In the last decade, the American Board of Pediatrics has reduced the number of required intensive care rotations. The Accreditation Council for Graduate Medical Education has established guidelines that limit on-call nights to 24 h and the work week to 80 h. This has had a positive impact on housestaff training and patient safety. Inadequate experience can reduce proficiency, especially in the acute management of a sick newborn. New guidelines and evidence-based standards need to assure competency without compromising work hours and broad-based exposure. Times change, but the passion and privilege of caring for sick newborns does not.