PhysEmp Insights

Most residents think they have two choices when the hours get out of hand: keep quiet and absorb it, or file with the ACGME and hope nobody works out who sent it. That framing skips the options in between. As with most of what we cover in our residency survival guide, the better move depends on who can fix the problem and what each route actually protects.

The current ACGME Common Program Requirements, effective July 1, 2026, cap clinical and educational work at 80 hours a week averaged over four weeks. They also require one day in seven free of clinical work and required education, limit continuous scheduled assignments to 24 hours with up to four more for patient-safety activities and handoffs, and require 14 hours off after 24 hours of in-house call. Moonlighting and clinical work done from home count toward the 80.

The averaging matters. A surgical intern on Reddit described logging more than 320 hours in a single month. Over four weeks, 320 hours sits right at the cap; spread over a 31-day month it averages under 80 a week. That intern may well be over the limit, and is certainly overworked, but the report that gets traction is the one that names the four-week block, the hours, and the specific rule broken. Pull your own logs before you write anything.

A note on what may change: the ACGME posted a major revision of the requirements for comment in September, with a proposed effective date of July 1, 2028. Summaries from AMSA and a residency scheduling company say it keeps the 80-hour and 24+4 limits but drops the every-third-night call limit and shortens post-call rest to 12 hours. The comment period closed October 22. For now, the 2026 rules are the ones your program must meet.

The fastest fix is usually local, and it starts with logging honestly. Residents who under-report to protect the program erase the only record that would prove the pattern later. Then take the specific numbers to your chief or program director: “Our ICU block put four of us over 80 averaged across the rotation. Can we look at the night coverage before the next block starts?” That is a scheduling question the program can solve without outsiders.