Gold miners have been underperforming the price of gold for a number of years. So why has the market' undervalued our gold miners relative to what they have been mining? The low valuation ascribed to gold mining companies is largely attributable to their profit performance. In the period since 2006 the price of gold in A$ has risen about $900/oz, but the real cash margin (operating cash costs + cost of finding and/or acquiring deposits + the cost of bringing them into production) has only risen about A$100. Rising operating costs are a major part of this reduction in real margin. Energy and labour costs have risen more than the inflation rates across a number of countries as have taxes, royalties, etc. There are however, more significant contributors to the rising cost base. Firstly, in 2006 the average gold grade was 2.0 g/t; today it is 1.3 g/t. Secondly, strip ratios (for surface mines) have increased by 19 per cent during this time. Open cut mining equipment unit output across the world has dropped by 26 per cent during 2006 - 2012. Finally, costs have risen by 55 per cent during this time period. Consequently, there is now 3.8 times more mining cost required to produce an ounce of gold from surface mines compared with 2006. The decline in gold grade looks to be a permanent trend as does increasing strip ratio if output is to be maintained. Costs will continue to rise although cost control will be necessary. Reversing the decline in equipment performance and closing the gap between median and best practice provides the hope for a sustainable reversal of cost increases. The current gap between best practice and median performance has grown to 112 per cent for mining trucks, 168 per cent for excavators and 169 per cent for front end loaders. Closing this gap is the potential for a more profitable future. For most gold mining companies improving mining efficiency is not an option; it is an imperative.CITATION:Lumley, G, 2013. How many gold mines will inefficiency kill?, in Proceedings World Gold 2013 , pp 267-276 (The Australasian Institute of Mining and Metallurgy: Melbourne).