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I appreciate the opportunity to respond to Dr Piening since it permits me to clarify some points that could not be incorporated into my original, rather brief letter to the editor. I will take up each matter in the order in which he raises it:"Compassion" was not the motivating force that led the faculty to agree to this arrangement. It was something called quality control, an issue that is of increasing concern in postgraduate medical education in Pennsylvania (and I assume in South Carolina, also).The plan was not conceived by the faculty but by the hospital administration, which believed that some house officers were not exercising good judgment in the amount of moonlighting they were doing or in the degree of responsibility they were assuming in view of their level of training. At first, the faculty resisted the program, not wanting the added responsibility themselves.
Cohen RL. Moonlighting: Making a Buck, Compassion, and Quality Control-Reply. JAMA. 1990;264(4):454. doi:10.1001/jama.1990.03450040042022
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