Graduate Medical Education
Program Administration
Resident Duty Hours: Policy
Duty hours are defined by the ACGME as all clinical activities related to the
residency program, i.e. patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house
during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
Each program has a written statement concerning the house officer’s duty hours which will be in
compliance with their RRC requirements. The ACGME Duty Hours Requirements, which are maximum duty
hour standards for all residency and fellowship programs (unless granted program specific exemptions
by the ACGME and by UNM)
are as follows:
- House officers work week which must not exceed eighty hours averaged
over a four-week period, inclusive of all in-house call activities and all moonlighting.
- House officers must receive one day off in seven from all educational and clinical responsibilities
averaged over a four week period, inclusive of call. One day is defined as one continuous 24-hour
period free of all clinical, educational, and administrative activities. At home call cannot be
assigned on these free days
- Duty hour periods for Interns must not exceed 16 hours in duration
- Duty hour periods for HO II and above may be scheduled to a maximum of 24 hours of continuous
duty in the hospital. Residents are encouraged to use alertness management strategies in the
context of patient care responsibilities. This includes strategic napping after 16 hours of
continuous duty and between the hours of 10 PM and 8 AM is strongly encouraged.
- Transitions of patient care must occur for patient safety and resident education.
Residents may be allowed to stay on site for an additional 4 hours to accomplish these tasks.
- Each program must have a procedure to ensure continuity of patient care if a house officer
is unable to attend to assigned patient care responsibilities.
- Residents must not be assigned additional clinical responsibilities after 24 hours of
continuous service. HO II and above cannot be scheduled for in house call more frequently
than every third night when averaged over a four week period.
- Residents may, in unusual circumstances, on their own initiative, may remain beyond their
scheduled period of duty to continue to provide care to a single patient. Justification for
such extensions of duty are limited to reasons of required continuity for a severely ill or
unstable patient, academic importance of the events transpiring, or humanistic attention to
the needs of a patient or family. Under such circumstance the resident must hand over the
care of all other patients to the team responsible for their continuing care, and document
the reasons for remaining to care for the patient in question and submit that documentation
in every instance to the program director. The program director will forward all such
documentation of these instances to the Duty Hour Compliance Task Force and the GMEC.
The program must review each submission of additional service and track both individual resident
and program wide episodes of additional duty.
- Residents should have 10 hours free of service between daily service rotations, and must have
8 hours scheduled duty periods. Residents must have 14 hours free of duty after 24 hours of in
house service. Residents in final years of training must be prepared to enter the unsupervised
practice of medicine and care of patients over irregular or extended periods. Final year residents
may have less than 8 hours free of service between daily service rotations as specified by their
RRC in some circumstances. All instances will be reviewed by the Duty Hour Compliance Task Force.
- Residents must not be scheduled for night float more frequently than six consecutive nights.
Night float may be further specified by individual RRC’s. HO II and above residents must be
scheduled for in house call no more frequently than every third night when averaged over a
four week period.
- For call taken from home (pager call), the time the resident spends in the hospital
after being called in is counted toward the duty hour limit. The only other numeric duty hour
standard that applies is that one-day-in-seven that must be free of all patient care
responsibilities, which includes at home call. The ACGME also requires that programs monitor
the intensity and workload resulting from at home call, through periodic assessment of the
frequency of being called into the hospital, and the length and intensity of in house
activities. Each episode of this type of care while it must be include in the 80 hour work
week will not initiate a new off duty period. Residents are responsible for monitoring fatigue
after home call and will be relieved of clinical responsibilities following home call if
necessary. Faculty physicians will assist in relieving house officers of duty responsibilities
after home call.
At this time, no UNM residency or fellowship programs have been granted exemption from these
maximum standards. Specific RRC duty hour regulations (e.g., specialty specific) may be more
restrictive than the duty hours standards described above, and those residency programs must
have departmental duty hours policy compliant with the standards of their RRC.
Each program shall distribute a copy of the departmental duty hour policy to all house officers
physicians and faculty. It is the primary responsibility of the sponsoring program to assure
compliance with RRC duty hour regulations regardless of the house officer’s rotation on or off
of the service.
House officers shall report duty hours honestly, completely, and correctly in accordance
with institutional requirements via New Innovations.
