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Small physician practices face many unique challenges when it comes to creating an effective time-off policy for their employees. In fact, many small practices choose not to have a time-off policy at all, because they lack the necessary staff to fill positions when employees are out. To complicate the matter further, "very few practices are large enough to fit under [the Family and Medical Leave Act or 1993] unless they're associated with a hospital, in which case they're usually under totally different guidelines," says Marge McQuade, an experienced practice manager and professional development coordinator for the Professional Association of Healthcare Coding Specialists in Brooksville, FL.