Stephen J.LurieMD, PhD, Senior Editor
To the Editor: Ms Philbert and colleagues1 summarized the controversies and conflicts in resident work hours. However, they appear to have treated resident work hours as entirely a function of residency schedules. This may not be realistic.
Along with altruism and dedication, modern residents bring to their new vocations high material expectations and substantial debt. These drive many to supplement their incomes through outside "moonlighting" employment. Regrettably, a resident who takes advantage of an 80-hour duty assignment to add two 14-hour, unsupervised, off-site emergency department shifts may not be substantially more rested than one who is assigned a 100-hour week. It may be impossible to control moonlighting, but attempts to improve resident performance by minimizing sleep deprivation must at least acknowledge and monitor its effects.
Massad LS. Limiting Residents' Work Hours. JAMA. 2002;288(23):2974. doi:10.1001/jama.288.23.2974-JLT1218-6-2
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