Is it time to ditch sick note requirements? Doctors and patients are tired of them
White Coat Black Art26:30The high cost of sick notes
Patients hate having to ask for them. Doctors don’t like writing them. But some employers across the country still demand employees get a sick note in order to stay at home for one or more days of illness.
Increasingly, some doctors and other health-care providers are taking a stand against them.
They argue the notes shouldn’t be required for minor illnesses, and have for years done little more than tie up an already overloaded health-care system.
“These patients don’t want to be there. They don’t want to wait eight, 10, 12 hours to see me,” said Dr. Kay Dingwell, an emergency room physician in Summerside, P.E.I. “They want to be at home recovering.”
Dingwell says she can’t work a shift at the ER without at least one person coming in to request a sick note. Many tell her they can’t get a day off to recover without it.
She’s sympathetic to employees who may be “stuck between a rock and a hard place,” but says doctors should not be involved in what is essentially a labour issue.
“This is not the role of the health system, to police employee attendance,” she told White Coat, Black Art’s Dr. Brian Goldman.
Hayley Bueckert-Dick, who lives in Roland, Man., remembers the trouble it took to get a doctor’s sick note in 2017 when she had a minor illness while working a minimum-wage job at a fast food restaurant.
“They would really put pressure on, and kind of implied that you might get written up if you didn’t get [a note] before your shift started,” she said.
She said the doctors at a walk-in clinic were often annoyed when they realized she was there for a note and not medical advice for treating a common virus.
“I would say I found it really annoying, and I found it very embarrassing, too.”
Badi Bloodworth, a nurse practitioner who works at a Winnipeg walk-in clinic, says low-income workers are more likely to need a sick note than those in higher-paying office jobs.
“They’re taking time off work or [coming into the clinic] when they could just be at home recovering, so it kind of disproportionately affects this population that is already disproportionately affected by, like, everything else,” Bloodworth said.
Trust your employees and pay for sick leave: experts
Calls for more paid sick leave increased with the COVID-19 pandemic, as staying home to keep everyone safe became a regular chorus.
More Canadians have guaranteed access to paid sick leave in recent years, according to a CBC News report from January 2023.
A 2023 report by Statistics Canada found that self-reported coverage of paid sick leave “increased moderately” between 1995 and 2022.
It noted, however, that it remained “far from universal” for many front-line workers, like those working in grocery stores, child care or nursing home care.
Dingwell says more paid sick leave is one of the best ways to reduce sick note requests.
“I think if we can get people feeling like they have the right to stay home when they’re ill, we may see fewer outbreaks of illness in employment settings,” she said.
Mike Salveta, president of human resources management at Pivotal Integrated HR Solutions, says it’s better for companies and managers to trust their employers when they tell their bosses they need a day off — especially for minor illnesses.
“You don’t want people in your workplace who are sick, because that can rip through your whole environment in no time,” he said.
Dingwell said this could be seen in places like crowded factories, where one person with gastroenteritis could spread it to half the workforce, rendering them unable to come to work.
“If the first sick person felt like they could take a day or two to just get better, then perhaps we wouldn’t be seeing so much in the way of clustered illness like that,” she said.
Salveta says absences will happen whether you like it or not, be it from a common cold or a sudden injury, so it’s best to be prepared for them.
He advises companies to do things like train employees — including supervisors and managers when necessary — to fill in the most critical tasks in the event of a colleague’s short-term absence.
The Canadian Medical Association is raising concerns about the Ontario government’s move to allow employers to require workers to provide a doctor’s note to explain even minor illnesses, such as the common cold. The association’s president says the measure could cause a public health issue
Pushback against sick note requests
Some health-care providers and medical organizations have taken some steps to discourage sick note requests after years of seeing them fill up waiting rooms.
In 2020, the Canadian Association of Emergency Physicians (CAEP) released a statement that advocated for sick note requirements from employers to be banned either by federal or provincial legislation, and encouraged employees to stay home to recover “if they do not feel they require acute medical assessment.”
In 2023, new rules came into effect in Nova Scotia that only permitted employers to request a sick note if an employee had been absent for more than five consecutive work days, or two absences of five days or less within the last 12 months.
Dr. Gregory Sawisky, a physician in Ponoka, Alta., takes a different tack whenever a patient requests a sick note: he sends an invoice to their employer.
“I tell them that what I can do is provide a note stating that a sick note is an uninsured health service … and if the employer is requesting it, then that payment is the responsibility of the employer,” he said.
If the patient insists on paying a fee themselves, Sawisky encourages them to file an expense claim with their employer.
He says he’s “never, ever” gotten a payment from the invoice. He suspects many employers accept it as a sick note, inasmuch as it’s proof the employee visited a doctor in the first place.
If nothing else, the tongue-in-cheek request may lift the patient’s mood.
“Patients … often have a little bit of a smile on their face and they say, oh, they will be happy to give this to their boss and see what their boss says,” Sawisky said.
