To the Editor.
—I read with interest and dismay the Resident Forum article by Dr Rainey,1 in which he describes his observations on the human cost of residency training. The author uses Duncan's2 book as a jumping-off point to discuss concerns about medical education in general, as well as the author's individual training experience. Rainey points out that although efforts have been made to cap resident hours, these limits are by no means adhered to routinely, and resident physicians, particularly during internship, are required to work for extended periods of time. I certainly agree that this approach is suboptimal for learning and for patient care, but it does prepare resident physicians for the realities of clinical medicine, including the demand for increased clinical activity brought about by the progressive influence of managed care and third-party payers on how medical conditions are treated.Rainey also suggests that it is