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Unofficial Guide to Paid vs Unpaid Leave for Dental Practice Owners

UPDATED 1/4/23

As an office manager of a dental, optometry, or other healthcare practice, the process of figuring out how to pay your employees for time off can seem a little complex.

What is required when it comes to vacation time, sick leave, and other forms of paid leave? Are there any gray areas when it comes to long-term employee absences, like pregnancy or sick leave? What kinds of reasonable accommodations should your office be expected to make in these leave-related work-life balance scenarios?

Paid Leave: What is Actually Required?

In your practice, it’s likely there are certain kinds of leaves that are pre-determined as paid. From vacation days and personal days to sick leave, paid holidays, and other forms of leave, there are distinct requirements that come with each type. To figure out a given instance of paid leave, you must first understand what is required for different leave categories.  

Vacation Time 

Most people are familiar with paid leave in the form of paid time off, or PTO. To earn PTO, employees accumulate days off over their time at work that they can then use for vacations. While there is no federal mandate regarding paid vacation leave (or even unpaid vacation leave), it is a popular benefit that some employers choose to offer.

The amount of paid vacation can be earned over time, or the hours can all be provided upfront as a lump sum. Not all employees are always entitled to vacation time per year. It is most often a benefit that is only for full-time employees rather than part-time employees. Vacation time may also vary by seniority. Simply put, to earn vacation time, eligible employees have to show up to work!

Sick Leave

Believe it or not, there are no federal laws that require employers to pay their employees' sick leave. However, some states, cities, and municipalities have mandates that require local employers to provide paid sick days. Of course, this leads us to one of the biggest questions surrounding mandatory paid sick leave: doctor’s notes.

In short, an office manager is not allowed to demand a written request or doctor’s note for any days that fall under the employee’s mandatory paid sick leave. Paid sick leave is a protected leave and must be given with no questions in most scenarios. Requiring a doctor’s note could be seen as an infringement on that mandatory paid sick leave, and the mandatory paid sick leave law — like all laws — is not at the discretion of the employer. It's a mandate the employer must follow.

Once an employee's mandatory paid sick leave is exhausted, an office manager has the flexibility to deny or approve additional absences. They may also ask for a doctor’s note to approve the absence. Keep in mind that, even with a doctor’s note, you should not follow up with the physician for more detailed medical information. This would infringe on your employee's HIPAA rights. What you can do, however, is reach out to the office to confirm that a doctor’s note was written for the employee.

The requested note can only say the name of the doctor and the date/time your employee was seen. This level of anonymity is needed, for example, in cases where employees suffer from chronic health conditions or must care for a family member with a serious health condition, as it keeps legally protected information secure.

To request a doctor’s note for an employee’s absence, your practice must already have a time off policy or leave policy in place that outlines this. For example, after three missed workdays, all employees must provide a doctor's note to justify their absence. This should be clearly outlined in the employee handbook so that all employees are aware and receive the same treatment.

For any further questions, schedule a consultation with HR for Health to ensure you know the state laws regarding doctor’s notes and mandatory paid sick leave. You also need to be sure your requests are in compliance with the U.S. Department of Labor in Washington, D.C.

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Other Paid Leave

In addition to vacation time and sick leave, your dental, optometry, or other healthcare practice is legally required to make leave accommodations for jury duty, voting, certain holidays, and any military responsibilities. Employees have the right to economic security for these listed cases.

Although whether these are required to be paid typically depends on a specific employee’s status (exempt vs. non-exempt). In addition, some employers choose to offer paid bereavement leave in the case of the death of an employee's immediate family member. Offering this type of pay may not be required but can be much appreciated and boost employee retention.

Gray Areas for Employee Leave of Absences

As you probably know, certain parts of employee leave benefits aren’t so cut and dry. In fact, some of these gray areas are just plain confusing. Still, these areas carry requirements of their own, just like the forms of paid leave explored above. These requirements help you better understand how these leaves of absence factor into the debate on paid leave vs. unpaid leave.

Gray areas can be controversial and not always easy to understand. In cases like this, it is best to contact an HR specialist to ensure you don't infringe on an employee's rights — or break federal or state labor laws.

Family and Medical Leave Act (FMLA)

The Family and Medical Leave Act is a federally mandated program that allows employees to take a leave of absence for personal medical issues like family health conditions or for military reasons. It helps them maintain their job and health insurance during unforeseen circumstances. While this mandate allows employees to take up to 12 weeks of unpaid leave and still return to work, there are still some stipulations related to eligibility.

First, employees only qualify if they have worked at your practice for at least a year and have worked at least 1,250 hours within the year prior to their requested leave benefits. New employees are not eligible for this type of leave. Second, this time off request is not required to be paid. An unpaid time off request is something to discuss with an HR specialist and include in your employee handbook as part of the unpaid time off policy beforehand. 

However, if an employee exhausts available paid leave, you are not obligated or required to pay for additional time under the FMLA's requirements. Lastly, employees are only eligible for FMLA leave if the employer has 50 or more employees within a 75-mile area.

Maternity and Paternity Leave

Paid family leave can vary by state. While parental leave may technically fall under FMLA in some cases, some practices still choose to offer paid or unpaid days off specifically for new parents as an additional benefit. (This can be an attractive option for your new and existing employees if you choose to offer it.)

Also, it's important to note that if your practice is in California, Rhode Island, or New Jersey, you may be legally mandated to provide parental leave, depending on the number of team members. Consider contacting HR for Health to learn more about your responsibilities if you are in these states.

Pregnancy Disability Leave

In some states, mandatory maternity, paternity, and/or pregnancy disability leave is required. In California, Pregnancy Disability Leave (PDL) can last up to 17 ⅓ weeks. Other states ask employers with a certain number of employees to offer disability leave to pregnant employees who cannot work. This type of leave is not always mandatory. It is yet another gray area where office managers have some flexibility to choose how they want to set up their specific policies to best suit the needs of their dental, optometry, or healthcare practice.

Risks of Not Giving Employees Paid Time Off

If you don’t offer employees the benefit of taking paid time off, there are many risks involved that can backfire on your small business. A lack of paid leave can significantly impact employees’ mental and physical well-being, attitude, and productivity.

  • Jeopardizes the health of employees and family members
  • Increases financial distress on employees
  • Perceived as workplace discrimination
  • Indicates a lack of supporting work-life balance
  • Causes employees to become stressed and burned out
  • Results in employees missing work or resigning

Offering paid time off shows employees that you care about them and support the individual worker’s balance of responsibilities. In turn, a positive company culture leads to loyal and productive employees, which is necessary for the future success of your company.

Unpaid Leave: What are Reasonable Accommodations?

In the world of HR, one phrase strikes fear into the hearts of employers everywhere: reasonable accommodations. This phrase conjures up images of expensive changes and potential lawsuits, but the reality is that these accommodations are often very simple and logical tools. One tool which should — and often must — be considered a reasonable accommodation for employees is unpaid leave.

Under the Americans With Disabilities Act (ADA), most periods of temporary leave should be considered reasonable accommodations if the employee requests them. Many legal cases in which employers were held liable for ADA violations involved their refusal to grant unpaid leave.

However, an open-ended period of unpaid time off is not required to be granted under the ADA. If neither your employee nor their medical provider can provide an exact return date, then the leave period may be indefinite. In this case, you may not necessarily need to provide unpaid leave since you can't be sure if or when they will return- always engage in the interactive process for every situation to determine if an unpaid time off is appropriate.

Ultimately, the best approach to addressing unpaid leave is to communicate with the employee about their needs in the workplace based on their doctor's recommendations. Be sure to document each conversation and the steps you take with regard to the accommodation request. This is especially true in cases of mental health issues, such as PTSD, anxiety, or depression. In these cases, short periods of unpaid time off may be requested by the employee’s provider, and this can significantly improve the mental and physical health of your employee and increase productivity. 

As always, consult with HR and/or your attorney for assistance and educate yourself about ADA requirements to prevent unintended violations.

About HR for Health

HR for Health is an all-in-one HR software solution dedicated to helping the dental, optometry, and veterinary industries. Our human resources platform gives practice owners the comprehensive toolbox to manage payroll, timekeeping, 401(k), and more with total integration and ease. HR for Health can automatically track any type of leave and hours used per employee and safely store your up-to-date company policies in the cloud.

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