Individual practitioners are usually aware of the dangers of sleep deprivation. The problem is they have very few options when it comes to controlling their own

Individual practitioners are usually aware of the dangers of sleep deprivation. The problem is they have very few options when it comes to controlling their own hours and most of those "top ranked" hospitals are often among the most notorious for having these toxic working conditions. Medical residents are also forced to go through these conditions almost as a form of hazing, justified only by attendings who "also had to go through it, so why shouldn't you?". The whole culture of medical training and hospital administration is corrupt and toxic. For a part of the program that I'm familiar with, a rotating fellow will be expected to be the sole physician of that specialty on-call for the entire weekend for 3 hospitals in a large US city. Then, on Monday it's back to work again at 6 AM. If it's a busy weekend, good luck getting more than 1-3 hours of a sleep a night during that time.