I've been thinking recently. Yes I know, shocking. I have essentially been working through high school toward my ultimate goal of becoming a doctor. In high school you work to get into a good undergrad school, at college you work hard to get into a med school, at med school you work hard to get into a good residency, in residency you work hard to get a good fellowship. But after that, what is left to pursue? Yes for some of us becoming the head of a deparment may push us to work harder, but for the rest of us, what happens when your ultimate goal is realized? Does it all just go downhill from there?