The word “cost” has very different meanings depending on its context. It can refer to the economics and efficiency of delivering health care, but also to harms that accrue as an unintended consequence of the actions of patients and physicians. Both types of cost are reflected in the articles that comprise this year’s JAMA Medical Education theme issue, in particular around providing high-value care and the toll that medical training and practice can take on the emotional health of physicians. Both represent a continued exploration of topics that have been raised in past theme issues.