Maternity and parental leave in residency: ACGME rules and who covers the schedule

Maternity leave in residency is at least six weeks at full salary. That’s the ACGME minimum, and it applies to any parent, as well as to medical and caregiver leave. Institutions can grant more under their own policies and applicable law (ACGME 4.8 and FAQ).

• It starts on day one. The six weeks are available from the day a resident must report, so an intern can take them in the first month (4.8.a).
• It applies in every program. The six weeks are available at least once in each ACGME-accredited program, so a resident who goes on to an accredited fellowship is eligible again (ACGME FAQ).
• It can be split. A resident who takes four weeks of approved leave and two more later gets full salary for both (ACGME FAQ).

FMLA for residents. The Family and Medical Leave Act gives eligible employees up to 12 workweeks of unpaid, job-protected leave in a 12-month period, but only after 12 months with the employer and 1,250 hours in the prior year (Department of Labor). A new intern usually doesn’t qualify yet; the ACGME six weeks apply from day one.

For residency scheduling, six weeks always splits at least one four-week or monthly block.

This guide isn’t legal advice; residents and programs should check their institution’s leave policy and their specialty board’s rules.

Chiefly re-runs the schedule around a leave, even one that starts partway through a block, while keeping your program’s rules intact, and saves every version so you can compare the re-run with the original before you publish.

• Your rules, loaded for you. Chiefly is used by residency programs across many specialties. Chiefly’s team loads each program’s rules and ACGME requirements, and Chiefly re-runs the block schedule against them when a resident takes leave, starts late or trains off-cycle.
• Daily, call and clinic. Chiefly also builds daily, call and clinic schedules and keeps them ACGME-compliant.
• Graduation requirements. The resident progress dashboard shows whether a leave puts a resident behind (short but within reach) or at risk (under 50% of what’s due by now), by requirement area, such as clinic, electives or ICU, and by PGY year. It flags how many weeks behind they are and sums up the shortfall in a sentence, so chiefs can plan make-up time. The numbers update on their own as soon as the leave goes in, and the program director sees the same dashboard.

See how Chiefly handles leave, off-cycle residents and late starts, or read about residency block schedule software.

The ACGME parental leave policy requires every Sponsoring Institution to offer, in a written policy, at least six weeks of paid medical, parental and caregiver leave, a reserved week of paid time off, and continued health and disability insurance. The ACGME six-week leave rule took effect July 1, 2022, as section IV.H (ACGME, 2022). Below, IR is the Institutional Requirements and CPR the Common Program Requirements, both effective July 1, 2026.

The rule doesn’t mandate using vacation or sick days (ACGME). Institutions may fund the pay partly from vacation, as long as one week of paid time off stays reserved; a resident with no vacation left still gets full salary for the six weeks (ACGME FAQ).

The short version is in our FAQ: what the ACGME requires for parental leave.

Yes. The ACGME requirement says parental leave, not maternity leave, and doesn’t distinguish between parents: the six paid weeks apply to the first approved medical, parental or caregiver leave a resident takes (ACGME 4.8.a and 4.8.b).

The ABMS leave policy requires specialty boards to allow parental leave for all new parents, including birthing and non-birthing parents, adoptive and foster parents, and surrogates. It defines caregiver leave as caring for a child, spouse or parent with a serious health condition, and medical leave as the resident’s own serious health condition (ABMS).

For the schedule, the type of leave changes the timing more than the work: due dates move, adoptions can come with little notice, and leave may be intermittent (ACGME FAQ).

It depends on how much time you take and on your specialty board’s rules. Under ABMS Policy 3.02.12, effective July 1, 2021, member boards must allow at least six weeks away for parental, caregiver or medical leave at least once during training, without exhausting a resident’s other allowed time away and without extending training (ABMS). It covers boards whose training lasts two years or more.

Boards must say when leave will require an extension. In 2023, ABMS reported that more than half had updated their policies to allow more time (ABMS, 2023). Two examples:

• Internal medicine. ABIM allows up to 35 days a year away for vacation, illness, parental or family leave, or pregnancy-related disability, cumulative across the program: 105 days in a three-year residency, or up to 140 if the program director and clinical competency committee attest to competence and ABIM approves (ABIM, December 2025).
• Pediatrics. ABP allows four weeks a year away for any reason; longer absences are made up so each level includes 48 weeks of training. For parental, medical or caregiver leave, six or eight weeks may be waived instead, depending on the pathway, if the program director and clinical competency committee find the resident competent, a decision that waits until the final three months of training (ABP, updated October 2026).

Programs must tell residents accurately, and in a timely way, how an extended leave affects completion and board eligibility (ACGME 4.8.g and FAQ). An extension means the resident finishes off-cycle, so next year’s schedule has to carry them past June 30.

The program does. ACGME Common Program Requirement 6.14.a requires every program to have policies and procedures that keep patient care covered when a resident can’t work, and chiefs usually build that coverage into the schedule. If you’re the resident taking leave, arranging coverage is the program’s responsibility, not yours.

• Backup (jeopardy) call. A resident on standby covers unplanned absences. Build a leave known months ahead into the schedule instead, so backup stays available for illness and emergencies.
• Redistributing shifts. Spread open shifts and call across the class or PGY level, and keep a running count.
• Moving electives. Let the leave fall on the resident’s own elective or outpatient time, and move a colleague’s elective later so they can cover a required service.
• Moonlighting, where allowed. Extra shifts can fill gaps, but moonlighting hours count toward the 80-hour limit, and PGY-1 residents can’t moonlight (ACGME 6.25.a, 6.25.b).
• Planning ahead. The earlier the dates are known, the more blocks share the coverage. If the resident wants it, front-load their call earlier in the year.

Do residents have to pick up the slack? Sometimes, and it’s a fair question. ACGME says teammates should help colleagues in need and fairly reintegrate them on return, and coverage policies must be carried out without fear of negative consequences for the resident who was out (Common Program Requirement 6.14). The burden isn’t meant to fall on co-residents alone: institutions need processes that provide resources to limit leave’s impact on clinical assignments (Institutional Requirement 2.6.c). Duty-hour limits don’t relax while colleagues are on leave (ACGME FAQ).

Any resident may need the same cover someday, so share it evenly and keep the count visible.

Chiefs rebuild the schedule around leave in six steps, a smaller version of building the block schedule:

1. Get the dates as early as the resident is comfortable sharing. An expected start and length is enough; due dates move, so plan for an early or late start, and keep details private.
2. Protect required rotations. Move them before or after the leave, and let the leave fall on elective, research or outpatient time where possible.
3. Rebalance staffing. Check each service’s staffing minimum in every affected block, and fill gaps evenly across residents.
4. Check duty hours. The weeks around a leave still have to stay within the 80-hour average (ACGME FAQ). Recheck the limits for everyone who picks up shifts; see ACGME duty hour rules for 2026.
5. Check graduation requirements. Compare weeks completed in each requirement area with what’s due, check the board’s allowance, and involve the program director early if make-up time looks likely.
6. Communicate and plan the return. Tell affected residents and rotation directors what changed, and keep the previous version. Programs must provide clean, private lactation facilities with refrigeration, close enough for safe patient care (Common Program Requirement 1.8.c).