IN THE mid-1970s, US government officials and other health policymakers began expressing concerns about the impact of physician maldistribution, both by specialty and by location, on the provision of medical care.1-3Government committees were established to study the problem and determine how the organization and financing of the nation's graduate medical education (GME) system was a contributing factor.4,5Stimulated by the government's interest, professional organizations and foundations sponsored independent studies of the relation between physicians' choice of specialty and location and the organization of GME. In general, these groups concluded that the policymakers' concerns were legitimate and the imbalances could not be effectively redressed without changing the way GME is organized and financed.6-8 Although many in the medical profession agree that the policymakers' concerns are legitimate, there is still no concensus within the profession as to how the GME system should be reformed to improve physician specialty