic productivity. Main Results: Monthly educational debt payments were a small fraction of junior faculty household income, but the debt/income ratio was larger for fellows and less for female faculty. The debt/income ratio was not associated with the perceived likelihood of an academic career. Respondents felt they lacked understanding of the roadmap to success and formal assistance in career development. Mentors were perceived as personally supportive, but less helpful in career development. Perceived likelihood of an academic career was most associated for faculty with institutional research support and for fellows with mentors' academic advising. Better research skills and more career development activities were associated with respondents having a PhD mentor. Perceptions about academic physicians' job security were pessimistic. Conclusions: Multiple factors influence decisions to pursue an academic medical career. In addition to alleviating financial pressures, academic careers may be aided by (1) providing more information about career pathways, job expectations, and success rates, (2) increasing career development mentoring and (3) implementing formal curricula similar to Ph.D. programs. For pulmonary/critical care medicine faculty, current Federal educational debt relief programs may have only a modest effect on academic retention.