It is 4:40 a.m., the thermometer says 102, and you are on the schedule for a 24-hour call that starts at seven. Before calling in, most residents open the group chat to see who would have to cover. A resident on Reddit this week described missing a 24-hour shift while admitted with a serious infection, then trying to get back to work before discharge because the guilt felt worse than the illness. This piece, part of our residency survival guide, walks through the sick call itself: how to make it, what to write down, when to come back, and the leave numbers worth knowing before you need them.
Make the call early, to the person who activates backup
Your program handbook names who gets notified for an unplanned absence. Usually it is the chief resident or whoever runs jeopardy, plus the attending or team you were due to join. A text to the co-resident you hope will cover is not notice. Call or page the person who can pull backup, and do it as soon as you know you cannot work, so the team does not start rounds short.
Keep it brief: “I have a fever of 102 and I’m not safe to take care of patients today. I’m calling to activate jeopardy for my 7 a.m. shift. Sign-out is updated, and I can answer texts about my patients until noon.” You do not owe a symptom tour, a diagnosis or a paragraph of apology. “Not safe to care for patients” is the same judgment you would make about a nurse who called in with that fever, and it is the one that matters.
Leave a paper trail the same morning
After the call, send a two-line email to the chief and the program coordinator with the date, the shift, and the fact that backup was activated. Then check how the day was logged in your program’s scheduling or time-away system, and keep your own running list: date, reason (sick, family, vacation), and how it was coded. That list becomes important in the board-eligibility math below.
Come back when you could clear a colleague, not when guilt says so
Returning on day two with a fever spreads the illness to the team and to patients. The test is simple: would you send a co-resident in your condition home? If yes, you stay home. If you were hospitalized, ask the discharging team for a written return-to-work date, give it to your chief, and find out whether occupational health has to clear you first.
Repay coverage once, on purpose
Thank the person who covered directly and offer one specific trade: “I owe you a call. Pick any of these three dates.” Then consider it settled. If your program runs a formal jeopardy pool, being pulled is the schedule doing what it was built to do; you are not personally in debt for it.
Another resident this week overheard an attending asking about the leave policy while they were home sick, and worried about looking like they were faking. An attending checking the policy is usually sorting out coverage, not building a file. If comments continue, or you are told to “make up” days that written policy does not require, raise it in writing with your chief or program director, and go to the GME office if that goes nowhere.
Know the leave numbers before the next absence
Your institution and your specialty board count time off separately, and both matter.
On the institution side, ACGME institutional requirements say sponsoring institutions must provide at least six weeks of approved medical, parental and caregiver leave at least once during an accredited program, available from the day you are required to report, paid at 100 percent of salary for the first six weeks of the first approved leave. Institutions must also keep at least one week of paid time off reserved outside those six weeks, according to the ACGME’s own explanation of the rule.
On the board side, the ABMS leave policy requires member boards with training programs of two or more years to allow at least six weeks away for parental, caregiver or medical leave, at least once, without using up vacation or extending training. How each board counts ordinary sick days varies. The ABIM’s policy, for example, allows up to 35 days per academic year, cumulative across training, and that single bucket covers vacation, illness, and parental and family leave together. A three-year internal medicine residency gets 105 days; beyond that, training is extended unless the program director requests a deficit waiver in the final year. A week of flu in PGY-1 rarely matters alone; it matters when a longer leave follows.
Federal job protection has its own clock. Under the Department of Labor’s FMLA eligibility rules, you need 12 months with the employer and at least 1,250 hours worked in the prior 12 months. Most interns do not meet that, and a fellow starting at a new institution starts over. In those stretches, your program’s written policy is what protects you, so read it now.
This is general information, not legal advice. If a program treats a documented sick absence as a professionalism problem, a call to an employment attorney, or to your union if you have one, is worth the time.
The one question to ask this month
Email your coordinator: “How are sick days coded in our system, and how many days have I used toward my board’s time-away limit?” Ask it while you are well. If the answer shows you are close to the limit in your final year, find out whether your graduation date could move before you sign an attending contract with a July start, because a hospital’s credentialing timeline will not bend around a training extension you learned about in May.