Why Clinicians Don't Call in Sick

Many health care professionals report to work sick, even when they know it will put patients at risk.

To better understand why, researchers surveyed physicians, registered nurse practitioners, physician assistants, clinical nurse specialists, midwives, and registered nurse anesthetists at the Children’s Hospital of Philadelphia.

Of the responding group of 280 physicians and 256 advanced practice clinicians, 95.3% said they believed that working while sick posed a risk for their patients. Nevertheless, about 83% said they had worked sick at least once in the past year. Fifty respondents said they had worked sick at least 5 times in the past year.

Alarmingly, many health care professionals said they would go to work even if they showed significant symptoms. More than half (55.6%) indicated they would work with acute-onset respiratory symptoms, 30% would work with diarrhea, and 16% would work with a fever.

When asked about reasons to work while sick, the clinicians said they did not want to let colleagues or patients down, were worried about staffing, feared being ostracized by colleagues, and were concerned about the continuity of care, in that order.

Advanced practice clinicians were more likely to fear ostracism from co-workers and unsupportive leadership, while physicians were more likely to worry about continuity of care.

Some of those who worked in procedural or ambulatory settings cited that their patients’ scheduled appointments—which may have been set months in advance—made them hesitant to stay home sick. More than half of the subjects (57%) also felt unsure about how sick was “too sick” to work.

Some respondents recognized their clinical work area’s sick relief policy, but few took advantage of it.

In an open-answer portion of the survey, 9 physicians simply put: “Physicians do not take days off.”

“The study illustrates the complex social and logistic factors that cause this behavior,” the researchers concluded. “These results may inform efforts to design systems at our hospital to provide support for attending physicians and advanced practice clinicians and help them make the right choice to keep their patients and colleagues safe while caring for themselves.”

The researchers reminded health care professionals that working while sick may cause infections among their patients that can lead to death or excess costs. Immunocompromised patients, specifically, face increased risk when a member of their health care team is sick.