AMGA CMO Council: Alternative Work Hours

AMGA COVID-19 Resources
 

Discussion Summary
August 4, 2020

This summary is based on discussions via AMGA’s Chief Medical Officer Council listserv as of August 4.  For more information on the Council, please click here.

 

Question:
Is anyone considering or implementing alternative schedules for physicians and providers to address childcare related to schools remaining on distance learning?

 

Have Not Implemented

  • We did this back in April and May, but clinics and hospitals have been ramped up since the first week of June, and so we had to go back to regular schedules. Haven't reconsidered yet.
  • We modified hours to get teams distanced back in March-May. We have not reconsidered doing so due to schools and distance learning. We will consider this option.
  • No specific plan yet, we are actively discussing.
  • Along the lines of return-to-school, we have concerns about the number of exposures that will result and how to [triage] these individuals—both employees and children/teachers—as they present for evaluation/advice.

Principles to Remember

  • We've established principles for our Medical Directors at each clinic to exercise local control regarding flexible scheduling.
    1. Remember that our people will always remember how they were treated during this time.
    2. This is a temporary arrangement, and we'll need to re-evaluate as the situation changes and hopefully improves.
    3. Virtual visits may not be reimbursed at the face-to-face rate in the future. 
    4. Encourage in-person clinic time with extended hours, Saturdays, and flexibility with the entire staff. Include the entire medical staff in the conversations.

Staff Survey

  • We are sending out a survey to our providers to inquire about their specific situation with long-distance learning plans for families and to understand what flexibility they may need as the fall approaches. Our goal will be to work with the providers and the staff to help accommodate, within our organization's means, what we can do in this unpredictable time.

Proposal for Alternative Schedules

  • Below is the framework we developed. We have received most of the site proposals, and the needs are variable in each site. We are still in the process of assessing how we are meeting our objectives. One of our biggest challenge is clinic staffing.

    Given the unprecedented times, we propose to offer significant flexibility for clinicians to provide patient care. The purpose of this proposal is to allow clinicians to continue to provide care to patients while also addressing their family needs, retain staff who are also facing similar challenges, and provide improved access for our patients who may be challenged with traditional scheduling.

    The proposal includes the following parameters:
    1. Clinicians will have the opportunity to provide in-person and virtual patient care Monday–Friday from 7 a.m. until 9 p.m., as well as 8 a.m.–5 p.m. on Saturdays and Sundays.
    2. Due to the 10% pay differential for staff, each clinic will limit in-person visits to one weekend day per week.
    3. Each site must have clinicians present in the clinic during traditional office hours of 8 a.m.-5 p.m.
    4. Providing patient care outside of traditional office hours (8-5) is voluntary, not mandated.
    5. We will still require 36 hours of patient scheduled visits/surgery for full-time non-shareholder physicians and 32 hours for shareholders. These "face-to-face" hours will be a combination of virtual and in-person appointments, as well as scheduled OR time.
    6. We will still require full-time primary care advanced practice providers (APPs) to provide 40 hours per week which will be a combination of visits (either in-person or virtual) and task support, based on current criteria. A minimum of 50% of their time will be patient visits.
    7. Virtual visits and task support can be from home if the home environment supports efficient use of the clinician's time. 
    8. Each site will provide a proposal for office hours and clinician schedules by July 24, 2020. Each site proposal will be reviewed by leadership as well as department chairs to ensure financial feasibility and patient care needs are being met.
    9. Each clinician will need to have a set schedule and a defined template, and each office will have defined office hours.
    10. We ask that each site works in collaboration with your dyad partners and staff to determine office hours and clinician hours and be mindful to address staff needs as much as possible.
    11. Leadership will define key metrics that reflect success of this flexible scheduling and fiscal sustainability. This will include clinical, business, and other system needs.  Each site/division will monitor their performance relative to these measures of success.
    12. Our Imaging Center is already expanding their hours to evening and weekends to accommodate patient care needs.
    13. We will notify union of the alternative schedules.  
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