I have been pondering the new guidelines for last couple of days and have come to some conclusions. I think there will be meaningful change SOON. I believe we are witnessing a true watershed event in Graduate medical training that will lead to this change. The new guidelines limiting resident work hours is merely the backdrop for all the hoopla. There are several other events that mesh well with my vision too. A powerhouse institution is under siege, fighting for it's very life and accreditation. For those of you who have been asleep, I'm talking about the Yale program. Indeed Yale wasn't plucked out of thin air. Certainly there are hundreds of other programs that could have been made an example of. The big gun was targeted deliberately. Recent studies suggesting that fatigued residents are no better than inebriated bums also paint a rather sinister picture of the graduate medical training process. Imagine lawsuits that will now be able to site this study when suing an institution and their residents. This is very powerful stuff. Armed with this knowledge, the threat of litigation becomes very real. Ultimately it will be the almighty dollar and blood-sucking lawyers that will actually bolster these guidelines and push them to mainstream in a more timely manner. Fellow lawsuits against corrupt institutions like the NRMP will also serve to highlight the depravity and squalor resident physicians must endure. Ultimately these issues will become mainstream, and Aunt Sallie and the general public at large will become more proactive on these issues. K.P.