“If you establish upfront that you are going to make that phone call, I think that’s fine to do,” he explains. “If you’re calling constantly and pressuring the person, I don’t think that that’s kosher at all.”
The best thing in the world is to have colleagues that you trust and can rely on. That way, people can help each other out in emergencies, like if someone has to take their kid to the doctor. That’s the kind of program I want to have and would want to be part of.
—Rachel Lovins, MD, SFHM, director, hospitalist program, Waterbury (Conn.) Hospital
The Coverage Plan
Most maternity leaves are from eight to 12 weeks, although the length varies by HM program and individual. It is essential to have your group’s coverage plan outlined well in advance of the maternity leave.
In a private-practice model in which hospitalists work weekdays and have a call-coverage schedule for nights and weekends, a group leader can spread the extra work among the other hospitalists in the group because there are more hospitalists working during the day when patient census is higher, Dr. Weiner says.
Shifting the workload in other schedule models isn’t always as easy. “In the seven-day-on, seven-day-off model, because of that maximum patient-to-doctor ratio, I don’t think there’s any way to do it without hiring help,” Dr. Lovins says. “It’s important to recruit per diems all the time. When you’re in a bind is the worst time to do it.”
To limit the disruption to patient care and operations quality, the goal when using outside hospitalists is to contract with physicians who have worked with the group before and who know the community, hospital, systems, and patients, Dr. Weiner says.
For HM groups that use a flexible schedule, maternity coverage plans aren’t really needed, says Reuben Tovar, MD, chairman of Hospital Internists of Austin, a physician-owned and -managed hospitalist practice in Texas.
“We’re not salary, so that changes the dynamic completely. People who work more make more, and people who work less make less,” he explains. “We are much more liberal about time off, because if a person is taking off to do what is important to them, like taking care of a child, then the rest of us feel better about doing extra work.”
—Michelle Marks, DO, FAAP, SFHM, director, Center for Pediatric Hospital Medicine, Cleveland Clinic
Things Change
Plans discussed at the outset with a pregnant hospitalist can change after the child is born, HM group directors caution.
“Particularly for the first child, people say, ‘I’ll come back full blast. Don’t worry about it.’ And they figure out how hard all that is in the first couple of weeks, and then I get a different answer,” Dr. Tovar says. “I think the whole mom/wife/doctor thing is tough. I recognize how hard that is. Even though I am not in that role, I can see it.”
Dr. Gundersen suggests group directors have a backup plan, in case the maternity leave lasts longer than expected or the transition back to work is delayed. “It really prevents you from putting pressure on the physician,” he says.
If a hospitalist who had planned to come back full time decides that she wants to work less, a director should check with HR to see what the process would entail.
“Generally, we have to negotiate a time frame for when they can drop down” to part-time hours, Dr. Marks says. “It usually takes three to four months for me to be able to adjust staffing to make it work.”