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To the Editor: Dr Volpp and colleagues studied mortality in hospitalized Medicare beneficiaries¹ and patients in US Veterans Affairs (VA) hospitals.² They assessed changes that were associated with limitation of duty hours for trainees in accredited residency programs in hospitals to 80 hours per week. Although their findings regarding mortality could be the result of limiting house staff duty hours, licensed residents in approved programs may accept additional work in other medical facilities that are not connected with their residency program ("moonlighting"), representing irregular overtime work.

I recommend that in further similar studies, off-hour coverage in nonresidency-approved medical facilities by licensed house staff be evaluated as a source of unmonitored and undocumented work, with a possible compromise in hospital quality of care.^3-4 A method to evaluate compliance with the 80-hour work week would be to identify and track nationwide all licensed house staff working in medical facilities, residency-approved and otherwise.

. . . [Full Text of this Article]

Millard Bass, DO, MPH, ScD
millardbass@hotmail.com
State University of New York Downstate
Brooklyn

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