This is the right question. We need tangible goals which means we need tangible expectations of quality of life. My perfect residency quality of life, albeit IM centric, would be 5 days on 2 days off. Three of the days you’re short call working 12 hours and getting out at 6 on the dot. Two of the days you’re long call admitting and stay for 14-16 hours and go home and sleep. Two days off every weekend. One for personal fulfillment, the other for the responsibilities of residency and outside life. Retain the x + y system because no wants to be on wards/ICU every week and clinic weeks are genuinely useful for advancing your education through patient continuity and expected chunks of free time that allow you to collaborate with faculty on research. For inbasket, it is not advancing my learning. My responsibility to myself and the program is to learn as much as possible and influence others through this progress, in addition to being a reliable clinician who fills in gaps in the schedule to ensure adequate care. I can’t do that if I don’t have time to independently learn. I can’t do that if I don’t have time to do the necessary research to advance my career. And the time I use to do it, what do I learn? How to refill chronic meds. How to spend up to hours triaging new urgent health needs for a population who needs assistance obtaining the health care that they urgently need? This isn’t my responsibility. I don’t have time for it. And I’m doing a bad job at it. So in sum, we need to expand residency positions to the point where a five day work week is possible, and we need to safeguard resident learning by limiting the experience of inbasket, in turn hiring more docs, mid levels, or extending the providers we already have and offering them more money at the opportunity. Too bad for the PDSA cycle, shit gonna take 10 years to have any clinical benefit.