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Child Neurology Residency

Work Hours, Leave, and Moonlighting

Introduction

The Child 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. Refer also to the section, Resident Well-Being Policy
  • 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 duty 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.

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Work Hours

Residents are responsible for reporting their work hours on time at the end of each week. If by chance the resident gets locked out from entering, they are to send the program coordinator their hours to enter by end of the month, before the program coordinator gets locked out as well.

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 most 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.

Jeopardy Resident (during PGY 3)

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, the adult neurology residency program has 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 the above. By designating a specific person for this, the adult neurology residency program intends to remove the difficulty and worry that are often associated with the need to obtain coverage, while ensuring continuity of care for our patients.

Resident Coverage (PGY 4 and 5)

During PGY 4 and 5 of the child neurology residency, resident coverage for the above circumstances will be provided by the pediatric neurology staff.  The size of the program does not allow for a jeopardy resident.  However, the pediatric neurology division is equipped to accommodate time away from the child neurology residents.  We share the adult neurology residency program’s commitment to resident well-being and encourage our residents to discuss when time is needed for the same circumstances listed above. When a child neurology resident needs to have time away, the resident is expected to communicate this with their supervising attending physician at the earliest time possible. The attending will then assume responsibility for all patient care while the resident is away. If the supervising attending is not available, the resident can contact the residency program director to help make accommodations.

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

For all leave types (ex. vacation), 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.

For a full list of leave types and definitions, please see the GME’s Time off Policy. In addition to the GME policy, there are a few leave types for which the department of neurology has its own internal polices:

Vacation: Like all UW Health residents, child 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. This vacation time is to be used during the training year in which it is allotted. In exceptional circumstances, if the resident is unable to use all allotted vacation during the training year due to service requirements; the resident may carry over up to one week of vacation to the following year with prior approval of the program director. When the resident is leaving UW permanently, accrued vacation entitlement must be used prior to termination or else is forfeited.

Career Development: Each resident receives up to five days for fellowship and other employment searches. Unpaid leave may be granted, or vacation used, for any additional needed time. All time used for this purpose must be approved by the program director. The GME Office will be notified via MedHub of any unpaid time granted.

 Professional Meetings: Each resident receives, in addition to vacation time, up to one paid week each year in order to attend professional meetings. The meeting is to be approved in advance by the program director and attendance documented in MedHub.  The resident is also responsible for finding coverage for the entire length of the trip when on a clinical service requiring coverage.

 Exams: Residents may take time off without loss of pay for up to two days per year for required licensure and similar exams. Time must be scheduled ahead of the leave via MedHub, with the approval of 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 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 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.

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 Child Neurology Program Director and then the GME administration. The Child 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.

Latest revision: 10/19/2022, Adam Wallace

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