Joining a practice for the first time after training, whether in academia or the private sector, is fraught with challenges and a learning curve. Postgraduate education has not sufficiently taught anyone how to manage the nuances of this new arena or how to become successful. Success is not solely a function measured by reportable taxable income. Respect by colleagues, patients, partners, and staff is just as important, if not more so. The financial attributes will be realized if the tangibles and intangibles discussed are appropriately executed in the correct environment. This article will discuss what to be cognizant of during the first years in academic practice and how to build a foundation for success.