Do students in medical school ever smoke?

[KnuxNole]

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A lot of prospective residents try to match in programs that won't nicotine test them, so they can smoke without worry. I know it sucks for a lot of med students who smoke, but I know people who smoke as a resident now without any clear path of stopping.

 

[mehc012]

I think the point of employer sponsored vs direct insurance is a very good one. It's one of those examples of how hard it is to take away a benefit once it exists.

But if you are looking at this from purely the hospital's/insurer financial perspective - in order for the hospital to have a negotiated lower rate with the insurer they need the smoking ban to be universal. It's not like they can just say - oh, well we can let the young employees smoke, that doesn't hurt anything - since the insurance company would never go for that.

This whole debate is also a reminder about how much of a PITA individual insurance is when insurers can't risk-adjust or exclude people. I understand the moral underpinnings of not excluding people for pre-existing conditions, but the result is that everyone else in the insurance pool has to pay for other people's risks.

Mimelim pointed out that he pays extra for disability insurance for taking a known risk (rock-climbing). Disability insurers can even exclude you entirely if you do riskier activities than that like sky diving. Car insurers can raise your rates if you have a history of getting in lots of wrecks. Health insurers don't get to do that, so the whole group of insured has to absorb everyone's risk.

Disability insurance is an entire separate issue, though. I would argue that there are still definite financial disadvantages to his employer due to his rock climbing. Sure, he will get disability elsewhere, but is his first line health insurance still through them? What about the opportunity cost of the program having invested years and dollars into training a resident which will be a loss if he destroys his hands or bashes his head on something?

Financially, his residency would be happier without that risk, no? But it would still be wrong for them to ban his extracurricular.

 

[mimelim]

Disability insurance is an entire separate issue, though. I would argue that there are still definite financial disadvantages to his employer due to his rock climbing. Sure, he will get disability elsewhere, but is his first line health insurance still through them? What about the opportunity cost of the program having invested years and dollars into training a resident which will be a loss if he destroys his hands or bashes his head on something?

Financially, his residency would be happier without that risk, no? But it would still be wrong for them to ban his extracurricular.

Disability insurance has nothing to do with my employer. This is personal insurance that I purchase to protect myself and future and is generally recommended for every surgical resident prior to leaving residency. My financial advisers gave me a list of 6 insurance companies to work with and negotiate based on my profile (including my rock climbing). Rock climbing, even at a high level is considered much less dangerous than riding a motorcycle, sky diving or even drinking alcohol to every single one of those insurance companies. I was kinda surprised, but given that risk adjustments is pretty much all they do, I'm going to go ahead and trust them on this.

 

[mehc012]

Disability insurance has nothing to do with my employer. This is personal insurance that I purchase to protect myself and future and is generally recommended for every surgical resident prior to leaving residency. My financial advisers gave me a list of 6 insurance companies to work with and negotiate based on my profile (including my rock climbing). Rock climbing, even at a high level is considered much less dangerous than riding a motorcycle, sky diving or even drinking alcohol to every single one of those insurance companies. I was kinda surprised, but given that risk adjustments is pretty much all they do, I'm going to go ahead and trust them on this.

I know it doesn't...that's my point. Your having gotten disability insurance does nothing to help mitigate the risks your employer faces due to your decisions. They would be better off if you didn't engage in such risky activities (risky enough that you think it worthwhile to purchase disability insurance)...would you be ok with them dictating that to you, then, if it is better for them?

 

[mimelim]

I know it doesn't...that's my point. Your having gotten disability insurance does nothing to help mitigate the risks your employer faces due to your decisions. They would be better off if you didn't engage in such risky activities (risky enough that you think it worthwhile to purchase disability insurance)...would you be ok with them dictating that to you, then, if it is better for them?

I don't think that my employer or HR thinks that they would be better off as a firm if I didn't rock climb. And it certainly doesn't cost them anything because I do what I do, in contrast to smoking.

If when I applied for a position and they thought that climbing was incompatible with doing the job, I would be forced to make a choice. I would not expect someone to support my lifestyle choices.

 

[JubalHarshaw]

Disability insurance has nothing to do with my employer. This is personal insurance that I purchase to protect myself and future and is generally recommended for every surgical resident prior to leaving residency. My financial advisers gave me a list of 6 insurance companies to work with and negotiate based on my profile (including my rock climbing). Rock climbing, even at a high level is considered much less dangerous than riding a motorcycle, sky diving or even drinking alcohol to every single one of those insurance companies. I was kinda surprised, but given that risk adjustments is pretty much all they do, I'm going to go ahead and trust them on this.

Unless you're Alex Honnold. 😛

 

[mehc012]

Unless you're Alex Honnold. 😛

And then it's not considered dangerous because you're too badass to fall (and if you do you just die anyway, which is cheaper).

 

[Promethean]

It is great to hear that surpassingly few medical students smoke. It has always disturbed me how many nursing students can't wait to get out of lecture so that they can light up. And don't get me started on respiratory therapists. I've known several who joke about how their understanding of breathing treatments just means that they will be able to keep smoking even longer due to being able to manage their own symptoms as pathology sets in.

 

[Promethean]

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...

Just because it is a nice graphic doesn't mean that it is remotely true. Solvents are rated as less harmful than ketamine and buprenorphine? In what world? Solvent abuse can kill you dead the first time out of the gate, or any time thereafter, ignoring long term neurotoxicity and carcinogenicity.

Ketamine and buprenorphine are both drugs with remarkable safety profiles when used reasonably, or even when abused with any degree of caution whatsoever*. The physical harm rating of LSD should be considerably closer to 0. It just doesn't do much physiologically. Khat's dependance rating should be up closer to 2, and GHB should have both a higher physical harm rating and dependance rating.

Who made this chart? What data are they using?

*Which is to say that, of course, dose makes the poison and it is technically possible to overdose on most anything... but both of those drugs tend to be pretty forgiving to all but the most absurd overdoses.

 

[KnuxNole]

It is great to hear that surpassingly few medical students smoke. It has always disturbed me how many nursing students can't wait to get out of lecture so that they can light up. And don't get me started on respiratory therapists. I've known several who joke about how their understanding of breathing treatments just means that they will be able to keep smoking even longer due to being able to manage their own symptoms as pathology sets in.

I remember a classmate saying "Oh, smoking and eating cheeseburgers is fine! Once I'm a cardiologist, I'll be able to treat myself!". Unless an epiphany occurred, he's still smoking like a chimney in residency.

 

[Law2Doc]

I remember a classmate saying "Oh, smoking and eating cheeseburgers is fine! Once I'm a cardiologist, I'll be able to treat myself!". Unless an epiphany occurred, he's still smoking like a chimney in residency.

he's hopefully learned that the heart isn't the primary target of smoking.

 

[masaraksh]

It is great to hear that surpassingly few medical students smoke. It has always disturbed me how many nursing students can't wait to get out of lecture so that they can light up. And don't get me started on respiratory therapists. I've known several who joke about how their understanding of breathing treatments just means that they will be able to keep smoking even longer due to being able to manage their own symptoms as pathology sets in.

proles smoke more, you're surprised by this.

 

[mmmcdowe]

Is it wrong that I was smoking hookah when I read this thread?

 

[NickNaylor]

Is it wrong that I was smoking hookah when I read this thread?

Good man.

 

[KnuxNole]

he's hopefully learned that the heart isn't the primary target of smoking.

Haha true, he'll probably continue to smoke a pack a day, like a lot of people 🙂

Honestly, I don't find it surprising that a ton of med students smoke, but I guess some did. There were groups of people who walk out of campus and smoke. Outside of school, you definitely saw people smoke cigarettes and stuff. But, I guess it's a myth that everyone who starts med school is a huge advocate to their own health. As we know, people love to counsel for the sake of checking boxes and for patient care, but for their own lives, they snort cocaine, bang a few strippers unprotected, etc.

 

[Easily_Sunburned]

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?

Good point, a person shouldn't be limited by their life style choices as long as they don't harm or compromise others. Discriminating against smokers isn't that far-removed from discriminating against people based off of their race, sexuality, the way they look or dress. Also, if they're limiting smokers from smoking on their own time from being parts of programs, they might as well limit people who drink alcohol as well bc alcohol use has just as many consequences if not even more than smoking. That'd at least be a consistent set of rules regardless of what objections you may have.

Two points - one, smoking is very much frowned upon. A lot of hospitals, residency programs, and fellowship programs have smoke free hiring policies. As in, if you smoke, they don't hire. Call it what you will, discrimination or otherwise, but it hasn't ever been successfully challenged.

The other point - they do limit people from drinking alcohol at a lot of places. Try showing up for work hung over - holy cow, are you ever going to be in trouble.

Something else to keep in mind - in a lot of settings, you aren't going to be able to take smoke breaks. Medicine is too hectic and unpredictable to reliably have a chance to step outside for a smoke break. So imagine trying to cope with daily cravings while attempting to get things done. It would be hard, I imagine.

 

[pyrrion89]

I know only a handful---albeit some---med students who smoke. It's definitely a source of shame within this community in this time in society. It's usually concealed, done in private, etc.

Far more med students smoke weed than smoke cigarettes, I'd wager.

 

[mehc012]

Two points - one, smoking is very much frowned upon. A lot of hospitals, residency programs, and fellowship programs have smoke free hiring policies. As in, if you smoke, they don't hire. Call it what you will, discrimination or otherwise, but it hasn't ever been successfully challenged.

Only it has...check the thread.

 

[veryborderlineapplicant]

Two points - one, smoking is very much frowned upon. A lot of hospitals, residency programs, and fellowship programs have smoke free hiring policies. As in, if you smoke, they don't hire. Call it what you will, discrimination or otherwise, but it hasn't ever been successfully challenged.

The other point - they do limit people from drinking alcohol at a lot of places. Try showing up for work hung over - holy cow, are you ever going to be in trouble.

Something else to keep in mind - in a lot of settings, you aren't going to be able to take smoke breaks. Medicine is too hectic and unpredictable to reliably have a chance to step outside for a smoke break. So imagine trying to cope with daily cravings while attempting to get things done. It would be hard, I imagine.

nicotine patch or nicotine gum would work I suppose would work for those cases of medicine being so hectic. issues of taking a smoke break are equivalent to trying to take lunch in a practice, even if there's a set time, it's often hard to make that and get your meal in.

 

[Goro]

To follow up on my learned colleague's comments, and to those of you making the "slippery slope" argument, I'll just point out that no one has ever developed cancer or heart disease from second hand Big Macs.

"but you can't honestly tell me that someone who smokes a cigar once in a blue moon represents as great of a risk as someone with DM type II or another chronic disease caused by lifestyle factors"

First, you aren't even remotely comparing two analogous things. If you compared eating McDonalds once in a while vs. smoking a cigar once in a while, it would be an actual comparison. Nobody decides, "I'm going to choose to be diabetic." One is a lifestyle choice, the other is the end result of thousands of insults (by choice) to the human body, among a miriad of other factors. I am currently at the Southern Association of Vascular Surgeons annual meeting (one of the largest conferences in vascular surgery) and there was a presentation yesterday that specifically stated that peripheral vascular disease was linked to 'any time smokers' with a specific subdivision for people who smoked a cigarette less than once a week. So, yes, as far as cardiovascular health, smoking is much worse than occasionally having a cheese burger or a soda.

I disagree about firms being "more successful" by doing things differently. We have heavy incentives to be healthy, just like at Cleveland Clinic. Just by having a PCP and getting biometric screening, our deductibles drop by over 50%. We don't have to actually improve anything, just do the screening.

I am a registered libertarian. I am a rock climber that pays extra because of it. I believe that people can choose to do what they want to their own bodies and nobody should be telling them what they can and can't do, as long as it isn't affecting other people. However, this does not offend my sensibilities on that front in any way. You can choose to smoke. But, I don't have to pay the price for you to do that. My hospital doesn't have to either. Smoking is easily demonstrated to be hazardous to your health in any amount. Insurance companies recognize this and charge a premium to cover you. Employers should not be required to cover you for this in the same way that you are not required to apply to our residency.

 

[litotes]

this seems like some serious BS. It's possible to smoke occasionally without being addicted or seriously compromising your health... I average about one cigar a month just because I enjoy the tactile experience and the good conversations you have over cigars; it's annoying that a moderate, legal indulgence can be taken away by a professional career.

 

[Dr Van Helsing]

this seems like some serious BS. It's possible to smoke occasionally without being addicted or seriously compromising your health... I average about one cigar a month just because I enjoy the tactile experience and the good conversations you have over cigars; it's annoying that a moderate, legal indulgence can be taken away by a professional career.

You must be so vexed that one day you might have to give up 12 cigars a year; my condolences.

Yeah, we pre-meds need to revolt! We can't sit back while the doctors have to give up cigars and smoking! The horror!

 

[Lysinee]

Do med students smoke? Yes
Do med students get DUIs? Yes
Do med students get speeding tickets? Yes

I can keep going, but you probably get the point.

 

[Dr Van Helsing]

Do med students smoke? Yes
Do med students get DUIs? Yes
Do med students get speeding tickets? Yes

I can keep going, but you probably get the point.

Wait, med students are human?

 

[moop]

"How can you smoke when you know of the negative consequences smoking-related cancer and diseases so better than anyone else?"

*lights cigarette*
"Because it motivates me to find a cure."

 

[xffan624]

"How can you smoke when you know of the negative consequences smoking-related cancer and diseases so better than anyone else?"

*lights cigarette*
"Because it motivates me to find a cure."

We found a cure. Don't smoke.

 

[medic86]

To follow up on my learned colleague's comments, and to those of you making the "slippery slope" argument, I'll just point out that no one has ever developed cancer or heart disease from second hand Big Macs.

This would be a great argument if we were advocating for exposing people to second hand smoke.

But we're not.

 

[litotes]

You must be so vexed that one day you might have to give up 12 cigars a year; my condolences.

Yeah, we pre-meds need to revolt! We can't sit back while the doctors have to give up cigars and smoking! The horror!

You're missing the point

 

[Dr Van Helsing]

You're missing the point

No, I was just bored.

 

[tymont12]

I've looked at a couple handbooks for schools I've applied to and most have the boilerplate, "no drugs or alcohol, including nicotine." FINE, I get it. However, the, "we can test you at any time without warning," erks me a little because what if you did have a one-off cigar at a wedding or smoked hookah? I get the impression that some schools want their students to be teetotaling non-imbibers which seems a little unrealistic.

 

[litotes]

I've looked at a couple handbooks for schools I've applied to and most have the boilerplate, "no drugs or alcohol, including nicotine." FINE, I get it. However, the, "we can test you at any time without warning," erks me a little because what if you did have a one-off cigar at a wedding or smoked hookah? I get the impression that some schools want their students to be teetotaling non-imbibers which seems a little unrealistic.

Yo yo yo hold up. You're not allowed to drink alcohol while in medical school??? whaaaat?!? can they drug test you for that??

everyone's of age, do they seriously expect you to never have a beer on a Friday night??

 

[Mad Jack]

We've got a few light smokers in my class.

 

[Mad Jack]

I've looked at a couple handbooks for schools I've applied to and most have the boilerplate, "no drugs or alcohol, including nicotine." FINE, I get it. However, the, "we can test you at any time without warning," erks me a little because what if you did have a one-off cigar at a wedding or smoked hookah? I get the impression that some schools want their students to be teetotaling non-imbibers which seems a little unrealistic.

I've never heard of such a policy outside of maybe LUCOM. I can count the number of non-drinkers I know in class on one hand lol.

 

[xffan624]

Yo yo yo hold up. You're not allowed to drink alcohol while in medical school??? whaaaat?!? can they drug test you for that??

everyone's of age, do they seriously expect you to never have a beer on a Friday night??

I have no idea what schools that poster is referring to. The only place I have heard of that is Loma Linda. Seriously we have school sponsored parties every couple months. One (Halloween) was so rowdy we couldn't show that part of the school to the interviewees the next morning.

 

[litotes]

I've never heard of such a policy outside of maybe LUCOM. I can count the number of non-drinkers I know in class on one hand lol.

I have no idea what schools that poster is referring to. The only place I have heard of that is Loma Linda. Seriously we have school sponsored parties every couple months. One (Halloween) was so rowdy we couldn't show that part of the school to the interviewees the next morning.

That's wassup haha thanks guys

 

[NickNaylor]

I have no idea what schools that poster is referring to. The only place I have heard of that is Loma Linda. Seriously we have school sponsored parties every couple months. One (Halloween) was so rowdy we couldn't show that part of the school to the interviewees the next morning.

A few friends and I threw a school-wide Halloween party at their place - we probably had 150-200 people show up. It was a pretty sick party. There are still, sadly, stains, burns, etc. from that party at their place.

 

[JPA178]

I have no idea what schools that poster is referring to. The only place I have heard of that is Loma Linda. Seriously we have school sponsored parties every couple months. One (Halloween) was so rowdy we couldn't show that part of the school to the interviewees the next morning.

I went to a holiday party this year held by one particular department at my institution that had nearly a thousand people on the guest list. They invited all the techs and nurses as well as the faculty/residents, and pretty much everyone brought a spouse or a +1. It almost felt like a frat party, which really surprised me! I love a good party, but I'd never want to get drunk at a work event like that - especially around faculty.

 

[xffan624]

I went to a holiday party this year held by one particular department at my institution that had nearly a thousand people on the guest list. They invited all the techs and nurses as well as the faculty/residents, and pretty much everyone brought a spouse or a +1. It almost felt like a frat party, which really surprised me! I love a good party, but I'd never want to get drunk at a work event like that - especially around faculty.

The party in reference was just students. There were two faculty monitors. Apparently they didn't do that great of a job. There are definitely more formal events where there are faculty present and in which case, getting drunk probably wouldn't be a great idea

 

[JPA178]

The party in reference was just students. There were two faculty monitors. Apparently they didn't do that great of a job. There are definitely more formal events where there are faculty present and in which case, getting drunk probably wouldn't be a great idea

Oh, at this party some of the faculty were pretty drunk too! I was just amazed. Yeah, it's definitely important to not make a fool of yourself around important people though.

 

[touchpause13]

Aside from the mormons I'm pretty sure my entire class drinks.
I don't know anyone who smokes cigarettes but I'm sure there are some
A lot of us will smoke hookah on occasion
I know someone who quit chewing before he came here, I'd venture there are probably quite a few people who still chew seeing as how common it is in this part of the country
There's a lot more drug/EtOH usage than tobacco.

 

[pithy84]

There is a good NEJM opinion article about why hospitals should ban doctors from smoking, even outside of work. Can anyone find it? I mostly agree with it.

This does not seem like a slippery slope to me. Cigarettes kill 440,000 Americans every year, and doctors need to tell patients to stop smoking. Doctors need to say it over and over again. If they themselves smoke, then that advice is disingenuous.

Why don't we ban motorcycles? Well, motorcycles kill far fewer Americans than cigarettes.

Why don't we ban obese doctors? Well, there are many reasons to be obese. Some obese people eat McDonald's all the time, but some obese people actually eat pretty healthy. An obese doctor telling an obese patient to lose weight is not necessarily disingenuous. In fact, they might tell the patient, "I know how hard it is to lose weight, just look at me. But if you decrease your weight just 5%, you will be so much healthier. I decreased my own weight 8%, and you can too!"

It is not a slippery slope. Cigarettes are uniquely devastating to health.

 

[tymont12]

I've never heard of such a policy outside of maybe LUCOM. I can count the number of non-drinkers I know in class on one hand lol.

Western Michigan. Link to handbook here, page 108.

I misread a little bit, it states "abuse of alcohol," not just use, is not permitted. I find their complete testing for tobacco interesting though. So in their case, no use is acceptable.

 

[mehc012]

There is a good NEJM opinion article about why hospitals should ban doctors from smoking, even outside of work. Can anyone find it? I mostly agree with it.

This does not seem like a slippery slope to me. Cigarettes kill 440,000 Americans every year, and doctors need to tell patients to stop smoking. Doctors need to say it over and over again. If they themselves smoke, then that advice is disingenuous.

Why don't we ban motorcycles? Well, motorcycles kill far fewer Americans than cigarettes.

Why don't we ban obese doctors? Well, there are many reasons to be obese. Some obese people eat McDonald's all the time, but some obese people actually eat pretty healthy. An obese doctor telling an obese patient to lose weight is not necessarily disingenuous. In fact, they might tell the patient, "I know how hard it is to lose weight, just look at me. But if you decrease your weight just 5%, you will be so much healthier. I decreased my own weight 8%, and you can too!"

It is not a slippery slope. Cigarettes are uniquely devastating to health.

They don't need to tell them to stop smoking, they need to ensure that the patient is fully aware that smoking will kill them. It's an autonomy thing.

 

[Mad Jack]

Western Michigan. Link to handbook here, page 108.

I misread a little bit, it states "abuse of alcohol," not just use, is not permitted. I find their complete testing for tobacco interesting though. So in their case, no use is acceptable.

That is quite interesting. They ban all nicotine products- so you could be on medically prescribed nicotine replacement devices to kick the habit and still lose your acceptance. How the hell do they justify that?

 

[mimelim]

That is quite interesting. They ban all nicotine products- so you could be on medically prescribed nicotine replacement devices to kick the habit and still lose your acceptance. How the hell do they justify that?

It says specifically that if you have a prescription it is okay for controlled substances. I would assume that this extends to prescribed nicotine products as well.

 

[medic86]

It says specifically that if you have a prescription it is okay for controlled substances. I would assume that this extends to prescribed nicotine products as well.

Not many people get a prescription for a nicotine patch/gum/lozenges. They go to the store and buy it.

 

[Dullhead]

To follow up on my learned colleague's comments, and to those of you making the "slippery slope" argument, I'll just point out that no one has ever developed cancer or heart disease from second hand Big Macs.

True. But what about this scenario? I smoke 1-2 sticks on Fri night to accompany my 6-pac of "unwind" beer. I do this in my "home" clothes. By the time I show up to work on Mon, I've showered 3 times (Sat, Sun, Mon), and been to the laundromat with all my clothes. (This may not be possible during GME/residency.) I've killed all that @#$% with a healthy dose of detergent and bleach. Would someone still develop cancer or heart disease from second hand smoke that they never ever contacted? Or am I ignorant? Is this stuff so pervasive as to survive 3-something days and plenty of detergent and bleach?

To clarify - I do understand why employers choose to issue restrictions. I'm a non-trad in the engineering sector and one of my clients mandates random testing of both employees and subcontractors for 420. I've been tagged for those and sweated because I'll do 420 1-2 times a year when I'm out camping and my buddy brings along the stuff. I do it where it does not affect work but apparently that stuff stays in my hair follicles for 30+ days. Like even when I'm not in any way under the influence of that stuff.

Anyway, an employee assigned to operate a forklift who shows up without control of faculties could do serious damage to himself, other employees, and the employer's property, all of which the employer would be financially responsible for. The employer has to protect themselves against such occurrences should an errant employee wreak havoc.

So I get it. But. it. still. feels. wrong to restrict the rights of "responsible" individuals to do what they please during their personal time. Unless there's an easy way to distinguish between "responsible" and "irresponsible" employees, I guess the more conservative standard will apply. I have mixed feelings about this.

 

[Spirit of the Student Doc]

So, my current employer gives out a "stipend" if you will for health insurance. What you do with that money is your own personal choice. Some of the employees pocket that money and stay on their spouses insurance. Others, like me, simply forgo insurance altogether..... let's face it anything super bad happens I'll be in bankruptcy regardless.

They also offer health insurance, but it isn't very good. Some of the employees actually choose this option. Why I dunno.

Although, in regards to smoking.... I think they should be limited to the same amount of breaks as any other employee. If they want to smoke they better eat fast. I hate lazy co-workers and the worst ones have been smokers who "have" to take a smoke break when the sh! t hits the fan. I've been known to work through breaks and to have a smoker take break after break is insufferable. Just saying, not acceptable.

 

[ta8901]

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.

The residency program of my local SOM as well as surrounding programs clearly state that they will no longer consider tobacco users for their match. This not only fits into the image of a physician as a model for health but also offers significant savings with regards to providing insurance for these employees.

 

[beachside]

This does not seem like a slippery slope to me. Cigarettes kill 440,000 Americans every year, and doctors need to tell patients to stop smoking. Doctors need to say it over and over again. If they themselves smoke, then that advice is disingenuous.

Oddly, you discuss the benefits of having an obese doctor telling an obese patient how to lose weight, but you totally discard the benefits of having a previous-smoker physician talking to a smoker patient.

In any case, an occasional cigar is not going to give you lung cancer. A nicotine test in the workplace would not be able to discriminate between regular smokers and someone who just happened to have a cigar last night for the first time in 6 months.

If I ever walked into a job interview as an attending, and they hand me a contract stating no smoking at all, I'd kindly walk right back out of there. What's your freedom worth to you? You better offer me an extra $100k/year minimum for that kind of restriction. I signed up to be a doctor, not a mormon.