End of life spending and chronic diseases like diabetes and obesity are bankrupting our country. We are in a true crisis, yet medical school education hasn’t changed in most universities to meet the demands of modern-day medicine. In the few schools attempting to design an innovative curriculum (Dell Medical School, UT Austin!), the fear is that students will graduate into old systems for which they weren’t trained. Investing in designing new medical schools, education, and curricula is far too infrequent. Disturbingly, doctors routinely think very differently from their patients and families. Some are on a different planet. What gives? How to change this? What is sustainable?