This thoughtful scholarly treatise on the residency, the most influential learning period for young physicians, is a major contribution to our understanding of how America produces its physician workforce. It notes the educational, scientific, economic, social, legal, ethical, and political influences which produce tensions and conflicts in the training experience. Dr. Ludmerer provides a platform for examining these influences and he proposes ways for the learning environment to be more flexible, while maintaining high standards and the professionalism we all want to retain in our nation's physicians. I heartily recommend this superb book to all who are interested in our nation's healthcare system.