ACGME duty hours explained
Updated October 12, 2026 · with an example to try
Residents may work at most 80 hours a week, averaged over four weeks, with one day in seven free and no more than 24 hours of continuous scheduled work plus up to 4 hours for handoffs. After 24 hours of in-house call they need 14 hours free. Emergency medicine residents have tighter limits, including a 12-hour cap on shifts in the emergency department.
Edit a four-week block
Example · runs in your browser; nothing you enter is sent
- Hours a week
- 66.0
- Days off
- 6
- Hours in 4 weeks
- 264
- Weekly hours, averaged over 4 weeks (80 hours, 6.20)Passes
The block Feb 1 to Feb 28 averaged 66 hours a week (limit 80).
- Time off between shifts (Should be 8 hours, 6.21)Passes
You had at least 8 hours off between all scheduled shifts; the shortest break was 12 hours.
- Time off after 24 hours of call (14 hours, 6.21.a)Passes
No scheduled period lasted 24 hours or more, so no 14-hour rest was needed.
- One day off in seven, averaged over 4 weeks (4 days off in 4 weeks, 6.21.b)Passes
The block Feb 1 to Feb 28 had 6 days off (at least 4 needed). A day off is 24 hours in a row with nothing scheduled, and home call can't fall on it.
- Longest continuous work (24 hours, plus 4 for handoffs, 6.22)Passes
No scheduled period was longer than 24 hours; the longest was 12 hours.
- In-house call, averaged over 4 weeks (Every third night, 6.27)Passes
No scheduled period here lasted 24 hours or more, so there was no in-house call to count.
A sample block starting Monday, February 1, 2027, in Eastern time. Moonlighting and home call aren't part of it: moonlighting counts toward the 80 hours, and so does patient care during home call.
Pick a shift and tap the days to place it. Each rule turns red or green as the block changes. To check your own schedule, add your calendar to the duty-hour check.
The rules every residency follows
| Rule | Limit | Section |
|---|---|---|
| Hours a week | 80, averaged over four weeks, counting in-house work, clinical work done from home and moonlighting | 6.20 |
| Time off between work periods | Should be 8 hours | 6.21 |
| After 24 hours of in-house call | 14 hours free of clinical work and education | 6.21.a |
| Days off | One day in seven, averaged over four weeks; a day off is 24 hours in a row with no clinical, educational or administrative work | 6.21.b |
| Longest continuous work | 24 hours of continuous scheduled clinical work, plus up to 4 hours for handoffs and education, with no new patients | 6.22 |
| In-house call | No more often than every third night, averaged over four weeks | 6.27 |
| Home call | Patient care time counts toward the 80 hours; not held to every third night; never on a day off | 6.28 |
| Moonlighting | Counts toward the 80 hours; PGY-1 residents may not moonlight | 6.25 |
The July 2026 requirements renumbered the former section VI.F as 6.20 to 6.28. Review Committees could once allow some programs up to 88 hours; the ACGME suspended enforcement of that exception in February 2026 (6.24). Internal medicine also limits night float: at most 1 month in a row, 2 months a year and 4 in residency (6.26).
How the 80 hours are averaged
The average runs by rotation: over four weeks, over a month, or over the rotation if it is shorter than four weeks, never as a rolling average. Vacation and leave days come out of both the hours and the days they are averaged over.
The same averaging applies to days off and to in-house call frequency.
Emergency medicine rotations
- At most 12 continuous scheduled hours in the emergency department (6.17.a.1).
- Time off between scheduled work periods at least as long as the shift before it (6.17.a.2).
- At most 60 scheduled hours a week seeing patients in the emergency department, and 72 hours a week in all (6.17.a.3).
- One 24-hour day free in every seven days, not averaged (6.17.a.4).
What a calendar can show
A calendar shows the time you were scheduled. It does not show staying late, coming in from home call, or notes written at home, all of which count toward the 80 hours. The duty-hour check reads scheduled time only, so treat its numbers as the floor of your hours.
Common questions
- Can residents work 28 hours in a row?
- Yes, but only 24 of them can be scheduled clinical work. Up to 4 more hours may be used for handoffs and education, with no new patients.
- What counts as a day off?
- One continuous 24-hour period free of all clinical, educational and administrative work. Home call cannot be assigned on it.
- Does moonlighting count toward the 80 hours?
- Yes, both internal and external moonlighting. PGY-1 residents may not moonlight.
Check your own schedule against these rules.
Use the free duty-hour check with your calendar link, the subscribe link your scheduling app gives you, or a calendar file. Our server reads a link once, sends back only the shift times and keeps nothing; a file never leaves your device. No account needed (what the checks see).