Last Updated: January 2026 | Reading Time: 12 min
Emergency Medicine ACGME Scheduling Requirements: The Complete Guide (2026)
Emergency Medicine residency scheduling is uniquely complex because ACGME prohibits traditional 24-hour call entirely, instead requiring a shift-based model with stricter rest requirements than any other specialty. EM programs must balance 24/7 ED coverage across hundreds of programs while maintaining compliance with rules that differ significantly from the Common Program Requirements.
Key Takeaways
- EM residents are limited to 12-hour maximum continuous shifts in the ED (no 24-hour call)
- Rest between shifts must equal or exceed the preceding shift length (10-hour shift = 10-hour rest minimum)
- Maximum 60 hours/week seeing ED patients and 72 hours/week total on EM rotations
- One day off every 7 days cannot be averaged (unlike other specialties)
- Night float limited to 6 consecutive nights maximum
How is EM scheduling different from other specialties?
Emergency Medicine abandoned the traditional call model in favor of shift-based scheduling because the unpredictable, high-acuity nature of ED work makes 24-hour shifts dangerous for both residents and patients. This fundamental difference creates a scheduling puzzle unlike any other specialty.
Where Internal Medicine or Surgery programs can assign 24+4 hour call shifts, EM programs must construct schedules from variable-length shifts (typically 8, 9, 10, or 12 hours) distributed across multiple time slots (day, evening, night, overnight) to maintain continuous coverage. The math is more complex: instead of assigning one resident to cover 24 hours, schedulers must coordinate 2-3 residents across overlapping shifts.
The core EM scheduling constraints:
| Requirement | EM-Specific Rule | Common Program Rule |
|---|---|---|
| Maximum continuous hours | 12 hours in ED | 24+4 hours |
| Rest between shifts | Rest must match or exceed shift length | 8 hours minimum |
| Weekly ED patient care | 60 hours maximum | N/A |
| Weekly total (EM rotation) | 72 hours maximum | 80 averaged maximum |
| Day off frequency | Every 7 days (no averaging) | 1 in 7 (can average over 4 weeks) |
| Night float limit | 6 consecutive nights | 6 consecutive nights |
What are the EM-specific duty hour limits?
The 12-hour shift maximum
ACGME explicitly states that EM residents cannot work continuous shifts exceeding 12 hours when providing direct patient care in the emergency department. This applies specifically to ED clinical time. Off-service rotations may follow different rules based on that specialty's requirements.
The 12-hour limit creates coverage challenges. A single resident cannot cover a traditional "24-hour call" period, so programs must schedule handoffs mid-shift, increasing the coordination burden and creating potential gaps in continuity.
The dual weekly limits: 60 hours ED + 72 hours total
ACGME Section 6.17.a.3 establishes two separate weekly caps for EM rotations that must be tracked simultaneously:
| Limit | Hours | Scope |
|---|---|---|
| ED patient care | 60 hours/week | Scheduled hours seeing patients in ED |
| Total EM rotation | 72 hours/week | All activities including conferences |
| General limit | 80 hours/week | Averaged over 4 weeks (always applies) |
All three limits are hard constraints that must be satisfied simultaneously. This means:
- •A resident could work 55 ED hours + 15 hours didactics = 70 hours (compliant)
- •But 60 ED hours + 15 hours didactics = 75 hours violates the 72-hour total limit
- •Moonlighting in the ED counts toward 72 hours total; moonlighting outside ED only counts toward 80 hours
- •The 60 and 72-hour limits are per week, not averaged, unlike the 80-hour general cap
The rest period requirement
This is where EM diverges most significantly from common requirements. While other specialties require only 8 hours between shifts, ACGME Section 6.17.a.2 requires EM residents to have "at least one equivalent period of continuous time off between scheduled work periods." This means:
- •8-hour shift → 8-hour rest minimum
- •10-hour shift → 10-hour rest minimum
- •12-hour shift → 12-hour rest minimum
Why this matters for scheduling:
If a resident ends a 10-hour shift at 11 PM, they cannot start their next shift until 9 AM the following day. For 12-hour shifts ending at 7 AM, they cannot return until 7 PM. This constraint eliminates many schedule configurations that would otherwise be mathematically valid.
Important: Conference time affects rest calculations
Per ACGME FAQ, didactic/educational time counts toward work hours but not rest periods. Example: A resident works 10 hours (9 PM–7 AM) then attends conference until 11 AM. The 10-hour rest period begins at 11 AM (conference end), not 7 AM. They cannot return to clinical work until 9 PM.
This rule also applies to transitions between the ED and off-service rotations. A resident finishing a night shift in the ED cannot start a morning rotation the next day without adequate rest equal to or exceeding their shift length.
What violations occur most frequently in EM programs?
The most common ACGME violations in emergency medicine programs:
1. Rest period violations (most common)
The transition between shift types creates the highest violation risk. Common scenarios:
- •Evening-to-day transitions: Resident ends 10-hour shift at 11 PM, scheduled for 7 AM the next day (only 8 hours rest, needs 10)
- •Night-to-afternoon flips: Resident ends 10-hour overnight at 7 AM, scheduled for afternoon shift at 3 PM (only 8 hours rest, needs 10)
- •Conference-to-shift errors: Rest calculated from clinical shift end, not conference end (rest should start after all educational activities conclude)
- •Cross-rotation handoffs: Finishing EM nights before starting a morning surgery rotation
Prevention:
Your schedule should flag rest violations automatically before you publish, not after. Remember that conference time extends the work period.
2. Consecutive night violations
The 6-night maximum for night float blocks is straightforward but easy to violate during schedule changes. If a resident covers an extra night shift due to illness, they may inadvertently hit 7 consecutive nights.
Prevention:
Track night shift sequences in real-time, with alerts when approaching the 6-night limit.
3. Day-off violations
Unlike other specialties, EM programs cannot average the one-day-off-in-seven requirement. Each week must contain at least one 24-hour period free from clinical duties.
Prevention:
Verify day-off compliance weekly, not at the end of a rotation block.
Stop manually checking compliance
Our free tool automatically flags rest period violations, consecutive night issues, and day-off problems before you publish your schedule.
Try the Free Compliance Checker →How should EM programs structure shift schedules?
Common shift models
Standard 4-shift model
- Day: 7 AM – 3 PM (8 hours)
- Evening: 3 PM – 11 PM (8 hours)
- Night: 11 PM – 7 AM (8 hours)
- + Overlap shifts for high-volume periods
Extended shift model
- Day: 7 AM – 5 PM (10 hours)
- Evening: 2 PM – 12 AM (10 hours)
- Night: 10 PM – 8 AM (10 hours)
- Overlaps provide double coverage
12-hour model
- Day: 7 AM – 7 PM
- Night: 7 PM – 7 AM
- Simplest to schedule, but limited flexibility
Shift distribution across PGY levels
ACGME requires graduated responsibility, which affects scheduling:
- •PGY-1: Cannot take unsupervised shifts; must have senior backup available
- •PGY-2/3: Can work independently with attending oversight
- •PGY-4 (4-year programs): Often serve as shift supervisors
Programs must ensure adequate supervision coverage, not just warm bodies in the department.
What are the supervision requirements for EM?
Emergency Medicine has specific supervision tiers that affect scheduling:
Direct supervision (PGY-1)
A supervising physician must be physically present in the ED and immediately available. This doesn't mean one-to-one coverage, but the attending or senior resident must be in the department, not available by phone from home.
Indirect supervision with direct availability (PGY-2+)
The supervising physician doesn't need to be physically present for every patient encounter but must be immediately available to provide direct supervision when needed. In practice, this means in the hospital or very nearby.
Oversight
The attending is available to review and discuss cases but doesn't need to be immediately available for direct intervention. Typically applies to senior residents on straightforward cases.
Scheduling implication: Every shift must have appropriate supervision coverage. If your only PGY-3 calls in sick, you can't just have two PGY-1s cover the shift. Supervision requirements would be violated.
How do off-service rotations affect EM scheduling?
EM residents spend significant time on off-service rotations (ICU, trauma surgery, pediatrics, etc.). These rotations follow the host specialty's scheduling rules, not EM rules.
Key considerations:
- •Transition days: Ensure rest between rotations equals or exceeds the preceding shift length
- •Hour tracking: Off-service hours count toward the 80-hour weekly maximum but not the 60-hour ED maximum
- •Call on other services: Residents may take 24-hour call on surgery or ICU rotations even though they can't in the ED
Common violation scenario:
Example: A resident ends a 10-hour night shift at 7 AM, then is scheduled for an evening shift at 3 PM the same day. That's only 8 hours of rest, but EM requires 10. Most scheduling tools miss this.
What should program coordinators track?
Daily tracking
- • Shift start/end times (actual, not scheduled)
- • Rest periods between shifts
- • Supervision coverage per shift
Weekly tracking
- • Total hours worked (all clinical activities)
- • ED patient care hours (toward 60-hour limit)
- • Total EM rotation hours (toward 72-hour limit)
- • Day-off compliance (cannot average)
- • Night shift sequences (toward 6-night limit)
Monthly/rotation tracking
- • 80-hour weekly average (rolling 4-week)
- • Case logs and procedure numbers
- • Moonlighting hours (if applicable)
FAQ: Emergency Medicine ACGME Scheduling
Can EM residents take 24-hour call?
No. ACGME prohibits EM residents from working continuous shifts exceeding 12 hours in the emergency department. They may take longer call on off-service rotations if that specialty permits it.
What happens if a resident voluntarily stays past their shift?
The extra time counts toward duty hours. Programs should discourage this practice and track actual (not scheduled) shift times. Repeated voluntary extensions suggest scheduling problems.
Can EM residents moonlight?
PGY-1 residents cannot moonlight under any circumstances. PGY-2+ may moonlight if the program permits, but all moonlighting hours count toward the 80-hour weekly maximum. Programs must have written policies and verify hours.
How do the 60-hour, 72-hour, and 80-hour limits work together?
EM rotations have three simultaneous limits: 60 hours/week seeing ED patients, 72 hours/week total on EM rotations (including conferences), and 80 hours/week overall (averaged over 4 weeks). Example: 55 ED hours + 15 hours didactics = 70 hours total is compliant. But 60 ED hours + 15 hours didactics = 75 hours violates the 72-hour limit even though both the 60-hour ED limit and 80-hour general limit are satisfied.
What counts as a "day off"?
One continuous 24-hour period free from all clinical responsibilities. This cannot include required educational activities. On-call from home does not count as a day off.
Can the one-day-off-in-seven be averaged in EM?
No. Unlike common program requirements that allow averaging over 4 weeks, EM requires one day off every 7 days without averaging. Each individual week must contain a day off.
What's the minimum rest between shifts?
For EM, rest must be at least equal to the length of the preceding shift (e.g., 10-hour shift requires 10-hour rest, 12-hour shift requires 12-hour rest). Common requirements only mandate 8 hours minimum. Note: conference/didactic time counts toward work hours but not rest. If a resident works 10 hours then attends 4 hours of conference, rest starts after conference ends.
How do you handle sick calls without violating duty hours?
The covering resident's hours must still be tracked. If coverage would push them over limits, you need a different solution: attending coverage, reduced census, or diversion. You cannot violate duty hours to cover staffing gaps.
Tools for EM Scheduling Compliance
ACGME Duty Hour Calculator
Check your schedule for violations before publishing. Upload an ICS calendar file or CSV export and the calculator flags rest period violations, weekly hour overages, and night float limit issues automatically.
Try the Free Compliance Checker →Sources
- ACGME Common Program Requirements (Residency), effective July 1, 2023
- ACGME Emergency Medicine Program Requirements, effective September 3, 2025
- ACGME Emergency Medicine FAQs, July 2025 (Section 6.17.a.2 clarification on rest periods)
- ACGME Glossary of Terms, 2025
This guide is for informational purposes only and does not constitute legal or compliance advice. Always refer to current ACGME program requirements for official guidance.