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It takes a gallon of water to produce one almond. And that's not the most insane fact about the mad dash to plant the thirsty trees in the middle of a catastrophic drought.

Given constant emergence of new infectious threats, Infectious Diseases (ID) should be one of the most attractive medical specialties to students and trainees. Yet, ID Fellowship programs continue to not fill in the match, and ID remains among the lowest paid specialties. Nearly 35 years after Dr. Petersdorf first asked the question, we find ourselves once again wondering, "Whither Infectious Diseases?" To answer this question, and align with predominant US market forces, ID experts should push for: 1) restrictions regarding utilization of ID diagnostics and antimicrobial agents; 2) pay-for-performance measures regarding antimicrobial prescribing rates; and 3) healthcare reform as called for by the American College of Physicians to move away from fee-for-service medicine. Einstein said, "Continuing to do the same thing over and over and expecting a different result is the definition of insanity." We must move towards alignment with market forces, to benefit our patients, society, and our colleagues.