Ideally, physicians would initiate discussions about advance directives with their patients at key milestones throughout their lives — perhaps when they get a driver's license, get married, begin a new job, relocate, or become eligible for Medicare — not just when advanced illness or death is imminent. Many physicians need to learn how to conduct these conversations respectfully and successfully. Physicians can then make their patients' preferences known to all members of the health care team. Physicians should be compensated for the time required to have these discussions — a change they can prod the government and other payers to make.