Academic medicine seems under pressure. The revolutionary changes in the practice of medicine of the last decades, the continuing demands for educational reform, decreased appreciation of the medical profession, budgetary constraints, and a variety of medical ethical issues have shaken up academic medicine and interest in an academic career seems to be waning. In this paper these issues are discussed from the viewpoint of a pathologist. The present situation can also be perceived as a challenge, which offers new opportunities. Better appreciation of educational efforts, more emphasis on the intellectual rather than the technological challenges of modern medicine, reconsideration of the strong tendency for super-specialization, recognition of originality and dedication over academic hierarchy and rethinking of strategies for development of patient-oriented research are briefly discussed