We appreciate the comments of Dr. Arora and colleagues. We agree that international medical graduates are an important part of the internal medicine residency workforce. As Dr. Arora and colleagues note, literature on the development of career decisions of international medical graduates is very limited. In our study, we elected to examine factors that have clearly been shown to affect career choice. Therefore, other potentially important variables, such as medical training site, were not evaluated.

Our data do allow some insight into how the career plans of international medical graduates may change over the course of training, but we have not yet conducted formal analyses to address this. We agree that this is a worthwhile question to pursue. Because our data do not provide information on why career plans are chosen, the possible influences of factors uniquely affecting international medical graduates cannot be assessed.

These questions highlight the fact that selecting a career is a complex process, and issues pertinent to career choice may differ across groups of residents. Our report represents an initial step toward understanding the choices residents make during their training. Further work is necessary to better understand why residents make these choices and why their choices change during training.