Dear Mr. Stadum and Drs. Desai, Hollander-Rodriguez, Skariah, Nordling, Moisa, and Lewis,

The way that our program has implemented guidelines from the American Board of Family Medicine forces resident family medicine doctors to choose between going to work sick and finishing our training on time. As primary care physicians, we should not have to make a choice between taking care of ourselves and our families and advancing to the next stages of our careers.

Our program has opted to count a “week” of vacation as seven days instead of five, even though our vacation eligible rotations are only ever five-day work weeks.This means that with only 30 days away from training allowed each year per ABFM, we only have two days of sick leave annually before being required to extend our residency training. Our program’s policy change also applies to federally protected Family and Medical Leave (FMLA), which is meant to give workers time to care for newborn children, sick and dying family members, and themselves when they have serious or life threatening medical conditions.

Extending residency training creates significant challenges for resident doctors when they transition to fellowship programs that have strict starting dates. Extensions can also significantly delay entry into the medical community as independent physicians, thus further exacerbating the primary care shortage. The only other option our program offers is making up sick time and family medical leave by sacrificing valuable clinical elective time. This means residents would give up training in addiction medicine, reproductive healthcare, trans health, and palliative care that is so important to providing great care to our patients.

We recognize that each rotation and clinical experience of residency is valuable to our skillset and foundation as family medicine physicians. We also recognize that our program prioritizes and works to maintain high quality training that sets us apart from other family medicine programs across the country. This new policy inherently places pressure on residents to go to work while they are sick, putting our patients at risk when they are cared for by residents who are fatigued and physically ill. It doesn’t have to be like this. We believe there is a solution that balances the need for high quality training with our basic human need for time away from work albeit sick leave, family leave or vacation. Our union demands the following changes to the OHSU FM policy:

(1) Vacation Time Classification: Classify the 4 weeks of vacation time allotted in our GME and HOU contract as the 20 working days of those 4 weeks, instead of 28 which includes non-working weekends. This would allow for 10 days of Other Leave before reaching the maximum 30 days per the ABFM leave policy to remain eligible for board certification. This is in line with how other top family medicine programs account for residents vacation time.

(2) Sick Leave Make-up: Allow residents to make up training hours lost to sick leave beyond the allotted 30 days absence during flexible, modifiable time, instead of automatic extension of training and only for the purposes of avoiding program extension. This does not apply to leave taken under the Family Medical Leave Act.

(3) Family Leave Considerations: If a resident exceeds 30 days of leave in a given year due to FMLA or Family Leave, the ABFM policy does not require automatic extension of training so long as the resident does not exceed 8 weeks of FMLA/Family Leave during total training, they maintain 40 continuity clinic weeks, and they have met clinical competency for the experiences they missed. We demand that in the case that a resident exceeds 30 days of leave in a given year due to FMLA that the decision regarding make up and/or extension of training should be made based on clinical competency in the experience and should consider total time they have spent in that experience inclusive of prior coverage they have provided.

(4) Standardize Competency Decisions: The decision of whether a resident has achieved competency in a missed experience or needs to make it up should be made collaboratively in a planned meeting that is attended by the resident, their core faculty advisor, the Program Director (PD), and at least one additional member of the Clinical Competency Committee (CCC). There should be a standard and transparent protocol on how competency is determined by this group and a final decision regarding competency should include discussion with the resident.

Sincerely,
House Officers Union Leadership and the undersigned Family Medicine Residents, Fellows and Interns.