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Fitness for Duty

Fellows must be educated about their “fitness for duty.” It is clear that current alcohol or illicit substance use is incompatible with fitness to provide medical care to others. Excess fatigue, medical or psychiatric illness may also preclude participation in the workplace. 

Examples of additional situations in which a fellow may not be fit for duty include but are not limited to:

  • Use of medications that impair adequate performance
  • Grief that precludes concentration
  • Acute illness that would make the physician a risk to other, for example, infectious illness

This policy is designed to:

  • Provide guidance to fellows and attendings when a fellow is unfit for duty
  • Provide coverage for clinical duties if another fellow is ill or has a family emergency
  • Ensure the availability of coverage for a fellow who calls in ill
  • Delineate the fellow’s responsibility for coverage
  • It is not designed to change the definitions of time off for human resources/payroll purposes.  These policies remain unchanged. 

Fitness for Duty:

A Nephrology fellow who does not feel fit for duty should consult with the fellowship program director or Employee Health.  Additionally, a supervisor who has concerns regarding a fellow’s fitness for duty should also consult with the fellowship program director and /or Associate Dean for Graduate medical Education.

Back-up Support:

Appropriate use of sick call includes unexpected illness, death in the family, or other personal emergency.  Sick call is not to be used for scheduled absences, e.g., doctor’s visits, family responsibilities, interviews, etc.  For such scheduled absences, the fellow will follow the Medicine Department procedures in compliance with human resources/payroll policy.


  1. The Nephrology fellow will call the supervising attending to inform them of his/her illness or situation. No voicemail messages should be left but the attending should be directly informed.  The fellow should also contact the fellowship program director or division chief.
  2. The Nephrology fellow will discuss the work type and duration for which coverage is needed.  The attending or fellowship program director will ascertain what responsibilities need to covered to ensure safe, comprehensive transfer of duties to the covering colleague. 
  3. As a general rule, each Nephrology fellow will be expected to complete an equal share of weekend and holiday calls. If the fellow is unable to meet this responsibility due to illness of another situation as listed above, the fellow will complete the requisite number of calls at a later date as determined by the fellowship program director.  It should be understood that receiving return coverage is a courtesy but is not an absolute requirement and may not be possible in all situations. SUNY upstate Medical University’s institutional policy allows employees to be out for a number of sick days without consequences.  It is in this regard that professionalism and courtesy should exist.
  4. NOTE: Repayment of coverage may never result in an ACGME of New York State duty hours regulation violation, no matter what the circumstances.
  5. If a Nephrology fellow is out sick greater than three days, documentation must be brought to the fellowship program director’s attention within 24 hours of returning to work.  Documentation needs to show name, date, time, and place where the fellow was seen.  Diagnoses do not need to be disclosed as this information is confidential.  Failure to comply with the documentation requirement could lead to comments regarding professionalism in the final evaluation of the fellow or disciplinary action. 
  6. For extended absences/illness, please refer to the institutional policy of leave of Absence available on SUNY Upstate Medical University’s website.  Nephrology fellows should be mindful of individual Board requirements that may set limits on the amount of leave one may take at any level.  In most cases, vacation time cannot be forfeited for leave.
  7. While every attempt will be made to cover a Nephrology fellow’s duties with another Nephrology fellow, the final authority for patient care and supervision lies with the attending.  In all cases when another Nephrology fellow cannot cover or cannot be reached, the attending on service will provide this coverage.