Being midway between residency and Medicare is an appropriate time to take personal stock of one's professional life. An honest self-assessment of achievements, misgivings, and goals is a worthwhile exercise in determining career satisfaction, which affects physicians, their colleagues, patients, and families. This essay is a purely personal reflection of my experiences and aspirations intertwined with perspectives on the present and future status of dermatology. The impetus behind this is based on multiple discussions I have had with my dermatology residents regarding the ethical issues that all of us face.