Background: Faculties' academic promotion process plays a significant role in career development and organizational change. Studies have indicated that this process is stressful and tense in the Iranian context. This study aimed to identify factors affecting medical faculty academic promotion at Tehran University of Medical Science. Methods: In this qualitative content analysis, 15 faculties at Tehran University of Medical Sciences were studied during 2016-2018. Purpose full sampling used for selecting participants. Data collection was performed using semi-structured interviews and demographic information. The collected data were analyzed through constant comparison analysis using grounded theory data analysis being recommended by Corbin and Strauss 2008. Results: Based on the experiences of participants, the factor affecting medical faculties academic promotion fit in two themes: problems in evaluation process and structural problems in promotion process. The first main theme consists of four main categories, i.e. “quantitative evaluation and objectivity "-'' necessity of differential evaluation "-'' lack of attention to the consequence" and other problems of evaluation area”. The other theme has the following main categories: “high research orientation in regulation "-" necessity of re-defining the promotion indicators"-"mandatory in promotion process" and " lack of attention to occupational problems of faculties”. Each category will have its subcategories. Conclusion: The results indicated that faculties are facing many problems in the field of academic promotion and need to improve the laws, evaluate qualitatively, pay more attention to education criteria, and redefine cultural and executive criteria. Keywords: Academic promotion, medical faculty, medical university, content analysis, challenge