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Residents often work long hours. Rules implemented by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 limit work hours for all residents.
These limitations mean residents can work no more than 80 hours per week, no more than 24 consecutive hours on duty, cannot be on-call more than every third night, and should have one day off per week. Also in 2011 ACGME also imposed a rule not allowing interns to work more than 16 hours consecutively.
While these rules were an improvement over previous working conditions, 80-hour weeks are still a significant time investment, especially when compared to the average work week. Let’s take a look at the actual number of hours residents and fellows are working as reported in our 2024 Residents & Fellows Survey.
How many hours do residents work?
We asked medical trainees how many hours they work per week, including on-call hours. Residents reported an average of 65.9 hours worked per week, while fellows reported an average of 59.7 hours per week.
| Hours worked | Percentage of respondents (residents & fellows) |
|---|---|
| <40 | 1% |
| 40-49 | 8% |
| 50-59 | 16% |
| 60-69 | 31% |
| 70-79 | 24% |
| 80-89 | 15% |
| 90-99 | 2% |
| 100+ | 2% |
19% of respondents reported working over 80 hours per week.
When asked about the most challenging parts of training, 44% of residents and fellows said their working hours or workload was one of the top three biggest challenges. 38% said lack of time for social life was in their top three biggest challenges.
How do hours worked change over the course of training?
As residents and fellows progress in their training, you may expect that hours worked changes over the years of training.
For residents, this isn’t the case. Average hours worked in residency stays between 64-66 for years 1-5 of training. In years 6 and 7, average hours worked jumps to 74, possibly due to these being primarily surgical residents who typically work longer hours.
| Year of residency | Average hours worked |
|---|---|
| 1 | 66.2 |
| 2 | 66.3 |
| 3 | 65.8 |
| 4 | 64.2 |
| 5 | 64.4 |
| 6+ | 74.1 |
For fellows, there is a noticeable change in hours worked from year 1 to year 2 of fellowship.
| Year of fellowship | Average hours worked |
|---|---|
| 1 | 57.0 |
| 2 | 63.2 |
| 3+ | 61.3 |
| Gender | Average hours worked |
|---|---|
| Female | 65.8 |
| Male | 63.5 |
How do hours worked impact burnout?
When compared to hours worked, the frequency of feelings of burnout rose steadily as hours worked increased.
| Burnout frequency | Average hours worked |
|---|---|
| 1 (rarely) | 55.7 |
| 2 | 57.8 |
| 3 | 57.3 |
| 4 | 59.1 |
| 5 | 61.1 |
| 6 | 62.5 |
| 7 | 65.2 |
| 8 | 66.6 |
| 9 | 65.7 |
| 10 (frequently) | 74.5 |
How do hours worked impact compensation satisfaction?
Residents are typically faced with long hours and low compensation, so how do hours worked impact a trainee’s satisfaction with their compensation? According to our 2024 report, as average hours worked decreased, residents and fellows reported being more satisfied with their compensation.
| Compensation satisfaction | Average hours worked |
|---|---|
| 1 (very unsatisfied) | 71.0 |
| 2 | 68.8 |
| 3 | 67.0 |
| 4 | 64.4 |
| 5 | 63.3 |
| 6 | 63.3 |
| 7 | 61.6 |
| 8 | 63.2 |
| 9 | 55.9 |
| 10 (very satisfied) | 58.3 |
What do residents & fellows have to say about their hours?
We asked what else residents and fellows had to say about their hours worked. Here’s what they said:
- “Fellowship is better than residency when it comes to work hours.”
- “High work hours and workload is part of being in a surgical residency, but the addition of financial stress outside of work really worsens the burnout during residency.”
- “Many hours are not logged as they involve things like pre-charting.”
- “The hours suck, but the lack of weekends is particularly difficult, especially with kids.”
- “My work hours are decent, but the amount of studying and lectures I have to prepare adds on an additional 20 hours.”
- “The first year of fellowship was much worse than my current year in terms of hours worked, but the burnout occurred in residency and there has been no time to recover.”
Addressing hours worked in residency
Long working hours can be challenging for many residents and fellows. The data shared above is just one glimpse at the challenges these trainees face. Find the full 2024 Resident & Fellow Survey Report for free here.
