The tenure track is a common career path for clinician–scientists who focus on research, but it comes at a life stage in which there are multiple competing personal and academic demands. The stakes for tenure review are high, with pretenure faculty at many institutions facing job loss if they are denied tenure. In academic medicine, the exacting requirements and intense demands of the tenure track frequently merge with a physician population carrying high and even unreasonable personal self-expectations of achievement. This combination can result in substantial stress on junior faculty with significant impact on personal and job satisfaction. The author uses her own experience to illustrate these themes and reflect on the circumstances surrounding clinician–scientists’ pursuit of tenure.