How flattering to have one’s article that was written in the past not only read by but commented on by a pediatric resident. Dr Moreno is correct: little has happened in the past 15 years to lessen resident stress. If anything, the situation is worse. Debts are greater and family stresses are unabated. More women in pediatrics means more child care worries for some, and more anxiety about ticking biological clocks for others. Another concern is the uncertain primary care job market. Debts and family concerns deter many from embarking on subspecialty training. The haggard looks on our overworked gastroenterologists, nephrologists, and pulmonologists are not good selling points.

The wards of tertiary care centers are even more bizarre. Patients have become virtual; rounds are often only a figure of speech. Teams sit in windowless conference rooms and examine pulse oximetry reports to determine whether or not a child...

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