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 to the GMEC.

 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, 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.

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 fellow on home call is subject to the 80 hour and one-day-off-in-seven rules.

Maximum Work Period Duration: Clinical and education work periods for fellows 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 fellow education. New patient care responsibilities will not be assigned to a fellow during this time. Our call system eliminates all 24-hour duty periods.

Work Period Time Off: Fellows shall have eight hours off between scheduled work periods. There may be circumstances when fellows 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.

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 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.” 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 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.

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 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.

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.)

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

Vacation: Like all UW Health residents and fellows, epilepsy fellows 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 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 manager). If more than 5 days are needed for job searches or interviews, fellows may use vacation or take unpaid leave for the additional time. Unpaid leave must be approved by the program director.

Professional Development: Each fellow may take up to one (1) paid week each year in addition to vacation time 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 the program administration and documented in MedHub.

Sick Days: Neurology fellows may take up to ten (10) days of paid sick leave each year. Sick leave may be taken when the fellow 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.

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

For all leave types, the fellow is required to submit all necessary documentation in a timely manner and inform the program administration of known absences at least 60 days in advance. Fellows can submit an absence request form online. These can be found on the department’s main internal 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 the program administration.

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’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 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.
• 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 below.)

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.
• 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 below.)

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 (vaccination requirements, medical licensure, etc.)  Upon the fellow’s return, program administration will determine whether the fellow is on track to meet the competency and other 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 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.

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 4 weeks of GME allotted time off: 3 weeks of vacation time and 1 week of sick time.

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.

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 remaining one week of vacation plus 5 weeks of paid parental leave. Training is extended by 5 weeks; all time is paid.

There are circumstances where a fellow will need time off during an otherwise scheduled workday. These include medical, dental, and mental health appointments, illness, fatigue, and family emergencies. Our program is committed to the health and welfare of our fellows, to ensuring that they can obtain needed coverage without fear of negative consequences, and to the continuity of patient care when a fellow does require clinical coverage.  When a fellow needs to call in for a day off, or leave for an appointment, the fellow is expected to communicate this with their attending at the earliest time possible. The attending will then assume responsibility for all patient care while the fellow is gone. If the attending is not immediately available, the fellow will contact the program director who will either assume these responsibilities or find another attending who can.

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 epilepsy 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.

IMPORTANT: UW Health does not provide any liability coverage for moonlighting activities, whether internal or external. The resident/fellow or the employer where the moonlighting takes place must provide 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 will only be approved if the fellow 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. If concerns arise, they will be resolved in collaboration with the UW Health Compliance Department.
• 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.