Dr. Green's recent paper on resident overwork and its detrimental effect on the residents' ethical practice of medicine [1] does not address the fact that long hours of clinical work are the norm for practicing internists.

I teach internal medicine to family medicine residents in a community hospital. When residents and I are in the emergency department during the night caring for our patients, practicing internists, family physicians, pediatricians, and surgeons—indeed, all specialties—are also there caring for their patients. Like the residents, these practitioners must come to the hospital in the morning for rounds and then go to their offices to care for their patients.

I endorse a residency faculty's obligation to minimize resident cynicism and dislike of patients. Our faculty does so, in part, by being there during those long hours—late at night and during the day—any time that learning and supervision are needed. However, the residents themselves must be there late at night, after a long day, and before another long day. Only then can they learn the practical implementation of their ethical obligation to be as awake, alert, and thoughtful as possible at whatever hour of the day or night their patients need care.

Before residency programs respond to Dr. Green's suggestions, they might assess what their own graduates report as normal hours for practice as well as the overall community standard. Physician extenders and ancillary support will not teach residents about the long hours in the real world of clinical practice.