The postgraduate education of physicians has been shaped by various forces other than the need to train appropriate numbers of physicians in specialties. The pivotal role of internal medicine in the physician work force and health system of the United States, as well as the complexity of internal medicine, makes this field an important one for study and inference.

The authors of this book have drawn on 17 years of demographic results from the valuable National Study of Internal Medicine Manpower (NaSIMM), additional survey information, the published literature, and interviews with prominent academicians. Beginning with historical, social, and economic influences, they cover general internal medicine, the subspecialties, geriatrics, and critical care, and, finally, current educational and policy challenges.

The text includes scores of tables and figures that are loaded with useful information. The narrative is driven by numerous quotations, which work best when they enhance the development of the discussion, as in the reviews of geriatrics and training in ambulatory care. The section on the development and characteristics of residencies is particularly thorough and is punctuated with interesting survey information and derived implications.

However, some of the descriptions are limited and skimpy, such as those dealing with the individual subspecialties, the residency review committee for internal medicine, certification and recertification, research, curriculum development, and the important influences of graduate medical education funding and the service pressures affecting training programs. The discussion of health system reform seems dated because it deals too much with the specifics of recently failed efforts and too little with the generic implications of various proposals.

Although it sometimes falls short in depth and analysis, this book is a unique contribution and a source of valuable reference information.