American medical schools in the year 2049 primarily consist of 2 types of faculty (Exhibit A, top). The first category includes full-time, practicing clinician-teachers who deliver excellent medical care, teach medical students to do the same, and conduct contracted clinical research for pharmaceutical companies. The second category is composed of basic scientist-teachers, whose primary function is to deliver preclinical teaching to medical students and who commit a limited amount of time to perform bench research. In contrast, the American medical schools of 50 years ago had 2 other kinds of faculty (Exhibit A, bottom). First, there were PhD scientists whose primary activity was basic research, who had a somewhat limited teaching role other than supervision of thesis projects by graduate and medical students. Second was the now-defunct category of biomedical researchers once called the “physician-scientist,” who conducted varying combinations of patient-and disease-oriented research, or basic research, while also participating to some extent in teaching. After reviewing all available data, this commission concludes that the single major factor responsible for the decline of American medical schools is the disappearance of the physician-scientist, with the flight of basic researchers to nonmedical institutions and to other countries being a secondary consequence.