Working When You're Sick: Symptom of a Larger Problem?


The phenomenon of physician presenteeism, doctors coming to work even if they themselves are sick, is an opportunity for residency directors to pull back on how they schedule physicians in training, one program head says.

A study last month found that 57.9% of residents reported working while sick at least once and 31.3% had done so in the previous year (JAMA 2010;304(11);1166-1168). In one outlier hospital, every resident surveyed reported working when sick.

"Hospitals have to learn not to schedule their people to the max," says Ethan Fried, MD, MS, FACP, assistant professor of clinical medicine at Columbia University, vice chair for education in the department of medicine and director of Graduate Medical Education at St. Luke's-Roosevelt in New York City. "Just because you can go 80 hours a week and take care of 10 patients doesn't mean you should go 80 hours a week and take care of 10 patients."

Dr. Fried, president of the Association of Program Directors in Internal Medicine (APDIM), says creating schedules with little or no flexibility can hamper a program's ability to handle inevitable sick calls. Larger programs might have "sick-call pools," which are used to cover staffing shortfalls, but smaller programs might not have that luxury, he adds.

Jack Percelay, MD, MPH, SFHM, FAAP, pediatric hospitalist with ELMO Pediatrics in New York City, says the culture of residencies is to "suck it up," and some physicians carry that attitude into private practice.

"The decision of whether or not to work sick is really related to the institutions' culture," Dr. Percelay, an SHM board member, writes in an e-mail interview. "If we are to discourage physicians from working when sick, some sort of sick leave benefit or backup system needs to be in place. ... It's a real Pandora's box. I don't want my colleagues to stay home with a runny nose, nor do I want them to come in and get IV fluids in the back room."

Dr. Fried notes that the issue is further complicated by rules on how much training time residents need to be considered competent. He says the American Board of Internal Medicine (ABIM) recently gave program directors discretion in "granting credit for up to one month of missed time in a three-year period."

Still, presenteeism may be less of a problem with the current generation of residents than in the past because of culture changes tied to duty-hour rules. "We make such a big deal about working while fatigued, and that's now considered completely inappropriate," Dr. Fried says. "The trainees ... are much more willing to admit when they under the weather."

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