ACGME duty-hour checker

Clinical and educational work hours (the modern term for what used to be called 'duty hours') must be limited to no more than 80 hours per week, averaged over a rolling four-week period. This includes all in-house clinical and educational activities, clinical work done from home, and all moonlighting (internal and external).

“Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, including all in-house clinical and educational activities, clinical work done from home, and all moonlighting.”

Residents SHOULD have at least 8 hours off between scheduled clinical work and education periods. This is a 'Detail' requirement (softer than a 'Core' requirement) - programs are expected to schedule for it, but a resident may choose to stay later or return sooner to care for a patient. The 80-hour weekly average acts as an indirect backstop against chronically shorter gaps.

“Residents should have eight hours off between scheduled clinical work and education periods.”

Residents must have at least 14 hours free of clinical work and education after completing 24 hours of in-house call. This is a Core (mandatory) requirement.

“Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.”

Residents must be scheduled for a minimum of one day in seven free of clinical work and required education, averaged over four weeks. At-home call cannot be assigned on these free days. A 'day off' is defined elsewhere in the ACGME Glossary of Terms as one continuous 24-hour period free of all administrative, clinical, and educational activities; consecutive days off ('golden weekends') are explicitly permitted, not precluded, by this rule.

“Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days.”

Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments. This is a Core (mandatory) requirement.

“Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.”

On top of the 24-hour continuous work cap, up to 4 additional hours may be used only for patient-safety-related activities such as effective care transitions and/or resident education - new patient-care responsibilities must not be assigned during this window. The full 24+4-hour period still counts within the 80-hour weekly average.

“Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education.”

In rare circumstances, after handing off all other responsibilities, a resident may voluntarily elect to remain at or return to the clinical site to: continue caring for a single severely ill or unstable patient; give humanistic attention to a patient or family; or attend a unique educational event. The resident must not be coerced into staying, and any such additional hours still count toward the 80-hour weekly limit.

“These additional hours of care or education must be counted toward the 80-hour weekly limit.”

A specialty Review Committee may grant rotation-specific exceptions of up to 10% above the 80-hour limit (i.e. a maximum of 88 clinical and educational work hours per week) to individual programs, based on sound educational rationale and DIO/GMEC approval, following the exception-request process in the ACGME Manual of Policies and Procedures. IMPORTANT: as of the ACGME-approved interim revision effective February 9, 2026, enforcement of requirements 6.24. and 6.24.a. is explicitly SUSPENDED pending the outcome of a major revision of the Common Program Requirements - programs should not currently rely on this exception path.

“A Review Committee may grant rotation-specific exceptions for up to 10 percent or a maximum of 88 clinical and educational work hours to individual programs based on sound educational rationale.”

Moonlighting (both internal and external) must not interfere with a resident's ability to achieve program goals and objectives, must not interfere with fitness for work, and must not compromise patient safety. All time spent moonlighting must be counted toward the 80-hour maximum weekly limit - it is not exempt or additive.

“Time spent by residents in internal and external moonlighting (as defined in the ACGME Glossary of Terms) must be counted toward the 80-hour maximum weekly limit.”

First-year (PGY-1) residents are not permitted to moonlight at all, whether internal or external.

“PGY-1 residents are not permitted to moonlight.”

In-house night float must occur within the context of (i.e., remains fully bound by) the 80-hour weekly maximum and the one-day-free-in-seven requirement. The Common Program Requirements text does NOT itself state a maximum number of consecutive weeks of night float or months of night float per year at the common-requirement level - it explicitly reserves the option for individual specialty Review Committees to further specify such limits. Do not assume a single universal consecutive-night cap; a program's applicable specialty-specific Program Requirements must be checked for any additional night-float limit.

“The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the Review Committee.”

Residents must be scheduled for in-house call no more frequently than every third night, averaged over a four-week period. This is a Core (mandatory) requirement.

“Residents must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period).”

Time spent by residents on patient-care activities while on at-home call must count toward the 80-hour maximum weekly limit (activities such as reading/studying do not count). Unlike in-house call, the FREQUENCY of at-home call is NOT subject to the every-third-night limitation - but at-home call must still satisfy the one-day-in-seven free-of-clinical-work requirement (averaged over four weeks), and at-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for the resident.

“Time spent on patient care activities by residents on at-home call must count toward the 80-hour maximum weekly limit.”