PROGRAM DIRECTORS in nephrology have been quietly dismayed by a perceived decline in the of many applicants to their training programs over the past few years. Their anecdotal experiences have received substantiation with the publication of the recent report, National Study of Internal Medicine Manpower: XVI. Subspecialty Fellowship Programs, 1988 Update.! The term quality as it is used in this context refers to the background medical education of applicant nephrology fellows with particular reference to the medical schools and residency training programs from which they emanate, rather than to some arbitrary measurement of personal quality. In essence, since 1976-77 the number of nephrology fellows entering training in the United States has decreased from 646 to 587, and the number of training programs from 178 to 147. While a decline in numbers does not necessarily bespeak of impending doom and, in fact, could reflect a healthy tendency to reduce the number of trainees entering an overcrowded subspecialty, the breakdown of the numbers does not support this contention. Those specialties with the strongest recent growth (general internal medicine, infectious diseases, geriatrics) are attracting the lowest number of foreign medical graduates, whereas nephrology has increased its proportion of foreign medical graduates to 38 % of its total fellowship population. While it is always inappropriate to lump foreign medical graduates into a single category or to make value judgments about their innate