The vacation conundrum most people face has to do with things like whether to drive or fly, or whether to sleep on the ground or in a hotel. But some hospitalists encounter tricky problems when figuring out how to operationalize their contractual provision for vacation time.
What is the Vacation Conundrum?
I’m a big believer in hospitalists having liberal amounts of time off, but I think most practices should avoid contractually specifying vacation time. This may sound contradictory and terribly unfair to the doctor. But avoiding a contractual guarantee of vacation time doesn’t mean the hospitalist gets any less time off. And the way hospitalist contracts address vacation time has gotten a lot of organizations in trouble. Let me explain.
Contracts often stipulate that a hospitalist will have a specified number of weeks of vacation time annually, and this language has usually been taken from the organization’s existing contracts with other physicians. But confusion often arises some time after the hospitalist practice is up and running. One big problem is deciding who will cover for the hospitalist on vacation. If all doctors work extra shifts to cover for a member of the practice who is on vacation, they will all take turns working extra—a practice that negates the effect of the promised holiday. Another problem is that most hospitalists follow non-traditional work schedules, making it difficult to determine which of the days not worked are vacation days and which are days the doctor just wasn’t scheduled to work.
To better understand this issue, it is worth thinking about how most hospitalist schedules differ from that of a typical office-based doctor or businessperson. Someone in business is usually expected to work every Monday through Friday of the year—except government holidays. Those weekdays that the business person doesn’t work are usually regarded as vacation days. (Note that I’m intentionally ignoring sick time in this discussion.) Weekend days are almost never regarded as vacation days in the business world.
But things are far more complicated for hospitalists because of the non-traditional—not always Monday through Friday—schedule they work. If a hospitalist has Tuesday and Wednesday off this week, should that be counted as vacation time or simply weekend days displaced into the middle of the week because the doctor worked the prior weekend? It is often impossible to answer this question unambiguously.
Another issue to be considered is that decisions about vacation time and the normal—non-vacation—schedule the hospitalists use are often made independently. For example, many groups use a seven days on-seven days off schedule, with 12-hour shifts on each worked day. This might lead to an agreement that every seven worked days will count as two weeks of work that has been compressed into one week on the calendar. If that’s the case, debate can arise when trying to figure out what one week of vacation really means.
One could reasonably argue that it means the doctor is relieved of five days of work, because in most jobs a week off means being off Monday through Friday. Or, because every seven worked days counts as two weeks of work, a week off could mean being relieved of half of those days—or 3.5 days off. Lastly, a hospitalist could reasonably argue that a week off means being relieved of all seven days of one of the worked weeks. This last approach is the most common way the issue is handled. Specifying vacation in numbers of days or hours, rather than in numbers of weeks, helps but does not eliminate this confusion.