Calling out sick culture!

Started by HoosierdaddyO
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HoosierdaddyO

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I recently had to call out sick for one of the very few times in the last couple years, and the reaction made me feel like a pariah despite genuinely being ill. Why has medicine normalized guilt and resentment around basic human needs like taking a sick day?

It feels like many healthcare systems staff at the bare minimum, leaving little to no flexibility when someone is legitimately sick. Then when a physician or provider calls out, even rarely, there’s this “suck it up” mentality where people are treated like they failed the team.

Curious if others have experienced this or why people think this culture persists.
 
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To further answer your question, there’s no calling out sick in medicine, especially the ED. Somebody has to be there. Many of the EDs across the country are single coverage so you have to have someone there or you completely shut the ED down. If I worked for a CMG then it’d be pretty easy not to care but if you’re in an SDG then it’s a bit different. My personal view is that I went into a profession that people count on me being there so I show up when I’m supposed to. My partners count on me so unless there’s a true emergency then I’ll be there. Otherwise, it’s up to me to find coverage and then I’ll happily pay that person back.
 
JacobMcCandles said:
To further answer your question, there’s no calling out sick in medicine, especially the ED. Somebody has to be there. Many of the EDs across the country are single coverage so you have to have someone there or you completely shut the ED down. If I worked for a CMG then it’d be pretty easy not to care but if you’re in an SDG then it’s a bit different. My personal view is that I went into a profession that people count on me being there so I show up when I’m supposed to. My partners count on me so unless there’s a true emergency then I’ll be there. Otherwise, it’s up to me to find coverage and then I’ll happily pay that person back.
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I don’t disagree for the most part. I think unless you are truly sick or unable to perform… however, ultimately this sounds like an admin issue and staffing issues then a me issue. And this is coming from someone who maybe has called out 3 times in the last 10 years.

Also, this moral injury component that physicians must be available for their patients, and it’s weak to call out sick… while yes I agree, but also the staffing and the business model shouldn’t rely on me, that should be on the administrators. So I get what you’re saying but at the same time I’m an employee. I don’t run the business.
 
HoosierdaddyO said:
I don’t disagree for the most part. I think unless you are truly sick or unable to perform… however, ultimately this sounds like an admin issue and staffing issues then a me issue. And this is coming from someone who maybe has called out 3 times in the last 10 years.

Also, this moral injury component that physicians must be available for their patients, and it’s weak to call out sick… while yes I agree, but also the staffing and the business model shouldn’t rely on me, that should be on the administrators. So I get what you’re saying but at the same time I’m an employee. I don’t run the business.
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I think it’s also clear that you’re not in a SDG.
 
JacobMcCandles said:
I think it’s also clear that you’re not in a SDG.
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Absolutely not in an SDG and possibly my feelings would change if I was in that dynamic. And I also agree with you that I tend to notice, newer grads, much more freely, taking days off or sickleave than my generation and older generations. it’s just an interesting phenomenon that not too many other careers have to deal with the guilt of not showing up to work for a day.
 
Maybe my feelings would be different in an employed capacity but I also think that comes with the territory of having a professional job and making professional job money. At some point, I think the attitude should shift more from “it’s someone else’s job to find a replacement for me” to “maybe I should have some responsibility in filling the hole I’m causing”.
 
I haven't called in sick for over 20 years. The closest I came was moving my shifts around a week when I had a PTX. I have noticed the newer generation of docs use sick days similar to how people do in corporate America. I'm not saying it's fair because it's not. Docs should be able to take sick days but as an old scheduler/AFMD...it's damn hard to fill these shifts at the last minute when your ED doc only gives you a few hours notice. It would be nice if we had some sort of call system but that's never been very popular either because nobody wants to twiddle their thumbs within a 30 mile radius and be unable to crack open a beer on their day off. I don't know what the solution is but any day that I've been sick....1g Tylenol, 800mg ibuprofen and 20mg dextromethorphan will get me very close to feeling somewhat normal and certainly feeling well enough to work.

I def used up my sick days in my old corporate America job but I was only getting paid around 50K/yr. It's a different kind of responsibility as an EM doc making half million per year.
 
This attitude is par for the course in medicine and doubly so for EM. I recall being told more than once that if you're scheduled for a shift in the ED, that you're going to be in the ED. Either as a doctor or as a patient. As a result, I can easily count the number of times I've called out sick in the past decade on one hand.

That said, this isn't healthy behavior. I (and my colleagues) have all worked shifts when we obviously have the flu/covid/whatever. In almost any other job that idea would be idiotic.

I haven't had a reason to call out sick since starting pain medicine, but I will say that I think my days of coming to work with a 102+ fever are over. Having to cancel a full day worth of patients is a lot less unpalatable than trying to get one of your colleagues to come in on their day off.
 
JacobMcCandles said:
To further answer your question, there’s no calling out sick in medicine, especially the ED. Somebody has to be there. Many of the EDs across the country are single coverage so you have to have someone there or you completely shut the ED down. If I worked for a CMG then it’d be pretty easy not to care but if you’re in an SDG then it’s a bit different. My personal view is that I went into a profession that people count on me being there so I show up when I’m supposed to. My partners count on me so unless there’s a true emergency then I’ll be there. Otherwise, it’s up to me to find coverage and then I’ll happily pay that person back.
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Every single job counts on you being there. Medicine isn't special. It should never be on the person calling out sick to find coverage. Ever. SDG or not. EVERY SINGLE GROUP needs a process for handling callouts that doesn't burden the person calling out.
 
carbonizedeyesockets said:
Every single job counts on you being there. Medicine isn't special. It should never be on the person calling out sick to find coverage. Ever. SDG or not. EVERY SINGLE GROUP needs a process for handling callouts that doesn't burden the person calling out.
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I’m sorry but being a physician is different than being a waiter at Red Lobster.
 
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JacobMcCandles said:
I’m sorry but being a physician is different than being a waiter at Red Lobster.
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Why should Red Lobster employees (or everyone everywhere) have a better call out policy than physicians? What you promote is stupidity and toxicity cloaked in some weird shroud of nobility.
JacobMcCandles said:
As in a call schedule? We have emergency plans in place but a call schedule we do not do. In my experience, that gets taken advantage of.
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In my experience, it doesn't. Maybe you work with crappy people?
 
carbonizedeyesockets said:
Why should Red Lobster employees (or everyone everywhere) have a better call out policy than physicians? What you promote is stupidity and toxicity cloaked in some weird shroud of nobility.

In my experience, it doesn't. Maybe you work with crappy people?
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It has nothing to do with having a different call out policy, it’s about expectations. There’s different expectations for all sorts of careers and jobs. Physicians/medicine have rather high expectations as they should. The people who are calling out several times a year are probably the same people complaining that they deserve more pay. Some people have that gravel in their gut and some don’t no matter what job they do. If you’re an adult and you’re scheduled to work and it’s a job where somebody HAS to be there then it’s your job to find that somebody. Of course, we’re not talking about deaths and true emergencies, I think everyone understand that’s going to happen to all of us.
 
Our group has an emergency text that goes out for coverage. It's 1.5x pay with $100 call in added on. We minimally utilize it for legit emergencies. We as SDG found this to be the best way to handle it, and review it when utilized. Twice in the last 5 years we had to increase it to 2x to cover a shift last minute. With that being said, we are really good at covering each other when a SOS email goes out. In 20 years I had to call out one time for a bike crash (rib fx's, PTX, clavicle and scapula fx), and the second time was for the last 3hrs of a shift as I was profusely puking and near syncopal (still put in 5hrs).... not bragging, but rather I'm a product of the "you're at the hospital - either working or as a patient" generation. Perhaps it could be better, but there is no great cost effective way of staffing if there are many sick callouts.
 
JacobMcCandles said:
As in a call schedule? We have emergency plans in place but a call schedule we do not do. In my experience, that gets taken advantage of.
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Ours doesn't because our medical group is solid. We have a backup system. I'm on backup roughly one day per month, maybe a little less. Often if someone knows days in advance they will it off (unexpected funeral or whatever) we have a chat and someone will typically just offer to do it without using the backup (unless the backup wants it since we pay ourselves extra for these shifts). I haven't covered a shift while on backup in years.
 
TooMuchResearch said:
Ours doesn't because our medical group is solid. We have a backup system. I'm on backup roughly one day per month, maybe a little less. Often if someone knows days in advance they will it off (unexpected funeral or whatever) we have a chat and someone will typically just offer to do it without using the backup (unless the backup wants it since we pay ourselves extra for these shifts). I haven't covered a shift while on backup in years.
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similar.

I take “call” just under 1 shift per month. In 5 years, I think i’ve been called in twice.

We are a sdg with a good culture - I’ve never felt it was abused.
 
TeddyBoomBoom said:
similar.

I take “call” just under 1 shift per month. In 5 years, I think i’ve been called in twice.

We are a sdg with a good culture - I’ve never felt it was abused.
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Only works if you have a big enough group. At my old gig there were only about 10 FT docs. That works out to 3 call days a month on top of a regular schedule. No one wants that deal.
 
EMhawkeye said:
If a shift can't be covered it is ultimately the medical director's responsibility to cover the shift. Literally what they are paid for.
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Wait what. Does this mean medical directors can never leave town?


If EM docs had the same call out culture as unionized nurses, it would be impossible to staff the ED.
 
This is an interesting thread. Perspective matters. I have never "called off" a shift in my life PGY~20. I have called and asked pepole to help me and we swapped.

Understand we are a profession we are well paid. It truly saddens me that there is a factory worker mentality that is espoused here but at the same time I get it because we are treated as truly expendable. Its a pretty natural reaction to the circumstances many face.

Im glad im in an SDG and at the same time I feel like I own the group and treat it as if I was the sole owner. Shifts must be covered. I have had to adjust my work schedule for family events, unexpected events (totalled car) etc.
 
BoardingDoc said:
Only works if you have a big enough group. At my old gig there were only about 10 FT docs. That works out to 3 call days a month on top of a regular schedule. No one wants that deal.
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This is precisely the problem. Got a group of 50 who staff 2 EDs and a FSED? Easy to assign one day of backup call a month and check utilization. Big ol corporate group? Cool have a call process, that’s the advantage of a big ol corporate group!

Got a group of 9 FT docs and 5 per diems who staff one place with 4 shifts a day…
Either everyone takes 3-4 days of call a month on top of their scheduled shifts.
Or
The medical director doesn’t leave town for years, and can never be far from the hospital, also sometimes they are post nights or also working clinically… you gonna pay for that level of “directing”?
Or
You minimize call outs and bend over backwards to cover each other when needed though it’s chaotic, stressful, and people end up both not calling out when needed and working crazy circadian flips to cover.

We did 3 with a pinch of 1 (for semi/planned parental leaves) and a pinch of 2.

It… is OK until it isn’t. Group culture keeps it from being abused, but it also means people soldier through things they shouldn’t.

For my first decade I’d only missed one shift (norovirus).

The next five years? I traded out of a weekend the first time I got COVID in ‘22 (miserable).

Then I woke up unexpectedly in an ICU having been tubed for over a week… missed a shift for that!

IMO, it is one of the real advantages of a group that has 30+ people… you can have a real backup call person, and use it like real normal people use their sick days… not for BS but for illness!
 
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I'm at HCA, and calling out sick has not been an issue here. They're usually able to offer a bonus and have the shift covered. That said, there's been only once I've called out sick, a few years back when I came down with pneumonia
 
I wanted to call out sick in the middle of a shift last week.

Fever to 101. "Walking pneumonia". Worked a 7am-7pm (a rare DAYshift) because reasons. Purulent cough.

I gutted it out. DayQuil for the win. Called in my own Azithromycin. Wife grabbed it. Home and bed. Fever at 102 the next day.

I didn't feel like I needed a call-out. You got a kidney stone? I think that's call-out worthy.

Bro called me 3 weeks ago asking for me to work the first half of his 6pm-6am at like 2pm. Why? Family item. Psychic damage. I worked it until midnight and he rally'ed and worked the last half. Guy is a real bro.
 
RustedFox said:
I wanted to call out sick in the middle of a shift last week.

Fever to 101. "Walking pneumonia". Worked a 7am-7pm (a rare DAYshift) because reasons. Purulent cough.

I gutted it out. DayQuil for the win. Called in my own Azithromycin. Wife grabbed it. Home and bed. Fever at 102 the next day.

I didn't feel like I needed a call-out. You got a kidney stone? I think that's call-out worthy.

Bro called me 3 weeks ago asking for me to work the first half of his 6pm-6am at like 2pm. Why? Family item. Psychic damage. I worked it until midnight and he rally'ed and worked the last half. Guy is a real bro.
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Y'all (and any hospital-based specialty) are in a tough spot.

When you're as sick as you were, you shouldn't be working as a general rule. Fevers make you stupid. But, you can't just close the ED so you're kinda stuck. Luckily, between experience and how our training is set up, most of us can do a decent job on autopilot if we have to.

Lots of decent fixes in the thread so far but there's never going to be a one-size-fits-all solution other than running slightly overstaffed 24/7 which would result in slightly lower pay and not many people will accept that.
 
I am a partner in a democratic group. Whatever amount of money you think these CMGs and hospitals are stealing from you, multiply it by 3 or 4. Seriously, if you only knew...it would absolutely shock you.

That being said, if you are some W2 / 1099 drone of a CMG or hospital, you should absolutely have the same call out culture as the RNs. When I was a hospital slave, I called out because a new video game I was itching to play was released. Let them deal with it. I promise you...promise you...the insane amount of money they are stealing from you is more than enough premium for them to have to solve this.

Now, as an owner of a business, I've called out zero times. See how behavior and mentality shift with this?

Hospital slave = wage bytch + no say in operations + cog mentality and behavior.

Partner = High income + control of operations + owner mentality and behavior.
 
thegenius said:
Interesting how many people seem to view physician sick days as a moral failing rather than a staffing issue.

If one doctor getting the flu creates a crisis, the problem isn't the doctor.
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Again, this depends on your situation. IMO we are a profession. If you are treated as a professional you should behave that way. If you arent then behave as an employee.

It’s like parenting, i may be sick but i show up for my kids. I do think this is an important distinction.
 
EctopicFetus said:
Again, this depends on your situation. IMO we are a profession. If you are treated as a professional you should behave that way. If you arent then behave as an employee.

It’s like parenting, i may be sick but i show up for my kids. I do think this is an important distinction.
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Are you suggesting it’s professional to show up for patients while sick with influenza?
 
I’m still surprised at the number of people who don’t understand how important their job is. I guess it makes sense on why so many work for CMGs because they’re convinced they’re not important. You can’t work from home. If you don’t show up then somebody has to. There’s no other option. This isn’t Applebee’s or even some white collar office job.
 
Yea sorry that I’m not sorry… I’m a doctor but I’m also a human being as well. If I’m sick or my child is sick? At the end of the day I’m an employee. If you want to make it seem like I’m holier than thouuuuu bc I’m a doctor… give me tort reform, give me the ability to advocate for things I need and want… if not then **** you and **** the system. I’m not morally corrupt… the system is the one that’s morally corrupt and I’m just a cog in the dysfunctional wheel. I show up for work 99.99 percent of the time. The one or two times for legit reasons… I will not feel guilty for my own personal health and wellness.
 
If I'm too ill to work, I utilize our backup system. I don't feel bad about it. My partner or employed eventual partner is paid to take call and paid more than normal shift pay on top of the call pay to work. We don't make the sick person or person with a sick kid or dying grandparent find their own coverage. It doesn't get used often enough that anyone is upset by it. It is often cited as one of many reasons people like being part of our group. It doesn't make us less professional, and one of us always shows up for every shift, every time.
 
This is the perfect example of how EM is terrible in the United States.

There is nothing professional about regularly working shifts with communicable diseases with immunocompromised patients.

In fact its the complete opposite and the fact that its accepted practice at work shows how unprofessional we are towards patients.

This might shock people but in most other countries they actually have enough physicians on their shifts to be able to cover for serious illnesses so its never an issue and sick people are not expected to sit in their bed calling and begging their coworkers to cover their shifts because their group will not provide coverage for sick physicians.
But god forbid you ever suggest taking in less in salaries to provide more staffing or more backup and suddenly its no longer a profession but rather a business.
 
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How did that work out for you guys during peak covid? Sometimes we found coverage, but quite a few times, docs worked sick. Man, that was rough.
 
Mount Asclepius said:
The degradation of a physician. It was, and sometimes still is, a calling - a profession. A calling… I don’t think that meant calling out. An owner, not an employee.
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I personally don't think showing up to work puke sick and delirious from fever is in the best interest of patient care, especially with the volume of undifferentiated mess seen in the ED.
 
EctopicFetus said:
Again, this depends on your situation. IMO we are a profession. If you are treated as a professional you should behave that way. If you arent then behave as an employee.

It’s like parenting, i may be sick but i show up for my kids. I do think this is an important distinction.
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What is this "professional" standard you are referring to? Airline pilots call out sick, CEOs can take sick days, members of Congress can take sick days, Four Star Generals can take sick days, I could go on...the issue isn't that we're professionals, it's that at a systems level we are "essential." COVID showed us what being an "essential" worker actually means to the powers that be. Many are saying it doesn't have to be that way if we put better systems in place, which I agree with in most circumstances.
 
Mount Asclepius said:
The degradation of a physician. It was, and sometimes still is, a calling - a profession. A calling… I don’t think that meant calling out. An owner, not an employee.
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It’s totally a calling and I love what I do… it’s in my DNA. But tell that to my employers who treat me as an employee 🤷‍♂️!
 
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