Dr. Reich expresses frustration with the seeming lack of progress and decisive action toward solving the host of problems confronting internal medicine and its subspecialties, particularly the need for more community internists. Like Dr. Reich, many program directors who complete the National Study of Internal Medicine Manpower (NaSIMM) surveys report frustration with seemingly erratic and incremental policy changes. A reading of the series of articles based on the NaSIMM data reveals that the profession is struggling today with the same issues as at the birth of NaSIMM in 1976, indicating a substantial basis for Dr. Reich's frustration. Nevertheless, the NaSIMM article in question provides a substantive basis on which the debate can proceed.

One of NaSIMM's main goals has been to collect and report accurate data on the training of internists relevant to current issues in the policy and planning arena, and its data are widely used. However, the adoption of policy positions by NaSIMM would not only interfere with our objective collection of data but would probably alienate many of our respondents. The recently convened NaSIMM Advisory Board has suggested that future reports more fully explicate the policy and practice implications of the data.

Also, NaSIMM welcomes substantive suggestions from Annals readers, as it does from the program directors, on topics relevant to questions of the policy and planning of graduate medical education.