Category: Sept/Oct 2026

Crouse NICU: Extraordinary Commitment

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By: Martha E. Conway

There are a lot of moving parts in developing and sustaining a Level IV neonatal intensive care unit; at Crouse, it’s not only their deliveries that rely upon the NICU, but also babies from 17 hospitals across a 14 county region that spans the Canadian to Pennsylvania borders and from Albany to Rochester. Through its Regional Perinatal Center, Crouse also provides services for the region’s high-risk obstetrics. Crouse has the busiest labor and delivery unit in Central New York, welcoming more than 3,000 babies annually. The NICU serves about 900 babies annually, which includes 300 babies transferred in from the 17 regional hospitals. Staff care for an average of 56 babies daily. The average stay is about 33 days.

First in women’s and infants’ health

Seth Kronenberg, M.D., President and Chief Executive Officer for Crouse Health, said Crouse started as a women’s and infants’ hospital 140 years ago, making it one of its core services. “We’ve been the Regional Perinatal Center since the 1970s, and we’ve always been the market leader in obstetrics and NICU. We have a saying that ‘those with low-risk pregnancies can have great experiences at Crouse, but those with high-risk pregnancies can rest assured that the time from their baby’s birth to the time they see a NICU doctor is reduced, and the shorter that timeframe, the better the outcome.’”

Crouse recently was awarded a grant from the state Health Department to help modernize and expand the NICU, as well as other areas. “We’re working on the architectural drawings, with a plan to deliver stronger, more accessible support to our entire 14-county region,” Kronenberg said. “We’re excited to have more capacity and space and continue to have the latest and greatest technology.” He said Micron will cause an influx of people, which will skew younger. “Maternity is going to be a big part of that, and with fertility treatment access, we’re going to see more multiples. We’re anticipating continuing growth in obstetrics.”

Level IV NICU designation requires full-time onsite subspecialty care, complex imaging capability, and ability to perform major surgical procedures. “We offer complete surgical and medical support to the sickest babies,” said Dr. Boura’a Bou Aram, Medical Director, Neonatal Associates of Central New York. “We’re the ultimate destination for the most complicated cases.”

Crouse is the only NICU in the region that guarantees round-the-clock board-certified neonatologist support. When a regional doctor needs a direct link to a neonatologist in an emergency, they can speak to one immediately. “When a life is on the line, you want a direct line, 24/7,” Bou Aram said.

Crouse’s isolettes monitor and control temperature, oxygen, humidity and light, as well as a neonatal transport team that can pick up a baby born in any of its 17 regional hospitals, utilizing one of these highly specialized isolettes to help deliver treatment in a controlled environment during the return trip. “You want your team to arrive able to start 

treatment,” Kronenberg said.

Sicker moms, sicker babies

“We can have NICU staff in the delivery room if the baby is born here,” Kronenberg said. The hospital is seeing increasingly premature infants and more multiples. Obesity and diabetes have resulted in sicker moms, which can lead to babies being born more premature and ill. Babies are getting smaller and equipment is getting bigger. “We need to expand to meet those demands,” Kronenberg said, adding that the NICU is seeing more micropreemies – really premature babies who require a tremendous amount of lung support. “The NICU isolettes monitor temperature, humidity and light at a level that didn’t exist years ago.”

Director of Nursing Joan Dadey said neonatology is a relatively new field of medicine that has come a very long way since the 1970s. “Even since the 1990s and early 2000s, medication called surfactant was developed, which helps lungs absorb and transport oxygen,” she said. Some of the most impressive gains have been around ventilation therapy and ways to support the development of preterm babies’ lungs, which are the last things to develop.

“We are getting better at our craft every year,” said Nurse Manager Lisa Hatter. “Our babies are a lot sicker than they used to be. Babies we couldn’t save 20 years ago can be saved now. Our technology is amazing.”

Loving care in a high-tech environment

There are myriad challenges in the NICU. The babies are tiny and fragile or very ill, so special care must be taken to ensure interventions won’t hurt them physically. “There is great responsibility on us as a team to keep these fragile babies alive and well,” Bou Aram said. “We have every level of advanced respiratory therapy support, MRI and echocardiogram, and the ability to perform major surgical operations here,” Bou Aram said. Fetal surgery can now prevent severe damage from complex fetal problems such as spinal defects, blockages of blood flow into the heart, or severe twin conditions. Precision medicine options have exploded; the rapid use of genetic mapping and neonatal-specific imaging now provide highly accurate results. Crouse has all the necessary equipment to insert breathing and chest tubes and to put babies on heart-lung bypass. “Though comprehensive mapping may take longer than other options, such as the use of microarray or gene sequencing, advanced tools like MRI and genetic testing allow for quicker, more accurate determination of a diagnosis,” he said. “Early, accurate diagnostics give doctors the opportunity to tailor a treatment plan earlier in an infant’s stay.”

“It is very stressful, especially when babies are very sick and every minute counts,” Bou Aram said. “I am a father first, so putting myself in the shoes of these parents adds to the weight of the responsibilities. New parents are naturally overwhelmed, so information needs to be clear, direct and honest. Multiply this by a hundred when the baby is sick.”

Crouse also cares for babies born with surgical emergencies. Ultrasound detects a host of anomalies that may require surgical intervention or specialized care. “It’s really tough on the parents – they go through a lot of emotions,” Hatter said. “We try to reassure them that it’s going to be okay and include them in as much care as we can. Nobody wants to give birth to a baby they’ve been so excited about and go home without them. We try to save all the firsts for the parents – the first bath and bottle – because those milestones mean the world to those parents. We try to let them do the things they can – change the diaper, take a temperature or move a probe from foot to foot. We have them put little tape recorders in the isolettes and read them books, so the baby can hear their voice when they’re not there.”

“Because neonatology has advanced as a field of medicine, equipment has followed suit,” Dadey said. “We have all the equipment and the doctors and midlevel providers like nurse practitioners, physician’s assistants, nurses, and respiratory therapists who are all trained to use it. But some of our toughest cases are big babies who aspirate meconium during birth or might have an infection when they are delivered, so their lungs are compromised. The technology has evolved to improve survival rates so these babies can leave the hospital. We work very hard for every baby to make sure they have the best outcome.”

What the future holds

“We started as a women’s and infants’ hospital – a critical piece that makes Crouse Crouse,” Kronenberg said. “We will continue to enhance, expand and invest in those services. The highest-level NICU requires investment in the latest and greatest technology. We already have the best doctors and nurses.”

“Over the next decade, we will adopt new clinical tools,” Bou Aram said. “Promising technology includes AI and predictive monitoring. Tele neonatology lifelines will provide greater digital reach; onsite clinical experts will be able to virtually assist with the initial stabilization of a baby in any of the regional hospitals. Over the next decade, the need to stay on the cutting edge will only increase. I’d say the focus will be on diagnostic modalities, imaging, and bedside technology.”

Pride in the program

“Crouse delivers world-class medical care and high-end programs like the Regional Perinatal Center in a family community hospital culture,” Kronenberg said. “It’s that culture that separates us: It’s how we treat each other, how we treat our patients, how everybody interacts. It’s special. Our people aren’t just employees; they are family. We invest in workforce development, invest in them as human beings, and try to have fun at work because healthcare is very serious business. Everyone believes in the mission. At Crouse we say ‘every moment matters,’ and that’s the influence everyone has on patient experience – from environmental services to security to patient access – they are all equal. It’s not just the doctors and nurses; it’s our entire Crouse family. Walk down the hall, and you see smiling faces and people who enjoy being here. That doesn’t take away the stress of being in healthcare, but that family environment really sets up our culture.”

Bou Aram is proudest of building a multidisciplinary team and the thousands of families in Central New York whose stories started in Crouse’s NICU. “Our team of physicians, advanced practice providers, nurses, respiratory therapists, staff, and the administration that supports them act like one family to provide seamless care under one roof,” he said. “To go around Syracuse and know that a child in the park or a grown adult or high school or college student you see was once a one-pound baby lying in a bassinet in our nursery brings me so much pride. Neonatal care is truly a collaborative endeavor, and we cannot do it without the backing of our entire Central New York community.”

“I’m proud to be part of this team – the work that is done here is nothing short of miraculous every day,” Dadey said. “We get influxes of patients – it’s not uncommon to get three sets of twins in four hours – and the team pulls together. Then we respond to a transport in our region, and the team pulls together. They deliver the very best care, are passionate about what they’re doing and want the very best for every family and baby. Our neonatologists and nurses embrace excellence; they’re constantly looking to improve – evaluating research, new technologies and practices. Seeing that come to life every day is incredible.”

“We have a motto: ‘Nobody sits until we all sit,’” Hatter said. “As soon as a baby hits the bed, we have so many nurses at the bedside ready to help. Whether running to the pharmacy, the supply room, hanging fluids, helping with procedures – everybody’s invested in the success of every baby, and just being able to watch everyone work together toward a common cause is absolutely amazing.” “Crouse is the only independent, locally governed community hospital in
Syracuse, and we are here to meet the needs of the community,” Kronenberg said. “There isn’t a solution to health care in our region that doesn’t include Crouse, so to be able to deliver the highest-quality care and really high-end, highly technical medical services within that family community hospital culture – that’s what makes me most proud.”

Going to the Zoo

NICU holds an annual reunion at the Burnet Park Zoo. “When babies are nearing discharge, they sometimes decide to be a little naughty, delaying the discharge,” Dadey said. “So, we don’t use that word. We say they’re getting ready to go to the Zoo. Then they join us at the reunion with their parents, siblings, grandparents, aunts, uncles … you have hundreds of people. It’s a beautiful experience.”

Kronenberg said the reunion is one of the most rewarding things he participates in yearly.  “You see children who were tiny, tiny babies and were in Crouse for months and months, and here they are just like every other kid. It’s really rewarding for the doctors, nurses and families because they get very close when their babies are here for a long time. To reunite the care team with patients and families is very rewarding.”

“Going to the reunion every year and seeing the babies growing and healthy is just phenomenal,” Hatter said. “Babies bounce back. They’re amazing.”

“When a family seeks care for their baby at Crouse, they don’t just have a physician: they have an entire community dedicated to their child’s care,” Bou Aram said.

“Our NICU is a special place, Hatter said. “Every nurse here loves every baby like it’s their own. We give some pretty amazing care.”

Culture in the Clinical Practice

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BY KATHRYN RUSCITTO, ADVISOR

I often wonder why the patient experience feels complete in one medical practice yet lacking in another. The answer usually lies in a collection of touchpoints: how the phones are answered, how staff greet patients, whether communication remains consistent between visits, and how issues are resolved when something goes wrong. These visible moments are only part of the story, but together they reveal the culture.

Exceptional patient care requires alignment across every department. Positive experiences reflect an organizational culture built on clear goals for every encounter, every person, and every time. Even when miscommunications arise, a strong culture ensures they are handled with courtesy, responsiveness, and accountability.

Leadership establishes this baseline and must hold itself to the same standards expected of everyone else. Hiring, training, and recognition programs should all reinforce the same core values. When expectations are transparent, team members flourish, morale improves, and retention is more likely to increase. Mutual respect is also critical. A healthy culture must clearly articulate expectations for patient behavior, especially given the recent rise in workplace safety challenges. Patients deserve compassionate care, and staff deserve a safe, respectful environment in which to provide it.

The key elements of a strong culture include safety and trust, accountability and decision- making, feedback and innovation, and work-life balance and growth. These principles should be stated clearly and revisited as the organization changes. Culture is not a one-time announcement; it is something that must be reinforced every day through leadership actions, team behavior, and organizational systems.

As Michael Watkins noted in Harvard Business Review, “Culture is the organization’s immune system.” This idea captures the role culture plays in clinical practice: it helps teams respond to stress, navigate unexpected challenges, and access the right support when problems arise. It also shapes what the organization tolerates, what it rewards, and how it behaves under pressure.https://hbr. org/2013/05/what-is organizational-culture

Looking back on a career in healthcare leadership, it is natural to think about how often l truly walked in the team’s shoes. While rounding can provide perspective, deeper listening often reveals whether an organization is living its values and whether the culture is supporting staff. Patient and client perspectives matter just as much. Surveys offer value, but in-person feedback creates a unique opportunity to ask follow-up questions, learn more deeply, and better understand what people are actually experiencing.
Finally, the empathy gap must be addressed. Many patients do not fully understand current workforce shortages or the administrative delays that affect care. It is helpful to provide that context and advocate for patience and kindness toward frontline staff. At the same time, the frustration patients feel when they cannot access care or communicate with providers is real. The challenge is to communicate these realities honestly while staying true to the organization’s values.

Resources for Building a Strong
Culture in Clinical Practice

• American Medical Association – Leading Change https://edhub.ama-assn.org/steps-forward/pages/leading-change

• National Center for Healthcare Leadership https://www.nchl.org/

• National Academy of Medicine – Culture of Health Program https://nam.edu/our-work/programs/culture-ofhealth-program/–

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynruscitto or at krusct@gmail.com

Nurses: The Frontline Syracuse Community Health

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By: Molly English-Bowers, LPN

Traditional healthcare hierarchies placed physicians at the top with various nurses in supporting roles–nurse practitioners, registered nurses, licensed practical nurses, and medical assistants, in that order. But in today’s complex and increasingly specialized medical environment, a cooperative team approach becomes necessary. Quality physicians look to their nursing staff to work with them to promote better outcomes for patients.

That is clearly the case at Syracuse Community Health (SCH), where Ofrona Reid, MD, MBA, MS, president and chief executive officer, not only recognizes the value of the nursing staff but also supports them furthering their education. He wants them to jump from LPN to RN, if they choose, and has structured the work environment to achieve this.

“Dr. Reid has fostered a culture that encourages professional growth, and as a result has been able to build the next generation of healthcare professionals and has strengthened healthcare right here in Central New York,” said Jessica Yoxall, vice president and chief operating officer at SCH.

In fact, he is so cognizant of the importance of the facility’s nurses that he chose not to be interviewed for this article; instead, he wants the nurses to tell their own stories. This article is the result of those interviews.

Fifty Years of Serving the Underserved

Syracuse Community Health was founded in 1978 with the mission to provide high-quality healthcare to the residents of Onondaga County, especially those who are uninsured, disadvantaged or who face other obstacles to care.

Nearly 50 years later, the health center has cared for more than 100,000 residents of Onondaga County, 91 percent of whom live in the city of Syracuse. In addition, 78 percent of patients are covered by Medicaid, Medicaid Managed Care or are uninsured; 92 percent have an annual income below 200 percent of the poverty line, and 45 percent are under the age of 21.

SCH opened a new, 56,000 squarefoot facility in 2023 at 819 S. Salina St., Syracuse. Patients can access care at 12 other clinical locations, eight of which are located inside Syracuse City Schools, convenient for parents who are unable to either take time off work or transport their child to a medical appointment. In addition to the main site, the nonschool- based sites are 930 S. Salina St., 1938 E. Fayette St., 603 Oswego St., and on the Onondaga Community College campus.

“Our clinics are intentionally and strategically located along transportation routes and in zip codes that contain demographic challenges,” Yoxall said.

SCH employs 200 staff, 23 of them nurses, including eight Registered Nurses and 15 Licensed Practical Nurses. “Nurses are the center of our organization and create the first impression for our patients,” said Yoxall. “We may not be able to pay the highest amount, it’s not the easiest job, not the highest paying, but it is the most rewarding. Our nurses are working here because they want to be here.”

At SCH, nursing duties often extend beyond traditional clinical responsibilities- helping patients navigate their social needs such as food insecurities and housing. “You’ll see them helping out at check-in meeting the patients where they may need help, providing compassion, dignity and respect,” said Yoxall. “Our nurses’ dedication embodies SCH’s mission.”

Working as a nurse isn’t easy but it is incredibly rewarding, satisfying and motivating. Sherri Henderson-Mitchell began her career at SCH in 1991 as a volunteer in the pharmacy, a role she said, “ignited my passion for healthcare.” She began working at SCH in October 2000 as a certified dental assistant and earned her LPN in 2009; she is currently attaining her RN.

She cites as motivation the support SCH has given her as well as SCH’s patient population. “My commitment to my patients and my community remains a primary source of motivation for my continual professional development,” she said. “Over the years, the evolving demographics of our patient population have presented new challenges that, in turn, have created opportunities for personal and professional growth.”

Sarah Platt, RN, came to SCH as an LPN and currently works as RN supervisor in the Pediatrics Department. “What brought me to SCH was the opportunity to service the children in my community,” she said. “My motivation to stay with SCH while continuing to advance my career was knowing I was going to be able to continue doing something that I enjoy. Watching the children come in as newborns and reach each milestone as they grow up brings the workday extra brightness.”

Maizie Millwood’s first contact with SCH was as a patient and her first job there was as secretary even though she already was a Certified Medical Assistant. She is now an RN. Three factors fuel her desire to remain at SCH. “I am motivated by the organization’s mission, the supportive work environment, and the chance to continue learning, growing and contributing to a team that is committed to improving the health and well-being of our patients,” she said.

Bre Anna Odom came to SCH as an intern in the Medical Assistant program before she was hired in the same role in the Eye Care Department. She then worked as an LPN for approximately 10 years when she decided it was time to become an RN. Her motivation to stay at SCH is simple. “The patients,” she said. “I really love the community we serve here at SCH.”

Samrawit Legesse’s introduction to SCH occurred during the clinical rotation for her Medical Assistant certification. She remained after the facility offered her a job “and I have been here ever since.”

While Triana Henderson also started as a Medical Assistant at SCH, her desire to work there is rooted in her childhood. “I always wanted to work at SCH since I was younger,” she said. “I knew a couple of people who worked here before and had nothing but good things to say.” She made the impressive, and challenging, leap from MA to RN.

All six women credit SCH for bolstering their efforts to further their nursing careers, especially adjusting work schedules around class times. “SCH provided encouragement along the way,” Odom said, “and was very accommodating with any schedule adjustments I needed while in school.” 

Henderson-Mitchell called out three physicians who were particularly encouraging while she studied toward her LPN, Oris Moore, DDS, Wilson Sithold, DDS and the late Henry Chionuma, an adult medicine internist who started SCH’s Walk-In Care operation.

“They all recognized my potential even when I did not,” she said. “Their guidance inspired me to strive for improvement, pursue opportunities for growth and seek further education. This journey has empowered me to take on more significant roles within our organization, enabling me to make a substantial impact on our system of care and the community we serve.”

Stated Platt, “SCH was great with allowing me to have a flexible schedule while studying for my boards. SCH staff also gave me amazing encouragement to continue to work toward my goals when they noticed I was struggling; they offer a great support system.”

Millwood, at one time a Medical Assistant, said that SCH played a significant role in her decision to pursue her lifelong dream of becoming an RN. “Working at SCH exposed me to a diverse patient population and allowed me to see the impact nurses have on improving patients’ lives,” she said.

“That experience inspired me to realize that I wanted to do more and take on a greater role in providing patient care. I would like to sincerely thank the entire Syracuse Community Health team for their encouragement and support throughout my nursing school journey. Their kindness, patience and belief in my potential motivated me to keep going, even during the most challenging times,” Millwood added.

“SCH loves to see their employees grow,” said Henderson. “Management actually listens to your concerns and tries to meet you where you are to help you along your career path. If you’re willing to work hard and give your best effort and take constructive criticism, SCH is the place to be.”

Nursing school is rigorous and demanding. Add work responsibilities and family obligations to the mix, and nurses often think twice about continuing their education. The support SCH gives its nurses can’t ease the challenges of school itself, but it can help mitigate the stress of the balancing act.

“Balancing family responsibilities with work and school proved quite challenging,” said Henderson Mitchell. “However, the assistance and support I received from SCH were unparallelled compared to any other organization where I have been employed.”

Odom agreed. “It got difficult at times juggling being a full-time parent, student and employee,” she said. “There were a lot of long nights being super tired but still having to show up and push through. I had a great support system and SCH was accommodating with any schedule adjustments that I needed.”

Millwood said that handling it all was as challenging as pursuing her nursing degree. “Working three days a week while attending classes required careful time management, organization and dedication,” she said. “I often had to balance long work shifts with studying, completing assignments and preparing for exams, which left little time for rest or personal activities.

“Although balancing these responsibilities was difficult, the experience strengthened my resilience, improved my time-management skills, and taught me the importance of perseverance. It also prepared me for the demands of the nursing profession, where managing multiple priorities while providing compassionate, high-quality patient care is essential.”

Legesse agreed. “Time management was the biggest challenge I experienced while balancing work, school and personal responsibilities,” she said about her LPN journey. “I worked part-time, my family kept me motivated and SCH helped by giving me a flexible schedule.”

Further, she was prepared for the rigors of advancing her career. “I knew this would be challenging but completely worth it,” she said.

A single mother, Henderson faced financial challenges in her quest. “Trying to manage personal finances, paying for school, and juggling home life was tough. But SCH supported me with schedule changes, especially Erin Healy, Dr. C and Heather Scott-Levy, director of nursing. They supported me from day one. I am forever grateful for each person that played a significant role in my journey.”

Grow Our Own

SCH administers a program called ‘Grow Our Own,’

 designed to attract individuals who possess a desire to pursue a career in the healthcare field with an intent to serve in community health centers. The program aims to foster personal and professional development, thereby retaining top-notch staff and ensuring quality patient care.

“We’re dedicated to ‘Grow Our Own’ to address the future shortage of primary care providers and supportive personnel,” Yoxall said. “By helping our employees grow through personal and professional development we can fill critical positions with internal candidates or secure critical competencies for our team.

“We achieve this through educational opportunities, clinical rotations, internships, cross training, career ladders and flexible schedules that align with school demands.”

In 2025, seven employees participated in ‘Grow Our Own,’ including medical assistants who became LPNs, as well as LPNs advancing to RN roles while working at SCH.

For those LPNs who are content in their current roles, this year SCH implemented a competency-based program. “This model helps identify opportunities for additional education and professional growth, provides quarterly feedback for all LPNs, and supports progression through three levels of increasing responsibility,” Yoxall explained. “This supports those who are not enrolled in formal coursework but want to continue to grow within their role.”

A quality facility that provides excellent patient care requires staff that is fully dedicated to the patient population, and nurses are a vital part of that team. “We are a reflection of our community, with a diverse workforce, some of whom are bilingual. We are constantly investing in our workforce,” Yoxall said, “which leads to better outcome for our patients, which then results in a healthier community.”

 

Who’s Exempt? New York Labor Law and Fair Labor Standards Act Overtime Rules For Physicians, PAS, and Practice Staff.

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It’s easy to assume that anyone with an “advanced degree” is exempt from overtime. For physicians managing a practice, that assumption can be costly. The framework for determining which employees are exempt from overtime pay is established by the federal Fair Labor Standards Act (“FLSA”) and the New York Labor Law (“NYLL”).

What Is the FLSA and How Does It Apply to Overtime Pay?

The FLSA is the primary federal law governing minimum wage, overtime pay, recordkeeping, and youth employment standards. Under the FLSA, non-exempt employees must be paid overtime at a rate of no less than one and one-half (1½) times their regular rate for all hours worked over forty (40) in a single workweek. The NYLL has similar overtime provisions and generally follows the FLSA in areas its own provisions do not address.

What Individuals are Exempt from Overtime Pay Under the FLSA and the NYLL?

For an employee to be exempt from overtime wages under both the FLSA and the NYLL, the employee must pass three tests: (1) Salary Basis Test, (2) Job Duties Test, and (3) Salary Level Test.

The Salary Basis Test.

Under both the FLSA and NYLL, an exempt employee generally must be salaried and  paid a predetermined, fixed salary. However, the FLSA provides that licensed physicians engaged in the practice of medicine need not meet any of the three tests. “Physician” here includes podiatrists, dentists, veterinarians, and optometrists. This carve-out also applies to physician residents and interns holding a requisite academic degree (e.g., M.D., D.O., D.P.M.) but does not extend to pharmacists, PAs, NPs, RNs, or similar roles. Most PAs, pharmacists, and certain practice staff, such as practice managers, are salaried employees and therefore may be exempt if they meet the following two tests.

The Job Duties Test.

Employees properly classified as professional, administrative, or executive employees under both the NYLL and FLSA pass the Job Duties Test. These are not formal labels preassigned by a government agency; rather, an employer determines the classification by reviewing the employee’s actual job duties. The classification is based on general work duties, not job title alone, and is usually scrutinized only if an employee disputes their overtime status. Executive employees carry out managerial duties such as managing the practice or office, regularly directing two or more employees, and having sufficient authority and discretion to hire, fire, or make other employment-status decisions. Practice managers generally qualify because they oversee office operations, supervise staff, and hold hiring/firing authority.

Administrative employees’ primary duties involve performing office or nonmanual field work directly related to management or general operations, regularly assisting an employer or executive employee, and exercising significant discretionary powers in performing their duties. Compliance officers and human resources personnel generally qualify because they perform office work, assist their employer, and exercise discretion.

Professional employees must meet three criteria to pass the Job Duties Test: (1) their primary duty requires advanced knowledge in a field of science or learning customarily acquired through prolonged specialized intellectual instruction and study, (2) their work requires regular exercise of discretion, and (3) their work is predominantly intellectual and varied in character such that output cannot be standardized in relation to a given time period.

Whether an employee qualifies as a “professional employee” is determined on a case-by-case basis, and no job title alone guarantees the classification. The analysis focuses on whether the job’s primary duty requires specialized academic instruction and uses advanced knowledge typically acquired through prolonged study. “Advanced knowledge” means the employee exercises discretion and judgment characteristic of the profession at issue. Although the required advanced knowledge need not come from a specialized advanced degree, an employer’s minimum academic qualifications and whether most employees in that role hold such a degree are considered. Work is “predominantly intellectual and varied” when it is not routine mental, manual, mechanical, or physical work. 

Pharmacists, PAs, and RNs (not LPNs) are generally considered professional employees because of their advanced knowledge, routine exercise of discretion, and intellectual work.

The Salary Level Test.

The salary thresholds for the Salary Level Test differ under the FLSA and the NYLL. Employees working in New York must meet the NYLL salary level, while employees in other states must meet the FLSA salary level unless their state imposes its own test for overtime exemption. Under the NYLL, the Salary Level Test applies only to executive and administrative employees. New York defers to the FLSA salary level for professional exempt employees. As of this article’s publication date, for employees outside New York City and Nassau, Suffolk, and Westchester counties, the test is met at a minimum salary of $1,199.10 per week ($1,275.00 per week for New York City, Nassau, Suffolk, and Westchester County employees).

Under the FLSA, the Salary Level Test is met when an employee earns more than $684 per week, regardless of employee type. This means that New York salaried professional employees who satisfy the professional duties test and earn above $684 per week generally meet the salarylevel requirement for overtime exemption. 

If My Employee Meets the Criteria, Are They Exempt from Overtime Pay?

If an employee passes all three tests, they are overtime-exempt and are not required by law to be paid overtime for working over 40 hours in a workweek (although an employer can still voluntarily agree to pay overtime). If an employee fails even one test, they must be paid overtime. Failure to pay an eligible employee overtime could require the employer to provide back pay for owed overtime wages. For this reason, it is imperative that practice owners and managers understand these rules to ensure employees are properly compensated and the practice avoids liability for unpaid wages.

Practice owners with questions about the topics outlined in this article can contact Lippes Mathias LLP health care team members Jennifer E. Forward (jforward@lippes.com) or Marc S. Beckman (mbeckman@lippes.com).