Resident Duty

Frequently Asked Questions

This set of responses to frequently asked questions (FAQs) about the common duty hour standards was updated in April 2007, and is organized by standard for easy reference. It reflects the growing experience of programs in adapting to the standards, and the ACGME in promoting compliance with the standards.

In addition to these minimum standards, individual Review Committees (RCs) may set more restrictive limits, as warranted by patient safety, resident education and resident well-being considerations in their discipline. The responses below 1) offer general answers based on the common standards and programs should address specialty-specific questions to their RC team; and 2) may not be able to offer guidance in cases of rare patient care and other events. In these situations, the best professional judgment of the program director and/or DIO should be applied. The standards and the FAQ below, address situations where activities are scheduled or occur with some frequency in residency and fellowship programs.

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Question: The common duty hour standards state that residents must be provided with 1 day free from all responsibilities, with one day defined as one continuous 24-hour period. How should programs interpret this standard if the “day off” occurs after the resident’s on-call day?

Question: What is the definition of “on-call duty”?

Question: Which standards apply to time in the hospital after being called in from home call?

Question: The required 10-hour rest period continues to be problematic for my program. How does the ACGME interpret this common duty hour standard?

Question: Our program only has a few residents and residents prefer to be on call for two days during one weekend, so they can have another weekend completely free of duties. Does this practice comply with the duty hour standards?

Question: What is the ACGME’s interpretation of the use of the added period of up to six
hours at the end of a 24-hour duty and on-call shift?

Question: How should we handle the averaging of the duty hour standards (80-hour weekly
limit, one day off in 7, and call every third night)? For example, what should be done if a
resident takes a vacation week?

Question: Can residents take in-house call every other night for some part of the month, if they
get extra time off later in the months?

Question: We would like to extend duty hours for our surgical chief residents to 88 hours per
week. Can we do this?

Question: What is meant by “sound educational justification” for a request to increase the
weekly limit on duty hours by up to 10 percent?

Question: Our residents engage in “in-house moonlighting.” Which ACGME duty hour
standards apply?

Question: Some of our residents volunteer in a free clinic sponsored by our institution. It is
not a required element of our program and residents do not receive pay for this activity. We
are not sure whether this constitutes ‘in-house moonlighting,’ since the activity is voluntary
and they are not being compensated.

Question: Why does the ACGME distinguish between “in-house moonlighting,” which is
counted under the weekly duty hour limit, and external moonlighting, which is not included?

Question: How do the ACGME common duty hour standards apply to research activities?

Question: How are the standards applied to rotations that combine research and clinical
activities?

Question: A journal club is held in the evening for 2 hours, outside the hospital. It is not held
during the regularly scheduled duty hours, and attendance is strongly encouraged but not
mandatory. Do these hours count toward the 80-hour weekly total?

Question: The ACGME states that it rigorously monitors duty hours in accredited programs,
and that the sponsoring institution has the responsibility for duty hour oversight. Does this
mean that our sponsoring institution must do electronic, “real-time” monitoring of duty hours
in all accredited programs?

Question: What determines the duty hour limits for residents who rotate in another accredited
program?

Question: Some of our residents are going to a conference on the West Coast that requires
travel. How should we count these hours for duty hour compliance?

Question: Our program completed the ACGME Resident Survey last fall. The data showed
that a number of residents exceeded several of the duty hour limits. What will the ACGME do?

Question: Now that the common duty hour standards have gone into effect, will the RCs
continue to enforce their own more restrictive standards?

Question: Can we “relax” the duty hour standards over holidays or during other times when
the hospital is “short-staffed,” during periods when some residents are ill or on leave, or when
there is an unusually large patient census or demand for care.

Question: What is included in the definition of duty hours under the standard “duty hours must be limited to 80 hours per week?

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