Elsewhere in this issue, Kastor details the merger and demerger of New York University (NYU) and Mount Sinai hospitals and medical schools. Academic medical center mergers are difficult endeavors to execute under optimal circumstances. The failure of the NYU–Mount Sinai merger was inevitable on the basis of preexisting cultural distinctions, lack of substantial faculty and staff support, and the inability to generate significant early accomplishments that were meaningful to the respective constituencies. Economies of scale and improved academic performance are challenging for merged medical centers to achieve in the short term—caveat emptor. The authors of this commentary discuss, from the NYU perspective, key lessons learned and offer insights about how certain difficulties could have been addressed.