16 minute read
StArtinG oUt
taking leave the right Way
Planning a break from your practice for a while? Here are some tips to help you work with your partners and patients.
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By Kate DeBevois
Starting Out
Whether you’re a physician going on maternity leave, volunteering overseas, or taking a vacation, it’s important to plan ahead if you need to take an extended leave of absence.
From communicating with colleagues and patients about care protocols to being sure you are easily available for emergency questions or concerns, there are a lot of first steps you need to take before you can walk away from your practice for an extended period of time.
Susan Abkowitz, a hospitalist and veteran volunteer who has volunteered with Washington, D.C.-based Health Volunteers Overseas for nearly 28 years, says, “I joke and say, ‘I do this parttime hospitalist job to support my volunteer habit.’ While volunteering I am very cognizant about how lucky we are in this country with the freedom to choose a profession and access to great medical care. I feel very fortunate that we can volunteer and come back to a really comfortable life.”
If you are thinking about taking some time away from your practice, our experts say a little planning and communication can help pave the way.
DeDication ProDuces results A mother of three, Abkowitz worked part time as a primary-care physician in private practice before transitioning to her current role. How did she take a two-month leave of absence every year while working part time? Year-round dedication to her patients and to her practice meant that when it was time to take leave, her colleagues were happy to cooperate. “I always worked harder than three days a week, and I was always there on my day off either doing paperwork or seeing patients I could not fit into the three days.”
This dedication resulted in an easy transition to taking leave. “No one had any bad feelings about my taking off because they knew I was committed to my practice and throughout the year I did not take much in the way of vacation,” explains Abkowitz.
Having chosen a practice that was open to her taking leave to volunteer, she chooses to save all of her vacation and use it annually, with her family accompanying her. “My [family] didn’t take any other vacations; we had fun on these trips … we love what we are doing, and we combine it with educational activities like an African safari,” she explains.
The same dedication to her practice that allowed her annual volunteer leave to go smoothly also created a smooth transition to and from maternity leave for the births of her three children. “[Maternity leave] was a similar process … only I wasn’t leaving to volunteer, I was at home with an infant and later, my other children,” she says. “I told specific patients to follow up with specific partners. I wrote long notes explaining where we were in care, and I was accessible by phone for any questions.” Both types of leave provided her family with different, yet invaluable, experiences and Abkowitz says she is thankful her practice was amenable to her taking both maternity and volunteer leave.
creating a smooth transition Abkowitz says the keys to preparing for a leave of absence include making sure that: •Everyone knows when you are going to be around; •You let your patients know there will be cross-coverage; •You discuss the needs of any particular patients you are worried about with a colleague; and •The staff knows you are making arrangements as effectively as possible.
“[This includes] seeing patients right up until you (leave) and making sure you have a plan for each person,” she emphasizes.
When working in private practice, Abkowitz prepared her staff by choosing colleagues she thought would be a good fit for a particular patient based on personality and style, and by “writing out instructions for particularly vulnerable or complicated patients and making sure I told colleagues about my concerns.” Because it was standard practice in her office to cover for each other frequently, many of the physicians got to know the medical history of some of the more complicated patients. In addition, the nurse practitioners would assist with patients while Abkowitz was on leave, especially if they’d had previous experience with them.
Abkowitz also prepared her patients by giving them plenty of notice. She says, “I always got positive reactions from [the patients]. They thought it was really great that we were helping others with our time.” Just as important, Abkowitz says these patients didn’t feel abandoned. “I don’t feel like patients thought their care suffered at all. I would tell them, ‘I’m not going to be here for a month and I want you to see doctor so-and-so and they will know all your medical conditions and have your chart.’”
An unexpected extra benefit was an added dimension to the doctorpatient relationship due to her volunteer work. “When we returned, the patients would spend part of the time in the office visit asking how things went and wanting to see pictures …You would even overhear them in the grocery store sometimes, saying, ‘My doctor went to Africa,’” she says.
Susan Abkowitz, hospitalist
Planning ahead For those who are thinking about taking a leave of absence for the first time, there are certain best practices to follow before having a formal discussion with management and/or colleagues, says Cheryl Jez, a national practice leader with Philadelphia-based Reliance Standard Life Insurance Company.
In preparation for leave, Jez says, “The [individual] needs to know their entitlements. If your company allows for personal time off, know the rules and guidelines for taking the time off. Personal leaves are often at the employer discretion.”
She explains that it’s important to know job protections under federal and state law as well as company policies. “Being informed upfront will enable the physician/employee to ask clarifying questions should concerns arise,” she says.
Jez adds that “with very few exceptions,” a leave of absence at a practice is unpaid. Also, unless the physician has a salary continuation program, like short- or long-term disability, the federal Family Medi-
cal Leave Act (FMLA) is job-protected, unpaid leave.
She also emphasizes the importance of understanding your rights for job protection and your responsibilities before taking a leave of absence. Jez says it’s essential to “determine if your company is required to provide job-protected, unpaid leave under the FMLA or state leave laws. Unless waived by the employer, federal guidelines only apply if the employer has ‘50 employees in a 75-mile radius before taking a leave of absence.’”
She highly recommends doing some homework ahead of time, including: • Checking the practice handbook; • Investigating practice policies and federal and state laws on how long your job will be protected; • Tallying your paid time off, vacation, and sick days (otherwise, Jez says, your leave may be unpaid); • Talking to other colleagues who have taken a leave of absence; and • Taking notes or typing an outline summary of your time away from the practice.
Jez recommends physicians plan ahead and incorporate the above steps as part of their leave of absence preparation. Checking the practice handbook (if there is one) provides a starting point for discussions with colleagues and ensures all aspects of practice policy are addressed. Investigating federal and state laws ensures your practice remains compliant. Tallying your vacation and sick days ensures you are prepared to plan the details of your leave of absence while accounting for built-in travel time or time at home before returning to work. Including all these aspects in your discussions with colleagues as you plan your leave helps ensure the process goes smoothly. In addition, taking notes while on leave provides a way for you to share your experience with colleagues when you return.
When it comes to job protection for maternity leave, Jez says it is defined by state and federal FMLA guidelines. In addition to state and federal FMLA job-protected leaves, many employers provide nonprotected leaves to their employers. Examples are bereavement and personal leaves, she says.
During the discussion with colleagues/management, Jez also suggests you discuss your availability to answer questions during leave. Regardless of the specific approach, “maintaining an ongoing dialogue as you prepare to leave is essential,” she says.
PreParing your Practice Maintaining an open discourse has worked well for Abkowitz’s husband Glenn Crawford, an orthopedic surgeon with Sports Medicine Atlantic Orthopedics in Portsmouth, N.H., for 21 years. Crawford shares his wife’s passion for volunteering and makes time at his practice to join his family, volunteering overseas.
When communicating with his colleagues and staff about taking a leave of absence, Crawford says, “It was generally perfectly fine; it didn’t put any extra onus on them. There were a few patients that needed follow up while we were gone, so before I left I would talk with the physician’s assistant or doctors and give them the patient’s file.” Otherwise, he didn’t perform any significant surgeries before he left, which he felt was important.
The first time Crawford took a leave of absence after he joined the practice, he prepared other physicians and the administrative staff in three key ways:
• He talked to patients openly ahead of time to make sure they were clear about who would take care of them when he was gone;
• For surgeons, he stressed the importance of not scheduling complicated procedures before leaving to ensure that his colleagues didn’t have to attend to post-op visits while he was on leave; and
• He maintained an open dialogue with patients who may have needed surgery during his absence.
“If you have patients who need an operation and you don’t have time to do it before you go, talk with the patient [to determine] if they want to wait until you come back or have a colleague do [the procedure] while you are gone,” he says.
Crawford is often able to time his volunteer leave for the orthopedic “slow seasons” of November and December and March and April. He says, “My colleagues know that in the summer I’ll be there all the time. They can actually take more vacation in the summertime, so it actually works out very well that way.”
CommuniCation throughout the Leave ProCess Initially, Crawford had concerns about how taking leave might affect his patients. “I thought I might lose patients, but it ended up being the opposite — patients wanted to know where I’d gone recently.”
Crawford discovered that while on leave, his office is able to handle most of the questions that come up without incident. This frees him to assist patients who may not otherwise receive medical care. “It’s interesting how unimportant that is. For example, when you are working at your practice and going full speed, you think you are very important. I found that when I go away and when I come back, it’s amazing how little I was missed,” he says.
“Now, I can communicate via email if I need to. When I first started volunteering, there really wasn’t any way to communicate,” explains Crawford, who believes that’s one of the main reasons why people don’t participate in this type of volunteer work. “It’s amazing how many really pressing issues [the practice] is able to handle without communicating with you. I find that even when I am available by e-mail, most of the things they ask you really aren’t very important,” he says. n
Kate DeBevois is a Philadelphia-based freelance writer. She has written for several healthcare and business publications. She can be reached at editor@ physicianspractice.com.
Administrator’s Desk 6 Ways to Get Organized
Tired of decreased productivity? Here’s how to get organized and whip your practice back into shape.
By Shelly K. Schwartz
You spent the last two hours trolling your file cabinet for a missing receipt. The staff keeps popping in with trivial questions. And it just dawned on you this morning that the monthly board meeting is on Friday, forcing you to cancel two appointments to prepare. Tired of spinning your wheels yet?
Office managers juggle a mindboggling number of tasks, from personnel problems and physician credentialing to budget planning and payroll. Without a strategy to stay organized, it’s easy to get lost in the minutia, creating higher stress levels for you and decreased productivity for the entire office.
“A practice administrator not only has to wear a bunch of different hats, but he or she has to keep all things related to those hats in good order so you can put your hands on what you need quickly whenever you need it,” says Mary Pat Whaley, a practice administrator for 25 years and founder of the consulting firm Manage My Practice in Cary, N.C.
LIMIT ACCESS “you have to be accessible to your staff, certainly, but you should set one-hour slots each day where you’re available to be seen and are able to accept interruptions.”
Judy capko, consultant
PRIORITIZE The first step to creating order from chaos, says Keith Borglum, a practice management consultant with Professional Management and Marketing in San Francisco, is to set priorities.
“A basic rule of management is that there is never enough time to do everything,” he says. “You can’t do it all. You have to triage your workload, figure out what’s
most important, and do that.” A daily to-do list, whether electronic or handwritten, can help. “It’s easy to look at your list and do the most attractive thing first, but you’ll be able to see at a glance what’s more critical,” says Borglum, noting a written list also helps to identify priorities for the following day, which helps you hit the ground running when you walk in the door.
Keep in mind that some of your lower-priority tasks may never get done, and some, like expansion plans or personal goals, will remain on the back burner for years. That’s OK, says Borglum. “I have things on my list that have been there for three to five years,” he says. “Long-range planning often evolves from daily to-do lists.”
CALENDAR CONTROL A carefully groomed calendar is also critical. Each month brings with it a new set of deadlines — financial reports, profit sharing and 401(k) filings, training requirements, internal project milestones. Everything you can reasonably anticipate should be documented on your calendar. “We sit down at the beginning of the year and plan out each month, designating a specific month for OSHA and HIPAA training and another for the government programs we participate in, like e-prescribing and meaningful use,” says Susan Miller, administrator of Family Practice Associates of Lexington, in Lexington, Ky. “We always know what deadlines we’re working toward.”
Her calendar also includes staff and board meetings, group gatherings for staff recognition, grand rounds for the physicians, and a series of reminders ahead of important deadlines to verify progress along the way.
REVISIT OPEN-DOOR POLICIES Though Miller is on top of her schedule, even the most organized manager can’t get down to business if she’s constantly being distracted, says Capko & Co.’s Judy Capko, a practice management consultant and author of “Take Back Time” for office managers. “Managers often brag about having an open-door policy with their staff, but that’s not something you should be bragging about,” she says. “You have to be accessible to your staff, certainly, but you should
set one-hour slots each day where you’re available to be seen and are able to accept interruptions.”
Even then, it should never be a free for all. “Put criteria on it,” says Capko. “Tell them if it’s something they can handle themselves, they should do that.” Make sure your team has the training and tools they need to solve their own problems. “A lot of times your employees come to you because it’s easier or faster, but that job should really fall to a lowerlevel person so you can spend your time doing things that require your level of expertise,” says Capko.
OPEN MAIL ONCE It pays, too, to establish a policy of not opening mail, electronic or otherwise, until you’re prepared to deal with it.
That prevents the time suck of having to sort through bills and emails more than once. A three-part file system of “do now,” “do later,” and “file” can help you process the most pressing paperwork quickly as your work flow allows. Everything else should be trashed, which has the added benefit of helping to reduce clutter.
Borglum also suggests asking your team for ideas on ways to organize their own departments. Allowing them to implement their suggestions fosters a sense of ownership.
ORDER ONLINE You should also have a system in place to keep close tabs on office supplies, which prevents the mid-morning rush to the store for ink cartridges and helps control inventory. The Internet makes it easy, says Borglum.
“It’s inefficient to be driving over to Office Depot or Staples every few weeks, when most suppliers these days offer online ordering,” he says. “That takes you [or a staff member] out of your seat, and interrupts efficiency.” Such vendors generally keep track of prior orders so you need not reinvent the wheel each time you go to order printer paper or new pens. You’ll also be better positioned to keep track of brand, model, and item numbers for all your office supplies and generate utilization reports. “That helps control embezzlement, and pilferage which is much more common,” says Borglum. “That happens when someone orders a case of tape for the office and brings half of it home with them.”
MAKE AN EMERGENCY PLAN Finally, the organized administrator should always be prepared. The Medical Group Management Association recommends all practices have a secure back-up system in place to store duplicate personnel and financial records, in the event of a power outage or IT meltdown. You should also have a plan for fire emergencies, hazardous spills, and breaches of security that includes a grab-and-go bag that has important phone numbers for the building manager, fire department, employees’ home and cell phones, and insurance contacts.
By putting your ducks in a row and setting priorities every day, you’ll be able to use your most limited resource — time — more effectively. An added perk: When you’re not playing catch up as a matter of course, you’re likely to sleep better, too. n
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.
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