We fully accept the principles set forth by the ACGME's task force: Patients must be safe and receive excellent care; outstanding education needs to be delivered today to ensure that trainees are capable of providing unsupervised care in the future; and a humanistic educational environment should nurture professionalism and the effacement of self-interest (19). However, these principles could be translated into standards in several ways while recognizing the risks of sleep deprivation and circadian misalignment and also attending to concerns about continuity, workload, and other factors that affect safety. For example, a recent survey of 429 program directors in medicine, pediatrics, and surgery reported that 56% strongly disagree and 23% moderately disagree with the proposal to limit duty periods for interns to 16 hours, with striking differences of opinion between surgical educators and educators in medicine and pediatrics (20). Therefore, a preferred alternative to the one-size-fits-all approach would be for the ACGME to offer a few acceptable alternatives for which there is suggestive evidence. Examples of potential alternatives could include 16-hour shifts for interns, which were shown to reduce errors in the medical intensive care setting but proved locally unsustainable (16); 5-hour mandatory naps on extended duty overnight shifts, similar to what was recommended in the IOM report (1); flexibility in the number of consecutive hours of duty, based on specialty- and program-specific workflows (that is, in some surgical specialties, emergency admissions are rare, teamwork is especially critical, and immediate perioperative care may extend longer than 16 hours); and no change from the present.