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In Reply: Our studies estimated the total effect of the duty hour reform on mortality in the Medicare and VA populations. Among Medicare patients, we found little evidence that mortality changed in association with the implementation of duty hour reform. Each of the letters observes that the work hour limitation for the residents themselves was only one aspect of the changes set in motion by the duty hour reform, and that changes in care or supervision provided by others may have been involved. This is certainly true, but it does not alter the basic conclusion that the combination of all the changes prompted by the reform did not alter mortality rates among Medicare patients. The situation is slightly more complex in the VA system, as indicated in the article.

In reply to Dr Bass, we agree that external moonlighting by house staff is a serious issue that could compromise the . . . [Full Text of this Article]

Kevin G. Volpp, MD, PhD
volpp70@wharton.upenn.edu
Center for Health Equity Research and Promotion (CHERP)
Philadelphia Veterans Affairs Medical Center
Philadelphia, Pennsylvania

Amy Rosen, PhD
Bedford VA Medical Center
Bedford, Massachusetts

Paul Rosenbaum, PhD
University of Pennsylvania
Philadelphia

Patrick Romano, MD, MPH
Primary Care Center
University of California Davis
Sacramento

Lisa Bellini, MD
University of Pennsylvania
Philadelphia

Jeffrey H. Silber, MD, PhD
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

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