In the rapidly changing world we now live in now, many strains have been placed on medical providers. One of the major strains facing providers is deciding whether to go to work if they are not feeling well.
For a recent post on STAT, a popular medical blog website, medical ethicist Steven Joffe, MD, wrote a piece titled, “Doctors working while sick is bad enough in ordinary times. During the COVID-19 outbreak it could be catastrophic.” The compelling article notes that the United States medical system actually incentivizes providers to work while sick. As Jaffe notes, “It’s bad enough in ordinary times for a doctor or nurse to work while sick. But as COVID-19 hits hospitals, as it almost certainly will, the tendency of health care professionals to work through illness will present a serious threat to both patient safety and the public’s health.”1
This ideology of “presenteeism” has been a discussed for many years in the literature, and has been linked to a decrease in productivity in the medical world. Dr Joffe, however, looks instead at the flaws in our medical system that drive sick providers to come into work and the dangers this poses to patients. Dr Jaffe notes that although we are quick to blame providers for this problem, the true culprit is a flawed system.
According to a 2017 survey, approximately half of hospitals responded that they lack policies about screening ill workers and fall short on policies that ensure sick providers will have coverage if they need to stay home.2 Dr Jaffe also cites data indicating that medical staff, including physician assistants (PAs) and nurse practitioners, come to work while sick because they do not want to add additional stress on their coworkers, and they feel worried about abandoning their patients.3
As a PA, I’ve observed the financial incentivization for staff to come to work when they aren’t feeling well while working in a major children’s medical center. The medical center had moved their staff leave system to “personal time-off ” (PTO). In this system, staff are given a set number of days (I believe it was 32 days at my hospital) each year for leave; combining sick leave, vacation, mental-health days, and holidays into one pool. When medical staff took leave, whether sick or vacation, it came from the same allotment.
What this did, as I regularly witnessed, was incentivize staff to come to work sick, because if they stayed home, the result would be to lose a potential vacation day. For example, if medical provider A called in sick 8 days and medical provider B called in 3, medical provider B would have 5 more days available for vacation than medical provider A. In my opinion, switching to PTOs reflects a common administrative view that everyone is cheating the sick leave system, calling in sick when they are not, and ineffectively strives to prevent this type of cheating. The unintended but obvious result is that providers who work while sick may contaminate their patients during visits.
Hospitals, clinics, and other medical facilities need to look at their systems and policies and ask themselves these questions: do we properly look for and screen sick providers? Do we have an adequate back-up coverage system in place, providing support to providers when they are ill? Do we have leave systems that incentivize our medical staff to come to work when ill?
Although this seems so intuitive to me, I struggle to understand why hospitals and clinics that are intended to heal the sick have systems in place that make patients, and the overall public, sicker. During the era of COVID-19, when the goal is to cure as many sick patients as possible, the stakes could not be any higher.
1. Joffe S. Doctors working while sick is bad enough in ordinary times. During the Covid-19 outbreak it could be catastrophic. STAT website. https://www.statnews.com/2020/03/09/doctors-working-while-sick-covid19-catastrophe/. Published March 9, 2020. Accessed September 10, 2020.
2. Chow EJ, Smit MA, Mermel LA. Visitor screening and staff sick leave policies in US hospitals. Infect Control Hosp Epidemiol. 2018;39(8):1006-1008.
3. Patel A. This flue season, physicians need to scrap the ‘martyr culture’ of working while sick. STAT website. https://www.statnews.com/2018/02/07/flu-season-physicians-need-scrap-martyr-culture-working-sick/. Published February 7, 2018. Accessed September 15, 2020.