ACGME Proposes Eliminating 8-Hour Rest Rule and Every-Third-Night Call Limit for Residents

The STAT News opinion by an otolaryngology instructor details how current ancillary protections prevent dangerous scheduling patterns even when programs exceed the nominal 80-hour weekly cap through underreporting. A 2019 JAMA Surgery observational study of 4,000+ residents found that shifts with less than 8 hours off between duties correlated with 1.6-fold higher self-reported medical errors and elevated burnout scores independent of total weekly hours. The proposal would permit three 24-hour calls separated by only 12 hours, a pattern previously constrained by circadian and recovery rules.

Existing evidence from the 2011 NEJM randomized trial of duty-hour flexibility showed no patient-safety benefit from relaxed rest requirements and documented increased resident sleepiness when recovery intervals shortened. Surgical training volume pressures make the 80-hour limit porous, so the removed boundaries function as the primary scheduling guardrails for chief residents and program directors. Hospitals facing staffing shortages have historically tested the edge of “nearly impossible” language in ACGME guidance.

If adopted, the changes would take effect for the 2027–2028 academic year. Programs would still report aggregate hours, but without the rest-interval metrics that currently trigger site-visit scrutiny. Next required data are prospective cohort studies tracking objective sleep logs, error rates, and 30-day patient outcomes under the new schedules rather than relying on self-reported compliance.