The requirements for promotion from associate to full professor should be reviewed with the chairperson as soon as this promotion is secured. Some of the indicators of success at this level are highlighted in Table 2. Membership in most of the midlevel societies with fixed membership should be gained during this phase of your career. These include the Society of University Surgeons and many of the elite regional organizations (Central Surgical, Western, Pacific Coast, Southeastern). Most of these still require a strong presence as first author, some level of funding, and membership in the junior societies. Universities will look for more university and departmental service and perhaps more contact time with senior students and residents or fellows. At the same time, the faculty member must begin to demonstrate an ability to help promote and develop entry-level faculty, and make the transition from individual success to team success. Intermediate-level organizations, such as the Society of University Surgeons, which also has a fixed membership, may put heavy emphasis on your accomplishments, which means continuing to first-author papers and secure funding as the principal investigator. A good rule of thumb is that any manuscript worthy of publication in a major journal should be first-authored by the faculty member, whereas he or she can be senior author on others. Many people at this level will be promoted to division chiefs, section heads, or even hospital chiefs in complex AHCs with multiple affiliations. For some faculty at this level, clinical practice may become a major problem, which can be difficult to control. The traditional approach is to receive substantial hard-dollar support for 3 to 4 years after initial appointment, after which the dean or chair may expect you to generate more of your own income and, in fact, reduce your hard-dollar support at the end of this time. Again, this is a contract issue and should be discussed and spelled out at the time of your initial appointment to avoid misunderstanding later. In the past at most AHCs this was not a problem because the distribution of income was controlled by matching clinical volume with the number of faculty members. More recently, with diminished state support, deans and chairs may want you in the operating room more, generating your own income, which of course they tax, in addition to meeting all your other requirements for promotion. Once you become a busy clinician, you cannot turn this on and off at will. Some centers are able to control this somewhat through call schedules and hard-and-fast rules about referrals. However, once it becomes common knowledge that you are the surgeon the head nurse in the operating room sent her father to for his rectal cancer, you are going to be busy.