Policy of the Graduate Medical Education Committee
Section: Resident Support/Conditions for Appointment
Subject: Leave for Residents
Number: 2.200
Date Developed:
1/89
Last Review/Revision: 12/06
Replaces:  previous policy of same name, dated 5/03; incorporates previous GME Policies 2.200 and 2.210
ACGME Requirement: Institutional II.D.4.h

Purpose
To define the policies and procedures as well as the related responsibilities of the UAMS College of Medicine (COM), Program Directors, and the residents/fellows for leave while enrolled in the GME program.

Definitions:
Sick Leave
is paid absence from scheduled work for reason of illness, maternity, paternity, or injury.
Family Medical Leave Act FMLA): 
See provisions of UAMS Administrative Guide No. 4.6.11.
Professional Leave
is paid absence to attend an approved function related to the specialty program of the resident.
Leave of Absence
is unpaid absence from the educational activities of the residency program when no sick or vacation leave exists to cover the absence and it is leave other than FMLA-qualified leave.
Bereavement Leave
is paid absence to attend a funeral of the resident’s immediate family.
Immediate Family: 
father, mother, sister, brother, spouse, child, grandparents, grandchild, mother-in-law, father-in-law, or any other person acting as parent or guardian of the resident.
Military Leave: 
absence from the residency program to fulfill obligations of the National Guard or any of the Uniformed Services of the United States as defined in 38 U.S.C. 4303.
Vacation Leave: 
paid absence from the residency program typically used for the purpose of personal travel or recreation; however, it may also be used for personal business.

Effect of Leave on Completion of Training
Each program must provide its residents with
(a)  a written policy in compliance with its Program Requirements concerning the effect of leaves of absence, for any reason, on satisfying the criteria for completion of the residency program, and;

(b)  information relating to access to eligibility for certification by the relevant certifying board
(American Board of Medical Specialties web site http://www.abms.org/Who_We_Help/Member_Boards/contactinfo.aspx.)

Resident physicians are in the unique position of having a role as students and employees.  Although brief periods of leave usually
can be accommodated, extended absences from the residency (fellowship) program for any reason may adversely affect both the resident’s timely completion of the educational program and the program’s responsibilities for patient care, allocation of clinical teaching opportunities, and funding for resident stipends.  Most specialty boards specify a minimum number of weeks of education (or training) that must be completed for a resident to receive credit for the educational (or training) time.  The resident should consult the appropriate Board regarding qualifications and requirements to sit for their specialty boards when requesting extended periods of leave from the program. 

I.    Policy
It is the responsibility of the Program Director to:
1.         Keep accurate records of sick leave, vacation leave, leaves of absence, and training status in order to have adequate information for Board certification;            2.         Determine whether the resident will be required to spend additional time in the program to compensate for the leave period and be eligible for certification for a
            full training year;
3.         Provide the resident with written documentation concerning the effect of leave, for any reason, on satisfying the criteria for completion of the residency
            program;
4.         Notify the Director of Housestaff Records to discuss the accounting of the leave, financial compensation, and record keeping requirements.

It is the responsibility of the resident to:
1.         Notify the Program Director as soon as possible about the need to take leave for any  reason;
2.         Supply the necessary written information about the reason for any type of leave;
3.         Gain a thorough understanding of the effect the leave will have on meeting the requirements of the residency (fellowship) program and board certification.

 II.        Sick Leave
Policy
Sick leave for medical reasons will be granted with pay for a maximum of 12 days during each year of the residency program.  Weekdays and weekend days during which the resident is assigned to work will be charged as sick leave if the resident is unable to work due to illness. Residents will not be charged sick leave for days on which they were not assigned to duty (i.e. scheduled days off).  Sick leave cannot be carried over from one year to the next,  nor will residents receive payment for unused sick leave at the completion of the program.  To access sick leave a resident must notify the Program Director or his/her designee.  The specific procedure for notifying the Program director of brief absences due to illness is developed within the individual program.  A resident may be placed on sick leave for extended periods of time (generally in excess of one consecutive week only) with the approval of the Program Director, according to the following:

Procedure for extended sick leave
1.         The resident submits a written request to the Program Director stating the nature of the illness or injury
and the reason for the requested extension of sick
             leave.

2.         The request is reviewed by the Program Director who determines the effect of extended leave
on continued participation in the residency program and the
            possible need for and availability of remedial training.  This information must be provided to the resident in writing
The Program Director may require a
            statement from the resident’s treating physician to help in these determinations.
3.         The Program Director must notify the Director of Housestaff Records about the planned leave period.
4.         Unused vacation time must be used after the exhaustion of sick leave.  When maximum sick leave and vacation time have been exhausted, the resident is
            placed on leave without pay as described on Section V.
5.         The Program Director shall decide whether the resident may return to full duties upon consideration of all circumstances involved.  The Program Director may
            require a statement from the resident’s treating physician to help determine if the resident is medically qualified to return to duty and if any restrictions are
            necessary in the resident’s clinical activities because of the illness.

Special Provisions for Pregnancy – Maternity Leave
In recognition of the variations in physical demands among the residency programs in the UAMS-COM, the interdependence between the numbers of the residents in a particular residency program, the educational and patient care experiences, and to ensure optimum consideration for both the mother and the unborn child, the following procedures should be followed:
1.         The resident should see a physician as soon as she believes there may be a pregnancy. When the pregnancy is confirmed, she should notify her Program
            Director promptly in order to plan future assignments within the residency program.  She should also provide the date on which she will most likely cease
            program responsibilities.
2.         By the end of the sixth month of pregnancy, the resident must provide the Program Director with a statement from her personal physician certifying the
            expected date of  delivery, her physical ability to continue working, and the date to which she is permitted to work.  Any subsequent change in medical
            condition that might alter these health guidelines is to be documented by an additional statement from her physician.
3.         The maximum period of maternity leave with pay is 33 days (12 days of unused sick leave plus 21 days of unused vacation time).  Time off-duty beyond that
            amount is without compensation.  The time off-duty is to be used in the following order, unless the Program Director gives permission to use the leave in
            another way:
           a.         unused sick leave
           b.         unused vacation time
           c.         leave without pay
4.         Under special circumstances, most commonly for reasons of pregnancy, the resident may request permission to start and complete
one year of residency
           program over a two-year period.  Such requests must be made in writing and in advance
to the Program Director. Approval will be based upon the educational
           curriculum of the program, the requirements of the clinical service, and the Residency Review requirements of the residency program.

Paternity Leave
A male resident may request leave in order to care for his newborn child or spouse who has delivered a newborn child.  He must make the request in writing to the Program Director, who will consider all aspects of the residency program in granting or denying permission for leave.  In order for the leave to be granted, the following procedure must be followed:
1.         Request for paternity leave must be made to the Program Director at least four (4) months before the date of the leave.
2.         The time will be used in the following order:
            a.         one day of sick leave for the birth
            b.         unused vacation time
            c.         leave without pay

III.       Family Medical Leave
Policy
Residents who meet the definition of “eligible employee” as defined by UAMS Administrative Guide No. 4.6.11, Family and Medical Leave Act (“FMLA”), may be entitled to leave benefits under that policy.

In order to request FMLA leave,
the resident should notify the Program Director as soon as possible and complete and return the requisite forms to the Program Director.  In order to use FMLA for the birth of a child or to care for a newborn, the resident must notify the Program    Director at least four (4) months before the date of the leave.  The terms of 4.6.11 apply to the use   of FMLA leave.

IV.       Professional Leave
Policy
Each Program Director must provide the residents in the program with written guidelines for leave to attend educational activities (e.g. professional meetings, taking board or other standardized examinations, employment or professional interview) related to the specialty.    Professional Leave is usually not counted as vacation.  The resident must complete a Travel Authorization form, return it to the Program Director, and receive approval prior to the beginning   of the leave.

V.         Leave of Absence (non FMLA qualified)
Policy
The Program Director has the sole authority to grant a leave of absence for a resident.  Leave of absence if leave other than FMLA-qualified leave.  Leave of absence is ordinarily unpaid; however unused vacation or sick leave may be used at the discretion of the Program director for certain circumstance such as serious health conditions affecting a resident’s spouse, child or parent and for whom he/she is needed to provide care.  In order for a leave of absence to be granted, the following procedure must be followed:

Procedure
1.         The resident must discuss the reasons and estimated length of time for a leave of absence with the Program Director.
2.         The discussion must include whether the resident will be paid, the financial source for  stipend and other benefits, the estimated length of time for the leave of
            absence, and a full determination of whether or not the resident is required to spend additional time in the residency program to compensate for the leave period
            and be eligible for certification for a full training year.  The decision regarding additional time in the program should consider the requirements of the individual
            specialty Boards.
3.         Prior to making a final decision regarding the request for leave of absence, the Program Director must contact the Director of Housestaff Records to discuss
            the accounting of sick leave, vacation time, restrictions about family medical leave, financial compensation (stipends and benefits), and the record keeping
            requirements.
4.         After consultation with the Director of Housestaff Records, thorough discussion with the resident regarding reasons for the leave, review of necessary
            documentation regarding the medical or other condition, and thorough review of the residency requirements for board eligibility, the Program Director makes
            the final decision regarding granting a leave of  absence.
5.         The Program Director provides a decision in writing to the resident and the Director of Housestaff Records which must include the starting and ending dates of
            the absence, financial support (stipends and benefits) if applicable, and the amount of additional time in the residency program that is required to compensate
            for the leave an fulfill board eligibility requirements.
6.         Once the resident is placed on leave of absence, the Program Director must notify the Director of Housestaff Records if there is any change in the dates of the
             leave of absence and confirm the date the resident will return to
the residency program.

VI.       Bereavement Leave
Policy
Residents may request leave of one (1) to three (3) days due to death of a member of his/her immediately family.  Requests for this leave or extension of this leave beyond three days must be approved by the Program Director.  Extended bereavement leave is administered under provision of Section V above.

VII.      Military Leave
Policy

The Uniformed Services Employment and Reemployment Rights Act does not apply to residents enrolled in the GME program.  Residents who are members of the National Guard or any of the Uniformed Services of the United States may be called to duty in such uniformed service.  The resident shall notify the Program Director in writing upon learning that he/she has been called to duty in a uniformed service.  Prior to leaving the program for active duty, the resident and Program Director shall discuss the tentative plans for the resident’s return to the   program including the level of re-entry.  Within the abilities of the program to accommodate the resident’s re-entry in the program, the duration of absence from the program and the resident’s activities during the absence, the program will make every effort to ensure that the resident re-enters the program at the level commensurate with his/her abilities.

VIII.    Vacation Leave
Policy

Each Program Director has the authority to determine the length and scheduling of vacation time for residents with in the program. 
The Program Director shall provide written instructions to residents within their program and to Program Directors of off-service residents about the procedures and rules for scheduling vacation time.  Failure to follow the specified procedure could result in loss of vacation time.

The annual vacation allowance is three weeks (15 working days plus weekends to a maximum of 21 days) for all residents.  Weekends and UAMS holidays are not charged as vacation time.  Vacation leave must be approved by the appropriate department/program representative.  An individual Program Director may alter the amount of leave but only in order to comply with the Residency Review Committee requirements.

Approved professional leave typically is not counted as vacation if the resident’s department sanctions the activity. 

Each department shall grant vacation time to residents from other departments on a FTE basis proportionate to the time spent on service in the other department.  For example, if four residents from Department A rotate on a Service of Department B for three months each, Department B must grant three weeks (15 working days plus weekends to a maximum of 21 days) to be distributed among the four residents [4 residents x 3 months = 12 months of 1 FTE; therefore 1 FTE = 3 weeks vacation].  The Program Directors of Departments A&B will arrange the appropriate allocation of the vacation time among the residents.

The nature of some educational experiences may preclude taking vacation time.  In this case, the Program Director shall communicate this decision to Program Directors of visiting residents in a timely manner so that this can be considered when preparing the overall rotation schedules.

Vacation time does not accrue from year to year and must be scheduled and taken in the same academic year the vacation is earned.  Further, residents are not paid unused vacation leave at the time of the completion of their program.