Service vs education in internal medicine residency. Need for a resolution.

Decreased availability of internal medicine residents for inpatient care may result from efforts to contain rising health costs and to decrease funding for graduate medical education. The movement toward increased ambulatory training, reduced work hours for residents, and the declining interest in internal medicine careers will further decrease resident numbers. Hospitals have relied on trainees for an extraordinary range of hospital services, resulting in long duty weeks, assumption of large amounts of ancillary responsibilities, excessive patient loads, and increased house staff stress. Residents must be relieved of time-consuming, nonmedical chores and internal medicine training must be redefined to provide experiences which are important to gain competence. Hospitals must find other resources for providing patient care functions not educationally valid for residents, to allow that training to refocus on the appropriate development of the internist of the future.