Increasing an academic health system's research productivity is an institutional challenge that requires multiple complex actions over a sustained period of time. In this Commentary, we describe how 2 academic health systems with different organizational structures used similar models of investment of clinical income in the research enterprise to enhance their success. This strategy assumes enhanced urgency in the current climate of flat National Institutes of Health (NIH) budgets. In 2006, NIH experienced its first budget cut since 1970, resulting in a 13% loss of research purchasing power since 2003, while grant applications have doubled since 1998.1