Do students in medical school ever smoke?

[mehc012]

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They could probably do this instead. However, there would likely be just as much, if not more uproar about being unfairly taxed for your personal choices (smoking). Given how good of standing hospitals (and other firms are for that matter) are on this, going to the extreme is not all that unexpected. I have no idea what the data is comparing the two methodologies, it likely doesn't exist.

Firms get to pick who they want as employees. You are not entitled to positions or consideration at a particular place. You simply can not be discriminated against for certain things. In the same way it is to a hospital's benefit not to hire lazy or stupid employees, it is to their benefit to not hire smokers. I see no problem with them looking out for their interests. If you disagree or think that they aren't fair, by all means complain, protest or do whatever else you want. But, the effect will likely be the same as the crappy student who thinks that they are being discriminated against because they have a low GPA and MCAT and no medical school accepted them.

If I am lazy or stupid, I suck at doing my job.
If I smoke a cigarette once a week on my off-day (yes, intentionally small, but it falls under the ban as described) I am not in any way affecting my ability to do my job.

It's not a fair analogy.

Your point thus far is basically 'the hospital has all the power, so suck it'. Yet there are many, MANY times in US history where we have decided that employers should not be able to take every action which benefits them at the expense of their employees, just because they have the power to make the employees suck it up and deal with it or gtfo.

 

[mehc012]

There tends to be this whole "don't tread on me" mentality and a lot of complaining about how unfair schools/hospitals are. They don't have to be "fair". They can make a policy that you have to show up in a bowtie every day if they want. As long as they aren't doing anything illegal that's their prerogative.

That affects how I conduct myself at work. If they said that I had to wear a bowtie at all times, even when at home, out with my friends, or in bed with my wife, it would be more analogous to the issue in this particular thread.

 

[masaraksh]

Employers are allowed to set contractual rules for employment. Something can be "perfectly legal" but also against the terms of employment.

Yes, except with residencies and "The Match" its far from a free market. You basically have to go where you match so by having such anti-smoking policies, programs are essentially mandating life-style behaviors.

From my 6 mo in med school so far, I have not seen a single classmate smoke... But I probably hang out less with classmates than would be average since I have more friends outside of med school. However, when the topic came up one time I hear that there are a few kids who smoke (also heard from a friend that his roommate occasionally smokes pot).

I came home for the holidays and saw a friend from high school smoke one of those electronic vaporizer cigarettes. Honestly, seemed healthier.

 

[mimelim]

I actually acknowledged that the difference was one of choice, but went on to point out that there are a LOT of choices in your day to day life that are directly analogous to this one. How is it not a "slippery slope"? That is exactly the problem here. Eating unhealthy foods, drinking alcohol, maintaining a healthy BMI...those are all very similar lifestyle choices to not smoking, and not at all 'much larger things'. If we are OK with this one 'calculated move', then how do we say the next one is wrong? Where do we draw the line?

They are infringing on your rights (not in the legalese way, but in the 'limiting your personal freedoms' way.) They just don't happen to be targeting any that you personally care about. Yet.

Pretty well agreed that minimal smoking (some in Cardiology/Vascular would argue ANY smoking) is detrimental to health. Nobody, even remotely considers eating unhealthy or drinking alcohol to be the same. Imagine trying to test the hypothesis: "Drinking soda once a week for a year has significant negative health consequences." I'm sorry, but if you can't see the difference between those and smoking, I don't know what to tell you. And again, "maintaining a healthy BMI" is not something that can be remotely compared as it catches multiple variables/inputs. One can eat unhealthy and drink alcohol in moderation without negative consequences. We DO 'discriminate' against those that have an alcohol problem by requiring them to report DUIs or alcohol citations before a medical board. The bar is just that much higher.

And again, the firm has no obligation to you, they are not telling you that you can't smoke. They are telling you that just like if you didn't meet their other requirements like being intelligent/hard working, they don't want you as an employee.

 

[mehc012]

Pretty well agreed that minimal smoking (some in Cardiology/Vascular would argue ANY smoking) is detrimental to health. Nobody, even remotely considers eating unhealthy or drinking alcohol to be the same. Imagine trying to test the hypothesis: "Drinking soda once a week for a year has significant negative health consequences." I'm sorry, but if you can't see the difference between those and smoking, I don't know what to tell you. And again, "maintaining a healthy BMI" is not something that can be remotely compared as it catches multiple variables/inputs. One can eat unhealthy and drink alcohol in moderation without negative consequences. We DO 'discriminate' against those that have an alcohol problem by requiring them to report DUIs or alcohol citations before a medical board. The bar is just that much higher.

And again, the firm has no obligation to you, they are not telling you that you can't smoke. They are telling you that just like if you didn't meet their other requirements like being intelligent/hard working, they don't want you as an employee.

I didn't say the health detriments were the same, I said that by your logic, the employer could dictate those things to me similarly. You're caught up on the health aspects of 'smoking is bad' which nobody has remotely disagreed with but which is, frankly, irrelevant.

A city has already decided that soda is enough of a health risk to discuss a ban selling it in large quantities...is it really such a stretch to suppose that an employer who has completely banned tobacco (which even the city has not done) would consider banning soda?

 

[mimelim]

If I am lazy or stupid, I suck at doing my job.
If I smoke a cigarette once a week on my off-day (yes, intentionally small, but it falls under the ban as described) I am not in any way affecting my ability to do my job.

It's not a fair analogy.

Your point thus far is basically 'the hospital has all the power, so suck it'. Yet there are many, MANY times in US history where we have decided that employers should not be able to take every action which benefits them at the expense of their employees, just because they have the power to make the employees suck it up and deal with it or gtfo.

This has been covered before. They ARE the same. They are hurting the firm. The firm has the right to select its employees to its betterment. Financially harming the firm is HURTING the firm. And again, if you don't think that is fair, look for employment elsewhere.

 

[mimelim]

Hardly irrelevant if the crux of your argument is, "but it is a slippery slope! Look they could go after all this other stuff next!"

This is no different than saying, "They are discriminating against me because I'm stupid, since they can pick and choose their employees who knows what they will use next!"

And with this, I'm done. I'm on vacation (well, at a conference, but in residency, it might as well be the same thing). So, I'm going to the pool to look over my presentation for tomorrow.

😛

 

[mehc012]

This has been covered before. They ARE the same. They are hurting the firm. The firm has the right to select its employees to its betterment. Financially harming the firm is HURTING the firm. And again, if you don't think that is fair, look for employment elsewhere.

Paying fair wages also hurts the firm. Too much money.
Keeping OSHA requirements can be expensive and time-consuming.

Let's just let employers dictate whatever they like and everyone who doesn't lap it up and dance to the tune should leave because they aren't willing to bend to ridiculous workplace conditions.

 

[mehc012]

Hardly irrelevant if the crux of your argument is, "but it is a slippery slope! Look they could go after all this other stuff next!"

This is no different than saying, "They are discriminating against me because I'm stupid, since they can pick and choose their employees who knows what they will use next!"

And with this, I'm done. I'm on vacation (well, at a conference, but in residency, it might as well be the same thing). So, I'm going to the pool to look over my presentation for tomorrow.

😛

I never once implied that employers couldn't choose employees who would do their job better. I just said it was ridiculous to then dictate their home life. My home life is none of my employers business.

I also think that disallowing people from smoking cigarettes at home is wrong for its own merits, not simply because it could lead to other things. I explained the issues I have with it, and then was also trying to point out the issues I have with the entire thought-process of the employer banning them by showing what that logic would look like when applied to other things. I'd like to discuss the huge issues involved with letting your employer decide which lifestyle choices they think are suitable for them - whether it be image-based, health-based, you name it - and make those choices for you. And I'd like to do it without getting caught up with how incredibly terrible smoking is for you because yeah, we all know that, but it doesn't change the fact that it's incredibly patronizing for your boss to make your health decisions for you.

If we had non employer-supplied healthcare, would you still think it was a reasonable decision? Because I hardly doubt that the policy would change.

And, just wondering, do these institutions hold their non-clinical employees to similar standards?

 

[veryborderlineapplicant]

Not


"Nicotine on your hands", if it was able to affect patients, would actually likely help respiratory problems long term. Nicotine is a bronchoconstrictor, which is bad for asthmatics (and I believe others with respiratory problems) if this occurs only a few times. But, bronchoconstriction has actually been found to paradoxically be beneficial over the long run for these people. I have nothing else to contribute to this discussion, just wanted to throw in some random medical trivia. Proceed.

Not to mention prescription nicotine has very good studies for treatment for anxiety, ADHD, and depression. My biggest complaint about the smoking debate is that people always try and make it black and white, just because smoking is bad for you doesn't mean that nicotine is harmful in all contexts, and the essence of "evil". You can want smokers to stop smoking in front of you and that's a valid objection, but that doesn't mean those who derive therapeutic benefit from it or use it as a lifestyle choice should be limited and stigmatized for what they do.

 

[milski]

And, just wondering, do these institutions hold their non-clinical employees to similar standards?

It is very likely that they do. There are companies in industries which are not related to healthcare at all which have similar restrictions on smoking.

 

[mehc012]

It is very likely that they do. There are companies in industries which are not related to healthcare at all which have similar restrictions on smoking.

Interesting. Researching the issue, it seems that this sort of policy is illegal in 'more than half the states' (seriously, at least 3 articles use that exact wording...gotta dig something better up), but not all. Looking into it more now.

 

[milski]

Interesting. Researching the issue, it seems that this sort of policy is illegal in about half of the states, but not all. Looking into it more now.

Look up Alaska Airlines if you're curious for something out of healthcare. They were the first to introduced it as a restriction for hiring/employment. I think there was even a lawsuit about it at some point but I could not find anything now, so I might be wrong about that. The reasoning, at least as far as the official statement went, was purely about health insurances costs.

 

[masaraksh]

That affects how I conduct myself at work. If they said that I had to wear a bowtie at all times, even when at home, out with my friends, or in bed with my wife, it would be more analogous to the issue in this particular thread.

Your wife might like that bow tie on you in bed.

 

[mehc012]

Look up Alaska Airlines if you're curious for something out of healthcare. They were the first to introduced it as a restriction for hiring/employment. I think there was even a lawsuit about it at some point but I could not find anything now, so I might be wrong about that. The reasoning, at least as far as the official statement went, was purely about health insurances costs.

Yeah, that was one of the earliest ones...interestingly, the ACLU was very concerned about that discriminatory policy and between their lobbying and of course tobacco companies, that's why 29 states have protections in place to prevent those policies.

I'm still going to have to side with the ACLU on this one.

 

[mehc012]

Your wife might like that bow tie on you in bed.

Ah true...but I'd rather it be her choice than my boss's!
*hypothetically, as she does not exist*

 

[masaraksh]

Hardly irrelevant if the crux of your argument is, "but it is a slippery slope! Look they could go after all this other stuff next!"

This is no different than saying, "They are discriminating against me because I'm stupid, since they can pick and choose their employees who knows what they will use next!"

And with this, I'm done. I'm on vacation (well, at a conference, but in residency, it might as well be the same thing). So, I'm going to the pool to look over my presentation for tomorrow.

😛

.... and if it wasn't for this 'firm' and your 'contract' just imagine. You could go to the pool, smoke, sip on tequila, and enjoy the view of all the pretty female vascular surgery residents in swimsuits

 

[mehc012]

.... and if it wasn't for this 'firm' and your 'contract' just imagine. You could go to the pool, smoke, sip on tequila, and enjoy the view of all the pretty female vascular surgery residents in swimsuits

Yeah, cuz nothing catches a pretty female vascular surgeon's eye like a man with a cigarette in his hand

 

[masaraksh]

Yeah, cuz nothing catches a pretty female vascular surgeon's eye like a man with a cigarette in his hand

Pfft, chain smoking is where its at.

A while ago, back in college, I played poker with some international students from pakistan. This one guy finished off a pack in under 4hrs.

 

[xffan624]

Pfft, chain smoking is where its at.

A while ago, back in college, I played poker with some international students from pakistan. This one guy finished off a pack in under 4hrs.

And how many did you finish off sitting next to him?

 

[masaraksh]

I don't smoke. Some of my friends do.

 

[medic86]

Interesting.

I'm actually amazed that a self-proclaimed libertarian can argue for the infringement of individual liberties. Just because it doesn't affect you doesn't mean it isn't representing a slippery slope.

 

[mimelim]

Interesting.

I'm actually amazed that a self-proclaimed libertarian can argue for the infringement of individual liberties. Just because it doesn't affect you doesn't mean it isn't representing a slippery slope.

Can you quote where a self-proclaimed libertarian is arguing for the infringement of individual liberties? I'm looking through this thread and can't find it. Or, for that matter, where anyone argues that because it doesn't affect them something isn't a slippery slope?

I mean if you make up characters saying things, I guess what you say makes sense. If you read the thread, less so.

 

[medic86]

Can you quote where a self-proclaimed libertarian is arguing for the infringement of individual liberties? I'm looking through this thread and can't find it. Or, for that matter, where anyone argues that because it doesn't affect them something isn't a slippery slope?

I mean if you make up characters saying things, I guess what you say makes sense. If you read the thread, less so.

So you're telling me that you haven't argued for an employer's right to dictate an employee's lifestyle choices anywhere in this thread?

Hm. I must have made that up!

 

[FutureOncologist]

Bro, chewing tobacco is the rage at my school right now. It's rather disgusting and turns girls off.

 

[mehc012]

Bro, chewing tobacco is the rage at my school right now. It's rather disgusting and turns girls off.

So do cigs, man, so do cigs...

 

[mimelim]

So you're telling me that you haven't argued for an employer's right to dictate an employee's lifestyle choices anywhere in this thread?

Hm. I must have made that up!

You did make it up. As previously stated, you should read the thread more carefully.

Once again, I invite you to quote where a self-proclaimed libertarian is arguing for the infringement of individual liberties? I'm looking through this thread and can't find it. Or, for that matter, where anyone argues that because it doesn't affect them something isn't a slippery slope?

You are shifting from "infringement of individual liberties" to "dictate an employee's lifestyle choice". Neither of which are argued for by anyone, anywhere in this thread, but regardless are not in any way equivalent.

Employers have the right to dictate certain elements of how their business is run. They have the right to enforce things in employment contracts that are unrelated to time when physically at work as they can still be detrimental to the firm. This is not a new concept and certainly not exclusive to hospitals and healthcare. You as an individual have rights and liberties, nobody is forcing you to interact with these businesses in any way. If you don't like it, take your business elsewhere and/or work somewhere else.

The sense of entitlement that someone else should sacrifice money and resources because of YOUR lifestyle choices is astounding. I mean I know we are the entitlement generation and the generation before us is constantly complaining that we "always want hand-outs", but really? You want financial support because of your "individual liberty" to smoke? Really?

 

[mehc012]

You did make it up. As previously stated, you should read the thread more carefully.

Once again, I invite you to quote where a self-proclaimed libertarian is arguing for the infringement of individual liberties? I'm looking through this thread and can't find it. Or, for that matter, where anyone argues that because it doesn't affect them something isn't a slippery slope?

You are shifting from "infringement of individual liberties" to "dictate an employee's lifestyle choice". Neither of which are argued for by anyone, anywhere in this thread, but regardless are not in any way equivalent.

Employers have the right to dictate certain elements of how their business is run. They have the right to enforce things in employment contracts that are unrelated to time when physically at work as they can still be detrimental to the firm. This is not a new concept and certainly not exclusive to hospitals and healthcare. You as an individual have rights and liberties, nobody is forcing you to interact with these businesses in any way. If you don't like it, take your business elsewhere and/or work somewhere else.

The sense of entitlement that someone else should sacrifice money and resources because of YOUR lifestyle choices is astounding. I mean I know we are the entitlement generation and the generation before us is constantly complaining that we "always want hand-outs", but really? You want financial support because of your "individual liberty" to smoke? Really?

Speaking of things that nobody has said in this thread...

 

[Dr Van Helsing]

Bro, chewing tobacco is the rage at my school right now. It's rather disgusting and turns girls off.

I tried chew once; Never again.

 

[mimelim]

Speaking of things that nobody has said in this thread...

If you...
#1 Acknowledge that it costs more to insure smokers
#2 Expect a hospital to cover that increase in cost

Then yes, you are saying EXACTLY what you bolded. Given that a number of people have indicated that they agree with #1 and #2, it has been said multiple times in this thread.

I don't really know the foundation of some of the people in this thread, but if you have ever worked with insurance companies and/or benefits from a company or hospital, it is very clear exactly what this increased cost is. What you are advocating for in the name of "individual liberties", is that a hospital should support the smoker's lifestyle choice financially.

Personally, I don't think that they are. I think that individuals should be responsible for their own lives and what they make of them and shouldn't expect handouts, especially when it comes to lifestyle choices.

 

[Temerit]

Where I live (Seattle) a law was just passed restricting background checks that can be performed by employers.

I hope in the future similar restrictions are placed on what employers can/cannot learn or dictate about their employees lives. Maybe at some point we will return to some semblance of privacy!

@mimelim

Your point about insurance is valid, but do these firms allow the option of working for them and personally bearing the additional insurance costs? This is not even to mention that employer-based insurance was never the best way of going about things and in all likelihood will cease to exist at some point.

We could also delve into the issue that since the poor smoke at higher rates that such an employment policy discriminates on the basis of class 😉 That of course applying more to non-clinical positions that clinical ones.

 

[mehc012]

If you...
#1 Acknowledge that it costs more to insure smokers
#2 Expect a hospital to cover that increase in cost

Then yes, you are saying EXACTLY what you bolded. Given that a number of people have indicated that they agree with #1 and #2, it has been said multiple times in this thread.

I don't really know the foundation of some of the people in this thread, but if you have ever worked with insurance companies and/or benefits from a company or hospital, it is very clear exactly what this increased cost is. What you are advocating for in the name of "individual liberties", is that a hospital should support the smoker's lifestyle choice financially.

Personally, I don't think that they are. I think that individuals should be responsible for their own lives and what they make of them and shouldn't expect handouts, especially when it comes to lifestyle choices.

Never mind the multiple times when I stated that it would be perfectly legitimate to increase insurance fees to smokers, or for their insurance to incur a penalty not covered by employers, or any other solution which does not entail the employer dictating the personal lives of its workers.

Never mind the fact that there are plenty of people who will cost more to insure due to other choices they make, yet we don't advocate banning them from jobs they're otherwise suited for.

I've made those concessions to you, even though I think it's bull$#@, because I don't want to get into the fact that yeah, even as a NONsmoker, I respect their right to make their choices even though my insurance bill is higher for it. When I pay for insurance, I take a calculated financial risk in order to avoid financial catastrophe. I am neither the best bet for an insurance company nor the worst one. I accept that some people will spend thousands on insurance and never get anything back from it...those are the lucky ones, they stay healthy. Others will pay a little and end up having hundreds of thousands covered. That's what insurance is, it's the entire point of the damn thing. And I accept that my fine is a bit higher because people did stupid things with their life choices, but I would take that trade any day over living in a society where everyone got to evaluate whether they thought that my life choices count as 'acceptable' or 'unacceptable' risks to them. But all of that aside, I have repeatedly stated that, if you feel that strongly about the damn finances, this should be made a financial issue, rather than an employment one.

Why do you keep putting individual liberties in quotations, as if it's not a real thing? It's not like it's some radical, hippie notion that people should be able to partake in legal activities in their off time, even if they risk injury because of it. It's not like this is some fringe idea. 4-5 states have laws which prohibit employers from dicatating/banning any legal activities in employees' off times. Several have ones referencing alcohol specifically. The fact that obesity and sexual orientation are protected classes indicates that there are some life choices which are widely considered important enough not to be dictated by employers, ever. And again, 29 states have laws on the books specifically preventing similar 'non-smoker' employment practices, because they're considered to be discriminatory. Again, it's fine if that's not a liberty that you value, but that doesn't mean that it's not a liberty.

 

[Gauss44]

Just the opposite. The smokers are all going to find each other behind a bush someplace and bond. The non-smokers will not have the same bonding experience. Smoking, despite it's nasty health effects, is like being part of a social club where you are constantly meeting new people and making new connections.

 

[mimelim]

Where I live (Seattle) a law was just passed restricting background checks that can be performed by employers.

I hope in the future similar restrictions are placed on what employers can/cannot learn or dictate about their employees lives. Maybe at some point we will return to some semblance of privacy!

@mimelim

Your point about insurance is valid, but do these firms allow the option of working for them and personally bearing the additional insurance costs? This is not even to mention that employer-based insurance was never the best way of going about things and in all likelihood will cease to exist at some point.

We could also delve into the issue that since the poor smoke at higher rates that such an employment policy discriminates on the basis of class 😉 That of course applying more to non-clinical positions that clinical ones.

I am all for most of the ACLU pushes for protecting people's privacy from their employer. It is very important. I just think that if you do something that intrinsically affects your employer, you should understand that they also have the right to care about that...

And as far as I know, most firms do not. This is me logicing through this from here on (ie somewhat guessing, but I don't think it lacks in foundation) The negative press about having a blanket tobacco ban is not much worse than having a 'tax' on smokers. People will make the exact same, "But they are infringing on our liberties!" And there are tangible benefits to outright bans. For starters, it is attractive to some to know that tobacco will not be a part of the work place in any way or a part of their coworkers' lives and can actually help with recruitment. Secondly, and more practically, I think that a blanket ban allows the firm to get a better deal on their health insurance plan than having to parcel it out for individuals.

And yes, I think that of all the arguments, the discrimination based on class because they smoke more is probably the most valid. Incredibly difficult to really prove practically speaking.

 

[mimelim]

Never mind the multiple times when I stated that it would be perfectly legitimate to increase insurance fees to smokers, or for their insurance to incur a penalty not covered by employers, or any other solution which does not entail the employer dictating the personal lives of its workers.

Never mind the fact that there are plenty of people who will cost more to insure due to other choices they make, yet we don't advocate banning them from jobs they're otherwise suited for.

I've made those concessions to you, even though I think it's bull$#@, because I don't want to get into the fact that yeah, even as a NONsmoker, I respect their right to make their choices even though my insurance bill is higher for it. When I pay for insurance, I take a calculated financial risk in order to avoid financial catastrophe. I am neither the best bet for an insurance company nor the worst one. I accept that some people will spend thousands on insurance and never get anything back from it...those are the lucky ones, they stay healthy. Others will pay a little and end up having hundreds of thousands covered. That's what insurance is, it's the entire point of the damn thing. And I accept that my fine is a bit higher because people did stupid things with their life choices, but I would take that trade any day over living in a society where everyone got to evaluate whether they thought that my life choices count as 'acceptable' or 'unacceptable' risks to them. But all of that aside, I have repeatedly stated that, if you feel that strongly about the damn finances, this should be made a financial issue, rather than an employment one.

Why do you keep putting individual liberties in quotations, as if it's not a real thing? It's not like it's some radical, hippie notion that people should be able to partake in legal activities in their off time, even if they risk injury because of it. It's not like this is some fringe idea. 4-5 states have laws which prohibit employers from dicatating/banning any legal activities in employees' off times. Several have ones referencing alcohol specifically. The fact that obesity and sexual orientation are protected classes indicates that there are some life choices which are widely considered important enough not to be dictated by employers, ever. And again, 29 states have laws on the books specifically preventing similar 'non-smoker' employment practices, because they're considered to be discriminatory. Again, it's fine if that's not a liberty that you value, but that doesn't mean that it's not a liberty.

I don't think that you understand what I am talking about when I am talking about insurance. This has nothing to do with you as another employee paying for insurance or your insurance going up because of it. This is about on the firm's end. What I am talking about is that when a employer supplies health insurance, often the employee will pay part of it, I'll use my wife as an example because I just did hers. She pays $150 per pay period for coverage. Her employer pays $500 every pay period to the insurance. The actual cost of the insurance is $650 per pay period. That $500 would go up if she were a smoker, often quite significantly. I understand what you are saying about people paying out of pocket if they are a smoker. What I am saying is that I don't think that a business should be obligated to do that. Is it a better system? Maybe. But, I think that a business should be able to make that determination themselves.

Why do I put "individual liberties" in quotes? Because the ability to smoke is not a right and some people in this thread seem to think that it is. This isn't about a "liberty" that I value. You have a right to privacy, which is the basis for most of this. Which I most certainly consider an individual liberty. But, I don't think that you have an intrinsic right to smoking, ESPECIALLY when it infringes on others. Also, every single one of those laws that you cite are the result of specific tobacco company lobbying. They tend to have more financing power than most medical groups as I'm sure that you are aware. They are on the books because of lobbying, which, is our system. And it is a protected class in a particular state, then so be it.

Personally, I don't think that smoking should be a "protected class" given that it is a lifestyle choice that infringes on others, but if you are okay with that, then we can just live in different states *shrug*.

 

[mehc012]

I don't think that you understand what I am talking about when I am talking about insurance. This has nothing to do with you as another employee paying for insurance or your insurance going up because of it. This is about on the firm's end. What I am talking about is that when a employer supplies health insurance, often the employee will pay part of it, I'll use my wife as an example because I just did hers. She pays $150 per pay period for coverage. Her employer pays $500 every pay period to the insurance. The actual cost of the insurance is $650 per pay period. That $500 would go up if she were a smoker, often quite significantly. I understand what you are saying about people paying out of pocket if they are a smoker. What I am saying is that I don't think that a business should be obligated to do that. Is it a better system? Maybe. But, I think that a business should be able to make that determination themselves.

It works out the same in the end anyway. Whether I directly pay more to the insurance company, or the employer pays more to the insurance company in aggregate and salaries end up going down a bit, etc.
I take the most issue with the fact that you find it less reasonable to obligate a company to work out their finances in a way that's reasonable to everyone than to obligate an individual to be held accountable to their employer for their private, off-the-job choices.

Also, every single one of those laws that you cite are the result of specific tobacco company lobbying. They tend to have more financing power than most medical groups as I'm sure that you are aware. They are on the books because of lobbying, which, is our system. And it is a protected class in a particular state, then so be it.

Yup, that's why alcohol is protected in fewer states than tobacco, and 'everything' is protected in only 4-5. It's sad, really, that things are determined more by who can fund things than anything else. For the record, though, one of the main proponents of those laws was actually the ACLU, who generally aren't in things for their own financial gain.

I'm sorry, I just don't really gaf about the fact that the employer has to pay extra for health insurance. I really don't. Maybe I should, but I actually give zero craps. The entire point of requiring employers to provide benefits in the first place was to protect the workers, all of the workers. Allowing employers to do an end run around that by saying 'well, we'll just only hire people with cheap insurance' and then dictating their workers personal lives in order to do it? Why not pull a McDonald's and just purposefully hire only part time workers so you don't have to give benefits at all? It's contrary to the entire purpose of the setup, and sets the stage for so many worse patronizing requirements it's not even funny. The fact that the hospital trailblazer in this area actually publicly stated that he wouldn't hire obese people if it were legal to discriminate that way just makes it that much more disturbing - do health insurance companies even charge extra for obese people, or is this purely a Hooters-style "we want our employees to look a certain way" thing (in this case, 'ideal' health-wise)?

 

[Law2Doc]

First, smoking does impact others. Second hand smoke is a real thing, and many of the kids you see with asthma these days is actually a sequella of it. Second, smokers stink up the place. They don't realize it, because they are desensitized but to everyone else we can often smell them as they enter the room. You are going to hate having to use the bed in a call room after a smoker. Third, smoking particles on people's clothing are allergens to some. Fourth, someone addicted to smoking will get downright irritable if stuck in a working environment or OR for a long time without the opportunity for a smoking break, and that can make for bad employee interactions. Fifth, smokers have a ton of ailments that employers dont want to subsidize in their group insurance plans. sixth, there are very real limitations to lung capacity that can matter in a Hospital situation -- if a guy has to run up a floor of stairs to a code you are going to see big difference in the smoker an nonsmoker. And that's ignoring the fact that it causes cancer and exacerbates almost all of the ailments we treat at hospitals day to day. And makes doctors who smoke into the world biggest hypocrites because the one thing we are supposed to council every patient about is smoking.

My point is the whole "it doesn't affect nobody else" line of discussion is kind of silly. And only made by people who smoke and should know better.

 

[Law2Doc]

...
I take the most issue with the fact that you find it less reasonable to obligate a company to work out their finances in a way that's reasonable to everyone than to obligate an individual to be held accountable to their employer for their private, off-the-job choices.
...

So you are saying you are fine with your salary being lower because someone else chooses to smoke? Smoking affects insurance cosrs far far far more than any other single line item. People aren't allowed to smoke, you earn more. It plain and simple. You may feel you don't mind earning less so that some guy can make unhealthy off the job choices, but I think you are grossly underestimating costs and thinking we are talking pennies as opposed to hundreds to thousands of dollars a year. Frankly I can't think of any colleague I would even consider coughing up a couple hundred dollars a year for, just to allow him/her the opportunity to smoke. Although I might be persuaded to kick in money to help a colleague quit. Let's not pretend there aren't real direct costs to the nonsmoker employees. People who think they are doing this to themselves and not everyone with a financial stake to their well being (ie everyone else on the same group plan) doesn't get it.

 

[medic86]

I take issue with the fact that almost no one in this thread gives a crap because these bans don't affect them. What about the rampant obesity in this country, along with the countless comorbidities? This is a far more expensive issue, but no one is arguing this case because they're a protected class. I think it's just easy to demonize the smoking class, and I don't necessarily believe it's right.

Law2Doc: I doubt anyone would argue with your points. I can understand employers making rules against smoking at work. If those "irritable" employers act up at work, that's on them - whether or not it's because they can't smoke, that's on them. They'll deal with the consequences.

But, just for the sake of argument, I can easily find a smoker who can run circles around those fat doctors.

The point mehc012 and I are trying to make: where do you draw the line? In regard to nicotine tests: I haven't smoked in years, but I have been using nicotine replacement. Do I just get fired because I have nicotine in my system? What about individuals who have the occasional cigar/pipe? How do you classify a smoker? I can understand charging smokers more for health insurance, but firing/outright denying employment because of it? Sounds a little ridiculous to me.

It's easy to look at a smoker and say "well, you should just quit" when you've never been on that side of the cigarette.

 

[NickNaylor]

I use an e-cig - never smoked cigarettes and I never will because both of my parents are smokers and I can see the long-term effects of that choice right in front of me, but I will enjoy an occasional bowl in the pipe or a cigar for special occasions. I make a point of not using it around my classmates or around the med school campus (and certainly not indoors, for obvious reasons). I can't think of anyone in my class that smokes, but I wouldn't be surprised if a few people did.

 

[Law2Doc]

I take issue with the fact that almost no one in this thread gives a crap because these bans don't affect them. What about the rampant obesity in this country, along with the countless comorbidities? This is a far more expensive issue, but no one is arguing this case because they're a protected class. I think it's just easy to demonize the smoking class, and I don't necessarily believe it's right.

Law2Doc: I doubt anyone would argue with your points. I can understand employers making rules against smoking at work. If those "irritable" employers act up at work, that's on them - whether or not it's because they can't smoke, that's on them. They'll deal with the consequences.

But, just for the sake of argument, I can easily find a smoker who can run circles around those fat doctors.

The point mehc012 and I are trying to make: where do you draw the line? In regard to nicotine tests: I haven't smoked in years, but I have been using nicotine replacement. Do I just get fired because I have nicotine in my system? What about individuals who have the occasional cigar/pipe? How do you classify a smoker? I can understand charging smokers more for health insurance, but firing/outright denying employment because of it? Sounds a little ridiculous to me.

It's easy to look at a smoker and say "well, you should just quit" when you've never been on that side of the cigarette.

While "obesity" is definitely a bad thing I (and insurers) disagree that it's a more expensive issue, particularly if we are looking at it in terms of group insurance costs. And the jump from obesity to diabetes is not as linear as the jump from smoking is to lung cancer. And again, it's not as simple as charging them more for insurance to be a smoker -- the insurance companies charge EVERYONE more if there is a smoker on their plan. Why? Because actuarially, their lifetime risks and healthcare costs are absurdly higher than everyone else's. Doesn't matter if you know a few that can run laps around their fatter colleagues, statistically they are more likely to die a horrible death younger, after a ton of expensive intervention. And in medicine you will see lots of this on a daily basis.

I'm not saying it's easy to quit. I'm saying there's not a rational or intelligent argument you can ever make not to, and employers/insurers forcing you to do something you'd be foolish not to attempt isn't such a horrible thing.

 

[Thoroughbred_Med]

What is the justification? Is it because having nicotine on your clothing or hands could harm some patients with severe respiratory problems?

I just don't see how a hospital or residency program, as an employer, can get away with dictating employees' lifestyle choices - which, while universally considered to be unhealthy, are still perfectly legal. I'm not a smoker, and I do think it's hypocritical for doctors to smoke, but I'm not so sure that it's right for any type of employer to tell employees what they can and cannot do with their own bodies/lifestyle (as long as it's legal). Of course, secondhand smoke does harm others, so most hospital campuses are tobacco free. And it's great for employers to want to help their employees be healthier through programs, incentives, etc. But telling them what to do when they're away from work? I don't know. It's a slippery slope. Would it be right to require doctors who are overweight/obese to lose weight or give up desserts? Because that's an even bigger problem than smoking these days in all patient populations (high rates of DM type II, HTN, etc).

Also, if "tobacco free" includes cigars, I know SO many surgeons and docs who smoke an occasional cigar. Is that not okay anymore?

If it jeopardizes patient safety, that's the only way I can see it being mandatory.

110%

 

[Thoroughbred_Med]

Bro, chewing tobacco is the rage at my school right now. It's rather disgusting and turns girls off.

Bro, chewing is so highly addictive its ridiculous. I got hooked during high school from being coerced by the guys baseball team... haven't been able to kick the nicotine habit since. It sucks.

On a side note. what's the consensus on vape smoking (e-cig, hookah) vs. cigarettes? Does vaporizing the smoke make it any less harmful on the endothelium?

 

[mehc012]

So you are saying you are fine with your salary being lower because someone else chooses to smoke? Smoking affects insurance cosrs far far far more than any other single line item. People aren't allowed to smoke, you earn more. It plain and simple. You may feel you don't mind earning less so that some guy can make unhealthy off the job choices, but I think you are grossly underestimating costs and thinking we are talking pennies as opposed to hundreds to thousands of dollars a year. Frankly I can't think of any colleague I would even consider coughing up a couple hundred dollars a year for, just to allow him/her the opportunity to smoke. Although I might be persuaded to kick in money to help a colleague quit. Let's not pretend there aren't real direct costs to the nonsmoker employees. People who think they are doing this to themselves and not everyone with a financial stake to their well being (ie everyone else on the same group plan) doesn't get it.

First of all, yup. I'm absolutely fine with paying a little bit more, and by that I do mean hundreds, not so much to allow people to smoke, because I actually hate smoking, but to continue with a system where my employer is not micromanaging my personal life and I am not setting the precedent that it is fine to screw people over for risks that they choose to take outside of work. I don't want to even remotely entertain the idea that it is acceptable for my boss to tell me 'hey, we have decided that x is an acceptable risk, but y is not...no more y for you.' Participating in the system as described, where employees are beholden to their employers for their decisions at home, is a far greater cost than the hundreds in insurance. So even though this particular stipulation involves people not myself, I'm really willing to cough up a few hundred a year for me.

Second, the portion you are quoting does not even say that. There, what I'm saying is that it is ridiculous that someone thinks it's OK to let employers obligate their employees to live the way which benefits the company most, but somehow not OK to obligate the business itself to work out a way to transfer the financial impact of smoking onto smokers, such as charging them in some way for the extra insurance rate.

 

[xffan624]

Bro, chewing is so highly addictive its ridiculous. I got hooked during high school from being coerced by the guys baseball team... haven't been able to kick the nicotine habit since. It sucks.

On a side note. what's the consensus on vape smoking (e-cig, hookah) vs. cigarettes? Does vaporizing the smoke make it any less harmful on the endothelium?

The jury's still out on all the side effects, but in general, e-vaping is less harmful to the lungs. You're pretty much taking the nicotine and vaporizing it. It can also be used as a smoking cessation tool (ie. scaled down the nicotine dose gradually). Plus less stinky.

 

[KnuxNole]

Just a random question that occurred to me. Would smoking a cigarette on a medical school campus be so frowned upon that nobody does it?

I would say 1/3 of my med school class regularly smoked cigarettes...

 

[KnuxNole]

Very few med students smoke these days. You will spend so much of your career dealing with the consequences of smoking that it would be foolish and you'll know better. You will need to tell every patient to stop smoking, and won't want to be too much of a hypocrite to boot. Plus, as mentioned, you tend to have to leave the premises to do it. If you are addicted, get the patch or gum and figure out how to quit.

I would disagree, as you know, a lot of people aren't as gung ho as taking care of their own health. Yes, they'll tell their patients to stop for patient care purposes, but for their own sake, they would do whatever they please...

Also, a lot of specialties who don't counsel on smoking will say "Dude, who gives a ****!".

 

[Thoroughbred_Med]

Even more striking is that tobacco ranks 3rd highest in addiction potential, right behind heroin and cocaine. Why drug test for tobacco vs alcohol? Alcohol is deemed more harmful than tobacco and even cannabis. The logic of legality of drugs is still something that puzzles me...

 

[Aloft085]

This debate illustrates well the dangers of obtaining your health insurance from an employer. If they're paying for it, they can attempt to dictate your lifestyle choices. It's time we did away with this anachronistic system and moved to a model where individuals purchase health insurance for themselves, perhaps with a portion of set-aside pay that can only be used for that purpose.

In my opinion, it is also plainly unethical for a residency program to make this demand on residents. Residency is legally required in order for us to practice medicine, and the slots are often limited and competitive. The power relationship is slanted overwhelmingly in favor of the 'employer', unlike more traditional jobs. You could take advantage of your residents in all sorts of ways, and they would probably comply. Does that make it ethical? No. If you wouldn't put the same stipulation on a highly-qualified surgeon that you're trying to recruit, then you shouldn't put it on a lowly resident.

Now let's attack the financial rationale for such a decision. Residents are generally young, and only with their employer for the length of the residency. If they occasionally enjoy a cigar or cigarette over the span of their residency, what's the likelihood of that causing a significant health issue during their term of employment? Basically zero. I'll give you my loose pocket change as compensation for the added risk.

 

[medic86]

This is where your point misses the mark. The hospitals that have explicitly banned smoking have done it for all employees. From the cafeteria workers to the surgeons to the CEO.

His argument isn't any less legitimate.