Work-Life Balance In Residency Programs: What To Expect

Residency directors discuss how to handle time off and medical leave requests from residents as well as on-the-job expectations that may exceed what is stated in their contracts.

Q:

How many vacations and sick/personal days are your residents allowed per year? Who keeps track of their schedule?

A:

David Bernstein, DPM, FACFAS, says that for his residents, parameters for time off are specified in their contracts and tiered by residency year. He notes that first-year residents are entitled to 10 vacation days, six holidays, five personal days and three to five conference days. Second-year and third-year residents receive 15 vacation days, six holidays, five personal days, and three to five conference days.”

In addition, Dr. Bernstein’s residents accrue one sick day per month from July to June for a total of 12 sick days per year.

Steven Vyce, DPM, FACFAS, explains how Yale’s Foot & Ankle Surgery Residency Program allows for three different types of leave: vacation, sick and CME/authorized absence. Residents are allotted 10 vacation days, seven sick days and five authorized absences per year. Residents can use authorized absences to attend educational conferences, interviews, and other professional-related activities, according to Dr. Vyce.

“We understand the importance of balancing professional duties with the ability for residents to have time available to take care of themselves medically as well as having stress-free time away from work,” notes Dr. Vyce.

Dr. Vyce says a full-time residency coordinator handles all resident requests for leave. Requests must be submitted 30 days in advance and require the permission of both the site director and senior resident at the hospital where the resident is scheduled to work during the time of leave.

In addition, residents must also submit a digital request in MedHub, Yale’s electronic system, says Dr. Vyce. MedHub also tracks the number of days used by residents throughout the year.

H. John Visser, DPM, FACFAS, and Carmina Quiroga, DPM, FACFAS, say their residents’ time-off requests—they receive 21 days of leave per year, encompassing vacation, sick, and personal time—are handled by the Assistant Program Director, Chief Resident, and Residency Program Coordinator.

Drs. Visser and Quiroga explain that time off is not transferable, requires permission from the director during podiatric rotations and must comply with their program’s requirements.

“Residents may not schedule vacation or personal leave during the first month of any year of training,” they say. “If vacation requests accounting for all residents’ remaining vacation/PTO time are not submitted by April 1 of each academic year, the residents’ remaining vacation time may be assigned at the discretion of the residency program administration to ensure that essential program (residency staffing) needs are met.”¹   

Q:

How does your program accommodate the resident who requires an extended leave for medical reasons?

A:

Dr. Vyce explains that his program follows the Family Medical Leave Act (FMLA) of 1993, which allows for up to 12 weeks of medical leave per year. If a resident requires such a leave, he says the resident must make up the time he or she missed in order to complete the program.

When it comes to making up time, there is some wiggle room.

“Our GME office allows for compression of this time by up to 50 percent if the Clinical Competency Committee feels the resident has shown sufficient competence,” says Dr. Vyce.

Dr. Bernstein’s residents can use their vacation, personal, or accrued sick days in the event of an extended leave for themselves or their family. Any time off they take beyond that allotment would be unpaid, he explains. When appropriate, Dr. Bernstein says residents on leave are required to submit weekly reports to the Residency Director.

In some cases, a resident’s schedule can be moved around so he or she doesn’t miss required rotations, says Dr. Bernstein. In the event a resident does miss his or her podiatric rotations, the resident is required to make up the time, which may delay his or her graduation from the program.

To ensure their residents can graduate on time, Drs. Visser and Quiroga explain that they must provide the Program Coordinator and Chief Resident with their requests as soon as reasonably possible. This allows for rescheduling of the program rotations, hopefully allowing the resident to miss as few required rotations as possible.

Residents may dip into their 21 days of allotted time off for a medical leave, they advise, and any time off taken beyond that must be made up at the end of the residency program.¹

Q:

How are residents informed of program expectations beyond their contract? Do you have a “Resident Survival Manual?”

A:

Drs. Visser and Quiroga’s residents are informed of program expectations at the beginning of their training when they review the program’s training manual.

“The Chief Resident is responsible for communicating and enforcing expectations of the residency program to all the residents and acts as an intermediary on their behalf should an issue arise,” they say.

However, they acknowledge that no aspects of the residency program are set in stone and are constantly subject to ongoing and episodic evaluation of purpose and effectiveness. Any improvements and/or changes to the residency program will be implemented once developed, Drs. Visser and Quiroga explain, and residents are expected to be involved in the quality- and process-improvement activities.¹

Dr. Bernstein notes that he reviews each page of his program’s “Resident Survival Manual” with the residents.

After incoming residents sign their one-year contracts, the program expectations are reviewed in detail with the Podiatry Resident Coordinator and Program Director. Each resident receives a hard copy and an electronic copy of the manual for reference, says Dr. Bernstein.

Dr. Vyce also provides his residents with a residency manual as is required by the Council on Podiatric Medical Education (CPME).

“We have an extensive manual that reviews everything from our leave policies to documentation requirements, logging working hours, on-call requirements, professionalism, and privacy rules,” he explains. “We review the manual with all residents in excruciating detail at the start of each academic year.”

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Wayne, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Quiroga is the Assistant Director of the Podiatric Residency Programs at Mineral Area Regional Medical Center in Farmington, MO and the DePaul Health Center in Bridgeton, MO. She is a Fellow of the American College of Foot and Ankle Surgeons, and is in private practice at multiple locations in Missouri.

Dr. Visser is the Director of the SSM Depaul Hospital Foot and Ankle Surgery Residency. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Vyce is the Chairman of the Department of Podiatric Surgery at the Yale-New Haven Hospital and the Program Director of the Yale Podiatric Foot and Ankle Surgery Residency Program. He is an Assistant Clinical Professor in the Department of Orthopaedics and Rehabilitation at the Yale School of Medicine.

Reference

1. SSM DePaul Podiatric Medicine and Surgery Residency Program. Reconstructive Rearfoot/Ankle Surgery Training Manual: Policies and Procedures, Duties and Responsibilities, Clinical Experiences. Version 9. Bridgeton, MO: SSM Health Center; 2015.