Work Hours, Leave, and Moonlighting

Definition: Formerly known as duty hours, work hours encompass all clinical and academic activities related to the training program. This includes inpatient and outpatient clinical care, in-house call, short call, in-house night float and day float, transfer of patient care, and administrative activities related to patient care, such as completing medical records, ordering and reviewing lab tests, and signing orders. This also includes patient care-related work from home such as using an electronic health record and making/taking patient phone calls and time spent in the hospital after being called in to cover clinical duties.

Work hours also include academic and administrative activities such as membership on hospital or departmental committees and attendance at mandatory conferences, and other mandatory program activities such as participation in GME recruitment activities, participation in program-mandated quality improvement/patient safety activities, and work as a chief resident. Time spent moonlighting is also recorded as clinical work hours.

Reading done in preparation for the following day’s patient care, independent studying or board review, and research done by residents on their own initiative (not in fulfillment of program requirements) do not count toward work hours. For additional details, please see UW Health GME policy on Work Hours (Policy 43.7).

The policies that follow apply to all activities that constitute work hours as defined above.

Maximum Work Period Duration: Per ACGME and UW Health GME policies, clinical and education work periods for residents must not exceed 24 hours of continuous scheduled assignments plus four hours of additional time to be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education.

The neurology day float and night float systems eliminate the need for scheduled 24-hour in-house call shifts as part of the standard block schedule, with a maximum scheduled shift length of 16 hours. Any change to scheduling in the future will comply with the UW Health GME Work Hours Policy (Policy 43.7).

Time Off: Per ACGME and UW Health GME policies, residents must have at least eight hours off between scheduled work periods less than 24 hours in length, and at least 14 hours free of clinical work and education after 24 hours of in-house call. In rare circumstances, after handing off all other clinical responsibilities, residents may choose to stay late or return early to the hospital for continuity of care. These instances must still occur within the context of the 80-hour and the one-day-off-in-seven requirements.

Residents shall be scheduled for a minimum of one day in seven free of clinical duties and academic requirements (averaged over a single rotation). The ACGME defines one day as “one continuous 24-hour period free from all administrative, clinical and educational activities.”

80 Hour Weekly Maximum: Work hours shall not exceed 80 hours per week, averaged over the course of each rotation, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting. Reading done in preparation for the following day’s patients, studying, and research done from home do not count toward the 80 hours.

Exceptions: In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances:

• To continue to provide care to a single severely ill or unstable patient
• To provide humanistic attention to the needs of a patient or family
• To attend unique educational events

These additional hours of care or education will be counted toward the 80-hour weekly limit.

Our program designed our Jeopardy system to ensure that residents are able to address emergencies and illnesses for themselves and their families easily and without fear of negative consequences while maintaining continuity of clinical care for patients. Secondarily, the Jeopardy system is intended to help the program meet unanticipated clinical coverage needs more easily and without overly burdening residents on elective or other outpatient rotations.

Duties of the Jeopardy Resident: The main responsibility of the resident assigned to the Jeopardy rotation is to provide urgent coverage for the Neurology clinical services. The chief residents and Program Director/Program Administrator will try to notify the Jeopardy resident as far in advance as feasible, though where a resident must leave work suddenly advance notice may not be possible. Residents are expected to remain available by pager and/or mobile phone at all times during the Jeopardy week and to remain within a geographic radius such that they are able to start work at their assigned clinical service within 60 minutes of activation.

The vast majority of Jeopardy activations will be for one of the following:

• Absences from inpatient services (Stroke Inpatient and Consults, General Inpatient and Consults, inpatient Pediatrics, Epilepsy) or call services (Night Float and Day Float).
• Absences from resident continuity clinics scheduled at the VA due to specific national VA policies regarding last-minute appointment cancellations.
• Additional assistance on a given inpatient or call shift when exceptionally high volumes raise concerns about patient safety and/or effective operation of the clinical services.

Other outpatient rotations (Continuity Clinics at the UW or 20 S. Park locations, Neuromuscular, outpatient Pediatrics, all electives) are not routinely covered by the Jeopardy resident. In rare cases, the Jeopardy resident may be asked to cover a UW or 20 South Park continuity clinic or other outpatient service at the discretion of the Program Director/Program Administrator.

The Jeopardy resident does not have other specifically assigned duties during their rotation. Instead, residents on Jeopardy rotation are encouraged to use the time in which they are not covering a clinical service for academic and/or administrative duties such as completion of training modules or other asynchronous learning, clinical inbox management, research or QI projects, preparation of academic presentations, self-directed reading, etc.

Rarely, there may be multiple competing clinical needs beyond the capacity of the single Jeopardy resident to cover. In those circumstances, the chief residents and the Program Administrator/Program Director will identify residents assigned to required outpatient rotations (preferred) and/or electives to cover the shift. The program will make every reasonable effort to make alternative arrangements before calling in residents other than the Jeopardy residents.

Please see the Jeopardy Activation and Voluntary Coverage as well as the Jeopardy rotation educational goals and objectives for additional details.

The ACGME and UW Health GME require all programs to educate faculty and residents to recognize signs of fatigue and sleep deprivation and to maintain alertness management and fatigue mitigation processes. All UW Health GME physicians and faculty complete online training modules regarding fatigue mitigation and management as part of UW Health annual required training. The Department of Neurology also provides resources including an annual lecture from our Sleep Medicine faculty on sleep deprivation and fatigue mitigation.

If residents are too fatigued to safely return home, there are two options provided by UW Health.

• The Neurology department is assigned a dedicated sleep room on the 4^th floor of the main hospital for use by the Night Float resident. Residents other than the Night Float resident may reserve a GME Hotel Sleep Room using the scheduling website (currently Resource Scheduler https://uwhealth.resourcescheduler.net/resourcescheduler) or mobile app (currently FMS:Now).
• Residents may pay for a ride home (ride-share or taxi service, etc.) and submit receipts to the Program Administrator/Program Manager for reimbursement from UW Health. Per UW Health Work Hours Policy, the resident may also submit receipts for reimbursement for the ride back to work if needed, which may be reimbursed within the discretion of the program and UW Health GME.

The amount of paid and unpaid leave available to each resident is established by the UW Health GME office. Full details of applicable GME policies regarding paid and unpaid leaves, please see the UW Health GME Time off Policy.  Neurology program-specific policies regarding certain types of leave are outlined below.

Vacation Blocks: Like all UW Health residents and fellows, neurology residents receive fifteen (15) days of paid vacation per year. In the neurology program, these are assigned as three 1-week blocks, Sunday through Saturday. Each week consists of five (5) vacation days covering weekdays and two (2) weekend days free from clinical duty. Vacation weeks may be requested individually to be distributed through the year or as a single consecutive block.

Individual Vacation Days: All residents who perform clinical duties on a UW Health holiday (New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Eve, Christmas Day) will receive a ‘floating’ vacation day that can be used later in that academic year or can be carried over to the following academic year.

In addition, PGY-3 and PGY-4 residents may, at their discretion, choose to convert one of their assigned vacation weeks to clinical elective time in exchange for 5 individual vacation days.

Residents may use individual vacation day(s) in one of the following ways:

• Residents may use one individual vacation day per year during UW continuity clinic time. Per national VA policy, scheduled clinics at the VA may NOT be cancelled for vacation or other non-emergent leave. Residents who intend to cancel one of their UW continuity clinic half-days to use vacation time must give a minimum of 6 weeks’ notice without exception.
• Residents may use one individual vacation day per week during required outpatient rotations (e.g., neuromuscular, pediatric outpatient (POP)).
• Residents may use any of their individual vacation days during their elective time, up to the total number of days available. Note that certain assigned electives (e.g., neuroradiology) do NOT permit rotators to use vacation time due to the clinical and academic structure of the rotation. Residents will be advised at the time of selection if their elective prohibits the use of vacation days and will be given the option to choose a different rotation if they prefer.
• Residents may also use individual vacation days to supplement other types of paid leave (e.g., sick leave, parental leave, professional development or career development time), up to the total number of days available. Use of vacation days for these purposes will be subject to existing departmental and UW Health GME policies for the relevant type of leave as described elsewhere in this policy.

Residents may not use individual vacation days during weeks in which they are assigned to inpatient services (Stroke and General Wards and Consult services, Day Float, Night Float, as well as Epilepsy and Pediatric inpatient rotations) or Jeopardy unless they are able to arrange acceptable voluntary coverage for their clinical responsibilities (see below)

Up to five (5) unused vacation days can be carried over to the following academic year. If a resident has more than 5 unused vacation days at the end of the academic year, the extra days will be lost. Carry-over days must be used before graduation and cannot be carried over between UW programs (i.e. from residency into a UW fellowship). There is no option to ‘cash out’ or otherwise receive payment in lieu of using vacation time. Please see the UW Health GME Time Off Policy for more details.

Career Development: Each resident receives a total of five (5) paid days per training program for fellowship interviews and other employment searches. All time used for this purpose must be approved in advance by the program administration (Program Director or Program Administrator).

If more than 5 paid days are needed for job searches or fellowship interviews, residents may use individual vacation days to supplement the amount of paid time available or may request unpaid leave for the additional time. Use of vacation time is subject to the above policies, and unpaid leave must be approved in advance by the Program Director.

Ideally, residents should work with their co-residents to find voluntary coverage for clinical shifts that may be affected. At the discretion of the chief residents and program administration, Jeopardy may also be activated to take over clinical duties if voluntary coverage is not available. Jeopardy may be used for up to five (5) days of absence for interviews/career development. Residents wishing to extend their interview time beyond the available five (5) days using vacation days or unpaid leave will need to arrange the additional coverage themselves.

Professional Development: Each resident may take up to five (5) paid days each year to attend professional conferences or other educational courses. This leave is in addition to vacation time. 

Professional development leave must be requested a minimum of 8 weeks in advance and must be approved by program administration and documented in MedHub. Routine travel to conferences or educational courses is generally not a program-approved reason to activate the Jeopardy resident. If the requested conference or educational opportunity conflicts with scheduled clinical obligations, residents must work with their co-residents to arrange voluntary coverage. In certain exceptional circumstances, the Program Director may approve Jeopardy coverage for a resident to present original research or to participate in conference activity of particular significance to their fellowship or career.

Residents will be given an opportunity as part of the annual block scheduling to include their plans for conference attendance or other use of professional development leave, which will be considered in scheduling as best as possible. If there are multiple conflicting requests, priority will be given to more senior residents and to residents who have not yet met program requirements to attend a national conference.

Sick Leave and Bereavement: Neurology residents may take up to ten (10) days of paid sick leave each year. Sick leave may be taken under the following circumstances:

• The resident has a medical condition or illness such that they are unable to work, with anticipated return within five (5) business days. Longer periods of absence for illness/medical condition may require evaluation by Employee Health Services to determine fitness to return to duty and/or a healthcare certification form to be completed for personal medical leave.
• The resident is caring for an immediate family member with illness or a medical condition.
• The resident wishes to take leave for bereavement due to the death of an immediate family member.

For full details, and for UW Health GME policies regarding return to work after a prolonged illness, please see the UW Health GME Time off Policy.

Residents should notify the chief residents and program administration as soon as they know that they will be unable to work due to illness or emergency.

Regardless of type, the resident must inform program administration of any known or anticipated absences greater than five (5) business days and submit all necessary documentation in a timely manner, at least 60 days in advance if possible. Residents can submit an absence request form online; these can be found on the department’s main webpage here. Failure to submit prior to 60 days in advance may result in leave request being declined.

Assuming that the resident is meeting their competency milestones and is in good standing with the program, up to 12 weeks of leave of absence for any reason can be accommodated with without extending the duration of residency training. This can be taken as one continuous leave of absence or as multiple shorter leaves of absence. Leave(s) exceeding that duration will require extension of training. Note that use of paid vacation time, sick time, career development, and professional development do NOT count against the aforementioned 12 weeks.

Parental Leave: Please reference the UW Health’s Parental Leave for Residents and Fellows Policy. Current policy and law allow for 6 weeks paid parental leave and up to 12 weeks total time off per the Family Medical Leave Act (FMLA) following the birth, adoption, fostering, or legal guardianship of a child.

• The resident should begin conversations with program administration as far in advance as possible when planning leave. The program must receive notice of the resident’s intent to request the leave at least 30 days before the anticipated leave, understanding that some circumstances change or do not allow for this much time. Parental leave is exclusive of vacation and sick leave.
• FMLA, Wisconsin FMLA, and any eligible personal medical or caregiver leave run concurrently with parental leave. A resident may choose to utilize vacation time to increase their paid time after the initial 6 weeks. Residents then have the option to take unpaid time to achieve the full 12 weeks FMLA allows.

Personal Medical and Caregiver Leave: Current UW Health policy provides 6 weeks paid personal medical leave or caregiver leave.  State and federal law under the FMLA allows for up to 12 weeks total time off for personal medical conditions or to care for family members with serious health conditions. The resident should begin conversations with program administration as far in advance as possible when planning leave. The program must receive notice of the resident’s intent to request the leave at least 60 days before the anticipated leave, understanding that some circumstances change or do not allow for this much time. Medical and caregiver leave is exclusive of vacation or sick leave.

• FMLA, Wisconsin FMLA, and any eligible parental medical leave run concurrently with personal medical leave and caregiver leave. A resident may choose to utilize their vacation time to increase their paid time after the initial 6 weeks. Please see the GME’s Time off Policy for additional details regarding personal medical leave, caregiver leave, and paid time off options.

Administrative Leave: Residents may be placed on paid administrative leave while under investigation for alleged misconduct or to determine fitness for duty. Residents may be placed on unpaid administrative if they become non-compliant with work requirements (vaccination requirements, medical licensure, etc.)  Upon the resident’s return from leave, program administration will determine whether the resident is on track to meet the competency and other requirements for graduation, or if training will need to be extended to achieve these.

Training Extension: Residents in training have complementary but separate roles. As employees of the hospital system residents are provided with vacation and paid leave time in accordance with institutional leave policies and are entitled to additional protections including work accommodations and time off under federal, state, and local labor laws, as described briefly above. As trainees, residents are subject to the policies of the Accreditation Council of Graduate Medical Education (ACGME) regarding the training period and of the American Board of Psychiatry and Neurology (ABPN) regarding their post-graduate eligibility for specialty and subspecialty board certification.

The current ABPN policy on leave during training requires programs to offer 4 weeks of combined vacation and sick time each year as well as a one-time additional 12 week leave of absence for medical, parental, or caregiving needs. If the combination of vacation, sick time, and personal/family leave taken during training exceeds this amount, it may be necessary to extend the period of residency training in order to complete academic requirements and preserve the resident’s eligibility for board certification.

Residents are strongly encouraged to use the paid and unpaid leave available for them to take care of themselves and their families. We will work with the resident to minimize the duration of extended training as much as possible.

Moonlighting is defined as compensated, medically-related work not related to the training program requirements. The department of neurology neither encourages nor discourages moonlighting. Of course, the primary responsibilities of our residents are to care for our patients and to learn the clinical and basic sciences of neurology. Moonlighting must not interfere with these, or with the resident’s fitness for work, and certainly must not compromise patient safety.

Moonlighting requests must be submitted via MedHub. They are reviewed first by the Neurology Program Director and then the GME administration. The Neurology Program Director has discretion to deny moonlighting requests if the resident is not compliant with administrative and/or clinical expectations of the residency program or is otherwise not in good standing. Only after approval by both can the moonlighting commence.

Time spent by residents in moonlighting must be counted toward the 80-hour maximum weekly limit; all moonlighting hours must be logged in MedHub as part of the weekly work hours.

PLEASE NOTE: UW Health GME does not provide liability coverage for moonlighting activities, whether internal or external. The resident or the employer where the moonlighting takes place must provide liability coverage for the moonlighting activities.

Moonlighting Restrictions:

• PGY-1 residents are not permitted to moonlight (ACGME rule)
• The State of Wisconsin Medical Examining Board requires that residents moonlighting in patient care outside of their training program have a full, unrestricted medical license. That is, one cannot moonlight under the Resident Education License that most residents initially obtain.
• Clinical moonlighting within UW Health (including SwedishAmerican Hospital/UW Northern Illinois and Meriter Hospital) will only be approved if the resident meets UW Health Medical Staff requirements for independent practice and obtains medical staff privileges independently. In addition, the clinical work performed must be distinct from the clinic work required as part of the training program. There may be additional restrictions on allowable billing for inpatient services for trainees attempting to moonlight internally. Internal moonlighting by neurology residents is very rare. The program will work with the resident and the UW Health Compliance Department on a case-by-case basis if an opportunity does arise.