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Reimbursement and Practice Management

Don’t Let Employee Absenteeism Make Your Practice Sick

Employees who abuse sick leave—even it’s just one or two people—can drag your practice down and, in the process, create work backlogs, raise stress, and reduce productivity.


In this article, you will learn how to:

  • Understand the positive impact that a paid-time-off (PTO) leave plan can have on reducing employee absenteeism
  • Design positive incentives, such as quarterly rewards for perfect attendance
  • Develop strategies for the use of cross-training and part-time employees to reduce the impact of unscheduled absences by employees

View related pearls


Employees who abuse sick leave—even it’s just one or two people—can drag your practice down and, in the process, create work backlogs, raise stress, and reduce productivity. Absenteeism may even be affecting your ability to provide the best patient care. While sick days are to be expected, frequent unscheduled absenteeism wrecks an efficient operation, not to mention everyone’s morale.

Here are some tips that reduce the amount of work time you are losing to unscheduled sick leave in your office:

Evaluate leave policies. Consider offering incentives for not using sick time, such as allowing employees to accumulate sick days, convert some of them into vacation time, or receive a partial payment for accumulated unused sick leave at the end of the year or when the employee leaves your employment voluntarily. Be cautious with your rewards system; you don’t want to encourage employees to come in when they are truly sick and could pass along their germs to others; in fact, this problem is actually so prevalent now that a term—presenteeism—has been coined to describe it.

Implement PTO. A paid time off (PTO) system provides employees with a fixed number of days to use for vacations, illness and/or personal time. Because the days are pooled together, there is no need to make any distinction as to the type of leave. Thus, it discourages the “need” to use up sick time, as that previously designated sick time can be used for vacation or personal leave. In other words, leave just becomes leave; PTO plans put the responsibility on employees to decide how and whether to use their time off. You can encourage the wise use of PTO by offering to buy back some or all of each employee’s unclaimed days at the end of the year. Absenteeism frequently drops after these plans are implemented.

Ask staff to schedule. Whether or not you offer PTO, set a policy that employees must submit a request at least two weeks before taking time off for vacation. This policy gives your practice time to prepare. While the use of sick leave usually cannot be scheduled, ask staff to call the night before, if possible.

Focus on the abusers. If you experience an inordinately high amount of absenteeism, consider a policy to request that employees bring notes from their physician to explain any unscheduled “sick” absences. (Check with an attorney familiar with employment law first, however.) Termination may be an option to consider if your interventions, warnings and attendance incentives do not get the message across.

Reward perfect attendance. Even a small bonus for perfect attendance at the end of each quarter or the year can boost attendance. A reward as small as $100 per quarter provided to the employee with perfect attendance can inspire a drop in unplanned absenteeism.

Be flexible. Don't force employees to use a full day of leave if they only need to take an hour or two off for an errand or appointment that cannot be done on the weekend. Many practices allow employees to take anticipated sick leave, such as for physician appointments, in hourly blocks or by quarter days.

Offer extra time. Instead of doling out incentive checks, get creative by offering employees an optional paid day off – or even just an early release. Working parents may jump at the chance to take an afternoon off in August for back-to-school shopping. Others may welcome the opportunity to take a shopping day on a weekday in December. By anticipating your employees’ needs, you can put the brakes on some unscheduled absences while reducing the stress of holidays, back-to-school preparations and other events. Of course, you’ll have to manage these time-off “bonuses” carefully, as you don’t want your practice to come to a screeching halt.

Shorten the workweek. The 40-hour work week is not carved in stone. There’s a growing trend for medical practices to shift full-time staff to 36-hour workweeks to save money—and make employees happy. Even with the slight reduction in pay, many employees welcome the trade-off of getting one afternoon off a week. If the office really slows down on certain afternoons, such as Fridays, try getting by with a skeleton staff on those days. Allow the skeleton-crew duty to rotate among staff. You may find that many will be pleased to get a little more personal time or a jump on the weekend, and your bottom line benefits as well.

Cross-train more staff. Untimely absences, as well as planned vacations, are bound to occur. You can reduce the pressure and avoid lost productivity if more of your employees are cross-trained to fill in for each other. Cross-training itself may be welcomed by staff who are looking for opportunities to spread their wings a bit and take on new challenges.

Hire some part-timers. Even if you do not have a problem with absenteeism, bringing a few part-time and per-diem employees into the mix will allow more scheduling flexibility. The result will be much less stress and disruption when full-time employees take vacations or when seasonal changes cause patient demand to increase. Part-time employees who know your practice’s operations can be the preferred option to fill in when other staff call in sick or take scheduled vacations.

There’s no one solution to excessive absenteeism. While many of these solutions will work for most employees, each practice has its own dynamics and pressures. Sometimes, an employee will have an illness or health condition that legitimately causes more than the average number of days off work. Make sure you understand the Family and Medical Leave Act (FMLA), which provides for up to 12 weeks of unpaid leave for certain medical situations for either the employee or a member of the employee's immediate family. While businesses with fewer than 50 employees are usually exempt, there may be a state version of the FMLA that applies.

By introducing a variety of solutions and, above all, remaining flexible but fair, you can find remedies to absenteeism that also increase productivity, reduce costs, and inspire greater loyalty from your employees.

Pearl 04/22/14

Bent Out of Shape? Flexibility
Look into the many options to create a more flexible work environment. These steps can include flextime, compressed work weeks, job sharing, telecommuting and other measures. Unlike human resources policies and disciplinary actions, you do not have to extend flexible work options to every employee but be sure to document any requests that you turn down and why.

Pearl 04/15/14

Sick and Tired of Being Sick and Tired
Allow employees to explain themselves when their use of unscheduled sick leave rises above your tolerance level. It is possible that job stress, an inordinately heavy workload or a lack of training are causing the problem. Be prepared for the possibility that your management style might be contributing to the problem.

Pearl 04/08/14

Clear the Air: HR Policies
In addition to explaining your policies on the use of paid and unpaid leave, a written human resources policy manual should spell out the consequences of unexcused absences and misuse of sick leave. Make sure to remind employees of the policy such as in memos, at meetings and by other opportunities. At the very least, a written policy makes it clear to employees that frequent absenteeism is not tolerated.

Pearl 04/01/14

The ER Factor: Employee Recognition
Initiatives such as incentive plans, flextime, wellness programs, and group rewards for completing projects can help improve employee morale, productivity and work attendance. Incentives also reassure employees that their contributions are recognized and valued. Don’t just give an incentive for no reason, however. Tie bonuses to something—a project (a successful EHR implementation, for example), accomplishment (no absences for the quarter, for example) or a positive annual performance review.

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