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How to keep sick staffers at home and healthy ones at work

A column about keeping your practice in good health

By Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted Feb. 13, 2012.

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How does a medical practice encourage staffers to call in sick -- but only when appropriate to prevent decreased productivity and the spread of infectious disease?

Most health care employers offer at least some paid time off -- with the option of sending home an ill employee if necessary -- but how it is structured may meet the needs of some practices better than others. Some may find separating sick and vacation time minimizes absenteeism, presenteeism (the human resources term for people who show up when they're too sick to work) and abuse of the time-off rules. Others function better if paid time off is bundled into one package.

"It's always a challenge," said James Pekarek, practice administrator for the 11-physician Northwestern Internists in Chicago. "There's a balance of providing sick time and having people here, available and ready to work. I don't want anybody here who is sick, but you always want to discourage abuse."

For example, Northwestern Internists provides staff with five paid sick days in addition to vacation time and two flexible days for nonmedical emergencies such as unexpected home repairs.

The mix works for Northwestern Internists because it is a midsize practice with fairly set Monday-through-Friday hours from 8 a.m. to 5 p.m. Employees are able to roll over a certain amount of vacation time, and unused sick time can result in a cash bonus at the end of the year.

According to the Illinois Medical Group Management Assn., 57% of practices in the state offer one to five sick days during the first five years of employment for nonmanagement employees. Thirty percent offer six to 10 days, and 11 percent offer 11 to 15 days. Two percent offered up to 20 days.

When it comes to vacation time, 19% provided one to five days, and 56% gave six to 10. Fifteen percent offered 11 to 15, and 8% gave 16 to 20 days. Only 2% provided up to 25 days of vacation to employees within the first five years on the job.

The challenge for medical practices providing paid sick days is deciding how to monitor this kind of time off. The policy at Northwestern Internists is that sick days are to be used only for an employee's illness. Such absences lasting longer than a couple of days require a doctor's note. The flexible days can be used to care for an unwell child or other relative.

Employees are generally given the benefit of the doubt if they call in sick. Although this policy works well for this practice, it may not for all.

According to a CareerBuilder survey of 4,300 workers released Oct. 20, 2011, 29% admitted to calling in sick when they were well. The survey by the online job search and recruitment company queried 2,600 employers about the most unusual excuses for calling in sick. These included: "had a headache after going to too many garage sales," "ate too much at a party" and "hurt his back chasing a beaver."

To avoid sorting or judging reasons for unexpected time off and simplify recordkeeping, Portland, Ore.-based PeaceHealth, which has 900 physicians and seven hospitals in several states, offers a bundled time-off bank. This organization differs from Northwestern Internists in that it is a large, integrated system that is covered 24 hours a day, seven days a week.

Experts say hospitals and large organizations are more likely to offer a single, paid time-off bank, but this also has its advantages and drawbacks. A paid time-off bank cuts down on the need for employees to provide a reason and prove how sick they are to take unscheduled time off. That should make for easier recordkeeping. Practices also may be able to offer fewer days off than would be on the table if vacation and sick time were separate.

"Employees have to manage it," said Robert Swanson, PeaceHealth's vice president of culture and people. "They have skin in the game and personal accountability."

Offering a paid time-off bank rather than separate pools of sick and vacation time is becoming more common. Fifty-four percent of 1,036 employers surveyed had a traditional system of sick and vacation time, according to a WorldatWork report issued June 30, 2010. The nonprofit organization, which studies human resource issues, found that 40% had a bundled or personal time-off bank model, and 1% offered staffers unlimited time off. A previous survey by this organization released in July 2002 found that 71% of companies had a traditional system and 28% offered a PTO bank. The remaining 1% had some other system.

A disadvantage of the paid time-off bank is that the value of the unused time may have to be paid out to a departing employee.

Northwestern Internists and PeaceHealth reserve the right to send home a worker who appears ill and contagious. This is unlikely to run afoul of the Americans with Disabilities Act, but any such policy must be applied uniformly, said Kara Maciel, a labor attorney and partner with Epstein Becker Green in Washington.

"In a medical practice, it may be seen as a best practice to send staff home if they are not feeling well or appear sick in order to prevent further exposure to other staff and even to patients. In doing so, it is important to ensure that the decision to send someone home is well-documented and based on legitimate business reasons and applied in a consistent manner," she said.

Another legal issue to consider is whether sick time is mandated in the practice's jurisdiction. A small number of cities require paid sick time for all employers -- no matter the size. Many more are considering such legislation. Connecticut became the first state to require companies with more than 50 employees to provide hourly service workers five paid sick days a year. The law took effect Jan. 1.

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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