Dr Mandel’s case for not exploiting international medical graduates (IMGs) is a strong one and we appreciate his historical overview. We concur that deficient programs that historically may have recruited IMGs served neither the educational needs of their residents nor the medical needs of the community. However, we do not make the leap to a view that the best way to prevent this exploitation is to limit entry of IMGs to graduate medical education (GME). Rather, we argue that strong oversight as provided by the Accreditation Council for Graduate Medical Education ensures that GME is fulfilling the highest standards. In addition, the lesser appeal of internal medicine and some of its subspecialties to USMGs has rendered Dr Mandel’s argument less compelling.