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To the Editor: As Dr Volpp and colleagues¹ state, "little empiric data guided the design of the duty hour regulations, and the design itself remains controversial." Although it is likely that residents' lives are better with duty hour regulations, the question is whether patients' lives are better.

Unfortunately, a study of all Medicare admissions to teaching hospitals will not answer the question of the effect of duty hour regulations on the patients cared for by residents. As Drs Meltzer and Arora² note in their accompanying Editorial, duty hour regulations have forced many teaching hospitals to design "nonteaching services" run by nonresidents. With duty hour regulations, many patients in hospitals (even with high resident-to-bed ratios) are no longer cared for by residents. It is unlikely that mortality is exactly the same on teaching and nonteaching services.

To see the effect of duty hour regulations on patient care, only patient care provided . . . [Full Text of this Article]

David Neely, MD
dneely@nmh.org
Department of Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois

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