Scrap sick notes for minor illnesses like colds, says CMA

The Canadian Medical Association wants governments to scrap sick note requirements for employees with minor sniffles, stomach aches or other short-term illnesses.

In a position paper published on Monday, the CMA said the notes burden physicians with unnecessary administrative tasks, and eliminating the requirement could prevent as many as 12.5 million unnecessary health-care interactions a year.

A new survey of 1,500 working adults conducted by Abacus Data for the CMA showed that in the last year, around one-third of working Canadians were asked by their employers to produce a sick note for a short-term absence at least once.

“That’s frustrating for the doctors, because we want to be able to spend the limited time that we have caring for patients who really need medical care, not filling out paperwork to address a human resource issue,” said CMA president Dr. Joss Reimer in an interview with CBC.

“It’s also frustrating for the people who need to come in, because if you’re having a migraine or you have a cold, the last thing you want to do is leave your house and have to go to a clinic and see a doctor.”

In many instances, Reimer says, patients see a doctor after their symptoms have already subsided, because they need to bring a note to work.

“There’s no way for me to verify whether or not yesterday they had a headache, but yet I’ll write a note basically saying, ‘They told me that they were sick.'”

A ‘waste of time’

“It’s a waste of time for us, and a waste of time for them,” said Dr. Michael Green, president of the College of Family Physicians of Canada. The college has been calling for employers not to request a sick note for short absence for years.

“Our job as doctors is to take care of people who are sick,” said Green. “It’s not to be the employers’ police service or fraud detection service.”

Green said family doctors already deal with heavy workloads and too much paperwork — which he says contributes to a shortage in primary care workers.

“I think we need an all-hands-on-deck approach to where we are with our shortage. Every little thing that we can do — sick notes, other forms, making them simpler, those sorts of things — each thing helps.”

But some employers said they need a way to keep workers honest if their behaviour seems fishy, such as consistently calling in sick on Fridays. 

Corinne Pohlmann, executive vice-president of advocacy for the Canadian Federation of Independent Business lobby group, suggested other ways to ensure people aren’t using sick days for vacation, like having a different provider write the notes, such as a pharmacist or nurse practitioner. 

“We’ve also been open to the idea of attestation, but the attestation would have to have some … legal recourse to it,” she said.

As alternatives, the CMA suggests signed declarations from employees, return-to-work interviews or employee check-ins.

Physician appointments, including those that require writing up a sick note, should be reserved for patients who “really need medical care,” said the CMA’s Reimer.

That includes people sick for more than a few days, or who may need lab work or a prescription.

Adopting those changes would ease the administrative burden on health-care providers and improve patients’ access to care and the overall efficiency of the health-care system, the association said.

Ban already in place in some provinces

Doctors in some provinces like Manitoba and British Columbia have also called on governments to make the change.

Federally regulated workplaces and some provinces are already moving toward eliminating sick notes in some circumstances. 

Earlier this year, the Ontario government proposed legislation to stop employers from being allowed to require a sick note from a doctor for the provincially protected three days of sick leave to which workers are entitled.

Under the bill, which received royal assent on Monday, employers retain the right to require another form of evidence from an employee such as a self-attestation or a receipt for over-the-counter medication.

Quebec also passed a similar bill in early October, preventing employers from requiring a note for the first three consecutive days of a sick leave over a 12-month period. That law will be in effect starting Jan. 1, 2025.

Nova Scotia also restricted employers from requesting a sick note, starting July 2023, unless an employee is absent for more than five working days or has already had two absences of five or fewer working days in the previous 12-month period.

It’s too early to say how successful these efforts have been, Reimer says. But she says the provinces’ recent moves are encouraging.

“We hope they inspire the other provinces, as well as the federal government.

“We want to see all levels of government getting involved, to make sure that we’re using our very scant health-care resources for health care.”