The article by Chen and colleagues in this issue suggests that the context in which clinical medical education is executed matters, especially if we intend to meet the projected future physician workforce needs in the United States. Placing learners in the highest-performing medical settings seems intuitive, but this can be disruptive to the patient care interface, especially in high-performing health care delivery systems. Simply placing learners in a well-functioning, highly reliable health care delivery system focused on systems of care and directed at improving quality and safety is not enough for learners. Educational experiences must be planned, organized, and strategically aligned with clinical operations to ensure seamless integration with highly reliable health care delivery systems. The authors draw on their experience at Geisinger Health System to explore the challenges and advantages to integrating the education and patient care missions of academic clinical sites for learners, patients, faculty, and the future of the workforce.