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: 2/04, 12/06, 6/09
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.

The financial accounting for resident salary and benefits is by the day.  Every calendar day (off, sick, leave and work days) for every resident must be paid from some source, except in instances of leave without pay.  An institution (ACH,CAVHS, UAMS MC, etc) or a program are usually the funding source.

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.
Parental leave: Time off duty, by the mother or father, for the birth of a child or the placement of an adoption
Professional Leave is paid absence to take boards or other standardized examinations required by the specialty.
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.

Responsibilities for Administering Policy

Resident physicians are in the unique position of having a role as students and employees.  Although brief periods of leave usually can be accommodated, time away from the residency (fellowship) program may affect not only the resident’s ability to sit for boards, but also may negatively impact the program financially and through its accreditation status.  Extending the program may not be possible due to the lack of salary funding, and/or fine imposed by the U.S. Citizenship & Immigration Service (INS).  Additionally, the program may not receive approval from the ACGME to increase the resident complement for the additional educational time. 

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 the program’s written policy concerning the effect of leave, for any reason, on satisfying the criteria for completion of the residency program. The policy will contain information on access to eligibility requirements, usually the American Board of Medical Specialties web site http://www.abms.org/Who_We_Help/Member_Boards/contactinfo.aspx.

4.      Provide resident in writing, the consequences of exceeding the amount of leave set by the ACGME and/or the Specialty Board.

5.      Notify the Assistant Dean for Housestaff Affairs 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.

I.    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.  Each program will inform its residents/fellows of the specialty Board regulation on leave used vs. Board eligibility. 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.  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 Assistant Dean for Housestaff Affairs 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.

6.      Under special circumstances, 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.

             Special Provisions for Pregnancy

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.      When the pregnancy is confirmed, the resident should notify her Program Director promptly. 

2.      The Program Director should be sensitive to the confidential nature of this information during the early part of pregnancy.

3.      By the end of the sixth month of pregnancy, the resident must provide the Program Director with a written statement about the expected date of delivery, and the intended dates of leave.  Any subsequent change in medical condition that might alter this information should be submitted in a revised statement. 

4.      The Program Director may request a statement from the treating physician, especially in the case of extended leave

5.      See UAMS Administrative Guide No. 4.6.11, Family and Medical Leave Act (FMLA) if leave is without pay or if she elects to take a leave of absence without pay before exhausting her unused sick and vacation time. 

II.    Parental Leave Policy

1.      The maximum period of parental 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. 

2.      Time off for parental leave must be requested in writing to the Program Director as soon as it is known, preferably at least four (4) months before the date of the leave.

3.      The program director will consider all aspects of the residency program in granting or denying permission for leave.

4.      See UAMS Administrative Guide No. 4.6.11, Family and Medical Leave Act (FMLA) if leave is without compensation.

 III.       Family Medical Leave Policy

1.      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 under that policy. 

2.      The terms of UAMS Administrative Guide No. 4.6.11 apply to the use of FMLA leave. 

IV.       Professional Leave Policy

 

1.      Each Program Director must provide the residents in the program with written guidelines for leave to take boards or other standardized examinations required by the specialty. 

2.      Professional Leave is usually not counted as vacation. 

3.      To ensure insurance coverage while off campus on official duty 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 is ordinarily unpaid. 
            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
                        Assistant Dean for Housestaff Affairs 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 Assistant Dean for Housestaff Affairs, 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 Assistant Dean for Housestaff Affairs
                        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 Assistant Dean for Housestaff
                        Affairs 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 within 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 21 days. Only 15 week days (i.e. Monday - Friday) may be taken. Each program will
            inform its residents/fellows of the specialty Board regulation on leave used vs. Board eligibility. 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 American Board of Medical Specialties requirements.

            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.

 American Board of Medical Specialties
Requirements on leave

April 8, 2009