How does your residency handle sick days?

[kaizenakira]

In my residency program, if a residents takes more than 1 sick day per year off that requires resident coverage, the resident is placed in the jeopardy pool.

Residents in the jeopardy pool can be called in on their days off (including weekends) or while on selective rotations to work shifts as long as working these shifts does not violate duty hours. Residents in the jeopardy pool cannot be called in during vacation or elective rotations.

Selective rotations are rotations where you are on call every 4th night. Elective rotations are call free rotations.

If a resident refuses to come in for a jeopardy shift, then the resident owes an additional jeopardy shift. For example, a resident who is placed in the jeopardy pool for being sick > 1 day in the year, initially owes only 1 jeopardy shift. If the resident then refuses to come in when called for a jeopardy shift, then the resident now owes 2 jeopardy shifts.

Just wondering how other programs handle residents calling in sick and whether there is punishment for residents who call in sick.

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[Raryn]

In my residency program, if a residents takes more than 1 sick day per year off that requires resident coverage, the resident is placed in the jeopardy pool.

Residents in the jeopardy pool can be called in on their days off (including weekends) or while on selective rotations to work shifts as long as working these shifts does not violate duty hours. Residents in the jeopardy pool cannot be called in during vacation or elective rotations.

Selective rotations are rotations where you are on call every 4th night. Elective rotations are call free rotations.

If a resident refuses to come in for a jeopardy shift, then the resident owes an additional jeopardy shift. For example, a resident who is placed in the jeopardy pool for being sick > 1 day in the year, initially owes only 1 jeopardy shift. If the resident then refuses to come in when called for a jeopardy shift, then the resident now owes 2 jeopardy shifts.

Just wondering how other programs handle residents calling in sick and whether there is punishment for residents who call in sick.

We each do 2-3 weeks of jeopardy every year while we are on clinics or elective. If someone calls in sick on an inpatient service, the jeopardy person of their year gets called to cover. Barring some kind of special circumstances, you can't be called in unless you're the assigned jeopardy person, something you know well ahead of time.

If it's just a regular day, no payback is required. If it is a call day, a weekend day, or a night shift, the person who called in sick is required to pay back the jeopardy person by covering one of their shifts of the same type at some later point when they would otherwise be on elective. If you call in sick on an elective, no one gets jeopardized. If you call in sick and you have continuity clinic that day, the chiefs will reschedule you an extra continuity clinic for a future elective block.

edit: fixed a typo

 

[Law2Doc]

This subject comes up a lot on SDN. There are small lean programs where sick days exist on paper but are rarely taken. And other places where people get, and use 7-10 sick/personal days. Some where you are expected to repay the time and others not. So basically the whole gamut.

 

[Wordead]

Seems pretty fair to me. In fact it's pretty ridiculous that you can just "refuse" to come in for jeopardy. That is some ***** ass bull****.

 

[j4pac]

What's a sick day? I thought there only infectious and non-infectious days...both of which are work days.

 

[Law2Doc]

What's a sick day? I thought there only infectious and non-infectious days...both of which are work days.

Yeah I've definitely seen the lose-lose system that if you are not that sick you should come to work and just wear a mask and if you are too sick to work then there's really no better place for you to be than the hospital. If a place is so lean that there's no redundancy you can pretty much expect this attitude.

 

[NotAProgDirector]

Payback systems tend to fail miserably in June, when people are leaving and have no time to pay anything back.

 

[SoCuteMD]

We all took a month of backup call each year. If you were sick, you called the chiefs who called backup. Backup shifts were generally repaid through a "pool" rather than payback directly from the person you got called in for. So, you'd get a shift reduction a couple months later to pay you back for the shift you covered.

 

[jonb12997]

I got jeopardized by one of my fellow third years right at the beginning of June of my last year for a 24 hour icu call. It was "understood" that if you had to use jeopardy that you would pay that person back by covering one of their calls. This person flat out refused to take my last call. That person did not end our residency on a good note with the rest of our class because of that. I'm a firm believer of what goes around comes around with these types of things....

 

[Doctor Bagel]

We had a backup and jeopardy system for calls that were covered by upper level residents who were primarily out of the regular call pool. If you got sick, your backup would come in, unless they also were sick, in which case jeopardy would cover. For daytime work, the attendings would pick up the slack unless you were in outpatient in which case you just rescheduled. No one paid back anything. Of course this is all assuming you're out for a brief period of time. For longer periods, the program would figure out other coverage to fairly (well, as much as possible) allocate things. Still no expectation of paying back time, although you might have to make up time if it were required for training purposes.

 

[mvenus929]

At my program....

Once you've done all the primary rotations, you get placed in the jeopardy pool (because there are 7 primary rotations, and in order to be eligible for jeopardy call, you have to be on an outpatient rotation, most interns don't get placed in the pool). If someone calls out sick and they need to cover the shift (night or weekend shift), the Chiefs call in jeopardy. It is generally expected that if you call in sick, and someone gets called in to cover you, you owe that person a shift. If you call off in an outpatient rotation, you just have to make sure you each the needed hours to receive credit for that rotation. On other inpatient rotations, you don't have a specific duty to repay the shift, but if you're a jerk about it, people will tend not to want to cover you if you want to switch shifts or cover you for interviews.

 

[dozitgetchahi]

We have almost 150 total IM residents, so our jeopardy pool is deep. At any given time, two people who are on electives are on jeopardy call for a given day (the 'A' and 'B' persons, respectively). For any given month that you are on electives, you have two jeopardy days that you could potentially have to cover. There is no expectation of 'payback' for jeopardy, and if the "A' person is somehow unavailable the 'B' person gets called in.

Despite this elaborate jeopardy setup, I have used exactly zero jeopardy days and have never been jeopardized.

 

[Promethean]

Yeah I've definitely seen the lose-lose system that if you are not that sick you should come to work and just wear a mask and if you are too sick to work then there's really no better place for you to be than the hospital. If a place is so lean that there's no redundancy you can pretty much expect this attitude.

I have been a part of a midnight OR case where both the patient and the anesthesia resident had IV fluids running.

 

[Law2Doc]

I have been a part of a midnight OR case where both the patient and the anesthesia resident had IV fluids running.

yeah, I've seen people wearing a mask/gloves and rounding with an IV pole along with the team.

 

[KnuxNole]

IIRC, we get around 12 sick days. Some people use them liberally compared to others if they got the sniffles or didn't want to come in on Mon/Fri.

 

[dozitgetchahi]

yeah, I've seen people wearing a mask/gloves and rounding with an IV pole along with the team.

I hear stories of this stuff and I think it's just unbelievable. Some programs really need to get a grip. Around here, anyone sick like that would be told to go the hell home - 'why are you here if you're that sick?' etc.

 

[Law2Doc]

I hear stories of this stuff and I think it's just unbelievable. Some programs really need to get a grip. Around here, anyone sick like that would be told to go the hell home - 'why are you here if you're that sick?' etc.

Ample personnel and redundancy are luxuries not every place has. At many programs if you are sick it at a minimum comes out of someone else's elective time or the like. While it would be nice for chiefs to be able to say, "you should stay home, take all the time you need" it's simply not always realistic. And when we are talking about overnight call or weekends later in the year when it's tough to even things out, it's often hard to find a replacement who isn't going to be real upset to do an extra call and miss his sisters wedding because someone has a bad cold.

Also in small surgery programs where people are already pretty much filling out time cards to reflect the "80" hours a week that their schedule says they are doing, you may not have the ability to ask someone to do an additional 14-24 hour shift because someone can't come in. At a big program where someone is always on elective that can be pulled, sure. At a program where people work 65 hours a week sure. At a lean program where everybody is maxing out hours most of the time-- then being sick causes a big problem.

 

[22031 Alum]

In my experience program culture > program size when it comes to this. I trained at a large (for my specialty) program that had a lot of redundancy and a very robust backup system. Yet the expectation was, "If you call in sick, don't forget to tell us which room in the ED you're in so the consult team can bring you flowers. Oh, not that sick? See you at rounds." Granted, if somebody was sick enough, they got sent home- but the general rule was, you showed up, and then get told you're too sick to work. On the other hand, I've been at a smaller program where a single absence could absolutely ruin multiple residents' days, not to mention cause someone to break work hour restrictions. Yet the attitude was "A bit sniffly you say? Oh, don't worry about coming in!!" and several residents took advantage of that.

 

[rokshana]

Ample personnel and redundancy are luxuries not every place has. At many programs if you are sick it at a minimum comes out of someone else's elective time or the like. While it would be nice for chiefs to be able to say, "you should stay home, take all the time you need" it's simply not always realistic. And when we are talking about overnight call or weekends later in the year when it's tough to even things out, it's often hard to find a replacement who isn't going to be real upset to do an extra call and miss his sisters wedding because someone has a bad cold.

Also in small surgery programs where people are already pretty much filling out time cards to reflect the "80" hours a week that their schedule says they are doing, you may not have the ability to ask someone to do an additional 14-24 hour shift because someone can't come in. At a big program where someone is always on elective that can be pulled, sure. At a program where people work 65 hours a week sure. At a lean program where everybody is maxing out hours most of the time-- then being sick causes a big problem.

come on there is a difference between a small cold and rounding with an IV in...if the people you work with are that self centered that they can't see giving a day up in their elective month (after all not everyone's sister is having a wedding) to their co-resident who is USING AN IV at work...then...well they are just crappy people ...

 

[Law2Doc]

come on there is a difference between a small cold and rounding with an IV in...if the people you work with are that self centered that they can't see giving a day up in their elective month (after all not everyone's sister is having a wedding) to their co-resident who is USING AN IV at work...then...well they are just crappy people ...

Electives aren't free time-- it may be the only opportunity you'll get to do/see certain things in residency, so it's also being a "pretty crappy person" to use someone else's up for anything short of major illness. And as mentioned the big programs are the ones that have ample people on electives, The leaner programs often don't have that luxury anyhow. The wedding example was an example I saw unfold in real life.

 

[Dral]

This thread again...

Ok, all the bleeding hearts who think that a resident who sneezes before they leave for work in the morning should take the whole week off and have Jeopardy deliver kleenex and homemade chicken soup to their door daily, move to this side of the room.

All the hard asses who think a resident with 6 broken legs and pneumonia should still work their 72 hour shift move to this side of the room.

Now agree to disagree about how sick days should be handled.

/next thread

 

[marsh20]

I went to a Psychiatry residency where we had ample residents, but my program director had a policy that residents would need to be evaluated in the ED by an ED attending prior to taking a sick day and my program director herself had wanted to see us in the ED.

In other words, absolutely no chance in hell you would get sick leave unless you were sick enough to be admitted to the hospital.

 

[RadOncDoc21]

I went to a Psychiatry residency where we had ample residents, but my program director had a policy that residents would need to be evaluated in the ED by an ED attending prior to taking a sick day and my program director herself had wanted to see us in the ED.

In other words, absolutely no chance in hell you would get sick leave unless you were sick enough to be admitted to the hospital.

I wonder if she was held to similar standards... Not to be rude but she sounds like a b**^%.

 

[Siggy]

Seems pretty fair to me. In fact it's pretty ridiculous that you can just "refuse" to come in for jeopardy. That is some ***** ass bull****.

I think it depends. If it's an assigned jeopardy period (i.e. person A covers all sick calls this week), then I agree.

If it's a pool jeopardy, then basically anyone in the pool can't take a weekend road trip... because you might be called in on Saturday after you've already driven 5 hours away.

 

[Crayola227]

I went to a Psychiatry residency where we had ample residents, but my program director had a policy that residents would need to be evaluated in the ED by an ED attending prior to taking a sick day and my program director herself had wanted to see us in the ED.

In other words, absolutely no chance in hell you would get sick leave unless you were sick enough to be admitted to the hospital.

Completely inappropriate employer and HIPPA behavior. Don't doubt you this was how it was and likely no lawsuit would be raised, but an anonymous and well placed heads up to hospital legal risk management and HR or department that handles disabilities/discrimination (no this isn't disability we're talking but it's a department that will regulate on other departments to be sure they're not crossing lines) would likely put an end to this Draconian practice because I'm confident it's illegal and opens the employer up to action. It's questionable if you should do this, risk of being found out/waves vs the pleasure of the passive aggressiveness in taking program to task for violating your rights

Employers can ask for a health provider to indicate if you are fit for work and if you can return and what if any restrictions/workplace accommodations are needed for return, but prying beyond that is a big no-no no-go if we're talking actual employment law. Demanding to know what room you're in ED is definitely crossing that line.

For the naysayers who will disagree with me on what they can demand legally I guess I will admit to having had close, like uh my friend, experience with health issues, disability, confidentiality, HR, employment law, lawyer negotiations all the way around, so YES I do know exactly what info they are entitled to and when employers can be told to stfu and gtfo regarding your medical stuff.

Bullying.

TLDR
no, your employer can't legally demand to come see you in the ED, or even that you go to the ED
they can demand a physician/health care provider testify to you being unable to work for whatever sick time you have, but even then details they are entitled to are limited
but don't make waves and in general do whatever the f* your PD wants, don't ever get sick and just show up
questionable if you should anonymously tip off the institutional TPTB that will crack down on these sort of practices

 

[j4pac]

I hear stories of this stuff and I think it's just unbelievable. Some programs really need to get a grip. Around here, anyone sick like that would be told to go the hell home - 'why are you here if you're that sick?' etc.

Sometimes it's the program..but it's just as often the person. I have now worked in medicine for 6 years. I haven't missed a day of work due to illness. Doesn't that mean I have never been sick? Absolutely not. But sometimes it's easier to ride out your shift and get an IV than get coverage. If you think coverage is hard in residency...you haven't seen nothing yet.

 

[Law2Doc]

@Crayola227
"Employers can ask for a health provider to indicate if you are fit for work and if you can return..."

HIPAA is broad enough that it would allow an employer to have a person assessed by an ED before returning to work. They can't ask the specifics of that encounter, or receive any protected health information without your consent. But they don't have to liberally allow you to get off work just because you can present a doctors note from whatever provider you choose for your assessment -- that's not anywhere in HIPAA, and would be silly in this field where all of our peers are doctors able to write such notes.

So no, if done in a way to protect privacy, I would think an employer could absolutely require a person to be checked out by the ED to determine if the person was okay to work. Of course the doctors note could not include specifics under HIPAA and the employer wouldn't be allowed to pursue it further, but they could probably legally force you to jump that hoop (and come into the hospital) before being sent home, if they wanted to take that approach.

 

[Law2Doc]

Sometimes it's the program..but it's just as often the person. I have now worked in medicine for 6 years. I haven't missed a day of work due to illness. Doesn't that mean I have never been sick? Absolutely not. But sometimes it's easier to ride out your shift and get an IV than get coverage. If you think coverage is hard in residency...you haven't seen nothing yet.

Often it's both. A lot of us have to be pretty sick to even consider pawning our responsibilities onto others, and for that same reasoning were less put off by programs with that same ethic.

And absolutely agree with your last statement. Coverage issues for illness are problematic at all stages of this career and only get harder as you go further out.

 

[KnuxNole]

This thread again...

Ok, all the bleeding hearts who think that a resident who sneezes before they leave for work in the morning should take the whole week off and have Jeopardy deliver kleenex and homemade chicken soup to their door daily, move to this side of the room.

All the hard asses who think a resident with 6 broken legs and pneumonia should still work their 72 hour shift move to this side of the room.

Now agree to disagree about how sick days should be handled.

/next thread

They would have a heart attack if they see how lenient sick days are used here 😛

 

[WinslowPringle]

Sick days? I don't understand. What are those?

No, really. No jeopardy here. If you're dying and you can't come in, generally the other person on the team covers for you. If neither of you are there, the attendings will just have to see their own patients, except for trauma and nights.

FWIW, I seriously considered going to the OR with an LR bolus going. Got some zofran, ended up sitting through the case just retracting, and barely made it out standing up; in retrospect, I should have gotten the fluids. (Plus, it's a baller story. Next time, I'm definitely getting the fluids.)

 

[Perrotfish]

And absolutely agree with your last statement. Coverage issues for illness are problematic at all stages of this career and only get harder as you go further out.

All depends on how you structure your career. It got way easier for me.

 

[Perrotfish]

FWIW, I seriously considered going to the OR with an LR bolus going. Got some zofran, ended up sitting through the case just retracting, and barely made it out standing up; in retrospect, I should have gotten the fluids. (Plus, it's a baller story. Next time, I'm definitely getting the fluids.)

At least you could get fluids. In Peds everyones' credentials only go up to age 26. No prescriptions, doesn't matter how sick you are. Water water everywhere and not a drop to drink.

 

[Doctor4Life1769]

All depends on how you structure your career. It got way easier for me.

Do elaborate.

 

[Perrotfish]

Do elaborate.

I didn't think it needed a ton of elaboration. My job is more accommodating of sick physicians than my residency was of sick residents. My clinic schedule is usually 8-12 scheduled appointments and the rest reserved for acutes. If a physician gets sick the scheduled patients get redistributed to everyone else's' acutes and life goes on. I wouldn't call out for a sniffle, but it seems like when people in my clinic get sick they stay home sick, rather than dragging themselves to work.

The only way that attendings should have more trouble calling in sick than residents is if they work in a practice where their partners all work every day (or every weekday) and all have full schedules the second they walk in the door. In other words, surgery, and maybe psych. If you're on a 7 on 7 off (or similar) inpatient schedule on a sick day you just switch shifts with whoever is off and pay them back the next week. If you cover a clinic with a lot of acute appointments you just reschedule your patients to your partners' open appointments and stay home sick. Most physicians out there cover something similar to one of those two schedules, and sick days shouldn't be a big deal for either of them.

The funny thing is I haven't actually had a chance to call in sick yet. For the last three years I was frequently ill throughout the winter and there was nothing I could do about it. Now I have easily accessible sick days and not so much as a head cold.

 

[Doctor Bob]

I hear stories of this stuff and I think it's just unbelievable. Some programs really need to get a grip. Around here, anyone sick like that would be told to go the hell home - 'why are you here if you're that sick?' etc.

I worked a shift with an IV... but it was a night shift, and I was supervising the residents. So I'd sit at the desk with my IV and zofran writing charts, talking with the residents, then locking off the IV, going into the patient's rooms and confirming the resident's plan, then back to the desk and reconnected the IV.

All the hard asses who think a resident with 6 broken legs and pneumonia should still work their 72 hour shift move to this side of the room.

This is my side

I went to a Psychiatry residency where we had ample residents, but my program director had a policy that residents would need to be evaluated in the ED by an ED attending prior to taking a sick day and my program director herself had wanted to see us in the ED.

I worked at a place like this... residents, nurses, techs, whatever... they had to be seen in the ED before they could get sent home.
I'd check them in, do a MSE, and send them home. Regardless of my feelings about whether they deserved a sick day or not for their condition, I didn't like the hospital dumping the onus for approving/disapproving sick days onto me. Sick days for everyone.

 

[Law2Doc]

...
I worked at a place like this... residents, nurses, techs, whatever... they had to be seen in the ED before they could get sent home.
I'd check them in, do a MSE, and send them home. Regardless of my feelings about whether they deserved a sick day or not for their condition, I didn't like the hospital dumping the onus for approving/disapproving sick days onto me. Sick days for everyone.

Meh, it doesn't really matter that you were liberal about sending people home. Not every ED doc would. And once those people were already forced to commute in, most of those people with just a sniffle or the like will likely just stay at work and not even go to the ED. The rule would have had its deterrent effect.

 

[hamstergang]

@Crayola227
"Employers can ask for a health provider to indicate if you are fit for work and if you can return..."

HIPAA is broad enough that it would allow an employer to have a person assessed by an ED before returning to work. They can't ask the specifics of that encounter, or receive any protected health information without your consent.

I'm pretty sure Crayola was responding to the part about the PD coming to the ED to see the resident, not the part of requiring the resident to be seen.

 

[mvenus929]

At least you could get fluids. In Peds everyones' credentials only go up to age 26. No prescriptions, doesn't matter how sick you are. Water water everywhere and not a drop to drink.

I got one of the Peds ED docs to write me a script for Zofran, after assuring her I wasn't pregnant. We still have to manage really sick adults in the ED thanks to EMTALA, though thankfully most of them get transferred petty quickly to the adult hospital for definitive treatment.

 

[Crayola227]

When you sign a contract for work you do agree to certain things from a medical treatment/information perspective, like rules on flu shot, TB testing, etc.

For example, workplace injuries/sticks they can require you to follow whatever procedure that is including an ED visit, but that is because you went into an at-will work agreement that agreed to those procedures, same thing with being eval'd by employee health and answering certain questions regarding minimum standards for work, how much you can lift, etc.

Maybe they can put in your contract that you go to the ED for whatever ailment is making you unable to work, but that is frankly bad use of resources, and again, if they are not obliged to your protected health care information distinguishing where you got your OK to to return to work (PCP vs ED phsyician) to be splitting hairs like that I'm still thinking is a violation. In my opinion a PD requiring an ED visit is wrong on so many levels. Perhaps they can require you to go to Employee Health, but that is still a far cry from requiring the inappropriate use of your personal healthcare insurance and the ED.

One can clearly be too ill to work, but symptoms on their face do not make it clear if an ED visit is indicated, the appropriate thing to do is to contact one's PCP and see where they want you to go. Fluids, IV zofran, can all be given in office, and may not reduce your frequency of vomiting to where a return to work is feasible even if you want to be that bad ass trailing along an IV pole. You don't need an ED eval or imaging for a gastroenteritis severe enough to require those. So for the naysayers go to work I'm just saying there's an example of can't work but don't need an ED visit.

So I'm just saying I think my argument stands that an employer cannot demand you pursue a certain course of treatment (PCP vs ED) to have an approved sick day. Even if this is legal which I don't think it is, I still think it is a waste of resources and inappropriate.

 

[Promethean]

When you sign a contract for work you do agree to certain things from a medical treatment/information perspective, like rules on flu shot, TB testing, etc.

For example, workplace injuries/sticks they can require you to follow whatever procedure that is including an ED visit, but that is because you went into an at-will work agreement that agreed to those procedures, same thing with being eval'd by employee health and answering certain questions regarding minimum standards for work, how much you can lift, etc.

Maybe they can put in your contract that you go to the ED for whatever ailment is making you unable to work, but that is frankly bad use of resources, and again, if they are not obliged to your protected health care information distinguishing where you got your OK to to return to work (PCP vs ED phsyician) to be splitting hairs like that I'm still thinking is a violation. In my opinion a PD requiring an ED visit is wrong on so many levels. Perhaps they can require you to go to Employee Health, but that is still a far cry from requiring the inappropriate use of your personal healthcare insurance and the ED.

One can clearly be too ill to work, but symptoms on their face do not make it clear if an ED visit is indicated, the appropriate thing to do is to contact one's PCP and see where they want you to go. Fluids, IV zofran, can all be given in office, and may not reduce your frequency of vomiting to where a return to work is feasible even if you want to be that bad ass trailing along an IV pole. You don't need an ED eval or imaging for a gastroenteritis severe enough to require those. So for the naysayers go to work I'm just saying there's an example of can't work but don't need an ED visit.

So I'm just saying I think my argument stands that an employer cannot demand you pursue a certain course of treatment (PCP vs ED) to have an approved sick day. Even if this is legal which I don't think it is, I still think it is a waste of resources and inappropriate.

You are technically correct, but when facing a PD who has the power to ruin your life in so many ways, it pays to choose one's battles carefully.

Sent from my SM-N910P using Tapatalk

 

[j4pac]

I actually saw a physician contract to moonlight that stated,"When you became a physician, you gave up the privilege of missing work due to sickness. You will be responsible for finding your own coverage, and if you cannot do so, you will be expected to work." This is becoming the reality that is medicine. You are a martyr. Working sick has become an expectation...forget the fact that you could be infecting your patients. That doesn't matter. All that matters is that you are seeing patients and making your company money.

 

[Law2Doc]

When you sign a contract for work you do agree to certain things from a medical treatment/information perspective, like rules on flu shot, TB testing, etc.

For example, workplace injuries/sticks they can require you to follow whatever procedure that is including an ED visit, but that is because you went into an at-will work agreement that agreed to those procedures, same thing with being eval'd by employee health and answering certain questions regarding minimum standards for work, how much you can lift, etc.

Maybe they can put in your contract that you go to the ED for whatever ailment is making you unable to work, but that is frankly bad use of resources, and again, if they are not obliged to your protected health care information distinguishing where you got your OK to to return to work (PCP vs ED phsyician) to be splitting hairs like that I'm still thinking is a violation. In my opinion a PD requiring an ED visit is wrong on so many levels. Perhaps they can require you to go to Employee Health, but that is still a far cry from requiring the inappropriate use of your personal healthcare insurance and the ED.

One can clearly be too ill to work, but symptoms on their face do not make it clear if an ED visit is indicated, the appropriate thing to do is to contact one's PCP and see where they want you to go. Fluids, IV zofran, can all be given in office, and may not reduce your frequency of vomiting to where a return to work is feasible even if you want to be that bad ass trailing along an IV pole. You don't need an ED eval or imaging for a gastroenteritis severe enough to require those. So for the naysayers go to work I'm just saying there's an example of can't work but don't need an ED visit.

So I'm just saying I think my argument stands that an employer cannot demand you pursue a certain course of treatment (PCP vs ED) to have an approved sick day. Even if this is legal which I don't think it is, I still think it is a waste of resources and inappropriate.

They can require you to jump through whatever hoops that they can defend as reasonable in terms of conditions for a sick day. They can require you to get checked out by the ED, or employee health, before sending you home, and they can choose not to accept a doctors note of your choice (especially in light of the fact that we all have doctors as colleagues more than happy to exchange favors). They cannot receive protected health information. As for requiring you go to the ED over employee health, while I agree that's not the best use of resources, that's for the facility to decide, not the resident, and frankly since a residents day tends to start hours before employee health opens, that doesn't really work.

 

[pulmoblast]

Question : Nurses call in sick all the time and nursing administrators can handle it...why can't we do it?

Ans : Unions

 

[Law2Doc]

Question : Nurses call in sick all the time and nursing administrators can handle it...why can't we do it?

Ans : Unions

Nah -- you don't have the same credentialing hoops for nurses. At a hospital I worked at the administrators could just call up a company last minute and say "send me three nurses" and within the hour they would show up. Quality was suspect, but they could handle the basics.

 

[NotAProgDirector]

As we can see from the discussion on this thread, there is broad variation in how sick days are handled. The situation gets much more complicated if we invoke FMLA, or the ADA.

For "plain old sick days", there is no legal requirement that employers allow them at all. Without an employment contract and in an at-will state, if you don't show up for work because you are sick, you can be fired. Most employers don't do this, as they would have few employees left. As a resident you have a contract, so in general you can't be simply fired, but frequent or untimely absences can certainly be considered professionalism issues and could lead to termination, or to contract non-renewal. In addition, since you need to be certified to take the boards, programs can require that sick time be made up. Each program will have it's own processes. As long as a program has an official process, follows it, and treats everyone the same, there isn't much you can do about it if you don't like it. They can require a physician note. They can require assessment in the ED / Occ Med, although they are then responsible for the cost of the visit.

Laws regarding what is allowed and not for salaried employees differ between states, so it's impossible to make any blanket statements. In general, programs are often allowed to count any missed full day against your vacation allotment if they wish. If you have exhausted your vacation days, they may be allowed to dock your pay for the missed day.

If you claim FMLA status for an absence, that changes everything. In order to claim FMLA, you must have worked for 12 months, your employer must have 50 employees, and you must have worked at least 1250 hours. So, basically anyone who is PGY-2+ is covered. You have to have an illness that is chronic with recurrent exacerbations, or an acute illness that lasts more than 3 days and requires some healthcare visits / treatment. FMLA can be continuous, or intermittent. Your employer can (and usually will) require medical certification, but they cannot force you to use any specific provider, you can use anyone you want. FMLA time is unpaid, but you are guaranteed your job back afterwards and using FMLA time can't be held against you for promotion.

If your absence is part of a disability / ADA request, it gets even more complicated. That's a whole discussion on it's own.

 

[Mass Effect]

Wow. I'm so, so thankful for my program. At my program, if you're sick, you're sick. You call in and that's that (we get 3 weeks of sick days a year). There are only two months during the year that if you call in, it will require the person who is "back up" to cover your shift. For the other 10 months of the year, you're just out when you call in and the attending works without you. I've never had a problem calling in sick.

 

[Law2Doc]

Wow. I'm so, so thankful for my program. At my program, if you're sick, you're sick. You call in and that's that (we get 3 weeks of sick days a year). There are only two months during the year that if you call in, it will require the person who is "back up" to cover your shift. For the other 10 months of the year, you're just out when you call in and the attending works without you. I've never had a problem calling in sick.

Sounds like a larger program with a lot of redundancy. Most of the leaner programs would love to be able to let people be out sick if it didn't drastically impact other people, force them to lose elective time, run afoul of duty hours, etc. But when you already have people maxing out allowable hours, there's just not as much give in the system. Doesn't mean the programs are being jerks, per se, there just isn't an easy answer.

And fwiw, everyone at these programs knows the score, nobody bothers the Chiefs about being sick, and it never even comes up. You just know people are sick when you see them popping OTC meds like pez, masking up, etc.

 

[Mass Effect]

Sounds like a larger program with a lot of redundancy

It's actually not a larger program (it's medium-sized). Not sure why you'd think it was. As I said, when you're sick, no one covers for you. You're just out. The only exception that is 8 weeks a year when you're on blocks that need resident coverage.

Most of the leaner programs would love to be able to let people be out sick if it didn't drastically impact other people, force them to lose elective time, run afoul of duty hours, etc. But when you already have people maxing out allowable hours, there's just not as much give in the system. Doesn't mean the programs are being jerks, per se, there just isn't an easy answer

Again, as I said, in my program, no one loses elective time and we don't come anywhere close to breaking duty hours either.

 

[gutonc]

It's actually not a larger program (it's medium-sized). Not sure why you'd think it was. As I said, when you're sick, no one covers for you. You're just out. The only exception that is 8 weeks a year when you're on blocks that need resident coverage.

Well that's the issue, isn't it. For most IM programs, you're looking at 6-10 months a year where you're on rotations that "need resident coverage". For Gen Surg (and most other surgery subspecialty programs), that number is more like 11-12 months a year. If you're in a specialty where <20% of your rotations require inpatient resident coverage, your sick call policies are going to be a lot different.

 

[Mass Effect]

Well that's the issue, isn't it. For most IM programs, you're looking at 6-10 months a year where you're on rotations that "need resident coverage". For Gen Surg (and most other surgery subspecialty programs), that number is more like 11-12 months a year. If you're in a specialty where <20% of your rotations require inpatient resident coverage, your sick call policies are going to be a lot different.

Yes, but this post is a general post about how your residency handles sick days and I'm answering the question. Most inpatient services survive without us for a day and sick days are not a problem at my program. That's all I'm saying.