The financial consequences of major changes in the financing of health care have affected academic health centers disproportionately, threatening the very survival of some, even when they are vitally needed in their communities. This report describes one model to respond to these changes, which uses the strengths of 2 academic health centers for mutual benefit. Meharry Medical Center and Vanderbilt University Medical Center, both in Nashville, Tenn, formed an alliance, with surgery as the first area of focus. The Meharry Medical Center–Vanderbilt University Medical Center Alliance was formed in 1998 and was designed to preserve the integrity of each institution while advancing the student teaching program at Meharry Medical Center, broadening Vanderbilt residents' clinical experience, and providing enhanced opportunities for research at both institutions. Surgery was the first program developed in this alliance, and we report the results to date. Quality faculty have been recruited, cross credentialing has been accomplished, and several programs have been shared. This has resulted in increased surgical volume, improved contracting with managed care organizations, and enhanced research opportunities. This model is working and expanding to the benefit of both institutions.