Work Hours, Leave, and Moonlighting

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 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
• 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.

As also described elsewhere, 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 that end, we’ve implemented a role called the Jeopardy Resident.

The Jeopardy Resident is assigned to the Jeopardy rotation to serve as the first call to fill in for another resident who needs time off for reasons such as the above. By designating a specific person for this, we intend to remove the difficulty and worry that are often associated with finding coverage, while also ensuring appropriate continuity of care for our patients. The Jeopardy resident can also provide additional backup when a service is very busy or a resident otherwise needs help in the morning before the day float arrives.

The Jeopardy resident does not have specifically assigned clinical duties (other than continuity clinic) during the Jeopardy rotation. Instead, the Jeopardy resident is encouraged to use any available time in which they are not covering a specific service to complete assigned asynchronous learning modules as well as taking care of administrative tasks. Please see the Jeopardy rotation goals and objectives for additional details. When the Jeopardy system is activated, residents taking leave do not need to ‘pay back’ the coverage or make their own coverage arrangements. Requests for Jeopardy coverage should go through the chief residents.

Only certain types of leave are eligible for Jeopardy resident coverage, as detailed below. For other types of leave (for example, changes in vacation plans or conference travel), residents may work with their co-residents and chief residents to arrange a shift trade or change in call week. Any change in shift or call week must be reviewed by the chief residents and program administration to ensure that the change is appropriately recorded and that trades do not violate applicable GME policies regarding time off or result in an ACGME work hour violation.

If the assigned neurology call room is already in use, a resident may reserve an unassigned room in the hospital ‘hotel system’ by making a reservation via mobile phone app, the touchscreen outside the room, or you may reserve a room through https://uwhealth.resourcescheduler.net/resourcescheduler.

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: Like all UW Health residents and fellows, neurology residents receive three weeks of paid vacation per year. In the neurology program, these weeks are taken in 1-week increments, which may be scheduled intermittently through the year or consecutively in a block up to the total number of weeks available. Vacations are scheduled before the start of each academic year during block scheduling, though can be adjusted during the year if necessary.

Career Development: Each resident receives a total of five (5) paid days 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 manager). If the interview can be scheduled in advance, residents should work with the chief residents to find coverage for clinical shifts that may be affected. At the discretion of the chief residents and program administration, the Jeopardy system may also be activated to take over clinical duties if no other clinical coverage can be arranged. If more than 5 days are needed for job searches or fellowship interviews, residents may use vacation or take unpaid leave for the additional time. Unpaid leave must be approved by the program director.

Professional Development: Each resident may take up to one (1) paid week each year in addition to vacation in order to attend professional conferences or other educational courses. This leave is to be requested a minimum of 8 weeks in advance and must be approved by program administration and documented in MedHub. The resident is also required to work with the chiefs to find coverage for shifts if conference dates conflict with scheduled clinical obligations. Jeopardy coverage typically will not be activated to cover clinical obligations for planned travel to meetings or conferences.

Sick Days: Neurology residents may take up to ten (10) days of paid sick leave each year. Sick leave may be taken when the resident is ill, and the illness is not serious enough to require a healthcare certification form to be completed as may be required for personal medical leave. It may also be taken for bereavement after the death of an immediate family member. For full details, and for UW Health GME policies regarding return to work after illness, please see the UW Health GME Time off Policy.

Residents should notify the chief residents and program manager as soon as they know that they will be unable to work due to illness or other emergency. The chief residents will activate Jeopardy where coverage is necessary, and the program manager will update MedHub and notify elective/outpatient rotations about the absence. If a resident will miss their continuity clinic due to illness or emergency, the resident should also notify the relevant clinic staff and their continuity clinic attending as soon as possible.

• For UW clinics:
  • Before 6:30 am: 608-890-6750
  • After 6:30 am: 608-516-3648
• For VA clinics: 888-478-8321
  • Vicki Bigler: x17728
  • Amanda Greeno: x11278

Regardless of leave type, the resident must submit all necessary documentation in a timely manner and inform program administration 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. 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 6 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, fellowship interviews, and professional development does NOT count against the aforementioned 6 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.
• 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 or caregiver 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 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 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 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, 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.

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 6 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 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.

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.