Vacation Scheduling 101

June 1, 2009

Summer vacation season is upon us. Here’s how to keep your practice running when your skeleton crew asks for time off.


You’ve done it. By some miracle of schedule shuffling, you’ve managed to accommodate all your staff’s requests for time off this summer. Never mind the fact that if anyone calls in sick you’ll have to ask the pizza delivery guy to pinch-hit.

Indeed, as medical groups stay lean in a rising-cost environment, many (which are already understaffed) are struggling with how to survive on a skeleton crew during holidays and summer vacation. Flu season is a challenge all its own.

“It’s really hard when everyone starts calling in because their children are sick or they’re not feeling well because it’s [last minute] and we’re usually busier here too with more sick patients,” says Susan Sevin, practice manager for Pediatrics and Adolescent Medicine, a 12-physician practice in Atlanta. “It’s still hard, but when our practice was smaller sick days made things really difficult. Our days were longer and we’d end up not having a lunch hour and working late into the day.”

A few preventive measures, however, can save your practice (and your sanity) when you find yourself temporarily short-staffed.

“There are practices that try to get by with a short staff and they end up apologizing all day for long delays, bills going out late, and claims being submitted late, and then there are those that step up to the plate and do what they need to do to keep their offices running,” says Bob Levoy, a practice management specialist and author of “222 Secrets of Hiring, Managing, and Retaining Great Employees in Healthcare Practices.”

Part-timers

One of the most effective ways to fill in scheduling holes is to hire part-time employees. “We have a fair number of part-time staff many of whom have young children so they want to job share,” says Sevin. “They’re usually willing to switch with someone else if something comes up in advance, especially in this economy when they’re looking to pick up extra hours. That really gives us a lot of flexibility.”

Administrators at smaller practices who cannot afford to retain part-timers should instead query their full-time staff about who is available for flexible hours during which days so they have a better understanding of their workforce. You may have more cushion in your schedule than you think.

Seasonal staffing

Obviously, office managers should also schedule vacation time thoughtfully, taking care to avoid too many empty seats at once. Be prepared to be the bad guy if multiple requests for the same week off would put your practice in a bind - or negatively affect patient care. “The office manager needs to be able to make difficult decisions that are appropriate for their practice,” says Nick Fabrizio, a human resources consultant with the Medical Group Management Association’s Health Care Consulting Group. “Above all else, though, you have to develop a system that’s fair.”

While some practices and hospitals use a seniority system, for example, letting those who have worked there longest have first dibs on days off, Fabrizio says that can cause unnecessary friction among the staff. “The older employees may not have as great a reason to take vacations any longer, since their kids may be grown and they may not be traveling,” he says. “I’ve seen a lot of flair-ups over that where you’ve got someone with no kids taking Christmas Eve off and someone with two or three kids at home has to work.”

A rotation schedule, in which employees get one year on and one year off for the prime holidays, often works the best.

Temp service/college students

Medical staffing services that hire clinical and clerical temporary workers also can be a lifesaver for practices with a sudden need for extra hands. Fabrizio says practices should develop a relationship with several such companies before a need arises. “There are now many nurses, for example, who work for temp agencies and just do part-time staffing,” he says. “You should have a relationship with these companies so you know who to call for these sick coverage situations.”

The cost for temporary workers varies by location, but expect to pay at least $20 to $30 an hour for receptionists, billers and, medical assistants.

Jim Barrett, practice administrator for Orthopedic Associates of Central New York, notes he’s had “very bad luck” with employment agencies and instead heads straight for the student population when he needs help. “When we need fill-ins we call the local college to find people or we ask our staff if they have any sons or daughters home from college who might be willing to fill in,” he says, noting even the best laid scheduling plans occasionally self-destruct.

During a single day in January, for example, his practice, which has eight physicians and three offices, had one employee call in sick, one take off for a death in the family, and another involved in a car accident. “We really had to shuffle,” he recalls. “We transferred all the calls to one location and brought as many staff members as we could to our busiest location. The patients just had to wait a little longer to get checked in.”

Cross-training

All the more reason to cross-train your staff, says Levoy, where each of your employees is trained to perform multiple job functions. “If your team is cross-trained, you can quickly plug critical gaps without calling in temporary workers, running up overtime costs, or stinting on patient services,” he says. “It also allows your employees to gain additional skills and improves morale by breaking up routines.”

Another perk? It helps uncover hidden talents. “You might find that someone who works as a receptionist has a knack for coding or that your biller turns out to be a crackerjack medical assistant.”

According to Sevin, who promotes cross-training among her staff, teaching workers to perform multiple jobs also helps foster a culture of teamwork, in which each employee appreciates the demands of their coworkers’ jobs. “Our nurses can help in the front and we have some front office staff trained to keep our patients moving back, prepare the room, and gather basic patient information,” she says. “Everyone knows it’s their responsibility to get our patients taken care of first. It keeps everyone flexible so no one is caught up in a ‘that’s not my job’ mentality.”

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for 12 years. Her work has appeared on CNNMoney.com, Bankrate.com, and Healthy Family magazine. She can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the June 2009 issue of Physicians Practice.