I am grateful for the opportunity to address the issues the respondents have raised.

The fourth year of training is indicated for a very few persons in our program. We have had no shortage of applicants, and have chosen to be highly selective. The issue is not learning procedures or performing services but rather acquiring knowledge that will enhance our program in general internal medicine. Our first "comprehensive internist" trainee has decided that she wants to spend the year in the departments of orthopedics and gynecology to learn techniques that will make her a better ambulatory care internist. We could not incorporate such an in-depth experience in our 3-year curriculum.

The acronym STAR was discovered and applied after the program was named. The many changes that we have made at the University of California, Los Angeles, seem to have made our program attractive for trainees in general internal medicine. These trainees do not seem to be bothered by the acronym STAR for the scientists being trained in this program (some of whom are general internists). The trainees in general internal medicine realize that those who have chosen the STAR program have committed to a postgraduate course that is twice as long as that required to become a practicing general internist. Moreover, the starting salaries for these scientists after completion of the program will be less than that of the practicing generalist. Therefore, the trainees in general internal medicine understand that we need to recognize and encourage those few who embark on this long, difficult pathway.

In reply to Dr. Moser, I can only say that the marketplace in southern California is acting as if there is a severe shortage of primary care physicians. Innumberable jobs are available for primary care physicians in southern California and virtually none for newly trained subspecialists. Additionally, the starting salaries for the generalists are considerably higher than that for the few subspecialists being hired.