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Eugene C. Rich, MD
University of Kentucky Lexington

Steve Hillson, MD; Bryan Dowd, PhD; Gregory Gifford, PhD
University of Minnesota Minneapolis

Michael Luxenberg, PhD
St Paul—Ramsey Medical Center Minneapolis

JAMA. 1991;265(2):212-213.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor. —

In his letter of August 1, Blumberg^1,2 described the very interesting finding of a July elevation in the mortality rate of teaching hospital patients undergoing nonelective surgery as compared with patients in nonteaching hospitals. While Blumberg's study differs from ours in various respects (eg, surgical patients, patient selection based on procedure, multihospital data for a single year), the most important difference is the focus on a unique effect in July. Our study explored the effects of increasing house-staff experience (as defined by the month of the academic year) on inpatient care, rather than identifying effects isolated to July.³

Many changes in patient care occur in July in teaching hospitals that are unrelated to house-staff experience but may affect cost or other outcomes. For example, although physician discontinuity is a common occurrence in teaching hospitals, July is the one month when all house staff change . . . [Full Text PDF of this Article]

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