This year, our institution restructured its residency programs in 57 specialties and subspecialties to fully comply with the Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions,1 which went into effect July 1, 2003. Since then, the regulations have had a profound and widespread impact on the delivery of health care in the surgical specialties at the University of North Carolina at Chapel Hill. The restrictions were implemented by the ACGME to "strengthen both patient care and [resident] education."2 While these restrictions have had beneficial effects, in some cases the effect has been different from what was intended by the ACGME.