Thanks for the welcome back.

Truth be told, the program's purpose is dual - training for the trainees, and healthcare for those they serve, and the two are hard to separate (which makes the question more difficult). The longer-term healthcare interests of the people in the area will be served by having the most outstanding trainees here; but if the most outstanding available trainees right now are of an origin (school of graduation) that is also likely to make outstanding trainees of the future less likely to train here, then I am robbing the future for the present. Likewise, if I take less-qualified American grads now to improve future prospects, I am sacrificing the best for those here now. I'll end up looking for something in the middle, but it isn't an easy question. Ultimately, I end up on the side of the former argument, mainly because it is also a way of showing the people already here that they can trust me to be a fair-minded boss. Still, no easy answers.