Working When You're Sick: Symptom Of A Larger Problem?

FROM: THE EWIRE, 10.27.2010

Study shows residents work when ill; hospital culture influences callout decision

by Richard Quinn

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.

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 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 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.

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

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. Dr. Fried says.

This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at reprints[@]wiley.com. Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.