Work Hours, Time Off and Moonlighting

Fellows are responsible for reporting their work hours on time at the end of each week. If by chance the fellow 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. The Graduate Medical Education Committee (GMEC) requires all fellowship programs uphold a 90% on time work hour submission rate. If the program is found in violation, the offending fellow will be responsible for establishing a remediation plan and presenting it to the GMEC.

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, home call, 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.

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 fellows 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 of the above activities.

Maximum Work Period Duration:

Per ACGME and UW Health GME policies, clinical and education work periods for fellows shall 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 fellow education. New patient care responsibilities will not be assigned to a fellow during this time.

Our call system eliminates all 24-hour in-house duty periods. 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, fellows 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 occur within the context of the 80 hour and the one-day-off-in-seven requirements.

Fellows shall have at least 14 hours free of clinical work and education after 24 hours of in-house call.

Fellows 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.” 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 fellow, on their own initiative, may choose to remain or return to the clinical site in the following circumstances:

• To provide continuity of care for 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.

The ACGME and UW Health GME require all programs to educate faculty and fellows 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 fellows 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. Fellows 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).
• Fellows 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 fellow 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 fellow 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 (Policy 43.1).

If the total amount of a fellow’s time off for vacation, sick, and leave of absences exceeds the total allotted time off per leave type, the program director will work with the fellow to extend the fellowship program timeline. Due to the limited duration of a 1-year fellowship program, this extension is essential in providing the fellow time to meet the graduation requirements set forth by ACGME and ABPN. (See “Training Extension” section for additional information.)

Neurology program-specific policies regarding certain types of leave are outlined below.

Vacation Blocks:

Like all UW Health residents and fellows, neurology fellows 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 fellows 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.

Fellows may 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.

Please see the UW Health GME Time Off Policy for more details.

Career Development:

Each fellow 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 Administrator).

If more than 5 days are needed for job searches or interviews, fellows 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 by the Program Director.

Professional Development:

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

Professional development leave must be requested a minimum of 8 weeks in advance and must be approved by the program administration and documented in MedHub.

Sick Leave and Bereavement:

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

• The fellow 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 fellow is caring for an immediate family member with illness or a medical condition.
• The fellow 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 illness, please see the UW Health GME Time off Policy (Policy 43.1).

Fellows should notify the program administration, relevant clinic staff, and attending as soon as they know that they will be unable to work due to illness or another emergency.

Regardless of type, the fellow 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. Fellows 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.

If the total amount of a fellow’s time off for vacation, sick, and leave of absences exceeds the total allotted time off per leave type, the Program Director will work with the fellow to extend the fellowship program timeline. Due to the limited duration of a 1-year fellowship program, this extension is essential in providing the fellow time to meet the graduation requirements set forth by ACGME and ABPN. (See “Training Extension” section below for additional information.)

Parental Leave of Absence:

Please reference the UW Health GME Time off Policy (Policy 43.1). 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 fellow should begin conversations with program administration as far in advance as possible when planning leave. The program must receive notice of the fellow’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 fellow may choose to utilize their vacation time to increase their paid time after the initial 6 weeks. Fellows then have the option to take unpaid time to achieve the full 12 weeks FMLA allows.

Due to ABPN board policies and the limited duration of a 1-year fellowship program, a fellow will need to extend their training for time taken that exceeds GME allotted vacation time (see Training Extension section.)

Personal Medical and Caregiver Leave:

Current UW Health policy provides 6 weeks paid personal medical leave or caregiver leave. State and federal laws under 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 fellow should begin conversations with program administration as far in advance as possible when planning leave. The program must receive notice of the fellow’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. 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 fellow 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.

Due to ABPN board policies and the limited duration of a 1-year fellowship program, a fellow will need to extend their training for time taken that exceeds GME allotted vacation time (see Training Extension section.)

Administrative Leave:

Fellows may be placed on paid administrative leave while under investigation for alleged misconduct or to determine fitness for duty. Fellows may be placed on unpaid administrative if they become non-compliant with work requirements (annual compliance training, vaccination requirements, renewal of medical/DEA licenses, etc.)  Upon the fellow’s return, program administration will determine whether the fellow is on track to meet educational requirements for graduation, or if training will need to be extended to achieve these.

Fellows in training have complementary but separate roles. As employees of the hospital system, fellows 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, fellows 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. Due to the limited duration of a 1-year fellowship program, a fellow will need to extend their training for time taken that exceeds 4 weeks of GME allotted time off (3 weeks of vacation time and 1 week of sick time) in order to complete academic requirements and preserve the fellow’s eligibility for board certification.

Example: The fellow takes 2 weeks of vacation and 1 week of sick time and then wants to take 6 weeks total time for parental leave. The fellow can use the remaining one week of vacation plus 5 weeks of paid parental leave. Training is extended by 5 weeks; all time is paid.

Note that UW Health provides neurology fellows with 10 days of sick time as noted in the “Sick Days” portion of the “Paid Time Off” section. However, ABPN only allows for 1 week (7 days) in accordance to the training extension criteria.

Fellows 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 fellow to minimize the duration of extended training as much as possible.

During the COVID-19 pandemic, protocols were implemented to limit personnel exposure to potential infection resulting in the identification of remote-capable services. Post pandemic, the Program Evaluation Committee (PEC) established remote working standards as in-person attendance is essential in developing a well-rounded, capable graduate of the clinical neurophysiology fellowship program and in providing high-quality patient care.

The best learning experience is one in which the fellow is on-site and able to ask questions of their attendings, along with providing instruction to neurology residents. Furthermore, there are a number of services requiring in-person daily rounding, such as Epilepsy Monitoring Unit (EMU), Epilepsy (EPI) and Peds Epilepsy Monitoring Unit (PEMU).

At this time, two services have been found to be remote-capable and will be utilized sparingly for unexpected situations; such as, inclement weather, school or child care closures, or testing positive for COVID and feeling well enough that the fellow requests to work. By no means is it ever expected a fellow work from home when sick.

Remote-Capable Services:

1. Long-Term Monitoring (LTM)
2. Intraoperative Monitoring (IOM)

During the first 3 weeks of IOM rotation, it is important the fellow is physically in the operating room. After those initial weeks, the IOM service may be managed remotely, pending UW Health grants access for remote work capabilities.

3. Elective- Research
4. Elective- Academic

Remote work requirements:

• Maximum of 10 remote days
• Fellow must be scheduled for a remote-capable service as identified above
• Fellow must work from their personal residence in Wisconsin
• Fellow must request remote work approval from their scheduled attending and coordinator in one email providing their year-to-date used remote days count
• If approved, fellow must communicate to all faculty they are scheduled to work with that day (e.g., scheduled for clinic or giving a presentation)
• If a request is not approved or the maximum number of remote days is met, the fellow must use sick time. If the maximum sick time is used, the fellow will need to take time without pay which may result in a training extension.
• In the event of extraordinary circumstances, the fellow will work with the program director for special approval.

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 fellows 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 fellow’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 Program Director has discretion to deny moonlighting requests if the fellow is not compliant with administrative and/or clinical expectations of the fellowship program or is otherwise not in good standing. Only after approval by both can the moonlighting commence.

Time spent by fellows 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 any liability coverage for moonlighting activities, whether internal or external. The fellow or the employer where the moonlighting takes place must arrange liability coverage for the moonlighting activities.

Moonlighting Restrictions:

• The State of Wisconsin Medical Examining Board requires that fellows moonlighting in patient care outside of their training program have a full, unrestricted medical license. A DEA license may or may not be needed for moonlighting depending upon institution requirements. This is not covered by the program.
• 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 (see below) 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.

• According to the Centers for Medicare & Medicaid Services Medicare Learning Network, moonlighting is defined as:
  • Services that are not related to the approved GME Program and are performed outside the facility where they have their GME Program
  • Services that are not related to the approved GME Program and performed in an outpatient department or hospital emergency room of the hospital where they have their GME Program

Although ACGME Fellowship Common Program Requirements allow for independent practice (IV.E.), the ACGME Epilepsy and CNP fellowship program specialties do not.