I read with interest the recent article about residency overwork by Dr. Green [1] and the accompanying editorial by Dr. Griner [2]. Both review the debate that has continued since the Libby Zion case. Very little discussion has addressed the number of hours worked by physicians in private practice.

I practice with a 14-person pulmonary and critical care group. It is typical for us to work between 80 and 100 hours in some weeks, and during certain stretches we may have only 1 or 2 days off in a month. My colleagues in cardiology and cardiothoracic surgery routinely work longer hours than does my group. Other medical subspecialists and the surgical specialties routinely put in more than 80 hours a week.

I remind those responsible for determining residency work hours that most of one's career is spent in practice. Training programs must prepare residents for real-life eventualities. It is essential that residents are trained to handle the workload that private practice often entails. One must learn to cope with fatigue and learn to set appropriate limits within their abilities. At times, this means that one must practice while somewhat sleep deprived. I do not see 40- or even 60-hour work weeks becoming the norm in hospital-based medicine. If I hadn't learned how to function under a heavy workload while a resident, I would never survive private practice!

Richard M. Hamrick III, MD

Pulmonary Associates of Richmond

Richmond, VA 23229