Residency Adaptations to FMLA

[Lefty]

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Recently our GME office has decided to change how they implement the FMLA benefits for residents. Previously you could take your 12 weeks off with your benefits protected and then finish your residency getting paid and receiving benefits for whatever amount of time you had to stay to finish your residency. Now, they will only continue to pay your salary and provide you with benefits for 1 month after June 30th. After that nothing.

For example, if a resident takes 3 months off for maternity leave (2 months bedrest prior to delivering and 1 month after delivery) then she will have to stay 3 months after June 30th. During her maternity leave she can continue to receive her benefits and she gets paid (I think--but varies from case to case--btw FMLA requires 12 weeks unpaid leave). Come June 30th she will get paid for 1 month and her benefits will continue for 1 month. Then she is on her own for 2 months--working w/o pay or benefits.

We are being told that this is a nationwide trend. Is anyone else seeing this in the country? Does it seem fair? I ask because we have a resident who is very angry about it and is fighting our GME office. Her complaint is mainly the loss of benefits and the fact that she feels it discriminates against female physicians who want to have a family. Most of the time I don't think this greatly affects female residents who are having a baby unless they have a complicated pregnancy and need more than 4-6 wks off or those who have more than 1 baby during residency (I don't think I know more than 1 resident who has done this).

Thoughts? Other angry residents?

Lefty

 

[Faebinder]

While the loss of wages maybe somewhat fair (not really, that's BS too)... the loss of benefits is harsh, like the medical insurance? They never want a woman to have kids in residency do they?

Gosh they really are trying to cut corners eh? Well residency is not a job and is considered "education" so these guys are able to do a lot of things under that flag.

 

[Winged Scapula]

Interesting.

I took several months off for personal reasons during residency. I was paid for the 12 weeks and after that, no pay but my benefits stayed intact, as long as I paid the portion normally coming out of my check (which was about $35 per pay period...much cheaper than COBRA).

I had not heard of any changes but this is a big deal because if you have any preexisting conditions, you CANNOT go without insurance otherwise you risk being dropped from plans or not having your preexisting condition covered for 12 months. Obviously you can go on COBRA, but for a single person, its around $350/month. Much more for a family...which can be hard to take, especially if you aren't working.

 

[fiatslug]

doesn't seem fair or legal!! I've never heard of this as a "nationwide trend"--I'd want to sue (but who can afford a lawyer?). Grossly discriminatory against women who choose to procreate during our prime reproductive years. I'm pregnant w/#2, and have been pleasantly surprised at how supportive the programs I'm looking at for fellowship have been.

 

[Winged Scapula]

I reread the OP's post and it seems strange to me....

First, you should not necessarily have to make up all the time off (for whatever) reason because there is, for most specialties, some leeway in how much time you have to do to be considered done with residency and be BE. Even if you had no vacation time left, I'd bet that ACGME or whatever governing body exists for specialty X, specifies exactly how many clinical weeks you have to have. Point being, that someone who takes 3 months off for medical reasons shouldn't necessarily have to spend 3 months making it up. Granted, I'd bet most programs would require it, but that's a program issue not a board issue. So you could fight that if one was so inclined.

Secondly, if you are being paid while on FMLA they CANNOT withhold your pay for the same length of time when you come back to work. I'm fairly sure that it is illegal. They have to hold your job, they do not have to pay you, but once you come back to work, you have to be paid.

The issue of benefits is a trickier one...I don't know that programs are required to offer you benefits, although since they would presumably have more than 50 employees, I would venture they are. However, I don't know that there are requirements on how much you have to pay into it and your contract probably states that benefits are only offered for a certain length of time, enough to cover the residency period. Seems to me that going on COBRA would be considered a legitimate substitute...even if it is expensive, I think you would find it hard to fight considering benes were paid while off work.

I'm no lawyer, but this doesn't make sense to me.

 

[Faebinder]

How about contacting ACGME about the policy of the GME office? They will send the medical inquisition to find out who dared defile the religious and glorious ceremoney of going through residency.😀

No seriously, call and find out if it is something they are doing or something the GME office is doing.

 

[NotAProgDirector]

The extension of training is board specific. The ABIM (Internal Medicine) and the Anesthesia board are VERY strict about this. The ABIM allows a resident to miss a maximum of 4 weeks of any training year, anything beyond that needs to be made up. This is each year -- you can't "save up" your time off. I hear that the anethesia board is even stricter, counting days of training.

So, making up the time is standard is some fields.

As far as payment, I agree with posters above. FMLA requires programs to give residents time off (12 weeks) without pay. If programs decide to pay residents during their FMLA, they then have to pay them during their make up time also. If programs want to avoid paying for the "make up" time, they should not pay for the leave (which is perfectly legal).

As for an argument for your program, how about this rule from the institutional requirements:

Financial Support for Residents: Sponsoring and participating sites must provide all residents with appropriate financial support and benefits to ensure that they are able to fulfill the responsibilities of their educational programs.

 

[Lefty]

Some of the regulations cited by our GME office include the following:

Some residencies like ortho & rads allow up to 6 wks off, for whatever the reason, per year. Any more than 6 wks and the resident has to make up the entire year.

Derm & anesthesia recently changed their policy to be a total amount of time off during residency (not per year).

I realize that if a resident has missed a total of 3 months they may not have to make up all three months (based on what the governing body for that specialty requires). The point is that our GME office is telling us that anything over 30 days beyond June 30th will be unpaid and without continuation of benefits.

Another argument for this new policy is that other residents training will be affected as well. For programs like surgery if there is an extra chief resident doing cases for 2-3 months into the next classes' training year then he/she is taking away from the total number of cases available to the current chiefs. (All the surgery residents in their last year are considered chiefs--at least at our institution).

This new policy doesn't make it particularly difficult to have 1 child during residency. It may complicate things if there are issues during pregnancy requiring bed rest or other treatment, and definitely makes it difficult to have more than 1 child during residency.

I am surprised that no one else has heard of such policies in their program. I wonder if that's b/c this is not really a national trend yet or b/c other programs are keeping the policy quiet and residents just don't know about it yet.

I do appreciate everyone's input.

Lefty

 

[Winged Scapula]

All surgery residents in their final year are Chief residents. There may be an Administrative Chief who does the call schedule, etc. but Surgery differs from medicine in that the Chief year is not a separate year, nor is a single person elected.

And while I can understand that having someone stay an extra 2-3 months into the next year might impact the case load for the other Chiefs, the fact is that those Chiefs would have been picking up the case load for the resident when they were gone on maternity leave. That argument of your GME office doesn't hold water for me. In most places, 4th and 5th years pretty much do the same type of cases...its not like if a Chief was gone for maternity leave that the program wouldn't have someone to cover their cases...they'd just get a 4th year to do them if the other Chiefs were busy.

 

[Tired]

I guess I'm the only person who thinks this sounds like a pretty good idea?

 

[Winged Scapula]

I guess I'm the only person who thinks this sounds like a pretty good idea?

Remember FMLA is not just for maternity leave.

Its for you if you need leave for an ill parent or SO, or whatever reason, so it might behoove everyone to not support GME policies like this because you never know when you might need FMLA. You don't need to be female or have children (or planning on them) to be affected.

 

[Lefty]

And while I can understand that having someone stay an extra 2-3 months into the next year might impact the case load for the other Chiefs, the fact is that those Chiefs would have been picking up the case load for the resident when they were gone on maternity leave.

So the argument here is that while one chief is out on leave the other chiefs pick up the slack (which would bolster their numbers). It is the next year when the chief who has been on leave returns only to "steal" numbers from the class below who is now the current chiefs.

Don't get me wrong--I'm not trying to argue with you, but I'm giving you the arguments that our GME is giving us.

I still haven't heard anyone else mention that their program is doing anything similar. I still question whether this is a policy unique to our institution or if other residents just don't know it's becoming a policy at theirs.

Lefty

 

[Winged Scapula]

So the argument here is that while one chief is out on leave the other chiefs pick up the slack (which would bolster their numbers). It is the next year when the chief who has been on leave returns only to "steal" numbers from the class below who is now the current chiefs.

Don't get me wrong--I'm not trying to argue with you, but I'm giving you the arguments that our GME is giving us.

I know you aren't. MY argument is that the current Chiefs will not be able to pick up the slack, so the cases that the Chief who is out on leave would have done, will instead go to the 4th year residents. At least some of the cases will. Unless your GME is willing to admit that the Chief residents will work over hours to cover the extra cases (which will of course, have to be scheduled after hours). What will happen instead is that 4th year senior residents will get the overflow cases, IMHO.

When she comes back, yes the cases will be divided amongst her and the current Chiefs, but since they got more cases as 4th years, it won't make a difference in their overall numbers. I don't know any Chief resident who has a problem making the minimum ACS numbers for their final year. I expect there might be some squawking from the current 4th years (about missing some Chief cases next year), but really the numbers will add up and it won't make any real difference.

Does that make sense? It might not to your GME office, but it does to me.

 

[Tired]

Let me ask this then:

I don't know the structure of rotations for Gen Surg, but in Ortho you will do certain blocks as a R3 or R4 that you may not Chief as an R5. So (using Ortho, since I know it better) suppose as an R4 you go out on FMLA for three months during Peds Ortho, but you don't do Peds cases as a Chief, does it really make sense to let that person just add on a few months after the end of their Chief year? I mean, you might get more cases, but you won't necessarily make up the Peds cases you missed.

Personally, repeating the year you missed a chunk of makes more sense to me than just letting you grab extra cases your Chief year.

 

[NotAProgDirector]

Let me ask this then:

I don't know the structure of rotations for Gen Surg, but in Ortho you will do certain blocks as a R3 or R4 that you may not Chief as an R5. So (using Ortho, since I know it better) suppose as an R4 you go out on FMLA for three months during Peds Ortho, but you don't do Peds cases as a Chief, does it really make sense to let that person just add on a few months after the end of their Chief year? I mean, you might get more cases, but you won't necessarily make up the Peds cases you missed.

Personally, repeating the year you missed a chunk of makes more sense to me than just letting you grab extra cases your Chief year.

In medicine we simply have people make up the blocks they missed. In addition, their training time is extended on the fly. So, let's say a resident has a baby in their PGY-2 year, and misses three months (Jan - March). Their schedule would be:

PGY-1 July 01 - June 02
PGY-2 July 02 - Dec 02 ; Leave Jan 03 - Mar 03; PGY-2 Apr 03 - Sept 04
PGY-3 Oct 04 - Sept 05

Hence, they make up the missed blocks immediately upon returning back, so they still get the same curruculum at the same level.

Repeating an entire year because you missed a few blocks seems a bit excessive, unless the resident's performance is the issue.

 

[Winged Scapula]

In response to Tired:

it would depend on what rotation the resident misses, what her numbers are and what she has left to do.

The ABS has specific criteria for what rotations/number of weeks you have to, especially during your Chief year. However, there is some leniency as to when it can be scheduled and the majority of the Chief year needs to be "essential content of General Surgery" which is a fairly broad definition.

For example, in my residency we served as Chief resident during our 4th year on Pediatric Surgery. ABS allows you to spend up to 6 months of your 4th year as Chief on a service. However, because we do a LOT of pediatric surgery and the numbers required by ABS are not high, if the resident in question missed doing a senior level Peds Surg rotation, they wouldn't necessarily have to make it up on a Ped Surg service. Same would be true for Trauma, Surg Onc and Gen Surg, all of which we do a lot of.

I don't know if that makes sense, but rather to point out that as long as the resident has their minimum numbers in the category they missed or has a way to get them (ie, I knew I was going to be short Vascular cases, and got the IR guys to let me do stuff with them that counted), they don't necessarily need to "make up" the exact rotation they missed, as long as they get minimum numbers in all categories (750 total starting 2008), 150 Chief cases, and coverage of "essential content" in general surgery as a Chief.

 

[PediBoneDoc]

to the op

although i don't necessarily agree with it, i think what you have stated is the basic rules of FMLA. regardless of when it is paid, on the front end or on the back end, it is still 12 weeks of unpaid leave. the education component seems to throw a wrench in the system. depending on the specialty, there is a required amount of time for clinical education as dictated by the ACGME and specialty boards. there was a NEJM article speaking directly to this difficult issue. from the gme perspective, if a resident extends length of time in a program, the money has to come from somewhere. if it comes from the gme, special permission has to be granted to use the funds for a short increase of resident complement. otherwise, the money would have to come from the department or hospital for an unfunded resident. i wish it was as easy just paying a resident. the argument then is who is paying. the benefit part is what really sucks because the situation this resident is in will require her to intact cobra which is not cheap. now, what she could do is go bare for the 2 months and if something requires her to use her cobra, pay the cobra payment. i don't think you have to pay the cobra up front.

 

[Winged Scapula]

You do not have to pay COBRA up-front. You have 63 days to sign up for it.

As I understand it, if you are injured you can even sign up for it after the fact, as long as you pay the premium (ie, in the situation in which you haven't signed up, but get injured or need medical care on day 60, you can sign up on day 61 and still be covered as long as you pay the premiums due).