Vital, productive faculty are critical to academic medicine, yet studies indicate high dissatisfaction and attrition. This article identifies key personal and cultural factors associated with intentions to leave one’s institution and/or academic medicine. A survey asking about advancement, engagement, relationships, diversity and equity, leadership, institutional values and practices, and work–life integration was completed by 2,381 faculty members from US medical schools. Findings suggest that academic medicine does not support relatedness and a moral culture for many faculty. If these issues are not addressed, academic health centers may find themselves with dissatisfied faculty looking to go elsewhere.