The 2050 vision of the BMJ Commission on the Future of Academic Medicine calls for a revolution in academic medicine to support positive changes in population health. Achieving this vision depends on a robust clinical academic workforce. Clinical academics are dual-career clinicians in research, teaching or leadership who support innovation in practice and healthcare. Research improves patient outcomes and contributes to economic growth. Clinical academics educate and mentor future physicians, which is important in the expanding healthcare workforce and changing job expectations. Globally, however, the clinical academic workforce is under threat. In England, despite policies to expand academic posts, only 57% of NHS staff consult in general practice and 3.4% of the workforce have academic roles. The workforce is aging.