Adult Neurology Residency

Adult Neurology Residency

Work Hours, Leave, and Moonlighting

Work Hours, Leave, and Moonlighting

Introduction

The Neurology residency training program aims to provide residents with not only the requisite educational and clinical experiences, but also reasonable opportunities for rest and personal activities needed to maintain wellness. Residents shall be able to attend their medical, mental health, and dental care appointments, including those scheduled during work hours, and they shall be able to transition the care of their patients when needed due to fatigue, illness, or family emergency. Residents and faculty members are expected to demonstrate an understanding and acceptance of their personal roles in:

  • The safety and welfare of patients entrusted to their care.
  • Their fitness for duty, and specifically the recognition of impairment, including illness and fatigue, in themselves and in their peers. Please also refer to the Resident Well-Being

  • Management of their time before, during, and after clinical assignments.
  • Honest and accurate reporting of work hours and other data.

It is the professional responsibility of the resident to notify the Program Director if he or she is approaching the limits of the requirements set forth below, whether in terms of work hours, fatigue or other fitness for duty. Patterns of problems experienced by the resident should be reported to the Program Director and/or GME Administration for correction. A GME Hotline is available at 608-316-9800 as a mechanism for reporting work hour problems that can’t be addressed at the department level.

Work Hours

Definition: Formerly known as duty hours, work hours encompass all clinical and academic activities related to the training program. These include inpatient and outpatient clinical care, in-house call, short call, 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.

Work hours also include conferences, call from home, and time spent in the hospital after being called in to provide patient care. Types of work from home that must be counted include using an electronic health record and taking calls. Hospital and program administrative time, such as attending committee meetings, must also be included in the count of clinical and educational work hours, as does time spent moonlighting.

The policies that follow apply to all of the above activities. For example, a resident on a night float rotation is subject to the 80 hour and one-day-off-in-seven rules. 

Maximum Work Period Duration: Clinical and education work periods for residents shall not exceed 24 hours of continuous scheduled assignments. Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. New patient care responsibilities will not be assigned to a resident during this time. Our night float system eliminates all such 24 hour duty periods.

Time Off: Residents shall have eight hours off between scheduled work periods. There may be circumstances when residents choose to stay late to care for their patients or return early to the hospital, but these must occur within the context of the 80 hour and the one-day-off-in-seven requirements.

Residents shall have at least 14 hours free of clinical work and education after 24 hours of in-house call (again, our program’s night float system eliminates most, if not all, such 24 hour in-house call shifts).

Residents shall be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over the course of a rotation). The ACGME defines one day as “one continuous 24-hour period free from all administrative, clinical and educational activities.” At-home call shall not be assigned on these free days.

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 his or her 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
  • 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.

The Jeopardy Resident 

There are circumstances where a resident will need time off during an otherwise scheduled work day. These include medical, dental, and mental health appointments, illness, fatigue, and family emergencies. Our program is committed to the health and welfare of our residents, to ensuring that residents can obtain needed coverage without fear of negative consequences, and to the continuity of patient care when a resident does require clinical coverage. To these ends, we’ve implemented a role called the Jeopardy Resident. The Jeopardy Resident is one who is on an elective rotation and is specifically designated to fill in for another resident who needs time off for reasons such as those above.

There is often a tension between a resident’s sense of responsibility toward his or her patients and colleagues on the one hand, and his or her need for rest and recuperation on the other. In order to encourage residents to use the Jeopardy system without feelings of guilt, it is our policy that the resident requesting Jeopardy coverage will “pay back” the covering resident with similar coverage at a later date. However, if the resident needing coverage has a physician’s or similar documentation, then no payback will be required. Requests for Jeopardy coverage should go through the chief resident.

Should the resident need to miss clinic due to illness, please inform the relevant staff:

  • For UW clinics:
    • Before 6:30 am: 608-890-6750
    • After 6:30 am: 608-516-3648

  • For VA clinics: 888-478-8321
    • Cynthia Branch: x17728
    • Justin Dedecker: x16447
    • Cathy Gallagher: x17728 

Call Rooms and Safe Ride Home

If there is not a previously assigned call room available for sleep, a resident may call Bed Control at 608-263-8775 and ask for a call room in the “resident hotel system.” In addition, GME Administration will reimburse a resident for a cab ride home in the case that s/he is too tired to safely drive themselves home following a duty period. Receipts should be turned in within 30 days of the ride.

Paid Time Off

Vacation: Like all UW Health residents and fellows, neurology residents receive three weeks of paid vacation per year. These weeks are to be taken in 1-week increments and can be used to take up to 3 total weeks off consecutively. 

Career Development: Each resident receives up to five days for fellowship and other employment searches. All time used for this purpose must be approved in advance by the program director. The resident is also responsible to find coverage for the entire length of absence.

Professional Meetings: Each resident receives, in addition to vacation time, up to one paid week each year in order to attend professional meetings. Attendance for the meeting is to be approved at a minimum of 4 weeks in advance by the program director and documented in MedHub. The resident is also responsible to find coverage for the entire length of absence.

Exams: Residents may take time off without loss of pay for up to two days per year for required licensure and similar exams. All time used for this purpose must be approved in advance by the program director.

Leave of Absence

For definitions of each leave type, please see the GME’s Time off Policy. In addition to this GME policy, there are a few leave types for which the department of neurology has its own internal polices; these are outlined below.

Regardless of leave type, the resident must submit documentation in a timely manner and inform the program coordinator of known absences at least 60 days in advance. Residents can submit an absence request form online; these can be found on the department’s main webpage as well as here. Failure to submit prior to 60 days in advance may result in leave request being declined, or additional call coverage, based on specific circumstances, to be determined by program administration.

Assuming that the resident is meeting their competency milestones, a leave, or a combination of leaves, up to 12 weeks’ total duration can be accommodated without extending the duration of residency training. Leave(s) exceeding that duration will require extension of training. Note that paid time off for vacation, professional meetings, etc. does 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 FMLA following the new child(ren) by birth, adoption, fostering, or legal guardianship.

  • 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.
  • Leave shall be taken from the resident’s allotted elective weeks, which may be re-scheduled among residents and across training years to accommodate the needed time off.
  • Parental leave is exclusive of vacation and sick leave.
  • FMLA, Wisconsin FMLA, and any eligible personal medical leave run concurrently with parental leave. A resident may choose to utilize their 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: Current policy and law allow for 6 weeks paid personal medical leave and up to 12 weeks total time off per FMLA. 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.

  • Leave shall be taken from the resident’s allotted elective weeks, which may be re-scheduled among residents and across training years to accommodate the needed time off.
  • Medical leave is exclusive of vacation or sick leave.
  • FMLA, Wisconsin FMLA, and any eligible parental medical leave run concurrently with personal medical 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 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, 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.

Moonlighting

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. 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.

IMPORTANT: UW Health does not provide any 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 start with.
  • Clinical moonlighting within UW Health will only be approved if the resident meets and obtains UW Health Medical Staff requirements for privileging. In addition, the services furnished must be separately identified from those services that are required as part of the training program. Even if distinguishable, there may still be restrictions on allowable billing for inpatient services. Neurology residents generally don’t moonlight within UW Health, but if such concerns arise, they will be resolved in collaboration with the UW Health Compliance Department.

Latest revision: 03-21-2022

 

Justin A. Sattin, MD

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