Many medical offices are following a popular trend in the business world—replacing employee sick leave, vacation, and any other miscellaneous time benefits with a combination of all of them, collectively referred to as “paid time off.”

There are several reasons why this is a good idea, but you should carefully consider all the pros and cons before you make such a change in your office. Contrary to what you may have read, a paid time off (PTO) policy is not without disadvantages.

Its advantages, however, are significant. Employees like the concept because most of them are generally healthy and never use all their sick leave. Allowing them to take the difference as extra vacation time makes them happy and makes your office more attractive to excellent prospects. They also appreciate being treated more like adults who can make time-off decisions for themselves, and they like the increased flexibility that PTO provides.

Employers like it because there is less paperwork and less abuse of sick leave. They don't have to make any decisions about whether an employee is really sick or not since reasons for absence are now irrelevant, making feigned illnesses a thing of the past. If an employee requests a day off with adequate notice, and there is adequate coverage of that employee's duties, you don't need to know or care about the reason for the request.

Critics of PTO say that employees are absent more frequently under a PTO system, which is sometimes true. Employees who never used their full allotment of sick leave will typically use all of their PTO every year, but most of these extra absences can be controlled by requiring prior approval for any PTO except emergencies.

Critics then point out that you are replacing decisions about what constitutes an illness with decisions about what constitutes an emergency, but as I will discuss below, most criteria for emergencies can be settled upon in advance.

You also have the option of allowing employees to take salary in exchange for unused PTO, which you can pay annually or when their employment ends. In general, though, I don't think that is a good idea. I believe vacations are necessary and important for good office morale, and they should be taken by all employees, as well as by all employers.

Remember Eastern's First Law: Your last words will not be, “I wish I had spent more time in the office.”

And as I've mentioned in several previous columns, you should be suspicious of any employee who refuses to take vacations. Such employees are often embezzlers who are afraid that someone will discover their illicit modus operandi during their absence.

If you're going to allow PTO to accrue and be paid later, it's probably best to allow only a portion (say, 25% maximum) to be taken that way.

The major disadvantage of PTO is the possibility that employees will resist staying home when they are ill. Some businesses converting to the PTO system have found that employees tend to view all paid time off as vacation time. So when they are sick, they don't want to “waste” any of their “vacation” days. The result is that many employees with upper respiratory infections and other communicable illnesses will come to work and transmit illness to fellow employees and patients alike. Productivity drops as more employees get sick, and patients, needless to say, are not happy about illnesses acquired (or suspected to be acquired) at the doctor's office.

So before switching to a paid time off system, it is important to weigh all the pros and cons and consider your options. Should you decide to proceed, anticipate the potential problems and put strategies in place to counter them.

First, define “advance notice”: Is it 24 hours, or is it a week? Then decide how you will define an emergency, and put these definitions in writing. Employees might regard waking up Monday morning with a bad hangover as an emergency, but you might not. Most would consider a sick child an emergency, but what about a malfunctioning car? Some circumstances will need to be decided on a case-by-case basis, but the more situations you can anticipate and settle in advance, the fewer hassles you will have.

Establish clear guidelines from the outset. Make sure everyone knows they will have to request PTO in advance except for emergencies.

Make it very clear that sick employees should stay home, and that if they come to work sick they will be sent home. You have an obligation to protect the rest of your employees, not to mention your patients (especially those who are elderly or immunocompromised), from a staff member with a potentially communicable illness.

To respond to this column, e-mail Dr. Eastern at sknews@elsevier.com

Paid Time Off