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In Reply: We endorse Dr Rice's call for evidence-based evaluation of the effects of reducing resident work hours. Sleep deprivation impairs neurobehavioral performance, and residents' performance on clinical tasks has been repeatedly found to decline with sleep deprivation. A meta-analysis that included data from 959 physicians in 20 studies of diverse clinical tasks found that 24 to 30 hours of sleep loss induced a severe degradation of clinical performance to the 7th percentile of mean rested performance.¹

We also agree that the fact that sleep deprivation impairs physicians' clinical performance does not mean that reducing work hours inevitably leads to better patient outcomes. The evidence to date indicates that Accreditation Council for Graduate Medical Education (ACGME) duty hour reform did not consistently improve outcomes.^2-3 Reducing resident work hours without considering circadian scheduling principles, resident workload, supervision, or continuity of care could potentially worsen safety. However, there is some evidence—including a . . . [Full Text of this Article]

Christopher P. Landrigan, MD, MPH
Sleep and Patient Safety Program
Brigham and Women's Hospital
Boston, Massachusetts

Kevin G. Volpp, MD, PhD
volpp70@mail.med.upenn.edu
Center for Health Equity Research and Promotion
Veterans Administration Hospital
Philadelphia, Pennsylvania

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Building Physician Work Hour Regulations From First Principles and Best Evidence
Kevin G. Volpp and Christopher P. Landrigan
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Evidence-Based Evaluation of Physician Work Hour Regulations
Louis B. Rice
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