Origins of Doctor's Dilemma

One of the most anticipated events at ACP's annual Internal Medicine Meeting is Doctor's Dilemma®, an international medical Jeopardy-style competition. Doctor's Dilemma was first held during ACP's 1994 annual session in Miami Beach, Florida. It was the idea of then ACP Florida Governor Philip Altus, MD, MACP. The Florida Chapter had held a Doctor's Dilemma competition during their local chapter meetings and Dr. Altus wanted to offer a "Southern States Competition" between his chapter's residents and ACP's Alabama and Georgia Chapters' residents. He was assisted in securing a room and staging this challenge by ACP staff. The Florida Chapter won the competition but was challenged for a rematch by the Georgia Chapter's Governor for the following year as coincidentally, Internal Medicine Meeting 1995 was in Atlanta, Georgia. The Georgia team won the second competition and interest in Doctor's Dilemma began to grow among the chapters.

By the 1996 meeting in San Francisco, it was added to the program of activities for Resident/Fellow Members. The program was run by volunteers from the Alabama and Florida chapters and had four team match-ups through 1998. By 2000, the competition had grown to 12 teams, and ACP staff had begun to request the submission of questions from chapters and councils. A member from the Pennsylvania chapter, Martin L. Evers, MD, FACP, volunteered to act as the physician consultant, and he provided questions for the program through 2004. In 2004, the program expanded to 16 teams. Steven E. Weinberger, MD, MACP, FRCP, who later became ACP's Executive Vice President and Chief Executive Officer, attended the competition that year in his role as Senior Vice President of Medical Education. He quickly recognized the potential of the program to enhance the College’s annual meeting and advocated adding more teams and positioning the championship as the final event.

The Osler Cup

Osler Cup
Osler Cup being presented to Doctor's Dilemma Champions

In 2005, the name "Doctor's Dilemma" became a registered trademark and the College expanded the competition to include 32 teams. This was also the first year that the championship game was held as the final event of the annual meeting. The arc of the competition was expanded with events held throughout all three days of the meeting: elimination rounds on Thursday, semi-final match-ups on Friday, and the championship game on Saturday. The following year, Dr. Weinberger and then Senior Vice President of Medical Education, Patrick Alguire, MD, FACP, came up with the idea of creating a championship trophy, the Osler Cup, to be awarded annually to the winning team. Like the NHL’s Stanley Cup, the Osler Cup has the names of all of the winning teams, but it is kept permanently in the College's Philadelphia Headquarters. Each winning team receives a miniature replica, while each individual on the championship team receives a Certificate of Merit.

Procees & Participation

Dr. Alguire assumed the primary role in developing the questions for the annual Doctor's Dilemma competition. He spent an average of 42 hours per year on crafting questions which were then peer reviewed, but ultimately weighted for value personally by Dr. Alguire. This role was taken over by Philip A. Masters, MD, FACP, Vice President, Membership & Global Engagement in 2018. Starting for Internal Medicine Meeting 2019, a Doctor's Dilemma Question Writing Committee, consisting of eight teams and a panel of team leaders and question reviewers, was established to develop questions which continue to undergo an extensive peer and expert review process before being chosen for use in the competition.

To participate in the competition, a team must be nominated by their local ACP chapter. Teams are accepted on a first-come, first-served basis until all available slots are filled. All team members must be active ACP Resident/Fellow Members. In 2008, the College created a website for members to play an online version of Doctor’s Dilemma with each game having three categories of five questions. The site is updated monthly and has averaged at least 1,000 users a month over the last several years. The College also offered an iOS Doctor’s Dilemma mobile app for four years. In the last 22 years, Doctor's Dilemma has become a hallmark event of ACP's annual Internal Medicine Meeting. For four consecutive years (2012-2015), the Pennsylvania chapter’s Einstein Medical Center won the Osler Cup. In 2018, Doctor's Dilemma was won by Indiana University.


  • Prepared by Eric Greenberg, based on materials from the Archives of the American College of Physicians
  • A special thanks to Patrick Alguire, MD, FACP, Philip A. Masters, MD, FACP, Steven Spadt and Brian Sweigard and other staff for providing background information and materials on Doctor’s Dilemma