Purpose: Faculty attrition, particularly among female and minority faculty, is a serious problem in academic medical settings. The reasons why faculty in academic medical settings choose to leave their employment are not well understood. Further, it is not clear if the reasons why women and minority faculty leave differ from those of other groups. Methods: One hundred sixty-six medical school faculty who left the School of Medicine (SOM) between July 1, 2001, and June 30, 2005, completed a survey about their reasons for leaving. Results: The three most common overall reasons for leaving the institution included career/professional advancement (29.8%), low salary (25.5%), and chairman/departmental leadership issues (22.4%). The ranking of these reasons varied slightly across racial and gender groups, with women and minority faculty also citing personal reasons for leaving. Women and minority faculty were at lower academic ranks at the time they left the SOM compared with male and majority groups. Although salary differences were not present at the time of initial hire, sex was a significant predictor of lower salary at the start of the new position. Opportunity for advancement and the rate of promotion were significantly different between women and men. Job characteristics prior to leaving that were rated most poorly were protected time for teaching and research, communication across the campus, and patient parking. Harassment and discrimination were reported by a small number of those surveyed, particularly women and minority faculty. Conclusions: The majority of reasons for faculty attrition are amenable to change. Retaining high-quality faculty in medical settings may justify the costs of faculty development and retention efforts. © 2008 Mary Ann Liebert, Inc.