As an international medical graduate who had residency and fellowship training in the United States and is currently working in an underserved area, I feel it necessary to add my views to the worthwhile suggestions in Dr. Levey's article [1]. I am concerned about the implications regarding humanistic and ethical behavior. Many foreign medical graduates are among the most humane and ethical people I have met during my years as a subintern, resident, and fellow in different hospital settings. It is the "House of God" philosophy so prevalent among U.S. graduates that still astonishes me.

Furthermore, we are allowed to train in the U.S. because of the need for the service we provide. When applying for a residency program in 1985, I heard rumors about closing all positions foreign medical graduates and of withdrawing Medicare funding from programs with a majority of foreign medical graduates. The AIDS epidemic and the reluctance of U.S. graduates to do residencies in inner-city hospitals precipitated the rise in the number of positions occupied by foreign medical graduates. In addition, as a trainee in a New York City university hospital, my ability to interact with and to provide advice and counsel to Spanish-speaking patients and families proved essential.

Another point addressed in Levey's article is the funding, but the salary paid to a resident is earned. In my experience in inner-city hospitals, the residents take care of patients, and faculty members only teach. As for the payback issues, there are already programs in place in underserved areas, ironically, not for the ones wanting to leave, but for the ones wanting to stay.

I agree that the United States has the finest medical education system in the world, and I feel privileged to be part of it, but please do not underestimate the contributions that foreign medical graduates make to keep this fine system running.