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The ACGME’s proposed 2028 work-hour rules: what changes for your call schedule
In September 2026 the ACGME proposed the biggest rewrite of resident work-hour rules in years. Here is every change side by side, and what each one means when you build a call schedule.
What the ACGME proposed
The ACGME’s Common Program Requirements Task Force posted a major revision of the residency requirements for public comment on September 8, 2026. The ACGME says the revision cuts the number of common requirements by 43 percent. The work-hour section is renumbered from 6.20–6.28 to 6.29–6.39 and changes in the ways below. The final draft is expected to go to the ACGME’s Committee on Requirements and Board in June 2027, with a proposed effective date of July 1, 2028.
Every work-hour rule, today and as proposed
Residency requirements. Fellowship requirements are being revised separately, with a draft expected in early 2027.
| Rule | Today (2026) | Proposed (2028) |
|---|---|---|
| 80 hours a week | Averaged over four weeks, even across two rotations | Still 80, averaged over up to four weeks and within one rotation |
| Time off between shifts | Should have 8 hours off (a non-citable “should”) | Deleted |
| Rest after 24-hour in-house call | At least 14 hours free | At least 12 hours free |
| A day off in seven | Averaged over four weeks; no home call on that day | Same, a full 24 hours, averaged within one rotation |
| Longest shift | 24 hours, plus up to 4 for transitions with no new patients | Unchanged |
| Staying late by choice | A resident may stay or return for a very sick patient, a family or a unique teaching event | Deleted; 24 + 4 is the ceiling |
| 88-hour exception | Up to 10% more, to 88 hours, by specialty exception (already suspended) | Deleted |
| Moonlighting | Counts toward 80; PGY-1s may not moonlight | Unchanged |
| Night float | Within 80 hours and a day off in seven; specialties may cap weeks and months | Rule deleted; specialties can no longer cap it |
| In-house call frequency | No more than every third night, averaged over four weeks | Deleted |
| At-home call | Counts toward 80; must leave a day off in seven and time to rest | Same, and programs must define which home-call work counts and monitor its intensity |
| Specialty limits | Review committees may add stricter rules, such as emergency medicine’s 60 and 72 hours | Not allowed; existing specialty work-hour rules deleted |
From the ACGME’s tracked-changes draft and its Rationale and Impact Statement, September 2026. A proposal, not a final rule.
The ACGME’s stated reasons are mostly about scheduling. It describes the shorter post-call rest as meant “to reduce burden related to developing resident schedules, while retaining sufficient time for rest.” It argues the every-third-night cap adds little because the other limits already make more frequent in-house call nearly impossible, and that different rules across specialties in one hospital create “significant burden for scheduling and monitoring.”
What it means when you build a schedule
- Post-call days get shorter. With 12 hours off instead of 14, a resident who leaves at 9 a.m. after a 24-hour call could be back for a 9 p.m. shift that evening. Under today’s rule the earliest return is 11 p.m.
- Call frequency is limited by the other rules, not by a cap. There would be no every-third-night rule, but the 80-hour average, the day off in seven and the 24-plus-4 ceiling still apply, so a resident still can’t take in-house call much more often than every third night across a rotation.
- Night float has no length limit. Programs could run night float for as many consecutive weeks as the 80 hours and the day off in seven allow, and specialty committees could no longer set a maximum.
- Each rotation must balance on its own. Today a two-week rotation over 80 hours can be offset by a lighter one after it. Under the proposal the average is taken within each rotation, so every block has to stand on its own. For short rotations this is the one change that is stricter than today.
- Specialty limits go away. Emergency medicine’s cap of 60 scheduled hours in the emergency department and 72 total hours a week is the best-known example. Programs could still choose lower limits for themselves; they just wouldn’t be accreditation rules.
- Eight hours between shifts is no longer even a “should.” It was never citable for most programs, and the ACGME argues the 80-hour average already makes very short turnarounds hard to schedule.
- Home call needs a written definition. Programs that use at-home call would have to define which home-call work counts toward 80 hours and keep a way to monitor how heavy it is.
What to do now
- Keep building to today’s rules.Nothing changes for 2026–27 or 2027–28. If the proposal is approved, the first affected schedules are for the 2028–29 academic year.
- Check your rotations one at a time.The rotation-by-rotation averaging is the change most likely to catch a schedule that is compliant today. Our free duty-hours checker tests any resident’s four weeks.
- Write down your own limits.If your program wants to keep a 14-hour post-call rest or a night-float cap, make it program policy; the ACGME will no longer require it.
- Comment by October 22, 2026.Through the comment form on the ACGME’s review-and-comment page, under Common Program Requirements (Residency).
Our view
The ACGME’s main reason for the change is that today’s rules are hard to build schedules around and hard to monitor. We build scheduling software, and we don’t think that holds up: a schedule that passes every one of today’s rules can be built and checked automatically, rotation by rotation, before anyone works a shift. “It’s hard to schedule” is a reason to fix how schedules are made, not to cut residents’ rest. We make the full case in our response to the proposal, and comments are open until October 22, 2026.
Keep your protections, whichever rules apply
Whatever the ACGME decides, a program can keep stricter limits than the minimum. In jacks, work-hour rules are settings, not something a chief checks by hand, so keeping today’s protections costs nothing extra.
- Every draft passes every rule. jacks checks the 80-hour average, rest after call, days off and shift length while it builds, rotation by rotation, and names the rule in the way when a seat can’t be filled.
- Keep today’s protections. Keep the 14-hour post-call rest, the every-third-night cap or a night-float limit even if the ACGME drops them; they are rules like any other, and jacks still fills every seat.
- Switch on the day it takes effect. If the new rules are approved, your schedules can move to them for July 2028 without rebuilding anything.
- It runs the year. Swaps and call-outs are checked against the same rules and go to whoever is eligible and under their target.
Building surgery call? See how to build a surgery residency call schedule.
Questions programs ask
When would the new ACGME work-hour rules take effect?
Not before July 1, 2028. The ACGME posted the proposal for comment in September 2026, comments close on October 22, 2026, and the final draft is expected to go to its Committee on Requirements and Board in June 2027. Until then the current 2026 rules apply.
Is the ACGME changing the 80-hour limit?
The limit stays at 80 hours a week. What changes is the averaging: hours would be averaged over at most four weeks and within a single rotation, so a heavy rotation could no longer be balanced by a lighter one that follows it.
How much rest after a 24-hour call under the proposal?
At least 12 hours free of clinical work and education after 24 hours of in-house call, down from 14 hours today. The 24-hour limit on continuous scheduled work, plus up to four hours for transitions, stays the same.
How do I comment on the ACGME proposal?
Through the comment form on the ACGME’s review-and-comment page, listed under Common Program Requirements (Residency). The deadline is October 22, 2026. The ACGME does not answer individual comments; the Task Force reviews them before the final draft.