Dr. Myerson, a resident in internal medicine, presents a credible argument in favor of working long hours. She claims that long working hours are optimal for patients and education because they promote continuity of care while teaching dedication, commitment, and perseverance. What this argument ignores, however, is that fatigue can impair reasoning while leading to unprofessional attitudes such as cynicism and anger toward patients [1]. Further, if continuity and education were the true primary goals of long work hours, then residents would presumably devote more time to direct patient care and education during overnight shifts. In fact, they spend little of that time in such activities [2, 3], suggesting that long hours are required for reasons other than optimal patient care and education.

Drs. Ellenbogen and Hamrick contend that long work hours are good preparation for practice after residency, because many internists also work long hours. Although my article did not comment on the merits of long hours for postresidency practitioners, this observation seems to miss the point. Even if long hours prepare physicians for the rigors of future practice, I am not convinced that routinely working 60 to 100 hours per week is a good idea for anyone. Perhaps the "real life eventualities" mentioned by Dr. Hamrick should also be altered, rather than inculcating young physicians to accept the situation as inevitable.

Dr. Matz claims that lengthy work hours promote, rather than diminish, compassion, but this assumption is counterintuitive and not supported by the literature. We all agree that physicians ought to show compassion, even under adverse circumstances, but it seems odd to espouse objectionable conditions as a pedagogic strategy rather than to foster the best possible environment for developing desired virtues. More research on the relation between work hours and attitudes would help to clarify this point.

Drs. Frost and Tachauer suggest that long working hours are not the only reason residents become cynical and angry—a shortage of good role models contributes at least as much. I agree. Physicians in training emulate the behaviors of those around them, and the importance of virtuous mentors cannot be overemphasized. When attending physicians fail to show compassion and empathy, it sends the inappropriate message that this behavior is acceptable.

Finally, Drs. Petersen, Brennan, and Lee assert that physician cross-coverage has been correlated with adverse clinical outcomes [4]. Their claim must be taken seriously because ultimately, patient care is the highest priority. For all the other reasons mentioned in my article, however, it would be wrong to conclude from their findings that the number of resident work hours should be increased. If cross-coverage creates problems for patient care, we need to creatively develop flexible schedules to minimize cross-coverage rather than return to 100-hour work weeks.