ACGME duty hour rules for residents (2026): 80 hours, 24+4 and the proposed changes

ACGME duty hours in 2026 are governed by sections 6.20 to 6.28 of the Common Program Requirements (Residency), effective July 1, 2026, which every ACGME-accredited residency program must meet (ACGME):

ACGME’s documents now call duty hours clinical and educational work hours. Each specialty’s Review Committee may set stricter limits under 6.20 to 6.28, so check your specialty’s program requirements too.

Most duty hour compliance is decided when the block schedule is built: it sets which months are heavy and who is on them, and the call, daily and clinic schedules then have to fit each rotation’s limits.

• Holidays don’t relax the rules. ACGME’s FAQ expects every four-week period to comply, including holiday months and short-staffed stretches.
• Monitoring is yours to design. ACGME requires programs to monitor work hours, including work from home, but doesn’t say how.

For the full process, see how chiefs build the block schedule.

How Chiefly handles it. Chiefly is both residency scheduling software and a service, so its team does the setup: it loads each program’s ACGME requirements as rules alongside the program’s own. Chiefly then builds the block schedule to those rules, so problems surface before the schedule goes out, and applies the core ACGME duty-hour rules to daily, call and clinic schedules. Moonlighting happens outside the schedule Chiefly builds, so programs still count those hours toward the 80 themselves, and Chiefly doesn’t model Review Committee exceptions, which ACGME says no program currently holds. When leave, an off-cycle resident or a late start changes the year, Chiefly re-runs the schedule in minutes with every rule intact, and if a rule needs to change, you change it in Chiefly and re-run right away. Chiefly is used by residency programs across many specialties. Boston Children’s had a fully ACGME-compliant block schedule for its 188 residents within a week (case study).

The 80-hour limit is an average over four weeks, not a hard cap each week, so one heavy week can be balanced by lighter ones (6.20) (ACGME). Days off and in-house call frequency are averaged over four weeks too.

What counts. All in-house clinical and educational work, clinical work from home such as EHR work and taking calls, and all moonlighting (6.20, 6.25.a). Required conferences and committee work count; reading, studying and research at home don’t.

The short version is in our FAQ on how the 80-hour rule is averaged.

Yes. Residents can be scheduled for up to 24 hours of continuous clinical work (6.22), and up to 4 more hours may be used for transitions of care and resident education (6.22.a). That makes 28 hours in all, and all of it counts toward the 80-hour average (ACGME).

• No new work in the last 4 hours. ACGME’s FAQ bars new patients in any setting, clinic assignments (including continuity clinic) and new procedures such as elective surgery. Residents can finish handoffs, round and attend conferences.
• PGY-1 residents too. ACGME’s 2011 rules capped first-year residents at 16 hours; the revision implemented in the 2017-2018 academic year returned them to 24 hours plus up to 4 (ACGME, 2017).
• One resident-initiated allowance. In rare cases, after handing off, a resident may choose to stay or return for a single severely ill or unstable patient, a patient’s family, or a unique educational event (6.23); the program can’t require it, and the hours count (6.23.a).

Residents must have at least 14 hours free after 24 hours of in-house call (6.21.a) and at least one day in seven free of clinical work and required education, averaged over four weeks (6.21.b). Between other shifts, ACGME says residents should have 8 hours off (6.21) (ACGME).

• The 14 hours start when the work ends. ACGME’s FAQ on 6.21.a starts the clock when the resident finishes all required work, not at the scheduled end of the shift.
• The 8 hours is a “should”. It is a Detail requirement, written so residents may still choose to stay late or return for a patient; ACGME adds that the 80-hour average makes shorter breaks hard to schedule. A return to the hospital from home call doesn’t start a new rest period, so the 8-hour rule doesn’t apply.
• What counts as a day off. One continuous 24-hour period free of all clinical, educational and administrative activity, ideally a calendar day that starts with the resident waking up at home. It can’t regularly fall on a post-call day or carry at-home call, though the day after home call can count. Golden weekends are allowed.

In-house call can come no more often than every third night, averaged over four weeks (6.27), like the 80 hours. At-home call counts toward the 80 hours only for the time spent on patient care (6.28) (ACGME).

• What counts on home call. Phone calls, EHR documentation and time in the hospital after being called in; reading about the next day’s cases, studying and research don’t.
• How often. At-home call has no every-third-night limit, but it can’t be assigned on the day off or for a whole month; a stretch of more than 6 and fewer than 28 days is possible. It must not be so frequent or taxing that it prevents rest (6.28.a).
• Night float. It must fit within the 80-hour and one-day-in-seven limits; Review Committees may cap it further (6.26).

ACGME’s proposed revision would keep the 80-hour week and the 24+4 limit, cut rest after 24 hours of in-house call from 14 to 12 hours, and delete several other limits. It was posted for comment on September 8, 2026, and the comment period closed October 22, 2026 (ACGME). ACGME expects to consider the final draft in June 2027, with a proposed effective date of July 1, 2028 (Rationale and Impact Statement). Until a revision takes effect, the 2026 rules apply.

Here is what the proposed requirements would change, by today’s requirement numbers:

• The 80-hour average (6.20). Written into the rule as at most four weeks within a single rotation, which ACGME says stops a short heavy rotation from being offset by a short light one. Days off (6.21.b) would be averaged the same way.
• Rest after 24-hour call (6.21.a). Cut to 12 hours, which ACGME says eases the burden of building resident schedules while keeping enough time for rest.
• The 8-hour “should” (6.21) and every-third-night limit (6.27). Deleted. ACGME says the remaining limits already make shorter breaks and more frequent in-house call very hard to schedule.
• Night float (6.26). Deleted as redundant with the limits that remain, and Review Committees could no longer cap night float.
• Exceptions (6.23, 6.24). Both deleted: the 88-hour exception, which ACGME says no program currently holds, and residents’ option to stay beyond 24+4 on their own initiative.
• At-home call (6.28.a). Programs would define which home-call activities count as work hours, monitor how heavy home call is and adjust.
• Specialty limits. Review Committees could no longer set their own work-hour limits, and existing specialty-specific ones would be deleted. Programs could still set lower limits themselves.

One day in seven and the PGY-1 moonlighting ban also stay. Our FAQ tracks whether the duty hour rules are changing.