Managing Your Practice

Paid (and unpaid) time off


Many medical offices are following a popular trend in the business world: They are 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” (PTO). There are several reasons why this is a good idea, but it is not without disadvantages, and you should carefully consider all the pros and cons before adopting it.

Dr. Joseph S. Eastern, a dermatologist in Belleville, N.J.

Dr. Joseph S. Eastern

Employees generally like the concept because most 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.

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; reasons for absence are now irrelevant, so feigned illnesses are 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 say employees are absent more frequently under a PTO system, since employees who never used their full allotment of sick leave will typically use all of their PTO; but that, in a sense, is the idea. Time off is necessary and important for good office morale, and 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.”)

Besides, you should be suspicious of any employee who won’t take vacations. They are often embezzlers who fear that their illicit modus operandi will be discovered during their absence. (More on that next month.)

chokkicx/Digital Vision Vectors

Most extra absences can be controlled by requiring prior approval for any time off, except emergencies. Critics point out that you are then replacing decisions about what constitutes an illness with decisions about what constitutes an emergency; but many criteria for emergencies can be settled upon in advance.

Some experts suggest dealing with increased absenteeism by allowing employees to take salary in exchange for unused PTO. I disagree because again, time off should be taken. If you want to allow PTO to be paid as salary, set a limit – say, 10%. Use the rest, or lose it.

A major issue with PTO is the possibility that employees will resist staying home when they are actually sick. Some businesses have found that employees tend to view all PTO as vacation time, and don’t want to “waste” any of it on illness. You should make it very clear that sick employees must stay home, and 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.

Other clear guidelines should be established as well. Make sure everyone knows they will have to request PTO in advance, except for emergencies. First define “in advance” (72 hours? A week?), and then “emergency,” and put these definitions in writing. Illnesses are emergencies, of course, but what about waking up with a bad hangover? A sick child qualifies if your employee is the only available caregiver, but what about a malfunctioning car? Some circumstances will necessarily 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.

What about unpaid time off? There are two basic options: Don’t allow it at all, or require employees to submit a written request, explaining why they need it, and why it’s a special situation and won’t be a regular occurrence. Even if you (almost) always approve such requests, forcing your employees to jump through a hoop or two makes it far less likely that anyone will abuse the privilege. And it allows you to make judgments on a case-by-case basis, while still being able to honestly say you offer it as a blanket policy to all employees.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

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