A new study by the U.S. Centers for Disease Control and Prevention reveals four in 10 healthcare professionals report to work while experiencing influenza-like symptoms, and many physicians work when having a cold, fever or other ailment.
A common rationalization for this behavior is that they are simply too busy to take a day off.
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“Unfortunately, it is not uncommon for physicians to go overboard and forget to care about themselves,” says Matthew Mintz, MD, an internist in Bethesda, Maryland, who notes the Hippocratic Oath has a lot to do with it. “In addition, some of the traditions of medical training, such as long work hours and the value of independence, reinforce that the patient always comes first, no matter the cost.”
This philosophy is often instilled in doctors early on. Tom Davis, MD, FAAFP, a family physician and founder of Tom Davis Consulting, St. Louis, Missouri, says the culture during training is one of ignoring one’s own health, even if it puts patients at risk.
“The pace and expectations of medical practice while in training (especially when expected work is not performed) clearly communicates that productivity trumps all,” he says. “This attitude carries over once the young clinician enters practice, especially those with heavy educational debt. Although employed clinicians are often allowed sick days, in reality there are significant financial penalties associated with missing work when ill—as well as pressure from administrators for not being a team player.”
Missing too much work can result in a physician being placed under a dreaded Performance Improvement Plan—a black mark that will follow the doctor if they wish to add or change licenses.
However, Davis notes, clinicians practicing in flat capitated systems, such as direct patient care, are far less likely to practice while ill.
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“Missing a day has virtually no financial consequences and cancelling a face-to-face appointment due to clinician illness is actually a practice builder through credibility development and patient bonding,” he says. “In private practice, given the personal financial risk involved, decisions not to work when ill can be more reasoned, but the same financial pressure applies. After sacrificing years for training and then carrying heavy debt, the financial pressure to catch-up is always there, no matter the age.”