What ACEP's shift work policy statement recommends

The statement and its date

ACEP first approved the statement in September 1994, reaffirmed it in 1998 and revised it in 2003, 2010 and June 2017. The June 2017 text, published in Annals of Emergency Medicine in December 2017, is the version summarized here. ACEP's own policy pages now ask for a member sign-in. Its companion paper, "Circadian Rhythms and Shift Work," is public and was revised in July 2026.

The six principles in plain words

The statement starts from two points. Patients are best served when emergency physicians work in a fair, supportive environment, and constantly rotating shifts wear down well-being in ways that add up and are among the main reasons physicians leave the specialty.

1. 1

   Follow the body clock

   Schedule by circadian principles whenever possible. For most settings that means single night shifts or fairly long blocks of nights.

2. 2

   Limit shift length and runs of nights

   Avoid very long shifts and long stretches of consecutive nights. Keep shifts to 12 hours or less in most settings, watch each person's total hours and time off between shifts, and give regular periods of at least 24 hours off.

3. 3

   Rotate clockwise

   Move from day to evening to night, even when days off fall in between.

4. 4

   Protect night workers' sleep

   Build night schedules around a protected anchor sleep period, keep daytime duties to a minimum and consider incentives for physicians who work mostly nights.

5. 5

   Fit the department and the person

   Account for ED volume, patient acuity, non-clinical duties and each physician's age.

6. 6

   Give a place to sleep

   Provide somewhere to sleep before the drive home after a night shift.

What the July 2026 companion paper adds

• There is no single best schedule. Census, acuity, group size, part-time help and individual preferences all shape it.
• There are two night strategies: as few nights in a row as possible, or blocks of nights, for example two months once a year in a group of six. A middle-length run gets the downsides of both.
• 12-hour shifts give one-third more days off; 8-hour shifts make circadian principles much easier to apply.
• Groups can shorten the night, for example with 10-hour days, 8-hour evenings and 6-hour nights.
• Night work can be rewarded with extra pay, with fewer total, weekend or holiday shifts, or with fewer administrative duties.

Checking a schedule against the statement

Here is one physician's proposed week of 8-hour shifts, and a revised version with the same shifts in a different order:

The proposed week rotates backward and leaves two 8-hour gaps. The revised week rotates clockwise, never drops below 24 hours between shifts and still leaves 48 hours between the end of the night and the Saturday day shift.

In Capillary scheduling, saving and publishing check each person's overlapping shifts and minimum rest, including shifts at another site. In a clinician's own schedule, My hours flags backward switches, quick returns, a 3rd night in a row and shifts over 12 hours.

Common questions

Has ACEP updated the statement since 2017?

This page summarizes the June 2017 text published in Annals of Emergency Medicine. ACEP revised the companion paper in July 2026, and members can check acep.org for any newer version of the statement.

Does ACEP set a minimum number of hours between shifts?

No. It asks schedulers to consider the time off between shifts and strongly recommends regular periods of at least 24 hours off. For hour figures from other sources, see quick returns and rest between shifts.

What is anchor sleep?

ACEP's companion paper describes it as a compromise used around a series of night shifts instead of switching fully back to days: going to bed around 03:00 or 04:00 and sleeping until 10:00 or 11:00. That leaves time to see people without losing the night pattern completely.

Sources

1. ACEP policy statement: Emergency Physician Shift Work (approved June 2017; Ann Emerg Med 2017)
2. ACEP policy resource and education paper: Circadian Rhythms and Shift Work (revised July 2026)

Related

• Shift schedulingForward rotating shift schedules: day, then evening, then night
• Shift schedulingEmergency physician shift length: 8, 10 or 12 hours
• Shift schedulingHow many night shifts in a row?
• Shift schedulingHow many hours between shifts? The 11-hour floor and quick returns