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.

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 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/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 resident/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.

Time Off: Residents/Fellows shall have eight hours off between scheduled work periods. There may be circumstances when residents/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.

Residents/Fellows 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/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.” 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/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.

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.

If there is not a previously assigned call room available for sleep, a fellow 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.

For all leave types (ex. vacation), the fellow must submit documentation in a timely manner and inform the program coordinator 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 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 director or associate program director.

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

Vacation: Like all UW Health residents and fellows, epilepsy fellows 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 fellow 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 fellow is also responsible to find coverage for the entire length of absence.

Professional Meetings: Each fellow 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 fellow is also responsible to find coverage for the entire length of absence.

Exams: Fellows 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.

Parental Leave: Please reference the UW Health’s Parental Leave for Residents and Fellows Policy. Depending on how much leave the fellow chooses to take, (6 weeks paid, and up to 12 weeks’ time off in accordance with FMLA and WFMLA), it will be up to the program director and Clinical Competency Committee to decide if the fellow will need to extend their training as long as all ACGME requirements have been met.

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.

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. 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 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 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. 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.