United States: Paid Leave For Medical Practices: Considerations For Setting Time Off Policies

Last Updated: August 21 2019
Article by Jason Flahive

In any business, staff members need the flexibility to take time off from work — whether for sick days, personal days or vacations. Some medical practices take a fairly casual approach, while others have more formal time-off policies. Whatever your current method, you should periodically review and reconsider what would be the most effective and efficient approach.

Casual or formal

Even if you want to keep your policies as informal as possible, you will benefit from setting up some sort of monitoring system. This can be as simple as a wall-mounted calendar on which all staff write their planned vacation and personal days. If you are using something that simple, you will still want at least a manual system to keep track of how many sick, personal or even late days a staffer takes. This will clarify the situation and prevent abuse.

On the other hand, if you want to adopt more formal time-off policies, a paid time-off (PTO) bank is one popular method to consider. This policy pools vacation days, sick time and personal time, allowing staffers to take those days off for whatever reason they see fit. It is important to note that PTO typically does not include paid holidays such as Labor Day, Memorial Day and Thanksgiving. If you want to include these holidays, you will need to increase the amount of PTO staff members receive to account for them.

PTO advantages

One advantage of PTO is that it gives employees control over why they are taking the time off without having to explain why. They can just say, "I need to take a day off," which provides both control and a sense of privacy.

Commonly, the PTO system allows days or hours to accumulate over the time a staffer stays with the office. For example, a new staffer may have 14 PTO days, while one with five years of experience might have 25 days, and so on.

It is an open question as to whether staffers should be able to carry over PTO days from year to year. Some practices allow staffers to carry unused days, or unused days up to a prespecified limit, into the next year. Part of the rationale is that PTO is part of employees' benefits package, and they should be allowed to carry days over. The flip side of this is that, as a benefit, it is accrued yearly — and staffers need to learn to manage their allotted time annually so they don't end up with an inordinate amount of PTO days.

Importance of consistency

Whichever approach is best for your practice, consistency is key. A written policy in the employee handbook is a must, even if you want to have a flexible work environment. Establishing a set policy and putting it in writing will help resolve any conflicts that may arise.

It is also important to track the number of hours and days staffers are taking off and how much time they have accumulated. This is particularly true if you are allowing carryover of PTO each year.

Payroll software often incorporates tracking systems that allow tracking of PTO hours, sick days and tardiness. This can provide support for why you might approve one person's time off and not another's.

Another aspect to consider when developing a program is how to handle maternity, paternity, adoption, surrogacy and bereavement leave. Some, all or none of these may become part of PTO, or they may be approached quite differently. Carefully define the parameters of PTO in your employee handbook.

Outside expertise

It is important to keep in mind that these types of policies are subject to state and federal regulations, including the Family and Medical Leave Act. After you create a policy, and before you add it to your handbook, ask a qualified employment law attorney to review it. Getting the benefit of outside expertise can ensure that the policy will go forward with minimal problems down the road.

Solo practitioners need time off, too

For physicians in multi-physician practices, the question of how to take time off without shutting down the practice is relatively straightforward. But solo practitioners have a more difficult challenge. Here are some helpful steps to take:

  • If You Just Opened Your Practice, Start Slow.
    Try a long weekend. This could even be every other week — for example, taking off every other Friday.
  • Call in Another Physician to Cover for You.
    Remember, if you are burned out from not taking any time off, you are not helping your patients or yourself. While you are gone, an on-call physician can handle emergencies while your staffers continue to take calls, make appointments and fill prescriptions, if qualified to do so.
  • Establish Boundaries.
    With email, text and cell phones available to nearly everyone, it is easy to think you can stay in touch with the practice or patients while you are away. But this also might lead to burnout and ruin your time off.
  • Plan for the Financial Impact.
    Particularly early in your career, a vacation might hit your pocketbook hard. Be prepared to lose some income caused by your time away, and allow for it in your budget.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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