ACGME Proposes 12 Hours Off After 24-Hour Call and Drops the Every-Third-Night Rule. Comments Close Oct. 22.
The proposed Common Program Requirements keep the 80-hour week but cut required time off after 24-hour call from 14 hours to 12 and remove two scheduling rules. Comments close Oct. 22; the proposed effective date is July 1, 2028.
The Accreditation Council for Graduate Medical Education (ACGME) has proposed cutting residents' required time off after 24 hours of in-house call from 14 hours to 12, and its public comment period on the proposal closes today, Oct. 22.
The change is part of a major revision of the Common Program Requirements for residency and post-doctoral education programs. The ACGME's review and comment page lists Oct. 22 as the deadline for both versions and showed both open for comment this morning. The proposal keeps the 80-hour weekly limit, and the ACGME gives a proposed effective date of July 1, 2028.
What would change in the work-hour rules?
Four changes stand out in the proposed requirements and the ACGME's rationale and impact statement.
Time free after 24 hours of in-house call would fall from 14 hours to 12. The statement that residents should have eight hours off between scheduled clinical work and education periods would be removed. The rule limiting in-house call to no more often than every third night, averaged over four weeks, would be removed. And both the 80-hour weekly limit and the one day free in seven would have to be met within the span of a single clinical assignment or rotation, rather than averaged across rotations.
Overall, the Common Program Requirements Task Force says the revision reduces the number of Common Program Requirements by 43 percent.
Why does the ACGME say it is making the changes?
The Task Force says the specific rules add scheduling and monitoring burden that other limits already cover. For the 12-hour rule, it wrote that the change is meant "to reduce burden related to developing resident schedules, while retaining sufficient time for rest." On the eight-hour statement, it noted that the requirement is categorized as a detail, so programs with continued accreditation cannot be cited for missing it, and that the 80-hour average already makes fewer than eight hours off hard to schedule.
On call frequency, the Task Force wrote that the 80-hour average, the day off in seven and the 24-hour maximum plus four hours for patient-safety activities "make it nearly impossible" to assign in-house call more often than every third night on average. It said it does not expect removing the rule to significantly alter how programs assign call. The within-rotation averaging, it said, is meant to prevent a short rotation with excessive hours from being offset by another short rotation with fewer.
The ACGME is betting that the 80-hour cap does the work the specific rules once did. Whether that holds will depend on how each program builds its call schedule.
What do critics say?
The main objection is that a weekly total does not show how the hours fall. In a STAT First Opinion essay published Oct. 20, Arifeen Rahman, a clinical instructor in rhinology and endoscopic skull base surgery at the Medical University of South Carolina, wrote that a resident could theoretically be assigned three 24-hour call shifts in a week separated by only 12 hours off without violating the 80-hour limit. She argued that the ACGME should strengthen protections for residents rather than weaken them.
Rahman supported the rotation change. She described being told as an intern that weekends on either side of a 21-day stretch meant she had technically averaged one day off in seven, and wrote that the proposed rules "fix this loophole."
What happens after comments close?
The comments feed a final draft. The Task Force says review and comment will inform additional changes before the final draft goes to the ACGME Committee on Requirements, and it expects the committee and the Board to consider it at their June 2027 meetings. The Fellowship and One-Year Fellowship versions are expected to be posted for comment in early 2027, with final drafts going to the committee and Board in September 2027 and the same tentative July 1, 2028, effective date.
What should programs and residents do today?
Anyone who wants to comment should do it today. The comment form is linked from the ACGME's review page, which invites comments from the community of interest and does not state a time-of-day cutoff, so do not leave it to the evening. Program directors can also start checking call schedules against the within-rotation averaging rule, which would change how blocks pairing heavy and light rotations are built. For the broader case that schedules shape wellbeing, see why burnout is a design problem.
Reported, fact-checked and edited by The Script Pad's editorial staff.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
