OBJECTIVE Conducted by a task force of the Association of Departments of Family Medicine, this study defines current issues in the clinical practice of academic departments of family medicine in US medical schools. METHODS A survey instrument on departmental demographics, funding, teaching, and governance in regard to clinical practice was sent to 130 family medicine department chairs or other key contacts in US medical schools. A total of 106 usable responses were obtained, for an 81.5% response rate. RESULTS Results indicate that, in response to a need to increase clinical practice income, academic medical centers (AMCs) and departments are increasingly hiring physician faculty for positions that mainly involve patient care, although at salaries less than the community level. In spite of increasing departmental responsibilities in predoctoral and resident education and clinical practice, much teaching is done by community physicians. There is significant purchasing of community practices and growing involvement of the AMCs in the practice activities of departments. Two thirds of clinical chairs reported "pretty good" to "great" satisfaction on a five-point scale. CONCLUSIONS Departments of family medicine are increasing their practice activities, perhaps to the detriment of teaching and research. The clinical practice autonomy of departments of family medicine is being diluted by increased institutional control and by mergers with the practices of other primary care disciplines. These changes give rise to a reasonable concern that academic departments of family medicine and their faculty may give up control of their clinical practice and lose their identity through conversion to "generic" primary care departments and providers.