Medical practice is increasingly subject to business values in the effort to constrain costs. Because medicine is connected to life and death, however, and to healing and bodily limitation, it is more than just a service-related industry. Patients want and need both competent, efficient diagnosis and treatment, and trusting relationships with health care professionals who genuinely care. Clinicians need to sustain their sense of personal commitment and caring despite conflicting pressures and through a lifetime of practice. This will require renewed attention to the character of the clinical practitioner, to the quality of the practitioner-patient relationship, and to the source of those values that sustain humanistic medical care. Above all, it will require exploration of what it might mean to view medicine as a spiritual vocation.