Jack Percelay writes…
Do you get paid holiday time off as a hospitalist? Or are you told that everyday you are not working is time off, just like the kids who ask, “If there’s a Mothers’ Day and a Fathers’ Day, why isn’t there a Children’s Day?” and are told, “Everyday is Children’s Day.”
As is true for most of my pediatric hospitalist colleagues, I am an employee of the hospital/Department of Pediatrics. I am not an independent contractor, do not own my own group, nor am I employed by a larger Hospital Medicine company. I love my work, work hard, and expect to work my fair share of nights and weekends. I respect my general pediatrician colleagues, but prefer the inpatient setting to the outpatient setting. (Guess I have too much ADD to treat it.) I value their work, and value mine equally. Their patient volume is higher with lower acuity. My acuity is higher with lower volume. In an ideal world, I would say that our work is of equal value and we should be equally compensated.
So, leaving out the night call and weekend call issues aside for now (I’d go crazy answering calls overnight or on the weekend in the middle of flu season), let’s examine the question of holidays. I am perfectly prepared to work my fair share of holidays. Not an issue. My family understands that I will miss some holiday dinners and even Christmas mornings. The same is true for office based primary care pediatricians (PCPs) as well. The difference is that the office is closed on holidays, and while the one PCP who is on call for the holiday may be working, her colleagues are off. Patients aren’t scheduled. In a typical institution in the US, there are about 10 of these holidays a year when the office is closed. If you are part of a 5 person group, you will cover 2 holidays and be off without obligations the other 8 holidays. As a hospital employed physician, you get paid for 10 holidays a year. (Typically, if you work the holiday, you get a “comp” day later that week.)
So, how does this apply to hospitalists? Here’s my take. I should work 1/n of the holidays where n is the size of my group. We typically divide this up into major holidays (Xmas, TGD, and New Years), and 3 day weekend holidays (President’s Day, Memorial Day, Labor Day). I’m Jewish and usually volunteer to work Christmas so that I can celebrate New Years Eve at home with Chinese food and a video (another Jewish tradition.) But that’s not the issue. The issue is whether or not I should get paid time off for the holidays. And if so, how?
Since our shifts generally run 12-24 hours, it would be unfair for me to ask for 10 shifts off to get the same 10 days off my PCP colleagues receive. Rather, to keep things equal, consider that the PCPs in this example have 2 weeks worth of holidays a year. (If you work 5 days a week in the office, 10 days = 2 weeks.) Thus, my holiday benefit should be 2 weeks off a year as well. Assuming one works an average of 12 shifts in a 4 week block (this number will vary from program to program depending upon the length of shifts and program workload), 2 weeks of vacation translates into 6 shifts holiday time throughout the year. Or, to apply this construct more globally, a full-time person with 4 weeks paid vacation, 1 week CME, and 2 weeks holiday time (just like the office docs, nurses, and staff) works 45 weeks a year. The number of hours per week or shifts per week will vary from one program to another, but the 45 weeks per year seems pretty standard in my experience.) So, in the theoretical example above, it doesn’t matter if I’m working Thanksgiving or not. Either way, I would get credit for 1 holiday shift that pay period. This would happen 6 times a year and everyone would be happy.
This is a true paid holiday. It’s not just time off not working; if you are scheduled to be off anyway, what value is it? I mean, I never hear office docs or hospital administrators who are on call one weekend a month say that they get 40 weeks paid Saturday and Sunday leave a year.
This argument doesn’t hold if you are self-employed or part of a group that manages holidays differently. When John Nelson talks about holiday and vacation time, he skips over paid holiday time and looks at it in the context of a year’s workload. (For me, this is the 45 weeks I work a year.) But if you are employed by a hospital or Department of Medicine or Pediatrics that also employs office-based providers, think about how your institution handles holidays? Are all docs being treated equally, or are some more equal than others?
If you disagree with my rationale or I haven’t explained it carefully enough, let me know, and I’ll try to clear things up before Christmas and New Year’s come around.
Thanks for reading, and enjoy your Turkey.