With mitigation of trainee stress in the United States, attending surgeons have quietly shouldered increasing responsibilities both in the operating room and nighttime call. In this issue of the Archives, Yamaguchi and colleagues use questionnaires and a biochemical marker to explore the effects of the stress of operative work and of nighttime clinical responsibilities on a cohort of attending surgeons. Operative stress and nights on call lead to diminished arousal and to increased excretion of a stress marker. How should the surgical community respond?

In one sense, the American surgical community has already responded. Some attending surgeons decline night and emergency duty. Others demand additional compensation from hospitals or their practice groups to offset the stress. Market forces thus attach a monetary value to the stress, and the American health care system appears willing to absorb the financial cost. Yet money cannot and will not counteract either the adverse effects on patients or the physical toll on their surgeons.