The Accreditation Council for Graduate Medical Education (ACGME) has proposed weakening several resident work-hour protections, according to a First Opinion essay by Arifeen Rahman, a clinical instructor at the Medical University of South Carolina. The changes would remove the requirement for eight hours off between shifts, reduce post-call rest after a 24-hour in-house shift from 14 hours to 12, and eliminate the rule limiting in-house overnight call to no more than every third night. The 80-hour workweek cap would remain, but Rahman argues that how those hours are distributed is what really matters.
Rahman writes that most surgical residency programs do not truly follow the 80-hour rule and instead underreport hours to avoid penalties. That makes the ancillary protections—time off between shifts and call frequency—critical concrete boundaries for scheduling. She gives the example of a resident potentially being assigned three 24-hour call shifts in a week with only 12 hours off between them, which would technically stay under 80 hours but leave almost no time for recovery or sleep. She cites data linking sleep impairment to physician burnout and self-reported medical errors.
Not all proposed changes are negative. Rahman notes that the ACGME also suggests closing a loophole that allowed residents to work 21 consecutive days by averaging weekends off across rotations. She supports that fix but argues the overall direction weakens meaningful protections. The rules are not final, and the public comment period runs until Oct. 22.