Paying physicians for on-call services is an emerging national trend. It is fueled by the growing demand for specialty services during nighttime, weekend, and holiday hours, coupled with the changing attitude of physicians, many of whom no longer view being on call as an obligation. Academic health centers (AHCs) serve as stewards of the public's health and are the primary educators for most health care workers. AHCs' policies, including their on-call practices, have significant influence on health care trends and the practice of medicine, but AHC leaders have not reached consensus on whether being on call should be a voluntary or paid responsibility. Graduate medical education programs at AHCs, which insist that trainees adhere to work hours restrictions, are teaching tomorrow's physicians that working fewer hours and getting enough sleep will help reduce medical errors. The unintended consequence is an increasing shortage of physicians who are willing to be on call. Faculty at AHCs need to critically evaluate the multiple factors creating on-call shortages, then formulate and implement practical solutions. Simply offering payment as an incentive for on-call services has not guaranteed the availability of specialty care around the clock and has not addressed the on-call burden for physicians.