Accepting a proposal filed last November, the Accreditation Council for Graduate Medical Education (ACGME) said on Friday that the cap on residents’ duty hours would be set to 80 hours per week with shifts not lasting more than 28 hours, beginning July 1.

The maximum shift will be 24 hours, but the new rule allows for an additional 4 hours “to manage necessary care transitions” including handouts and writing patient notes.

Limits on duty hours will now be the same for PGY-1 and later residents, including fellows. The policy also establishes that residents must have one work-free day each week, eliminates “moonlighting” for PGY-1 residents, and counts work at home toward the 80-hour weekly maximum.

In 2011, the ACGME had reduced the maximum shift duration for first-year residents to 16 hours. However, the organization said, its task force on residency requirements “determined that the hypothesized benefits associated with the [2011 policy] have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole.”

“It is important to note that 24 hours is a ceiling, not a floor,” the ACGME continued in its announcement of the new standards. “Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

Public Citizen and the American Medical Students Association, which have campaigned to keep the 2011 limits in place, quickly attacked the ACGME announcement.

AMSA President Kelly Thibert, MD, who will begin her residency training this summer, commented as follows: “Extreme sleep deprivation and long hours are a holdover from the early 20th century when residents literally resided in the hospitals in which they trained. There is no reason to continue to subject medical trainees to mental and physical exhaustion for years on end, with the harm that ensues to them, their families, and their patients, simply to maintain an archaic tradition.”