Sometimes, life calls for you to be out of the office for a length of time. Whether the absence is planned or not, it’s important to consider the best actions to take given the circumstances to ensure patients are cared for during your absence.
Alexa Meara, MD, clinical instructor and rheumatologist, The Ohio State University Wexner Medical Center, Columbus, Ohio, was a general medicine attending when she went on maternity leave twice. Both times, her children arrived before their due dates.
“I called my boss [from] the hospital and said that I would not be in clinic or on the hospital wards,” she says. For her first pregnancy, her boss planned ahead and had arranged for several others to be available on short notice in case she went into labor early. For her second pregnancy, her boss hadn’t done any pre-planning, but her colleagues covered her work by dividing inpatient and outpatient duties among themselves.
James Udell, MD, FACR, rheumatologist, Arthritis Group, Philadelphia, has also found that cross coverage works well for lengthier absences because his group has five rheumatologists on staff. He also recommends finding a locum tenens physician or training a physician extender in advance, if the length of the absence is known.
As a solo private practitioner, Karen S. Kolba, MD, rheumatologist, Pacific Arthritis Center, Santa Maria, Calif., has established a time-off schedule. She always closes the office the weeks of Christmas and the 4th of July. Because no one is in the office, voicemail is forwarded to her cell phone.
When Dr. Kolba is traveling in North America, she doesn’t seek additional physician coverage, because she can easily handle cell phone messages. Any patient who is acutely ill is referred to the emergency department, which is the same protocol as when she is working. For longer or overseas trips, Dr. Kolba asks a rheumatologist from a nearby town to provide emergency rheumatology coverage and relays information about any patients who are acutely ill at that time. Because most of her office notes are automatically sent to patients’ primary care physicians, they know her current plans for each patient and can handle most urgent situations.
Revealing Absences to Patients
Amanda Myers, MD, clinician educator, Pritzker School of Medicine, Division of Rheumatology, NorthShore University HealthSystem, Evanston, Ill., believes that patients should be made aware of their practitioner’s availability. “This helps them make decisions about their healthcare, allows them access to care and alleviates anxiety,” she says. “If you will be away for an extended period, explaining to the patient the plan (e.g., temporary care by a covering practitioner) is appropriate. While I worried about my patients transferring to a new provider during my absence, I felt that they appreciated my honesty and communication and, as a result, were more likely to continue in my care.”
Dr. Udell is also a firm believer in informing patients of an upcoming absence. “I think the patient will be more understanding if it comes from the doctor,” he says. “The patient can then discuss options if necessary, such as skipping an appointment, seeing another partner or returning only for emergencies. Many of our patients are long term, and would be truly concerned about the physician’s welfare if they weren’t informed.”
How Much to Divulge
Dr. Meara’s patients figured out that she was pregnant by observing her large belly and, therefore, they knew she would be taking leave at some point. “I told them my estimated return date if they asked,” she says. For an unexpected leave, she suggests having office staff tell patients that an employee is unavailable. They can also ask the individual in question what information they prefer be shared with patients.
If you decide to tell patients about your upcoming absence, how much should you tell them? Dr. Meara recommends providing basic information, such as the timeframe you’ll be away. If there are sensitive issues, you might simply want to say that you will unavailable for an unspecified amount of time.
For all other causes, Dr. Meara suggests providing as much information as you are comfortable with. “If you want to tell your patients your mother is sick and you need to care for her, then do so,” she says. “That is between the provider and the patient. Although there are minimal data about this, some articles note that telling patients personal details can build trust and helps smooth a transition.”
Because Dr. Myers’ reason for absence was pregnancy, as she became more visibly pregnant, the topic opened up discussions. “If the reason for an absence is a more personal one, such as surgery or cancer treatment, it would be more appropriate for the practitioner to divulge a leave of absence to the patient with an expected date of return,” she says. “This could be addressed in a mailing or by staff outside the context of an office visit if the practitioner must leave suddenly or if the practitioner is uncomfortable addressing a patient’s questions.”
Accessible While on Leave
Remaining available for consult while away is a personal decision. Dr. Meara was available via email and returned emails while on maternity leave, which she felt was possible because there weren’t any complications with her deliveries. However, she does not feel that anyone should be forced to be accessible. “If it helps smooth the transition, the employee taking leave should set concrete expectations” (e.g., they plan to check emails every Friday), she says.
Unless incapacitated, physicians in Dr. Udell’s group are available via the electronic medical record (EMR) system. He has conversed with patients while halfway around the world. Physicians’ smart phones contain the practice’s EMR system, as do their laptops, iPhones and Microsoft Surface devices.
Dr. Kolba checks email from office staff once a day while away. If she’s in the U.S., she’ll answer voicemails as well, but otherwise she doesn’t address patient issues.
One way to reduce patient phone calls when a rheumatologist is away—or at any time for that matter—is by having a policy to only give prescription refills at the time of an appointment. “We do not charge for refills, but when patients have to show up for an extra office visit because they didn’t pay attention to refill needs, they are much more careful,” she says. This policy and notes regarding office closures are posted in each exam room.
Alternatives to Coverage
When existing physicians are unable to fill the gap, Dr. Udell suggests turning to a locum tenens agency to provide someone. Dr. Kolba is aware of locum tenens agencies that work with rheumatologists for short-term positions. “It is an expensive proposition; they would have to stay pretty busy to generate overhead in addition to the physician’s salary and expenses,” she says.
Illnesses, vacations, pregnancies and other workplace absences are part of life. Don’t disappoint your patients while you’re away. Take steps to have someone fill in or make yourself available to handle urgent requests.
Karen Appold is a medical writer in Pennsylvania.
When Employees are absent
Dr. Meara recommends having administration create an outline for coverage when an employee files for leave to ensure the clinic’s workflow isn’t disrupted. Divide duties appropriately among staff, making sure that employees are equally affected and no one is unfairly burdened. If the leave is unexpected, then create a framework to ensure nothing is forgotten.
Dr. Kolba also calls on existing staff to cover absences. “Temps just don’t work because there are so many idiosyncratic workings to my office,” she says. “It takes too much time to train and supervise someone new; I’d rather pay existing staff overtime—even for a six- to eight-week absence. When you anticipate an employee returning, it’s pretty easy for everyone to gear up and fill in the gaps, because you know how long they will be gone.”
Dr. Udell suggests cross-training staff to fill in as needed. “In a medium to large practice, someone always seems to be out, so having floaters is essential,” he says. When an employee is out for an extended, unspecified time due to illness, you may have to decide whether to replace them. “Even if they return at some point, they may want to work [fewer] hours, so additional staff will become necessary,” Dr. Udell says. “Perhaps the ill person and the new person could work as a team.”