Guide · Surgery

How to build a surgery residency call schedule

Trauma call, night float, acute care surgery and senior backup, layered by PGY, around long OR days and a case log that has to keep growing. Here is how general surgery programs build it, the rules that make it hard, and what to expect from software.

Jackson Cantrell · Updated October 8, 2026 · 7 min read

Short answerA surgery call schedule layers services (trauma, night float, acute care surgery, senior backup) by PGY, so every intern has a senior and every senior has an attending. It has to keep 80 hours a week averaged over each rotation, 14 hours off after 24 in-house hours, call no more than every third night, one day in seven free, and night float within its caps, while juniors still reach 250 cases before PGY-3. jacks builds that schedule from your program’s rules with every rule checked and everyone at their fair share, and keeps it right through every call-out.

How surgery call is usually built

Most general surgery programs mix two models. Juniors and mid-levels take 24-hour in-house trauma or general surgery call every third or fourth night; a night float resident covers the floors for a run of nights; interns staff acute care surgery days with a senior; and a chief or senior takes backup call from home. Weekends are where the models meet, and where most of the swaps happen.

One week of call, by service

Illustrative. Initials and PGY; interns are PGY-1, the chief is PGY-5.

One illustrative week of general surgery call, by service, with each resident’s initials and PGY
Day	Trauma call (24h)	Night float	ACS days	Senior backup (home)
Mon	MK·2	JR·2	DH·1	NG·4
Tue	TB·3	JR·2	AL·1	BH·5
Wed	SP·3	JR·2	DH·1	NG·4
Thu	MK·2	JR·2	AL·1	BH·5
Fri	TB·3	JR·2	DH·1	NG·4
Sat	SP·3	24-hour team	AL·1	BH·5
Sun	MK·2	24-hour team	DH·1	NG·4

On weekends the 24-hour trauma team covers the floors, so the night float resident gets two days off in a row.

The rules that make it hard

Each rule is simple. Keeping all of them true at once, for every resident, across a whole year, is the hard part.

80 hours a week, averaged by rotation. ACGME averages over each rotation (four weeks, a month, or a shorter rotation), not on a rolling basis, and leaves vacation out of the count. Long OR days count, and so does time on a busy trauma night.
Rest after a 24. In-house shifts top out at 24 hours plus up to four for handoffs, followed by at least 14 hours off. Residents should have eight hours off between any two shifts.
Every third night, at most. In-house call no more often than every third night, averaged over four weeks.
One day in seven, truly free. Averaged over four weeks, and home call cannot land on that day.
Night float caps. For general surgery, no night float rotation longer than two months, no more than four months in a PGY year, and no more than twelve across the program.
No 88-hour cushion. The provision that let review committees approve up to 88 hours on a rotation was suspended in February 2026. Plan on 80.
Interns need a senior. PGY-1s work under direct supervision or with it immediately available, so intern shifts have to line up with an eligible senior.
The case log keeps score. 850 major cases by graduation, at least 250 before PGY-3 and 200 in the chief year. A call pattern that keeps a junior out of the OR for weeks shows up later as a case-log gap.

What software should do for a surgery program

Build call and rotations togetherTrauma, night float, ACS and backup in one pass, around the rotation each resident is on.
Check every rule while it buildsRest after 24s, every third night, one day in seven and night float caps, averaged the way ACGME averages them.
Pair interns with seniorsAs a rule the schedule cannot break, not a habit someone has to remember.
Keep the OR in viewShow case-log progress next to the call schedule, so call doesn’t quietly cost a junior their cases.
Make fair visibleTrauma calls, nights, weekends and holidays per resident against a target for their PGY.
Handle Saturday’s call-outFind who can legally cover, keep counts fair, and track who owes a call back.

The same week, by hand and with jacks

The same surgery call week built by hand and with jacks
Stage	By hand	With jacks
Building the week	A chief fills a spreadsheet around OR blocks and clinic, then checks it by eye	jacks builds call and rotations together, every service at once
Rest after a 24	Someone counts the hours after every trauma night	Every draft keeps 14 hours off after 24 in-house hours, and 8 between shifts
Every third night	Averaged by hand, often across rotations	Checked per rotation, the way ACGME averages it, with vacation left out
Night float	Blocks tracked in a separate sheet	Each resident’s night float counted against the caps for the rotation, the PGY year and the program
Interns	Hoping a senior is on with every intern	Set it as a rule: no intern shift without an eligible senior
Cases	Juniors on nights quietly miss cases	OR assignment shows case-log progress, so call doesn’t starve a PGY-2 who is behind
Fairness	Counted up at the end of the block	Everyone balanced against a target for their PGY: trauma calls, nights, weekends and holidays
A call-out on Saturday	A group text and a favor	The shift goes to whoever is eligible and furthest under target, the owed call is tracked, and everyone affected is told on their phone and calendar

Every rule checked is a big claim, so we tested it. Given a real program’s full year of call, a general-purpose AI broke eight rules. jacks broke none. Read the test, or drag residents around the surgery call week in the live demo on our home page and watch it recheck the schedule.

Where jacks fits

jacks is a scheduling platform for residency programs and attending groups. For a surgery program, that means:

Setup, together. We sit down with your chiefs and coordinator, turn how your services run into rules, and stay until your first schedule is published.
It builds the schedule. Call and rotations together, with every rule checked and each resident balanced against the target for their PGY. When a seat can’t be filled, jacks names the rule in the way.
The OR, too. Daily case assignment with each resident’s case-log progress in view.
It runs the year. Call-outs go to whoever is eligible and furthest under target, owed calls are tracked for payback, and everyone affected gets the change on their phone and calendar.

More on the rules themselves in our ACGME duty-hour checklist, on targets in how to build a fair call schedule, and on tools in the best residency scheduling software in 2026.

Questions surgery programs ask

Is night float or 24-hour call better for a surgery residency?

Both can meet the rules. In one study of PGY-1 and PGY-2 general surgery residents, 24-hour call came with more operative cases, while both systems met the 250-case minimum before PGY-3; residents moved to night float report less fatigue and more time to read. Many programs run a hybrid: night float on the busiest services and 24-hour trauma call for juniors and mid-levels.

Can surgery residents work 88 hours a week?

Not something to plan on. ACGME rules let a review committee grant rotation-specific exceptions up to 88 hours, but in February 2026 the ACGME suspended that requirement while it rewrites the Common Program Requirements. Build the schedule to 80 hours a week, averaged over each rotation.

How often can surgery residents take in-house call?

No more often than every third night, averaged over four weeks. ACGME averages by rotation, not on a rolling basis, and leaves vacation days out of the count, so the heaviest rotation has to comply on its own.

What software do surgery programs use for call schedules?

Most build the schedule in a spreadsheet or by hand and publish it in Amion so everyone can see who is on; larger systems use enterprise platforms such as QGenda. jacks builds the call schedule and rotations together from the program’s rules, then runs the year: call-outs, swaps and payback.