ACGME Duty Hours: What the 2028 Proposal Would Change
On September 8, 2026, the ACGME posted a proposed major revision of the Common Program Requirements (Residency) for review and comment, with a proposed effective date of July 1, 2028. It rewrites the whole document. The ACGME says the revision “represents a 43 percent reduction in the number of Common Program Requirements.”
This explainer covers what program coordinators, program directors and chief residents will feel first: work hours and call. Nothing changes today: the requirements effective July 1, 2026 still apply. One note on words: the ACGME’s own term is “clinical and educational work hours”, which replaced “duty hours” in its requirements.
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Key dates
| Step | Date, as the ACGME states it |
|---|---|
| Proposal posted for review and comment | September 8, 2026 |
| Deadline for comments | October 22, 2026 |
| Final draft considered by the ACGME Committee on Requirements and Board | “June 2027 meetings” (anticipated) |
| Proposed effective date | July 1, 2028 |
A Post-Doctoral Education Program version was posted with it, with the same deadline. The Fellowship and One-Year Fellowship versions are also under major revision. The ACGME expects to post those for public comment “in early 2027”, with an effective date “tentatively planned for July 1, 2028” (Rationale and Impact Statement). For fellowship programs, no text has been proposed yet.
What would change for work hours and call
| Rule | Today (version effective July 1, 2026) | Proposed (posted September 8, 2026) |
|---|---|---|
| Time off after 24 hours of in-house call | At least 14 hours | At least 12 hours |
| Time off between scheduled work periods | Eight hours, a “should” (Detail requirement) | Deleted |
| In-house call frequency | No more often than every third night, averaged over four weeks | Deleted |
| Night float | Within the 80-hour and one-day-off-in-seven limits; Review Committees may cap weeks and months | Deleted; Review Committees could no longer cap it |
| Staying past the schedule by choice, for one patient or an educational event | Allowed, hours count toward the 80 | Deleted |
| Exceptions up to 88 hours | Possible (enforcement suspended since February 9, 2026) | Deleted |
| Averaging | Over four weeks; the FAQ requires averaging by rotation | Written into the rule: “within the span of a single clinical assignment/rotation” |
| At-home call | Not so frequent or taxing as to preclude rest | Programs must also define what counts as work hours and monitor intensity |
| Specialty work-hour rules | Review Committees may add them | Existing ones deleted, no new ones |
12 hours instead of 14 after 24-hour in-house call
The proposed text: “Residents must have at least 12 hours free of clinical work and education after 24 hours of in-house call.” The ACGME gives its reason as “to reduce burden related to developing resident schedules, while retaining sufficient time for rest.”
In practice, a resident can be back two hours sooner. If post-call time off starts at 10:00 am, the earliest return moves from midnight to 10:00 pm. A post-call day off followed by a normal 7:00 am start the next morning is well above both minimums, so it would not change.
The eight-hour line goes
Today’s text reads: “Residents should have eight hours off between scheduled clinical work and education periods.” The ACGME notes that, as a Detail requirement, “programs with a status of Continued Accreditation are not subject to citation” for it, and that the 80-hour limit “is a deterrent for scheduling fewer than eight hours off.” The Common Program Requirements would then set no minimum between ordinary shifts. Programs could still keep their own.
Every third night and night float
The ACGME says the 80-hour, day-off and 24-hour limits “make it nearly impossible for a program to assign a resident in-house call more frequently than once every third night on average.” It does not expect a change in practice: “it is not anticipated that removal of this requirement will significantly alter the manner in which programs assign in-house call.” For night float, the Task Force proposes that Review Committees “not be permitted to set additional limits related to assignment of night float.”
Averaging stays inside one rotation
The 80-hour rule would read: “when averaged over a maximum of four weeks and within the span of a single clinical assignment/rotation.” The one-day-in-seven rule gets the same wording and defines the day as “a period of 24 consecutive hours”. The proposed guidance gives an example: two two-week rotations at 100 and then 50 hours a week are non-compliant “because the first rotation exceeds 80 hours when averaged over the course of the rotation.”
Home call: define what counts
The proposal adds: “Programs that utilize at-home call must define the patient care activities that must be counted as work hours, and must maintain a process to monitor workload intensity and make adjustments as needed.” Per the guidance, managing patient care from home counts; routine daily notes, reading about the next day’s case, studying and research do not. It also warns: “Scheduling structures labeled as ‘home call’ should not functionally replicate extended in-house call or continuous overnight shifts.” The ACGME adds that “no specific process nor documentation is prescribed.”
Specialty-specific limits
Each work-hour requirement carries this note: “Upon approval and implementation of the Common Program Requirements, existing specialty-specific requirements in this section will be deleted.” The ACGME’s examples are specialty rules that do not permit averaging over four weeks, or that set the maximum below the common one. Programs may still schedule fewer hours: those that find it serves education and patient care “will continue to do so.” Specialty requirements now labeled “detail” would also be deleted, unless a Review Committee obtains approval to keep them.
What stays the same
- 80 hours a week at most, averaged, including all in-house clinical and educational activities, clinical work done from home and all moonlighting.
- 24 hours of continuous scheduled clinical assignments, plus up to four hours for transitions of care and education, with no additional patient care responsibilities.
- One day in seven free, averaged, with no at-home call on those days. The guidance still accepts a “golden weekend”, a Saturday and Sunday off together.
- At-home call: time spent on patient care counts toward the 80 hours.
- Moonlighting counts toward the 80 hours, and PGY-1 residents may not moonlight.
- Health appointments: residents must be given the opportunity to attend medical, mental health and dental care appointments, “including those scheduled during their working hours.”
Other proposed changes that touch the schedule
- One coverage policy: “The program must have a policy describing how planned appointments during work hours, unanticipated absences, and leave are requested and covered.”
- Lactation: “time free from clinical and educational duties during work hours to address lactation needs.”
- Pregnancy: “a program-specific policy addressing the needs of pregnant residents, which includes duty and schedule modifications and management of unique occupational exposures, as warranted.”
- Logging: the guidance states that “the ACGME does not prescribe or require logging mechanisms for resident clinical and educational work hours.”
How to comment
The ACGME Review and Comment page lists the Common Program Requirements (Residency) as a major revision, with October 22, 2026 under “Deadline for Comments”. The comment period runs from the September 8 posting to that date. The page links the tracked-changes requirements, the Rationale and Impact Statement and the comment form, and states: “Comments must be submitted electronically using the form below by the date indicated.” The ACGME does not reply to individual comments.
Specific comments help most: cite the requirement number in the proposal (6.31 for the 12 hours) and say what the change would do to your schedule.
What to check in your call schedules now
- Keep scheduling to today’s rules. The 14 hours and the every-third-night limit stay in force until a revised version takes effect, and the proposed date is July 1, 2028. Schedules you build before then follow today’s rules.
- Find post-call patterns built on the minimum. For each 24-hour in-house call line, note when residents actually leave and when they are next scheduled. Only patterns at or near 14 hours would be affected.
- Check short rotations. A rotation shorter than four weeks must average 80 hours or less on its own. Today’s FAQ already requires this.
- Write down your home call rules: which activities count as work hours, and how you spot a line that has become too heavy. Home call that works like in-house call is what the ACGME warns about.
- List your specialty limits. Mark which limits in your schedule come from your specialty’s requirements, and watch for your Review Committee’s updates.
- Review your coverage policy: how appointments, unexpected absences and leave are requested, and who covers.
- Count a day off as 24 consecutive hours, inside each rotation.
Rule changes are easier when the rules are written down in one place. In Momentum, a program’s rules, such as time off after call, maximums and who covers which line, are set up once and applied every time the schedule is generated, and the counters stay current with each swap. Book a demo to see it on your own rotations, or start with our physician call schedule guide and free Excel template.