The process of becoming a physician-scientist is a long and often harrowing one. The author reflects on her own experience deciding to commit to a career as a physician-scientist and setting out on that career path. She identifies the largest challenges as the lack of clear direction to becoming a physician-scientist; the long lag time between the end of graduate medical education and becoming faculty, resulting in lower wages, less job security, and conflicts with personal goals; and a tension between traditional definitions of success and her own areas of interest. The author also reviews the advantages that led to her first faculty position as a physician-scientist: innovative educational programs that integrate medical and research training, financial support for physician investigators, a supportive educational milieu, and appropriately tailored promotion tracks. Advances on these three fronts could support increasing numbers of trainees pursuing careers as physician-scientists.