Flannery et al1 report on the continued decrease in the number of US graduates who are choosing internal medicine as a discipline. One reason that no one has described, and that is becoming more prevalent lately, is board certification that is becoming a prerequisite to join many insurance groups. The American Board of Internal Medicine has one of the lower certification numbers of any of the other boards. In 1993, of 9697 candidates only 54% passed; even of the 5915 first takers only 66% passed. Medical students will become more discouraged in the pursuit of internal medicine as a discipline and having the risk that after 3 years of training they may not be considered internists if they are unable to pass the American Board of Internal Medicine certification.