Management Essentials

PTO Benefits Both the Staff and Practice

By Farrell “Toby” Tyson, MD, FACS

Many ophthalmology practices have chosen to take advantage of the efficiencies of a paid time off (PTO) system instead of traditional vacation and sick leave. Both systems are a voluntary benefit granted to attract qualified employees, provided by the employer with no federal regulations requiring it. Time off with pay provides staff downtime to relax so they can perform at their fullest potential in the workplace. A PTO system rewards your best workers, reduces administrative work and provides flexibility in scheduling.

Playing Sick — or the Benefits of PTO

Under the traditional system of vacation and sick days, an employee with less than one year of service is usually granted 10 days of vacation and five sick days a year. Your motivated workers seldom use their sick days, while your less-than-stellar employees seem to always use all of their allowable time off. This system penalizes your good employees while rewarding your poor performers, thereby fostering discontent. Your responsible employees constantly have to pick up the slack for the allegedly "sick" employees on less than a day's notice.

PTO fosters a more responsible workforce since PTO days are managed by the individual employee and can be utilized at their own discretion. Paid time off includes scheduled time off, such as holidays, that are scheduled by the practice, and elective time off, utilized much like vacation and sick days. PTO has the added benefit of streamlining your clinic by reducing the disruption of "sick" days.

The use of PTO days allows for a larger percentage of days being used on a planned basis, thus minimizing clinic disruption. Your responsible employees will now have more useable days off while your underperformers will be penalized if they use more than has been granted.

In managing PTO days, a practice only needs one accrual calculation performed each pay period, instead of one for vacation and one for sick leave, drastically cutting down administrative time and errors and reducing the need for verification of sick leave usage. With electronic time-keeping software, PTO can be measured in as small as minute increments. This allows for the flexibility of granting partial days or hours away from work to take care of doctors' appointments or other personal responsibilities.

Since PTO is a granted benefit, it can also be taken away. Limits can be set for the accrual and redemption of PTO days. Many practices do not allow for the use of PTO days during an employee's 90-day probationary period, even though it starts accruing from day one. If it has been written into the practice's personnel handbook, PTO payouts can also be withheld from employees terminated or those who resign, but do not complete two-week notice. Progressive discipline of staff can also include the loss of PTO days — which can be very effective.

Abuse of PTO

An undependable staff member, no matter the skill level, becomes less valuable to the practice if he has an attendance problem. In our practice, if an employee does not maintain a positive PTO balance and exhausts his allotment, any further time off from work will not be paid. If any employee fails to budget his paid time off wisely and uses more than the accrued time, they can be put on probation for a period of time. During this probationary period, the employee will not be granted any time off until they have accrued sufficient PTO to cover their leave requests, or have established the use of Family and Medical Leave. An employee who is on PTO probation will not receive any bonus checks, raises or practice benefits.

If the employee does not maintain a positive PTO balance after the first infraction, he may either be terminated or receive a 2% reduction in pay to reflect drop in effectiveness and reduced value to the practice.

Reducing Burnout

Medical practices usually have a "cap" on the amount of PTO one may accrue and carry forward from year to year. One may feel it is wrong to limit how much PTO an employee can carry forward, when in reality you should incentivize your employees to take time off from work. That time is needed so your employees don't burn out.

It is best not to allow staff to accrue more than 240 hours of PTO, which is six 40-hour weeks, the amount usually used for the birth of a baby or major surgery. Once that mark is reached, an employee should either "use it or lose it" because time off is beneficial to every employee and paying staff for unused PTO is setting the stage for staff burnout. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.