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To assess the total number, recruitment rate, departure rate, and growth rate of full-time academic dermatologists in the United States over the last decade.Mail survey.Academic dermatology departments in the United States.Respondents among 113 chairs or chiefs of academic dermatology departments or their designees.The total number of full-time academic dermatologists including departures and recruitments in 4 selected academic years (1994–1995, 1998–1999, 2001–2002, and 2003–2004).Of the 113 academic dermatology departments, 89 (79%) responded. During the 4 selected academic years, more dermatologists joined academia (n = 255) than departed (n = 200). Those recruited into academia were predominantly graduating fellows (35%), residents (30%), and in private practice (16%). Of those who left academia, their primary roles were clinician-educator (55%), followed by dermatologic surgeon (16%). Most of those who departed went into private practice (65%). From 1994–1995 to 2001–2002, the recruitment rate increased by 36% (from 10.1% to 13.7%), and the departure rate increased by 88% (from 5.8% to 10.9%), resulting in a 35% decrease in growth rate (from 4.3% to 2.8%).Retention of academic dermatologists is as important as recruitment. Our results confirm that insufficient retention has contributed to a substantial decrease in the growth rate of academic dermatologists. Future efforts to increase academic manpower must focus on retention as well as recruitment, particularly of clinician-educators. Specific strategies for improving retention include identifying or establishing funding sources for teaching/mentoring and clinical research. Recruitment efforts may be improved by focusing on fellows and private practitioners with academic affiliations.