Introduction
The Stroke Fellowship training program aims to provide fellows with not only the requisite educational and clinical experiences, but also reasonable opportunities for rest and personal activities needed to maintain wellness. Fellows 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. Both fellows 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, Fellow Well-being.
- 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 fellow 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.
Work Hours
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 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 resident during this time. Our night float system eliminates most such 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.
Additional Needed Time Off
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 that can.
Call Rooms and Safe Ride Home
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.
Leave Types
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 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 the program director or associate program director.
Vacation: Like all UW Health residents and fellows, vascular neurology fellows receive three weeks of paid vacation per year. This vacation time is to be used during the training year in which it is allotted. The allotted vacation must be used prior to termination or else is forfeited.
Career Development: Each fellow 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 fellow 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.
Jury Duty and Witness Service: Fellows may take time off for jury or witness service without loss of pay. When not impaneled for actual service, but instead on call, the fellow shall report to work unless authorized otherwise by the program director. Fellows needing time off for these responsibilities must provide advance notice to their program director and provide a copy of the jury summons or subpoena. Time off must be recorded in MedHub.
Exams: Fellows 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.
Bereavement: A fellow may take time off for a death in the immediate family. These include the fellow’s spouse, parent (including in-laws and grandparents), child, or sibling or those of the resident’s domestic partner. Fellows may take up to three days with pay. If additional time off is needed, fellows may use vacation or request unpaid time.
Holidays: When patient care responsibilities allow and with program director approval, UW Health legal holidays will be observed. Fellows do not accrue holiday time or have the option of a floating holiday, “comp time” or additional holiday pay. However, if a fellow requires time off for a religious holiday, such can be taken in lieu of a legal holiday. Holidays taken should never exceed the number of UW Health legal holidays observed.
Personal: A fellow may be granted a leave of absence without pay at the discretion of the program director and the director of Graduate Medical Education. All unpaid leaves must be reported to the GME Office by the resident and program via MedHub. Personal leave for more than 30 days will only be allowed in extraordinary circumstances and requires the approval of the residency program director, director of GME, and the DIO.
Parental Leave: Please reference the UW Health’s Parental Leave for Residents and Fellows Policy. Current policy and law allows for 6 weeks paid leave and up to 12 weeks total time off. 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. 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.
Sick leave: The program director may approve up to 7 days of paid sick leave per year if needed. Sick leave, as with all leave time, must be submitted via MedHub. Sick leave should be used when:
- The fellow is ill
- A family member requires the fellow’s care
- The fellow is on a personal medical leave of absence (i.e., sick leave is to be used towards the paid medical leave period)
Military service: Fellows may take time off for military service as required by federal and state statutes. The fellow is required to provide advance documentation verifying the assignment and pay to the GME Office. UW Health will pay the excess of a fellow’s standard wages over military base pay for military leaves of 3 to 30 days to attend military schools and training.
For fellow who are recalled to active duty, UW Health will pay the difference between the fellow’s wages and the active duty military pay for up to one year (average UW Health pay over the past year minus military pay). Please see the UW Health GME Time Off Policy for further details about this type of leave.
Military caregiver: If eligible under the FMLA, fellows with a covered military family member serving the National Guard or Reserves make take leave up to 26 weeks in a 12 month period (one time leave only) to care for a family member who is a current service member with a serious injury or illness. Please see the UW Health GME Time Off Policy for further details about this type of leave.
Administrative leave: At times there may be a need for the program director, the director of Graduate Medical Education, or other UW Health leader to place a fellow on administrative leave; this may be paid or unpaid, based on the reason for the leave. Fellows may be placed on paid administrative leave while under investigation or to determine fitness for duty. Fellows may be placed on unpaid administrative if they become non-compliant with work requirements (e.g., non-compliance with flu vaccination requirement, gap in medical licensing, etc.).
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 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:
- 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 do not moonlight within UW Health, but if such concerns arise, they will be resolved in collaboration with the UW Health Compliance Department.
Latest revision: 09/17/2021
Jamie Elliott, MD, PhD
