Extra Shifts or Call for Extra Pay

Scope

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Policy Statement

Some training programs and partnering institutions may offer pay for performing additional clinical work as a way of recognizing extra effort on the part of high performing residents to acquire additional skill and training that exceeds the minimum requirement to meet the educational objectives of the training program and to permit residents to earn a limited amount of additional income in a supervised environment.  

Residents who are approved to perform extra shifts must be in good standing and be approved, in advance, by the Program Director.  

Participation by residents is voluntary and cannot be required. 

At all times, the supervision, work hours, and clinical duties in Extra Shifts must comply with the ACGME Common Program and Institutional Requirements as well as IUSM GME policies and procedures.

• Supervision must remain at the same level as during regular clinical training.
• Time spent on these additional clinical duties must be included in the reporting of total clinical and educational work hours.
• Extra Shifts cannot be completed for the same clinical activity in which the resident is scheduled for the current month’s rotation (e.g., a resident currently assigned to the MICU may not schedule an extra shift on the same MICU).

As residents are exempt from overtime under the Fair Labor Standards Act (“FLSA”) and receive a monthly stipend for their work without regard to the number of hours worked, they are not paid a stipend based on an hourly rate. As such, close monitoring of both number of shifts and payment limits for extra shift work has been advised by IUSM Legal Counsel.

Eligibility to participate in Extra Shifts, compensation maximums, and shift frequency limits will be determined by the Senior Associate Dean for GME (DIO). The GME Office will monitor the frequency of shifts and the amount paid per shift.

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Reason for Policy

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Procedures

Initial Eligibility Requirements for Programs

• Residency or fellowship programs may participate.
• Must meet with and obtain initial permission from the DIO before any shifts are scheduled.
• Must identify specific service or services where extra shifts would be beneficial and be able to describe the scope, purpose, and nature of proposed extra shifts activity.
• Must set a pay rate for in-hospital, and if applicable, home call.
• Financial Requirements:
  • The program’s home department must agree to take responsibility for invoicing of extra shift-related labor, if applicable.
  • A department account number for payment of the residents’ wages must be provided prior to approval to participate in Extra Shifts.
  • For regional programs, must have name and contact information for the Service Line administrator and confirmation of billing contact.

Initial Eligibility Requirements for Residents

• Must be PGY2 or greater.
• Must be in good standing.
• Must obtain advance permission from the Program Director to participate in the program.
• Cannot be on a J-1 visa (other visa types may be eligible pending evaluation).
• Must possess an Indiana medical license (Physician/Osteopath license or Postgraduate Training permit). Independent hospital privileges or additional liability insurance are not necessary, as Extra Shifts are not independently billable activity.

Maintaining Eligibility for Participation in Extra Shifts

Participating programs and residents are expected to follow the policies and procedures outlined within this document. Noncompliance to the Extra Shifts or ACGME policies may result in suspension from participation in the Extra Shifts program.

Supervision, Scope, and Nature of Duties on Extra Shifts

• Residents must maintain the same level of supervision as during a normal shift or rotation.
• The clinical activities performed during the shift must align with duties which are part of their normal training.
• Residents cannot work an extra shift in the same clinical activity or rotation they are currently on.
• Participation by residents is voluntary and cannot be required.

Work Hours Considerations

• Work hours for Extra Shifts must be included in the reporting of total clinical and educational work hours. Thus, trainees who are on scheduled vacation or leave are not eligible to work Extra Shifts since they will be unable to report work hours.
• Residents are still subject to the work hour maximums set forth by the ACGME.

Compensation

• Compensation maximums per hour:
  • Residents: $100
  • Fellows: $120
  • Programs may set their own pay rates for home and in-hospital call, provided it falls within the maximum allowable rate.
    • Programs that invoice affiliated hospitals to recoup the cost of extra shift payments are encouraged to discuss proposed rate changes with department and hospital contacts prior to implementing rate increases, since departments would be responsible for the difference between approved invoice rates and an increased maximum pay rate.
  • The GME Office will review compensation maximums at least every five years.
• Payment timeframe:
  • Once confirmation of the shift is received, payment will be processed for the next on-cycle paycheck. Given the monthly payroll cycle for residents, this may mean that payment may be received 1-2 months after the date of the extra shift.

Frequency Limits

• Limit of 2 Extra Shifts per calendar month
• Limit of 20 Extra Shifts per academic year (July-June)

Compliance Monitoring and Tracking

• All extra shifts will be entered in a Smartsheet database using the processes outlined in the Attachments. Programs may keep local records of extra shifts as well, but reporting shifts is mandatory.

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Definitions

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Implementation

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Oversight

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Forms

Attachment 1:  Extra Shifts for Pay Procedures 

Attachment 2:  Initial Approval Process for Extra Shifts Program Participation 

Attachment 3:  Extra Shift Process Lifecycle 

Attachment 4:  FAQ 

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History

1. Policy gme-adm-0044 drafted 28 August 2018.
2. Policy reviewed by GMEC 18 September 2019.
3. Revisions to draft policy made 2 December 2019.
4. Revisions to draft policy made 13 February 2020.
5. Revisions to draft policy made 23 July 2020.
6. Revisions to draft policy made 17 August 2020.
7. Policy reviewed & approved by GMEC 19 August 2020.  
8. Policy reviewed & approved by GMEC 16 August 2023.
9. Policy revised 12 February 2025.
10. Policy reviewed & approved by GMEC 19 February 2025.

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