Things can get really tricky when hospitalists start adjusting their standard work schedule. They might shorten or lengthen certain existing shifts or add new shifts (e.g., an evening admitting shift) all of which complicates figuring out what a day or week of vacation really means. Think about a group that has a standard schedule of 10-hour day shifts, 14-hour night shifts, and a six-hour evening admitting shift (e.g., 5 p.m. to 11 p.m.). What will a day or week of vacation mean for them? Maybe they could specify a certain number of hours of vacation rather than days or weeks. That would be useful only for practices that contract for doctors to work a specified number of hours annually, which is probably not the best way to organize a hospitalist’s work. And hours of vacation time can get pretty complicated because doctors usually don’t regard an hour of a day shift as equivalent to an hour of the night or evening shift.
I have a great relationship with a hospital executive who works a Monday-through-Friday schedule. For years, when she noticed that I had been off for a few days, she would always ask if I had just gotten back from “vacation.” I wouldn’t bother to explain to her that it usually wasn’t vacation; it was just days I wasn’t scheduled to work to make up for working 12 to 20 consecutive days. But after about a year of her asking me about my vacation every two or three weeks, she mentioned how much she envied that I had so much vacation time, when in fact I had worked more days that year—had less time off and less vacation time—than she had. I could have taken the time to respond to each of her inquiries about my vacations by explaining which were just days I wasn’t scheduled to work and which really were vacation days. But the distinction is really arbitrary. As long as I’m getting enough time off—a lot—how each of those days is labeled doesn’t really matter.
Solutions to the Vacation Conundrum
I think it’s best to use one of the following two approaches to avoid confusion about vacation time:
- Specify how many shifts—or other work periods—the hospitalist is expected to work monthly or annually; or
- Agree—perhaps in a contract—that each hospitalist will work the same number of days (shifts) annually unless doctors mutually decide to do otherwise.
All of the other days can be thought of as days not scheduled to work—weekends, if you will, even if the days off occur during the week instead of Saturday and Sunday—vacation days, or even CME days. That way there is no need to keep track of how the days not worked are labeled or classified.
Full-time hospitalists in the group I am part of work 210 days annually. After I explain our schedule to a prospective new member of the group, I’m often asked how much vacation a new hire will get. I explain that we just specify how much work is expected of a doctor, and the non-worked days can be classified any way they would like. Understandably, some people really want a provision for vacation in the contract, so I will sometimes ask them to tell me how many vacation days they would like annually. If they say they’d like 21 days of vacation, I tell them that will be fine. We will write the contract to reflect the 231 days they are expected to work annually, but they will have 21 days of vacation. So they’re back to working the same 210 days a year that the rest of us work.