The Vacation Conundrum

John Nelson, MD, FACP

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.

I want to emphasize … that a hospitalist will have exactly the same amount of time off for vacation or any other purpose in a contract that just specifies the number of shifts/days worked and is silent on vacation time.

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.

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