Should Otolaryngologists Work While They’re Sick?

According to a 2022 Medscape survey (www.wb.md/3YEAcLB) of 2,347 U.S. physicians, 85% came to work sick in 2022. In the last pre-pandemic year (2019), about 70% came to work feeling sick one to five times, and 13% worked while sick six to 10 times.

“Most physicians have a tremendous work ethic—otherwise they wouldn’t be where they are today,” said John T. McElveen, Jr., MD, otolaryngologist and president of Carolina Ear and Hearing Clinic in Raleigh, N.C. “In addition, many patients have waited quite some time to have their surgery and physicians don’t want to disappoint them by cancelling it.”

In Medscape’s survey, the majority of physicians cited professional obligations as the main reason for not taking a sick day; 73% noted that they felt an obligation to their patients and 72% felt an obligation to their co-workers. Half of the physicians said they didn’t feel bad enough to stay home, while 48% said they had too much work to do to stay home.

Some 45% of survey participants said the expectation at their workplace is to come to work unless seriously ill; 43% had too many patients to see and 18% didn’t think they were contagious when they headed to work sick. Because they would lose pay, 15% chose to work while sick.

Bradford Holland, MD, an attending otolaryngologist at the ENT Clinic Ascension Providence in Waco, Texas, had similar sentiments to those expressed by the physicians in Medscape’s survey. “When many of us were in surgical training programs, missing work or rounds for cold symptoms wasn’t tolerated,” he said. “We powered through; it was part of our culture. If I didn’t do the work, then my coworkers would have to do it and I hated to put that burden on them.”

When physicians don’t feel well, Richard V. Smith, MD, professor and university chair of otorhinolaryngology–head and neck surgery at Montefiore Health System and Albert Einstein College ofMedicine in Bronx, N.Y., said they will typically do a personal assessment on how sick they feel and whether it’s reasonable to see patients. “Oftentimes, not feeling well is unrelated to something transmissible—such as back pain, headaches, or injuries—so they usually try to deal with those symptoms and still see patients,” he said.

Taking Sick Time When You’re Employed

Some good news is that sick time offered by employers has improved in the last 10 years, Dr. Holland said. “Hospital employers are more understanding and willing to grant the same sick policies that they’ve had for other personnel to physicians,” he said. “A greater percentage of hospital physicians are becoming employed, so those benefits now apply to a greater number of doctors.” He’s quick to point out that HR policies typically aren’t the main motivator of whether a physician who doesn’t feel well shows up for work.

Regarding whether physicians are incentivized by their payment systems to work rather than take sick time, Dr. Smith doesn’t believe that’s the case. “Not all salaried plans are tied to the number of patients seen,” he said. “I never felt that this was ever a reason to avoid taking sick days when warranted.”

Conversely, Julie Wei, MD, MMM, professor of otolaryngology–head neck surgery at the University of Central Florida College of Medicine in Orlando, said some physician compensation plans incentivize unrealistic targets without any consideration for human factors. “Budgets and relative value unit targets are created with a focus on how to achieve financial targets purely from a business perspective,” she said.

Being Sick at a Private Practice

As a physician who works in a private practice and has 10 employees, Dr. McElveen said the practice depends on him to generate income. “In the rare event that I’m unable to see patients due to illness, patients typically reschedule and I end up doing additional procedures on subsequent days to accommodate them,” he said. “Consequently, the practice is minimally impacted.”

When many of us were in surgical training programs, missing work or rounds for cold symptoms wasn’t tolerated. We powered through; it was part of our culture. — Bradford Holland, MD

There are fewer people to cover for you when working in a private practice, Dr. Holland said. “It’s very difficult to get coverage; it’s almost unheard of,” he said. He worked at a private practice for 18 years and became an employee in March 2021.

When he feels ill, Dr. Holland checks his temperature and assesses whether what he has is contagious. Like lay people, he believes that physicians take over-thecounter medications to treat their ailments and try to feel as good as possible. “But you have to be sure that any medication you take doesn’t interfere with your decisionmaking process,” he said.

Dr. Holland is motivated to go to work even when he doesn’t feel well because he envisions the workload that will pile up if he’s out for a few days. “It’s a highly motivating force,” he said. “I hate the thought of burdening my coworkers.”

Coping with Outages

The post-COVID workplace has seen extreme shortages of healthcare workers at all levels.

It’s not always helpful to ask physicians if they want to go home. They often reply “no,” not because they don’t want or need to, but because they can’t get themselves to say what they need. — Julie Wei, MD, MMM

“We’re stretched so thin as it is; there usually isn’t anyone to cover at any level,” Dr. Holland said. “Therefore, physicians are motivated to show up under minor debilitating conditions just to keep the system afloat.”

When nurses are out sick, Dr. Wei said that staff who are in the same or similar roles may be able to step in and provide coverage. For example, a nurse in one surgical subspecialty clinic may be able to cover for someone in another subspecialty clinic.

For nurses on the inpatient unit, instead of having one nurse cover three patients, the ratio may increase to four, five, or even more patients assigned to one nurse. Oftentimes, however, a charge nurse will get pulled to work temporarily as a bedside nurse.

If a supporting staff member who works in the operating room is absent, then someone else may be asked to volunteer to work on their day off, or staff may have to perform additional duties and cross-cover additional areas when possible, Dr. Wei said. If a clinic nurse is absent, however, most likely there will be more stress and chaos in the clinic flow, and voicemail messages from patients and colleagues may not be answered until the next day.

When surgical technicians call in sick, cases may have to be delayed or cancelled unless someone else who is trained and comfortable supporting those types of subspecialty cases is available, Dr. Wei said.

In private practices, cross training is critical to good coverage when someone is sick, Dr. McElveen said. If a midlevel provider is ill, other members of the clinic may need to step in. In addition, a surgeon may need to take on more responsibility in the administrative aspects of patient care, such as filling prescriptions.

What You Can Do When You Can’t Work

When a physician is ill and unable to work, they should report it to their designated leader as soon as possible. When Dr. Wei was a division chief, she worked closely with the operations manager to review all the templates of other team members and create the best strategies to minimize the need to reschedule or cancel patient appointments.

Dr. Wei will ask surgeons who are working that day if they’re able to add a few cases on to their schedules. “Some cases can’t be done by other surgeons and some families prefer not to change surgeons, so we need to consider all of that,” Dr. Wei said. “All changes and updates are provided to everyone on the team. All of this helps to achieve the goal of removing unnecessary and unconstructive guilt feelings.”

At times, Dr. Wei had to force physicians to leave work when they were dealing with grave personal issues. “It’s not always helpful to ask physicians if they want to go home,” she said. “They often reply ‘no,’ not because they don’t want or need to, but because they can’t get themselves to say what they need. Instead, I assess and make the choice for them and give them time and space.”

Added Dr. Wei, “It’s the duty of the ill physician to communicate early and often with their supervisor, provide updates, and express gratitude to other physicians who protect them and afford them the time off to recover.”

Sometimes a physician can’t help but miss work. “When I have an acute illness, I feel guilt and anxiety because patient appointments and procedures will have to be cancelled,” she said.

Dr. Wei also experiences angst because her partners and colleagues will have to cover her responsibilities, and she knows that she is creating more work for others.

When you do have to call in sick, Dr. Wei advised embracing the discomfort and practicing not feeling guilty. “Those feelings are temporary and are quickly gone after a few minutes, especially if physicians commit to an accurate narrative about themselves and their own wellbeing,” she said.

“COVID has made a difference,” added Dr. Wei. “Now physicians must comply and embrace the guilt of staying home for the sake of upholding best public health practices and minimizing transmission.”

Dr. Smith said that it’s understood by most physicians, particularly since the COVID-19 pandemic, that when someone isn’t healthy, they can’t reasonably take care of others.

“The requirement to take time off for COVID positivity, [even] in the absence of symptoms, and the realization of the potential significant consequences of transmitting a disease, has appropriately refocused the conversation,” said Dr. Smith.

Whenever he feels guilty about taking a sick day, Dr. Holland recalls the words of the Hippocratic Oath, which states, First, do no harm. “I certainly don’t want to come in and infect patients and make them feel worse than they already do,” he concluded.

Karen Appold is a freelance medical writer based in Lehigh Valley, PA.