Advantages and disadvantages of academic tenure for clinical faculties, including an appraisal of its financial burdens, the utility of modified or alternative systems, and the issue of abolition of tenure, were examined through a questionnaire to which deans and faculty representatives of 106 American medical schools responded during 1975-76. Tenure is valued by most deans and faculty members. A flexible tenure policy permitting appointment of some faculty members to senior academic posts without tenure was endorsed by the deans of 10 selected medical schools who were interviewed. Growth of medical faculties is decelerating; a steady state has not been attained but is imminent. Financial pressures and demands for change will increasingly challenge the tenure system.