ACGME duty hours for call schedules: the 2026 checklist and a free checker

Every work-hour rule a call schedule has to pass, what each one means when you build the schedule, where schedules usually break them, and a checker you can run on any resident’s four weeks.

The rules, and how call schedules break them

These are the common rules for every residency. Your specialty’s Review Committee can add to them, for example by capping night float, so read your specialty requirements alongside this list.

• 80 hours a week, averaged over four weeks (6.20)Counts everything in the hospital, clinical work done from home (answering calls, charting) and all moonlighting. Averaging happens per rotation: over four weeks, the month, or the rotation if it is shorter. There is no rolling average, and vacation or leave days come out of the count entirely. Where it breaks: a heavy rotation averaged together with a light one, handoff hours and late stays left out, and home-call work nobody counted.
• One day in seven free, averaged over four weeks (6.21.b)A day off is one continuous 24 hours free of clinical, educational and administrative work, ideally a whole calendar day. Home call cannot be assigned on it. Where it breaks: weekend 24s that eat both weekend days, a post-call day labeled as the day off, and backup (jeopardy) call that pulls someone in on their free day.
• In-house call no more often than every third night, averaged over four weeks (6.27)Home call is not held to every third night, but its hours count toward 80 and it must still leave one day in seven free (6.28). Where it breaks: holiday blocks, swaps that stack two people’s calls on one resident, and jeopardy call that turns into in-house call.
• No more than 24 hours of scheduled clinical work in a row, plus up to 4 for handoff (6.22, 6.22.a)The extra 4 hours are only for transitions of care and education. No new patients and no clinics, including continuity clinic. Where it breaks: a post-call resident still on the clinic list, a 24-hour call followed by a scheduled morning, and a night shift that runs straight into a day shift when someone switches from night float to days.
• 14 hours free after 24 hours of in-house call (6.21.a)The 14 hours start when the resident actually finishes, not when the call was scheduled to end. Where it breaks: a post-call evening shift, an early start the next morning, and a handoff that runs long.
• Should have 8 hours off between shifts (6.21)This one is a should, not a must: residents may choose to stay for a patient. A schedule should still never plan fewer than 8 hours. Where it breaks: switching from nights to days, and back-to-back evening and morning shifts.
• Night float fits inside the 80-hour and one-day-in-seven rules (6.26)There is no common limit on consecutive nights. Your specialty’s Review Committee may cap consecutive weeks or months of night float per year. Where it breaks: long night blocks with no full 24 hours off, because the day you come off nights is not a day off.
• Moonlighting counts, and PGY-1s cannot moonlight (6.25)Internal and external moonlighting both count toward the 80 hours. Where it breaks: moonlighting tracked outside the schedule, so the average looks lower than it is.

Two more things decide whether a schedule passes. Residents may stay on their own initiative for a single very sick patient, a family that needs them or a unique teaching event, and those hours still count toward the 80 (6.23). And the exception that let a Review Committee approve up to 88 hours a week for specific rotations (6.24) has been suspended since February 9, 2026, while the ACGME revises the requirements.

What may change

In September 2026 the ACGME posted a proposed major revision of the Common Program Requirements for comment, with a proposed effective date of July 1, 2028. It keeps the 80-hour week, one day in seven and every third night, and renumbers the rules. It would also average hours within a single rotation, and shorten the rest after 24 hours of in-house call from 14 hours to 12. Until it is approved, the rules above are the ones that apply.

Check a resident’s four weeks

The checker below takes one resident’s four weeks, starting on a Monday, and tests them against the rules a schedule controls: the 80-hour average, days off, how often in-house call comes around, the 24-plus-4 limit, 14 hours off after call, and 8 hours between shifts. It runs in your browser. Nothing is sent or saved.

The example month is a common surgery pattern: call every third or fourth night with long days between. It averages over 80 hours, and in week three a resident comes back for an afternoon shift eight hours after a 24-hour call. Both are easy to miss on a spreadsheet and impossible to miss here.

Where jacks fits

A checker tells you what is wrong with one resident’s month after you build it. jacks is a scheduling platform for residency programs and attending groups, and it checks every rule while it builds, for every resident, across the whole year.

• Every draft passes. Duty hours, rest after call, coverage and your program’s own rules are checked while jacks builds the schedule, not flagged afterwards.
• It names the rule in the way. When a seat can’t be filled without breaking one, jacks tells you which rule and which people, instead of quietly bending it.
• It stays true all year. Swaps, call-outs and jeopardy pulls are rechecked before they go out, so a schedule that passed in July still passes in March.
• Your specialty’s rules too. Night float caps, post-call clinic bans and anything your program adds become rules jacks checks, set up with you.

For the other half of a good schedule, see how to build a fair residency call schedule. And for why a chatbot is not a substitute for rule checking, read what happened when we asked Claude to build a real program’s year.

Questions programs ask

Is the ACGME limit still 80 hours a week?

Yes. Clinical and educational work is limited to 80 hours a week, averaged over four weeks, counting in-house work, clinical work done from home and all moonlighting. The current Common Program Requirements took effect July 1, 2026, and a proposed revision posted in September 2026 keeps the 80-hour limit.

Does home call count toward the 80 hours?

The time spent on patient care while on home call does: answering calls and messages and working in the electronic health record. Home call is not limited to every third night, but it must still leave one day in seven free when averaged over four weeks, and it cannot be assigned on those free days.

Can a post-call day count as a resident’s day off?

Not as a habit. A day off is one continuous 24-hour period free of all clinical, educational and administrative work, ideally a calendar day. A post-call day only counts if the resident leaves early enough to get 24 hours off, and the ACGME says this should not be scheduled regularly. The day after home call can be a day off.

Is there a limit on consecutive night float shifts?

Not in the Common Program Requirements. Night float has to fit within the 80-hour and one-day-in-seven rules, and each specialty’s Review Committee may set a maximum number of consecutive weeks or months of night float per year, so check your specialty’s requirements too.