Fam Pract Manag. 2002 Sep;9(8):60.

Sick-leave policy for physicians and midlevel providers


I’m trying to establish a sick-leave policy for the physicians and nurse practitioners in our practice. What kind of policy do you recommend?


One approach practices commonly take is to offer enough paid sick leave to cover the time before the disability policy kicks in. Typically, this is 30 days.

Balancing semi-retirement and overhead costs


Our senior partner is interested in moving to half time as a step toward full retirement. How can we help him do this while still balancing the burden of overhead costs? Currently, our practice bases 90 percent of physician income on productivity and allocates most overhead based on productivity as well.


You have a couple of options. The fact that you are already dividing the pie based mostly on productivity (for both income and expenses) makes this easier and will involve less of a dramatic change than if you were currently dividing the pie equally.

One option to consider is buying out the senior partner now and continuing the relationship under an employment agreement that has a specific end date and would only be terminable by the practice for cause. Compensation for the senior partner could be a set percentage of collections, such as 40 percent or 50 percent, depending on the practice’s overhead. In this situation, the buy-out payments may often be deferred until full retirement, but the buy-out figure would be determined when semi-retirement began. In addition, the senior partner would be required to relinquish voting rights so the practice could make certain decisions affecting the long-term outlook of the practice without needing his or her approval. If your senior partner is not ready psychologically to give up the reins, this option might not be best for your group.

The other option I would suggest would be to keep the 90-percent productivity formula in place, since the cutback in your senior partner’s hours will correspond to a decrease in income. Keep in mind, though, that if your partner is dropping call as well, you’ll need to assess him or her with a financial penalty. In addition, you should probably change the overhead allocation to some extent so that certain fixed expenses, such as rent, utilities, maintenance, depreciation, accounting fees, legal fees and interest, are shared equally among the partners, while other more variable expenses, such as supplies, staff salaries and billing expenses, can still be allocated on productivity.

Before you decide which option to take, run the numbers using projections to see which change would make the most sense for your practice.

Open-access scheduling


In open-access, or same-day, scheduling, how does a practice handle physicians’ vacations and half days?


When a physician is on vacation, he or she obviously cannot directly match the demand for his or her services. To manage this, the best systems give patients a choice: to be seen by a colleague of the physician today (with visits divided equitably among the practice’s physicians, not just given to the physician with the first open appointment) or to wait for the primary physician’s return. In my experience, about half of the patients will opt for a visit today with a colleague and half will wait. If the practice has reduced its backlog of appointments under open access, patients should need to wait only until the primary physician’s first day back in the office. This helps the practice achieve better continuity and allows the physicians who are present to focus on their own patients. To ensure space on the schedule for the returning physician, the practice should implement a post-vacation contingency plan that allows for a week-long, “carve-out” model. Under the carve-out model, half of a physician’s appointments are held (or carved out) for same-day appointments, while the other half are booked in advance.

A half-day physician should be treated like an absent provider during his or her half days off. Define the end of the day for the physician’s patients (e.g., “If you can get here by 11 a.m., your own physician will see you today”). Then offer patients the same choice as above: to be seen by another physician today or to wait for an appointment with their primary physician.

[For more on open-access scheduling, see “Same-Day Appointments: Exploding the Access Paradigm,” FPM, September 2000, page 45.]

* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.


Copyright © 2002 by the American Academy of Family Physicians.
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