In the linked analysis article (doi:10.1136/bmj.b4260), Purcell Jackson and Tarpley describe their concern that surgical trainees in the United States might be forced to work within a maximum 80 hour week.1 Meanwhile, the European Working Time Directive (EWTD) demands that all trainee doctors in Europe work an average of only 48 hours a week,2 and the Royal College of Surgeons of England is appealing for all their trainees to be allowed a 65 hour average week.3 Although Purcell Jackson and Tarpley’s concern that a maximum of 80 hours a week is insufficient for surgical trainees to gain the necessary experience, their argument that all surgical trainees need to be available all the time—for example, to observe rare procedures such as elective surgery on conjoined twins—overstates the case. How can we strike the right balance between gaining sufficient experience, ensuring safe working practices, and allowing doctors to have a life outside work?

The American College of Surgeons reflects Purcell Jackson and Tarpley’s position by also rejecting the 80 hour week; this implies that American surgeons believe that working with little rest is …