Misalignment between physicians and health systems is among the fundamental issues ailing U.S. health care. One major cause is the tension between the goals of improving clinical quality and controlling financial costs, including aligning physicians’ compensation with value-based payment models. A second is the burden that administrative and documentation tasks such as updating electronic health records has placed on physicians who would rather spend that time with patients. Left unresolved, these issues will slow progress in achieving affordable high-value care.