The ACGME’s 2011 Changes to Resident Duty Hours: Are They an Unfunded Mandate on Teaching Hospitals?

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Throughout America, teaching hospitals are struggling to meet the Accreditation Council for Graduate Medical Education’s (ACGME) new resident duty-hour standards. Effective July 2011, the Common Program Requirements state that duty hours must be limited to 80 hours per week, averaged over a four-week period, including in-house call and moonlighting (although exceptions may be granted up to 88 hours “based on a sound educational rationale”). Residents must be scheduled for at least one duty-free day (without at-home call) every week, averaged over four weeks. Duty periods of interns must not exceed 16 hours. Upper level residents may be scheduled up to 24 hours of continuous duty, with up to four additional hours for transitions in care, but “strategic napping… is strongly suggested.” PGY-1 and intermediate-level residents must have eight duty-free hours between scheduled duty periods, and 14 duty-free hours after 24 hours of in-house duty. Residents must not be scheduled for more than six consecutive nights of night float, and higher level residents must be scheduled for in-house call no more frequently than every third night (averaged over four weeks). Finally, the ACGME mandated changes to the training environment to improve residents’ educational experience and to mitigate potential adverse effects of the duty-hour restrictions.1