Academic surgery is a microcosm of the greater academic medical enterprise—albeit with some admitted idiosyncrasies. Most of the issues and challenges are common to other areas of academic practice, but the means by which academic surgeons meet these challenges will be different. Along with continuous process improvement, future innovation is imperative in virtually all areas. Some specific solutions to challenges in clinical care that academic surgeons should pursue include promoting both evidenced-based and more uniform, quality surgical clinical care; incorporating more efficiency into the clinical care environment; continuing to develop minimally invasive technology and techniques; and implementing the use of prospective clinical databases in real time. Goals of surgical education should include using simulation technology, standardizing technical evaluation techniques, incorporating more basic science, and focusing more on professionalism. Lastly, the surgical research enterprise needs restructuring (including a new process for making decisions regarding who receives resources), strategies to improve extramural funding, and new approaches for selecting foci for surgical research efforts that build on differentiated strengths related to surgical practice.