Medical schools and departments are funded by a variety of revenue sources, each with unique designations and restrictions. Academic business managers and faculty leadership are careful to spend funds according to their restrictions in order to avoid costly rework and the potential of jeopardizing future funding from government, university, or donor sponsors. The annual budget process brings this all together in a skillful balancing exercise to plan how the next year’s projected revenues will cover projected expenses. Important to individual faculty or programs are commitments made by leadership that span more than 1 year. Having clearly written commitments is an important step in securing funding and avoiding future disagreements or disappointment. Funds flow is the common term for the methodology governing how money generated from patient-related activities is passed to the school or department. Funds flow methods differ at various academic medical centers but are typically based on the professional fees collected or on a payment-per-work RVU method. Achievement and fulfillment in academic medicine are enhanced with a basic understanding of how the “business” of academic medicine works.