One of the many privileges of working in an academic medical center is the opportunity to share career advice from time to time with bright enthusiastic people who will become the medical leaders of the future. The following comments began as a series of after dinner remarks that I made to some MD/PhD students at the University of Iowa in 1998. Someone at the dinner suggested that I write them down. I added a few things in the ensuing years and these fifteen ideas now represent pretty much everything I know about succeeding in academic medicine.