ACGME Answers: Resident Leave Policies

September 28, 2022

This post is part of an ongoing “ACGME Answers” series, expanding on frequently asked questions the ACGME often receives or sees online. To learn more about the ACGME and graduate medical education (GME), review the ACGME FAQs on our website.

On July 1, 2022, new institutional requirements went into effect mandating Sponsoring Institutions to have leave policies that include a minimum of six paid weeks off for medical, parental, and caregiver leave. The establishment of this requirement is part of the ACGME’s commitment to resident and fellow well-being. Since discussions about codifying these types of leave in the Requirements began, and now that the final requirement is in effect, we receive questions and see some confusion about what is actually required. We recognize this particular area of the resident/fellow contract can be confusing. This post attempts to provide clarification.

Let’s start with the actual requirements.

Sponsoring Institutions must “provide residents/fellows with a minimum of six weeks of approved medical, parental, and caregiver leave(s) of absence for qualifying reasons that are consistent with applicable laws at least once and at any time during an ACGME-accredited program, starting the day the resident/fellow is required to report.” They must also “provide residents/fellows with at least the equivalent of 100 percent of their salary for the first six weeks of the first approved medical, parental, or caregiver leave(s) of absence taken.” Note that the requirement does not mandate vacation or sick days be used. It does, however, state that the minimum of six weeks of leave must be paid time off and that at least one week of paid time off must be reserved for use outside of these six weeks. Section IV.H. of the ACGME Institutional Requirements details specifics with regards to vacation time and leaves of absence. The Institutional Review Committee will cite Sponsoring Institutions for violations of the new requirements beginning July 1, 2023.

While the ACGME does not—and cannot—set the terms of resident/fellow appointments concerning salary and benefits, there are guidelines in place through the accreditation requirements to help protect residents and fellows and promote their health and well-being while they are in their residency/fellowship program. To clarify, while the particulars of an individual’s vacation, sick, or paid time off, for example, are included in the resident’s/fellow’s employment contract (with the organization/institution), the Institutional Requirements mandate that the Sponsoring Institution provide that time during an individual physician’s residency or fellowship program as part of that contract.

Section VI of the ACGME Common Program Requirements references our “commitment to the well-being of the students, residents, faculty members, and all members of the health care team.” This includes protected time for lactation, medical appointments, mental health care, coverage for family emergencies, etc. It is critical that these requirements are implemented, and that residents and fellows are able to take that time without fear of retaliation for doing so.

The ACGME recognizes that leave policies vary between Sponsoring Institutions and employers, but firmly believes certain minimum requirements must be met when it comes to supporting individuals’ (as noted above) well-being.  

To learn more about these requirements and their implementation, and to access related documents and resources, visit the Institutional Review Committee section of the ACGME website. On this section of the website, you can find the Institutional Requirements, as well as answers to common questions about medical, parental, and caregiver leaves of absence for residents/fellows. The Institutional Review Committee is responsible for assessing Sponsoring Institutions’ substantial compliance with the ACGME’s Institutional Requirements, and as such, questions about Sponsoring Institutions or those requirements should be directed to the committee’s ACGME staff members, whose contact information can be found on the website. If you believe a program or institution is violating these requirements, we encourage you to consider reporting the issue to the ACGME Office of the Ombudsperson or Office of Complaints.

We hope this post helps clarify the ACGME’s new requirements related to medical, parental, and caregiver leave. Find answers to other questions on our general Frequently Asked Questions page.
Look for other posts in this series coming soon. If you have questions or potential topics you’d like to see explained in more detail in a future post, email