In Reply.—I agree with Dr Cheng's comment that "what the residents want" may not be "what the residents get or should get." However, house staff views on the stresses they face are crucial to the discussion of work hours and to the formulation of strategies to reduce stress, promote education, and provide quality patient care.1
The need for "continuity of care" for optimal patient care and resident education has often been raised as an argument against work hours regulation. Discontinuity is inherent in our system, however; physicians cannot remain in the hospital indefinitely. The tradition of 36-hour (or longer) shifts is not grounded in science. Discussion of continuity inevitably involves discussion of hours.
The question is clear: what is the optimal number of work hours to maintain continuity, and how is this number decided? In the survey, respondents often commented that the current level of continuity and the