A survey of osteopathic physicians who were training in non-American Osteopathic Association (AOA)-approved (ACGME-accredited) internal medicine programs was undertaken in 1988. This was done in response to the AOA approval and implementation of the recommendations of the Task Force to Explore Alternative Mechanisms for Approval of Postdoctoral Training. Of the 188 physicians surveyed by mail, 137 physicians' responses provided the data for the results presented here. These respondents represented 39% of those residents who were training in nonosteopathic medical programs in 1988 and whose records were on file with the AOA Department of Education. The questionnaire investigated the factors that influenced these physicians' decisions to enroll in non-AOA-approved (ACGME-accredited) internal medicine residency programs. These reasons are discussed along with suggested solutions to alter this unhealthy trend.