Urgent message: Paid time-off (PTO) is a common benefit among urgent care providers, but when urgent care operators benefit from an “always on” culture that is open evenings, weekends, and holidays, there may be times when employees are unable to utilize their PTO and expect some kind of accommodation for sacrificing this benefit back to the company.

Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine.

According to the Society for Human Resource Management (SHRM), 98% of all companies offer paid time off (PTO) to their employees, with urgent care being no exception. Almost everyone at some point needs time off for sickness, family illness, injury, or other emergency, and it’s a nice perk to still get paid. It’s also allows for compensated personal and vacation time, key for maintaining a healthy work-life balance.

Every now and then, though, your center may face a situation where an employee who has accrued PTO is requesting that some or all of it be paid out, yet they’ve not requested time off or missed work. In other words, they’re attempting to “cash out” their PTO simply to add it to their paycheck. There are a couple common reasons employees request these payouts: Those who rarely take time off will hit their PTO accrual ceiling and attempt to “reset” the PTO while getting paid for it, while others seek to cash out as year-end approaches, especially if company policy caps the amount of unused PTO that can roll over.

This of course begs the question: How is it that a fast-paced, often stressful environment like urgent care winds up with staffers who have taken almost no time off to recharge and unwind? Some HR studies of PTO liability point to our nation’s 24/7, “always on” culture for creating a legion of work martyrs who take such pride in not missing a day that they’ll even show up for work sick. These workaholic employees deem it a badge of honor to be present and accounted for without fail, even at the expense of their own physical and emotional health. Other times a short-staffed center will lean on a few “iron men” team members willing to always fill gaps or pick up extra shifts, resulting in staffers with large banks of PTO at the end of the year.

In either case, PTO stacks up, and some employees want to be paid outright for it. The company is the primary beneficiary of their hard work and if PTO is part of a “total compensation policy” why should the company’s most dedicated employees be required to “donate” part of the compensation (a paid benefit) back to the company?

So, how should your center manage such situations involving the use and payout of PTO? Industry experts, managers, and practice administrators alike have chimed in on the issue. Here are their recommendations for handling PTO payouts such that it remains fair and flexible to the employees, yet not open to the kind of misuse that puts the center and other staff in a bind:

Use It or Lose It
Oxford Economics asserts that 26% of all U.S. employees have a “use it or lose it” policy for handling their PTO, with many medical practices following suit. That is, all unused vacation time is forfeited at the end of the year. While this policy may seem punitive, it does encourage employees to take time off during the year: Nearly 84% of employees will use all their time under this policy.

We’ve found that many practice administrators often seek out a happy medium here: capping the amount of PTO that can be banked at any one time. Hence, if the PTO cap is, say, 40 hours per year, any unused PTO beyond 40 hours is simply lost at year’s end. Doing it this way allow for employees to still bank PTO for unforeseen circumstances, while also encouraging them to take much-needed time off to recharge.

Payout a Percentage
In this case, the medical practice still enforces Use It or Lose It, but will indeed pay out the PTO at a percentage, and only at the end of the year. We’ve seen some urgent care centers pay out 80%, while others will only pay out 50%. However, they all generally enforce that a payout cannot completely exhaust the PTO: the employee must have a set number of days remaining in the bank. This policy works well for workaholics who don’t take time off, while encouraging other staff to take the PTO knowing that a payout has a reduced value.

Make a Portion of PTO Mandatory
Especially in high-stress medical practices, we’ve seen policies where taking accrued PTO—even if just a day or two—at regular intervals is mandatory. The managers at these practices are very familiar with the negative consequences of burnout, and work diligently to head it off before it becomes an issue. Of course, the practice will allow the employees to maintain a bank of PTO for sickness and vacation, but when the unused PTO gets exceedingly high—say, 30 days or more in some practices—they require some of it be used. Additionally, these practices don’t allow for unpaid time off if there is accrued PTO, meaning if an employee needs time off, they do not have the option to take it unpaid when PTO is available.

Have a Written Policy
Regardless of how a practice decides to approach the handling of PTO, they should never just wing it or do it case-by-case; there should be a written policy in place, and it should be strictly enforced. In situations where exceptions arise or contingencies need to be made, such as when an employee accrued excessive PTO due to staffing needs, for example, those exceptions should be spelled out, or made clear that they are at the discretion of the practice manager.

Although PTO is a perk that almost every company offers, its use and payout must be managed carefully to allow employees security and flexibility, and to avoid situations that can put the center under strain or liability. By researching the different PTO policies then custom-tailoring one that works best for your urgent care, you can protect your employees from unforeseen financial hardship, grant them the time off or pay that they’ve rightfully earned, and help them maintain a work-life balance.

Handling Paid Time-Off in Overtime and Unpaid Leave Situations
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