6 strategies for covering physician vacations to address on call scheduling expectations and promote Group harmony.
How happy are your Physicians with their allotted time and frequency of vacation? What are other Groups doing to crack this nut?
In recent years, I have noticed more and more foreign last names in the Groups we serve. I have also become aware of increased difficulty when it comes to scheduling a break long enough so physicians have the opportunity to see friends and relatives overseas, since a single week is generally not enough for such a trip. This new “wrinkle” is in addition to the already dissonant needs of Generation X vs the Baby Boomers.
The reality is that for many Groups, vacations of more than a week or so are hard to come by; extended vacations are simply too disruptive. Some Groups simply find themselves too short-staffed to grant the time, even when colleagues are willing to pitch in to help each other. Burn out can be a real factor for those “covering” and for those “catching up” after they return from their trip.
It may seem early to be thinking about days off when then February as barely started and snow is still on the ground. However, starting vacation planning early will keep time on your side, help physicians coordinate tickets and family plans, and prevent ugly surprises. A well documented and executed vacation process is essential to keep you out of the hot seat, and will help promote harmony within the Group.
To avoid too many empty seats at once, the Scheduler must be prepared to be the bad guy if multiple requests for the same week off would put the practice in a bind. This is nothing new. The Scheduler needs to be able to make difficult decisions that are appropriate for the practice, and develop a vacation request system that’s fair, even if some of those requests are for a three week vacation.
Many medical groups are already struggling with how to survive on a skeleton crew during holidays and peak vacation seasons without having to factor in longer breaks for overseas travel. What are some strategies Groups use to cover the extended vacations needed for physicians to see the folks back home when “home” may be overseas?
When it comes to solving the "vacation conundrum", size helps. Through their sheer size, larger groups often have built-in vacation coverage. But while size brings flexibility, it also brings increased complexity. Different cultures bring different expectations, as do various religious traditions and generational needs (ages) of the physicians being scheduled. Groups with physicians of foreign descent, with family in India or Japan (for example), will have different needs than a Group whose physicians all have State-side or local relatives.
1) Seniority System. Check your assumptions! Letting those who have worked in a Group longest have first dibs on vacation can cause friction among the staff. Also, the assumption that long-term employees do not need to take long vacations since their kids are grown; this may not be valid if they have relatives overseas. It also assumes someone with two or three kids at home will not want to travel.
Seniority (long-term employee) seems to work best in a larger, homogeneous, stable Group who has been together for a long time. A rotating schedule can be worked out when there is history to support it. This doesn’t work as well in Groups with a high turn-over rate, or a newly merged Group. Who is “senior” under those circumstances?
2) First Come-First Served. Vacations are processed in the order they are received. This seems to be the most common method lately, usually in combination with a deadline. After the “cut-off” date, Providers wanting a vacation need to either find their own replacement or take their days off when they are not already scheduled. Since the vacation schedule is known well in advance, the On Call Schedule itself may also be known well in advance. With this information, a Provider can work out swaps amongst themselves… many on call software programs have Provider Requests areas to assist with this. A small disadvantage may be that the “Techie Doctor” in the group may submit his requests well in advance of other less computer-savvy physicians, so you will want to be aware and ease the Group into this feature so all can benefit.
3) Lottery. I haven’t heard of this low-tech solution in quite a while. Providers put their names in a “jar”, and they get to choose vacations in the order their names are drawn.
4) Group Sharing On Call Coverage. By developing a relationship with several other Groups in the area, you can plan ahead with another group to over call while your docs are on vacation. Some hire Locums as they run short. I’ve seen this most often with smaller Groups, and planning well ahead is key!
5) Laissez-faire – “let them do as they will”. This would seem to be less stressful for the Scheduler, since the Providers work everything out amongst themselves. Not surprisingly, issues arise with “he said, she said” if physician requests are not documented and implemented right away, and communication coordinated throughout the Group. As the core Group changes or the Group grows in general, this method quickly falls out of favor.
6) Reverse Vacation Scheduling. In this scenario, the physician on-call schedule is turned out well ahead of time with the Holiday rotations worked in. An unscheduled week may even be worked into the on-call schedule’s pattern so that each Physician has a predetermined “time off” already “worked in”. The providers can take vacation whenever they are not already scheduled for assignments and if they need different (or additional) time, they swap it out amongst themselves. The prescheduled un-assigned time allows a buffer that can be used either as vacation time or to “catch up” for vacation taken elsewhere.
This idea works well if the physician on call schedule is turned out six to twelve months at a time. With a larger group, it’s easier to have people do extra shifts since the call is more spread out in general. In small practices, giving a Provider two weeks of vacation would disrupt the whole schedule, and there would need to be several physicians involved to make it work.
It all begins with a shared Policy and expectations at the Group level rather than only meeting an individual Physician’s needs as they come up. The Group needs to communicate and document these expectations clearly so vacation planning can be implemented.
As recruiters work to find an edge to differentiate their Group, vacation time is becoming a important perk that younger physicians, who are known for their interest in lifestyle, are seeking. As more foreign physicians are hired, their overseas family needs will influence their decision about which Group they will join. Don’t let your Group be left out of consideration.
Key Takeaway: The No. 1 reason for Group disappointment in general is failure to communicate. Vacation expectations only intensify this. The most important strategy for practice harmony regarding vacations is to address these issues early, before they become too big, and promote the shared Group expectations.