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Dear Director,
I requested a vacation from December 20th-30th this year thinking it would allow me to work my holiday (New Year’s Day) yet spend time with my family. My chairman said I couldn’t do it. Can I ever take off around the holidays?

Nothing shows that we’re a 24/7/365 business and makes us feel Grinch-like than when we leave our families to fulfill our clinical obligations on a holiday. Certainly, the winter holidays are the biggest stressor for many physicians when it concerns their schedules.

Rules
Let’s establish some ground rules when it comes to holiday coverage and scheduling. First, all shifts must be covered. Extending shift times may be acceptable to free up a person, but making noticeable decreases in physician coverage is not a good idea, unless your volume takes a consistent dip as well. On Thanksgiving and Christmas, we drop our total daily physician hours from 42 to 39 by delaying our double cover physician an hour and extending shift length (8.5 hour shifts become 9s, 10, and an 11). The net result is that we staff with 4 docs instead of 5, thus saving one person from working. However, our patient load typically drops by 30%, thus patients/hour and metrics are not impacted. Before you make any changes in coverage, I would cover yourself by discussing it with your hospital administrator so they understand the rationale and that patient care will continue at a high level. On the other hand, Christmas Eve and the days after Christmas are consistently as busy as a Monday, so we staff at full capacity.

Rule number two is that the schedule must be fair both for the current year and on a year to year basis. Next, everyone must participate. If you’re a regular doc on my staff, you will work a holiday and some of the time surrounding the holiday. To your question directly, this means that it would be really unusual to allow anyone to take a vacation over the entire holiday stretch. Depending on the model that is used to cover Christmas and New Year’s, if people go on vacation for the week between the two winter holidays, coverage can be a bear. For part-timers, I leave it to their discretion and availability, though many do help us each year. The final rule is that the department’s clinical schedule and how much each individual works (whether it’s one or two of the three winter holidays) is a function of how many physicians staff the ED on a monthly basis. Hey, if you really don’t want to work any shift, holiday or not, then sell it! Yes, I said sell it. Although you are obligated to be scheduled for your fair share, you certainly should be allowed to trade them away, at personal expense, if you want to. If it is that important to you, let your partners know that you will pay a premium if they’ll pick up any of your holiday shifts. Free enterprise may result in a free holiday schedule.

Strategies
There are a variety of strategies that I have seen used to maintain fairness and minimize the pain of holiday scheduling. Being consistent with one strategy over time and making sure that expectations are established long before the holidays is probably the most important component. One strategy is to divide staff into two teams (A and B) and then assign all holidays at the beginning of the year alternating A and B. Each team will do half of the holidays and then the assignments alternate from year to year, so you work half the holidays every year and whichever one you have off this year, you will work next year. This doesn’t prohibit trading shifts but it does assign responsibility of shifts. A winter holiday split of doing Christmas versus working Thanksgiving and New Year’s is another option. Another possibility, if you have enough physicians to cover all of the shifts, is to divide the group into two teams and have each team do a long block of consecutive days over the holiday (typically December 23rd-27th for one team and then the second team does December 28th-January 1st). Five days in a row can be tough but knowing that you get a nice chunk of time before or after to enjoy the holidays is a good trade off. Of course, the following year, the teams would stay intact but the block of time would rotate. This also allows people to possibly take a longer holiday since you might be able to get time off adjacent to your scheduled 5 days.

As for vacations, most EDs generally prohibit them from about the December 22nd through January 2nd. However, if you have off Christmas and took a vacation for the week leading up to and including December 27th but came back and were scheduled for 5-6 shifts in a row, that might be fair to your group.

Finally, there is always the option of taking requests and seeing how it works out. Most groups probably have at least one person who doesn’t have family nearby or small kids and would rather party on New Year’s than have Christmas off. I’m always amazed at how well this typically works, but there must be a rule that no one is mandated to work the same holiday two years in a row. This can even be expanded to identify the entire year’s holidays, take requests and make assignments early in the year. This allows for maximal planning and takes the stress of the major summer and winter holidays off the table because of the advance notice.

Pay it Forward
I was discussing holiday coverage with a colleague, and she told me that she usually worked Christmas. I thanked her, and then asked, “Why?” She said that her kids were grown, and she would prefer to see people with small kids at home with their families. I’ve been very fortunate that most people in the few groups that I’ve worked with have carried the same philosophy. Before I had kids, I usually worked Christmas. Now that I have small children, I’m glad I’m usually home to watch them open presents. Of course, in a few years, I’m back to working the holiday and making sure that the others with small kids are there for their families.

Best Scenario
Although you’re willing to work “your holiday,” taking a vacation over the majority of the holiday period is generally unfair to the rest of your group.

As far as scheduling for the group, there are some “best case scenarios” that I think should be incorporated, since holiday schedules can leave some physicians feeling very dissatisfied with their group. I try to let people prioritize their holidays and their shift preference and do my best to honor their requests. If your kids still believe in Santa Claus, I try to have you home with your family. Remembering, though, that the time will come for you to work extra holidays down the road. Also, I really like the idea of splitting up holiday coverage. If you work Thanksgiving, I think it’s great if you can get the weekend after the holiday off. With Christmas, if you’re working the holiday and coverage allows, I like to have people off on the 24th, so they can still enjoy quality holiday family time. Rarely, are extended vacations approved over the holidays. So, if you request one, you are setting yourself up for disappointment when it’s not approved, while asking a lot of your colleagues. Finally, coverage needs to be adjusted annually giving everyone an opportunity to spend time with their family over the holidays. While you can request the same major holiday off two years in a row, it’s unlikely to happen unless no one else requests it off. We have a lot of benefits when it comes to flexibility and vacations with our schedule. However, the group benefits more if we collectively pitch in and do our share rather than leave it to just a few members of our team.

Michael Silverman, MD, is chairman of emergency medicine at Harbor Hospital in Baltimore, MD and is on TEAMHealth’s Medical Advisory Board.

 

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