Internal medicine residency training at a crossroads.

The 1987 National Resident Matching Program resulted in a substantial number (18%) of vacant positions in internal medicine. Among the many factors inducing this change are: negative experiences in internal medicine training in medical school; lower compensation for cognitive versus procedural services; the shift of care from hospital to ambulatory settings inducing a decreased intensity of exposure; and the stringency and stress of internal medicine residencies. Various measures to address this problem are outlined.