Providence Health & Services
Graduate Medical Education Committee (GMEC) Policy on Vacations and Other Leaves of Absence
1. Purpose / Scope
The purpose ofthis policy is to meet the Accreditation Council for Graduate Medical Education (ACGME) requirement that the Sponsoring Institution have a policy for vacation and other leaves of absence.
Each ACGME accredited program must provide its residents with accurate information regarding the impact of leave and other time away from the training program upon the criteria for satisfactory completion of the program and upon a resident's eligibility to participate in examinations by the relevant certifying boards.
Resident Time Away Bank
All residents have a "Provider Time Away (PTA) Bank" (referred to as the Bank) that contains 200 hours at the beginning of training that is used for both vacation and sick leave. The Bank is refreshed every subsequent year of training on or about July 1. For residents progressing from the PGY-1 year to additional years of training, up to 40 additional hours can be rolled over from the prior contract year into the new. Any unused PTA will not be paid out upon promotion, graduation, termination/dismissal, contract non-renewal, or other actions that end employment with Providence.
The Bank is based on an HR platform assuming 40-hour work weeks rather than the highly variable resident work week. The intent of the Graduate Medical Education Committee (GMEC) is for the PTA bank to include 20 days of time away from training for vacation and reserve 5 days for sick time at the beginning of the year which may be used for vacation or stored to roll over if no other absences are taken. Programs must award up to 2 consecutive weekend days for vacation in combination with 5 consecutive weekdays days off. The weekend days will not be charged to the Bank and are also protected from after hours and contingency call.
Pairing Provider Time Away with Program Level Rules
Programs may pre-schedule resident block leave or limit resident leave during high volume request times to ensure all residents are able to take leave while also providing appropriate coverage of clinical services. Programs will publish local policies on the process to schedule leave to make the process transparent to residents.
Pairing Provider Time Away with ABMS Guidance
Governance of Resident Time Away- Regulatory guidance on resident time away are issued by the federal and state governments, the ACGME, the American Board of Medical Specialties (ABMS), Providence system Human Resources regional and local program policies. The American Board of Family Medicine (ABFM) and American Board of Interna! Medicine (ABIM) are examples of ABMS specialty boards. For both the ABFM and the ABIM, 12 months must be spent at each level (PGY-1/2/3) oftraining with allowances for vacation, illness, and other special circumstances where a resident is absent from training. The ABFM and ABIM differ somewhat in their guidance.
ABFM Policies - These are detailed at Absence From Residency / Family Leave Policy I ABFM 1 American Board of Family Medicine (theabfm.org). The ABFM requires 40 weeks of continuity clinic yearly and requires that the resident be on track to see 1650 continuity encounters over their 3-year residency. The ABFM allows up to 4 weeks of vacation and sick leave and 8 weeks of family leave before it would be mandatory for the program director to extend training. No more than 20 weeks of combined vacation and family leave can be missed throughout the entire residency without a mandatory extension of training under the ABFM policy.
ABIM Policies - ABIM policies can be found at: https://www.abim.org/certification/policies/internal medicine-subspecialty-policies/internal-medicine.aspx The ABIM allows up to 35 days away from training in addition to the usual 35 days of time allowed per year away from training if the program director and clinical competency committee approve and the ABIM endorse the recommendation under its deficits in training policy. No more than 140 days of combined vacation, illness, parental, or family leave could be missed throughout the entire residency without a mandatory extension of training under the policy. lt is up to the program director on whether to ask for forgiveness of time missed under the ABIM policy. Tobe admitted to the Certification Examination in Interna! Medicine, residents must complete training by August 3i5t the year of the examination.
Notification of Extension ofTraining - The program director will evaluate the resident's academic progress in meeting ACGME/ABIM requirements and the staffing needs of the program. The program director will notify the resident after the resident returns to work on their new provisional graduation date and any impact the graduation date may have on ability to take the certifying boards. Extensions of training for leaves of absence under this policy are considered non-disciplinary and are not appealable under the Due Process Policy. The decision on whether to extend a resident in training is an academic decision that is separate from financial support the resident may receive when absent from training. Residents are encouraged to meet with the program director prior to taking the LOA to discuss the impact of the leave on the total training time and possible extensions because of the Leave.
Financial Impact- Residents are encouraged to request a meeting with their program administration and/or the regional GME office to review options on how the leave can be funded with the least expense to the resident as regulatory and corporate guidance on leaves can be complex to navigate.
Process to Apply - residents can request paid time away for vacation and illness from the Bank through their local program coordinator. Applying for longer leaves of absence such as disability, medical, parental, family, and other types of leave tend to be more complicated as subcontractors such as Sedgewick or the State of Oregon are involved. Residents should ask for assistance from their GME program coordinator, the GME institutional administrator, or human resources to navigate the administrative process and refer to the corporate policy. Residents generally must apply to BOTH the Providence subcontractor and the state to obtain full benefits. Details on the State of Oregon paid leave benefits can generally be found at: https://paidleave.orgeon.gov/employees/overview.html
Benefits Associated with a New Child
Please refer to the corporate policy on resident leave for details on resident short-term disability leave and parental leave. For birth parents, short-term disability leave generally must be used before parental leave.
Medical Leave
Please refer to the corporate policy on resident leave for details on resident medical and disability leave.
Medical Appointments
Programs must give residents the opportunity to attend medical, mental health, and dental care appointments, including those scheduled during their working hours. For treatment of non-acute, ongoing medical conditions, the resident must inform the program of appointments scheduled prior to each assignment for the program to arrange coverage in accordance with the program's time off policies. lf resident absences for medical appointments and therapy interfere with fulfilling educational objectives and the smooth operations of the residency program, the residency director, as core leader of the resident, should discuss additional options with human resources.
Family Leave
Please refer to the corporate policy on resident leaves of absence for full details.
Administrative Leave for Personal Reasons
Leaves of absence for issues not described above are managed in accordance with applicable state and federal laws such as the Family Medical Leave Act. The Bank can be used to cover these absences. The maximum time of absence permitted under state and federal law may exceed the time in the Bank, resulting in a period of leave without pay. Administrative leave in these cases is managed through a Third-Party subcontractor of Providence, Sedgwick. Further details can be obtained through the program administrator. The state has special programs for paid leave for victims of harassment, sexual assault, domestic violence, and stalking.
Leave Restoration after Prolonged Leave
Please refer to the corporate policy for full details.
Extension of Training after Returning from Leave
The program director will evaluate the resident's academic progress in meeting ACGME/ABMS requirements and the staffing needs of the program. The program director will notify the resident after the resident returns to work on their new provisional graduation date and any impact the graduation date may have on ability to take the certifying boards. Extensions of training for leaves of absence under this policy are considered non-disciplinary and are not appealable under the Due Process Policy.
Interview Absences
Up to 5 days oftime can be granted for interviews without having it deducted from the Bank. An interview can be an important training experience when paired with preparation by a faculty mentor, reflection on goals and expectations for future employment or training after graduation, and a debriefing after the experience.
Scholarly Presentations
Up to 5 days can be used to present scholarly activity at non-local educational conferences without a deduction from the Bank.
Wellness Half-Days
Three half-days for preventive medical, dental, behavioral health appointments, and other non-health related wellness activities approved by the program. The resident must inform the program of the half
day off request prior to each rotation for the program to arrange coverage in accordance with programs time off policies. These days will not be deducted from the Bank.
Bereavement Leave
Residents may receive up to 40 hours (5 weekdays) with pay without a deduction from the Bank in the event of the death of the caregiver's spouse, domestic partner, or child. Residents may receive up to 24 hours (3 weekdays) with pay without deduction from the Bank in the event of the death of a father or mother, brother or sister, stepparent, stepchild, stepbrother or stepsister, grandparent, or grandchild a person who stood in loco parentis, or current in-law through marriage or partnership of the above.
Jury Duty and Witness Service
Residents will not receive a deduction from the Bank for serving on a jury or a witness in a court for time up to four weeks per calendar year. The resident may request to be excused or deferred from jury duty if in the facility's judgment the caregiver's absence would create serious operational difficulties.
Residents should share their jury summons or subpoena to serve as a witness or defendant as soon as possible with their program director so arrangements can be made to prepare for their absence and inform them of policies regarding pay and absences. Attending a court case as an expert witness, a defendant, or as the victim of a crime has more complex rules, and the resident is advised to query HR for support.
Monitoring of Leave Policies on Resident Satisfaction and Wellness
The GMEC will periodically solicit feedback from the residents on the efficacy and structure of this policy on resident satisfaction and wellness.
Approved by the GMEC on 17 July 2023
Corporate Leaves of Absence for Medical Residents Policy
Department: Human Resources
Approved by: Chief Human Resources Officer
Date Last Reviewed: 7/2/2023 Date Last Revised: 7/2/2023 Date Adopted: 7/2/2023
Policy Name: Leaves of Absence for Medical Residents
Scope: All medical residents
Purpose: In keeping with our mission and values, the purpose of this policy is to describe the various paid leaves available to medical residents in accordance with the Accreditation Council for Graduale Medical Education (ACGME) requirements.
Terms:
Actively at work: Attending to normal duties at the medical resident's assigned place of employment. Being "actively at work" includes working on any regularly scheduled days, holidays and time away days as long as the medical resident is capable of active work on those days.
Elimination period: The waiting period during which the medical resident is not eligible for short-term disability pay.
Family member: A child (biological, adopted, foster, stepchild, legal ward, or a child for whom the caregiver stands in loco parentis), parent(s) (biological, adoptive, foster, stepparent, legal guardian of the caregiver or the caregiver's spouse or registered domestic partner, or a person who stood in loco parentis when the caregiver was a minor child), spouse, registered domestic partner, grandparent, grandchild, and sibling.
Objective medical evidence: Clinical information such as diagnosis, physical findings, chart notes, telephone contact with the physician offices, treatment plans, lab reports, x-rays, medical testing, a description of functional limitations, and documentation offunctional limitations such as impaired concentration, poor social-emotional regulation, impaired judgment, and diminished ability to start, maintain, and complete tasks that are due to a mental health diagnosis.
Planned absences: Any time the medical resident knows that they will need to be absent from work for a leave-qualifying event (e.g., scheduled procedure, appointment, surgery or an anticipated pregnancy delivery).
Regular and appropriate care: The medical resident is receiving regular and appropriate care if they are:
Receiving care as often as medically required from the physician whose specialty or experience is the most appropriate for the diagnosed disability.
Receiving treatment that conforms to generally accepted medical standards for treating the diagnosed illness or injury.
Participating in treatment at the intensity and frequency !hat is consistent with the diagnosed illness or injury.
Engaging in face-to-face office visits with a physician or medical resident.
Altending all scheduled appointments and treatments.
Complying with the treatment recommended by the physician or medical resident.
Receiving appropriate physical and psychological rehabilitative services.
For mental illness related disabilities, engaging in active treatment with a behavioral health medical resident or other physician.
Treating physician: The medical provider responsible for directing care of the eligible medical resident's disabling condition.
Policy: In keeping with our mission and values, we provide benefit eligible (.5 FTE or greater) medical residents with an employer-paid short-term disability program designed to financially protect them during periods of non-work-related illness or injury, including maternity.
Leaves Provided Under Federal and State Law. Applicable federal and state law leaves will run concurrently with other leaves whenever possible and in accordance with applicable law. Medical residents should refer to the Leaves of Absence - Family and Medical Leaves and Other Leaves Policy for additional information.
Short-Term Disability
Short-Term Disability Requirements. The 26-week short-term disability program is designed to provide financial protection to medical residents unable to work due to a non work-related illness or injury, including maternity. This program is available to all benefit eligible medical residents.
Short-Term Disability Eligibility. Eligible medical residents will be covered by short term disability beginning on their date of hire or the date moved into an eligible FTE status (.5 FTE or greater).
Elimination Period Before Benefits Can Begin. Short-term disability pay applies for disabilities lasting longer than 7 consecutive calendar days. lf available, time away hours can be applied for regular workdays missed during the elimination period. For example, a full-time medical resident (1.0 FTE) can use 40 hours of time away to replace pay for absences during the first 7 calendar days of disability. Recurrences 14 days or more following a return from a short-term disability warrant application for a new claim requiring another 7-calendar day elimination period.
Short-Term Disability Pay
The employer-paid benefit pays 100% of pay, subject to all applicable laxes, for up to 8 weeks following a 7-day elimination period. Short-term disability pay reduces to 66½ percent for disabilities longer than 9 weeks up to a combined 26 weeks. Long-term disability may apply for disabilities lasting longer than 26 weeks.
Short-term disability pay is taxable as ordinary income in the year received. Applicable state and federal laxes will be withheld from payments along with other regular deductions.
The short-term disability program does not pay for intermittent absences of short duration. Accordingly, benefits are not payable for disabilities lasting fewer than 7 consecutive calendar days.
lf available, time away hours can be used to replace pay during the elimination period and to supplement the reduced short-term disability benefit. (Please note !hat some shift based medical residents may have different time-off benefits !hat can be applied.)
The following applies to caregivers who live in a state with a state disability insurance (SDI) program:
Caregivers are required to apply for benefits with both SDI as weil as short-term disability.
The short-term disability benefit will be reduced by the SDI benefit amount for a combined total benefit as noted above.
lf a caregiver is denied benefits by the state, the offset will remain in place until the caregiver exhausts their appeal opportunities with the state and the claim remains in denied status.
Short-Term Disability Procedures
Reporting a claim. Leaves of absence lasting 3 days or langer should be reported to the third-party administrator as soon as practicable or in advance for known or planned absences (e.g., scheduled surgery, estimated delivery date). At intake, it will be determined if the reason for the leave would qualify for short-term disability pay. The deadline for filing a short-term disability claim is no later than 10 days from the medical resident's first day of absence due to their disability. lf this deadline is not met, short-term disability pay may be denied.
Conditions to Receive Benefits. Medical residents are eligible to receive short-term disability pay if all the following conditions are met. A non-work-related injury or illness is sustained (see "Special Rules for Maternity") and the medical resident:
ls an active caregiver at the time of disability
ls under regular and appropriate care of a physician. The physician is required to provide objective medical evidence to support the disability. This evidence must indicate:
Thal the illness or injury prevents the medical resident from performing their work.
Thal the medical resident is undergoing appropriate treatment.
The start date of the illness or injury.
The expected duration of medical resident's disability.
ls compliant with courses of treatment established by the treating physician.
Ensures that healh care and treatment documentation that is acceptable is provided upon request in a timely manner.
Special Rules for Maternity. Pregnancy claims will be approved for, and limited to, 2 weeks pre-partum (including the 7-calendar day elimination period) based on estimated date of delivery and 6 (regular) or 8 (Cesarean) weeks starting with the child's date of birth unless objective medical evidence supports the extension of lhis already approved period. Following the disability period, additional time off may be available for baby bonding. Time Away hours can be used for income during the baby bonding period.
Authority to Approve and Continue Benefits. Final determination of benefit eligibility will be made by our third-party administrator, based on objective medical evidence. Medical residents are required to ensure that supporting medical evidence is provided to our third party administrator no later than 20 days from the date the claim is filed or first dale of absence, whichever is later. Periodic updates from the treating physician will be required to justify continued payment of benefits. Supporting medical information for extensions must be submitted within 7 days of the certified disability end date. The medical resident may also be required to undergo an independent medical evaluation with a physician chosen by our third-party administrator to validate or clarify medical evidence presented as support of the claim. lf the treating physician has copying charges or other costs related to gathering information to substantiate a claim, the medical resident will be responsible for the costs incurred.
When Benefits End or Are Not Paid. Below are some examples of situations when short-term disability benefits may end or not be paid. The medical resident is not eligible for coverage under the program for any of the following reasons:
Returns to work at their regularly scheduled number of hours.
Receives the maximum short-term disability benefit for a qualifying disability.
Fails to provide the appropriate notice of the need for a leave.
Refuses medical care or fails to cooperate with a course of treatment.
Stops receiving regular and appropriate care from a health care medical resident.
Unreasonable refusal to comply with a "return to work" plan.
Has an illness or injury that is caused by, or contributed to, being engaged in an illegal situation or occupation.
Becomes incarcerated for a criminal conviction.
lndicates that a condition is work-related.
ls no longer employed at the facility.
Appeals. The caregiver has 60 days from the receipt of notice of a denial for short-term disability benefits to file an appeal. Requests for appeals should be sent to the address specified in the claim denial.
Paid Parental Leave. The facilily provides eligible medical residents (0.5 FTE or greater) the opportunity to take time off with pay to spend time bonding with their families following a
birth, adoption, or foster child placement. Paid parental leaves for absences from work are subject to the limits and conditions described below.
Eligibility. Medical residents with a full-time equivalent (FTE) of 0.5 or higher and scheduled to work 20 hours or more per week will be eligible for paid parental leave coverage as of the date of hire.
Benefits. Medical residents may begin their leave immediately following the birth, adoption, or foster child placement. The parent who gives birth should first apply for short term disability before requesting additional paid parental leave under this section of the policy.
Medical residents on an approved leave will be paid 100 percent of their base pay in effect at the time the medical resident begins their leave. Paid parental leave benefits are taxable as ordinary income in the year received. Applicable state and federal laxes will be withheld from benefit payments along with other regular deductions.
Medical residents in states and/or cities that have paid parental leave programs must also apply for benefits with the applicable state/city to be eligible for this supplemental facility paid benefit. The facility-paid parental leave will be offset by any state/city paid parental leave benefit amounts for a combined total benefit of 100 percent of base pay at the time the leave commenced.
lf a medical resident is denied benefits by the state/city, the facility will pay the medical resident the difference between base pay and the anticipated state/city paid benefits as an offset until the medical resident exhausts their appeal opportunities with the state/city and the claim remains in denied status.
Medical residents are eligible for up to 6 weeks of facility-paid parental leave in a rolling 12-month period (regardless of the number of qualifying events - e.g., multiple births, adoptions or foster placements or combination thereof during a 12-month period). Medical residents may choose to take this time off in increments of up to 3 occurrences, each a minimum of 1 week (7 calendar days). All available time must be used within 12 months following the birth or placement.
Leave to Care for a Family Member: The facility provides eligible medical residents paid time off to provide care to a family member, subject to the limits and conditions described below.
Eligibility. Medical residents will be eligible for paid leave coverage as of the date of hire.
Benefits
Medical residents an an approved leave to care for a family member will be paid 100 percent of their base pay in effect at the time the medical resident begins their leave. Leave to Gare for a Family Member benefits are taxable as ordinary income in the year received. Applicable state and federal taxes will be withheld from benefit payments along with other regular deductions.
Medical residents in states and/or cities !hat have paid leave benefits must also apply for those benefits with the applicable state/city to be eligible for this supplemental benefit. The facility-leave benefit will be offset by any state/city paid leave benefit amounts for a combined total benefit of 100 percent of base pay at the time the leave commenced.
lf a medical resident is denied benefits by the state and/or city, the facility will pay the medical resident the difference between base pay and the anticipated state/city paid benefit as an offset until the medical resident exhausts their appeal opportunities with the state/city and the claim remains in denied status.
Medical residents are eligible for up to 6 weeks of this type of facility leave. Medical residents may choose to take this time off in increments of up to 3 occurrences, each a minimum of 1 week (7 calendar days). Leave to Gare for a Family Member will only be available once during the residency program.
Special Leave: In addition to the above, medical residents may be eligible for 1 week of Special Leave paid at 100% of their base pay in order to allow for time off if the medical resident has exhausted all other leave options. Special Leave is available only once during the duration of the residency program.
The statements of this policy document are not to be construed as a contract or covenant of employment. They are not promises of specific treatment in specific situations and are subject to change at the sole discretion of the facility.