• Recognize the importance of the issue. Physicians suffer from loss of sleep and patient safety can be affected.
• Work to change attitudes about long hours of work. Instead of bragging about 100-hour work weeks, we should condemn them as dangerous to patients as well as physically and emotionally unhealthy to ourselves as practitioners.
• Accept that while the system cannot be corrected overnight, we should still set goals to lessen the problem. Many would argue that long hours are necessary in resident training and that the costs of reducing clinician’s hours of work and call would be prohibitively expensive. These concerns have been addressed in Europe and health care is functioning there at least as well as in North America, aided by the fact that physician shortages pose less of a problem in Europe than they do in North America. However, without some targets, little change will occur in work habits on this continent.
• Encourage group practice with shared call schedules. This is already well established in many specialties, but is admittedly a challenge in smaller communities and for certain subspecialties with few practitioners, such as vascular surgery.
• Consider enforceable legislation. Guidelines and recommendations will be largely ignored. The situation in New York State demonstrated that even legislation will be ignored until penalties are applied. Hospitals in New York flouted the laws on resident work time limits for 10 years until they were threatened with loss of accreditation. The European Working Time Directive is a good example of formal legislation with penalties for noncompliance.
Striking problems are a tired, like-everyone-else’s opening that will not catch the reader or let the reader know right away there is an interesting voice in this piece; a weak ending; a bit of rambling or disorder in the whole essay; and spots where there is need for more vivid and specific detail. There may also be more of a sense of describing what happened than explaining why this trip was significant—a question of the right emphasis. It is also a bit too long. Its’ okay to go over 500 words, but not 200 words over, especially if there are sections that can be left out.