This commentary discusses the tension between limiting work hours for trainees (ACGME Duty Hour Restrictions) and the impact such changes have on fatigue, education, and patient safety. Balancing these seemingly competing interests, the authors present an evidenced-based review of existing literature before drawing several conclusions. These include the lack of evidence to support continued work shifts of more than 24 hours and a paucity of well-studied solutions to the issue. The authors reference several commentaries that debate the work hour issues and call for greater attention to mechanisms that make 24-hour shifts a practice of the past. A widely referenced past study by one of the same authors, Dr. Christopher Landrigan, was one of the first to suggest that work hour reductions may decrease the incidence of medical errors.