Medical professionalism is an increasingly common topic of discussion in the medical education literature. Much of the recent literature on this subject addresses areas of weakness in the educational curricula of medical schools and residency programs. But students are living a world in which professional behavior is being redefined, often in ways that run contrary to the medical education curriculum. This article outlines three fundamental challenges that powerfully affect the ability to promote professionalism in students and young physicians. To overcome these challenges, the author suggests four steps that can be taken in the medical education community. First, medical schools should address cost and access to care as first-order intellectual problems and should encourage research programs in these areas. Second, schools should develop programs to humanize science and restore scientific integrity beyond the requirements of compliance programs. Next, medical school leaders should celebrate those who best embody moral leadership in the profession. Finally, the medical education community should acknowledge that the availability of affordable health care to the public depends on the practice choices of medical school graduates and should accept greater responsibility for this outcome.