Nicotine Free Residency?

[MountainEM]

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Wow...did not know residencies did this:

http://www.mystlukesonline.org/for-...on/residents/nicotine-free-hiring-policy.aspx

found this when looking at EM programs today. Not a problem for me but interesting-did not know these policies exist.

 

[Kubed]

I found out my hospital had adopted this at orientation.

"Hi, welcome! ... now head down to the lab for a blood draw."

 

[MountainEM]

That is crazy.

I don't smoke but if I do go camping or to a wedding I like to think I could have a cigar or something.

I think this policy is a little scary as much as I hate the cigarette industry and health effects.

 

[Cerberus]

I don't smoke but I dislike policies like this. Do they also have an "anti-fatty" policy? A "no more than 2 alcoholic beverages in 1 sitting" policy? Do they require residents and employees to engage in 30minutes of exercise4-5 times per week? They should stay out of peoples personal health choices if those choices don't affect the quality of their work.

 

[Antibodies]

I think that is way too much. Why do we have to baby everyone. I will bet you can buy greasy hamburgers in their cafeteria.

 

[dchristismi]

The link you provided specifically notes that they only do the cotinine test in the pre-employment part... seems odd that they specifically note that - unless they realize that it's quite possible (and presumable?) to quit for the 4 days it takes for cotinine to clear from the bloodstream, and then resume.

And yes, I googled it.

If you match there, you're contracturally bound to go there and they're contracturally bound to hire you. I wonder how that would play out? Do their program, quit, pass the damn test and start again if you wanted to? (I know people who would do that just on principle).

I am very anti-smoking, but it seems like a bit of a ridiculous policy. Especially when half of all nurses I've ever met smoke, and the element of chance in the match. (And agree with the greasy burger statement!!) I could see jacking up their insurance costs, or levying other financial penalties, but losing a match spot seems a bit much for something that's quite legal. Heroin? Cocaine? Grounds for termination... but nicotine?

 

[Cerberus]

Another thing about tests like this is that I worry about the false positive rate. What if someone lives in a state where they still allow smoking in bars and is exposed to second hand smoke? What if it's just a straight false positive? Should someone lose a position simply because they tested positive for an entirely legal substance?

 

[docB]

Very 1984.

I suspect the $$$ savings they are getting on health coverage is motivating this.

Interestingly this will presumably ding anyone who is using nicotine supplementation to try to quit too.

 

[EMCC]

I graduated from this hospital a few years ago--the policy was not in effect at that time.

What led to this was the ridiculous amount of staff that would not smoke on campus (smoke free), but would go and smoke on the corners near the hospital. The resulting litter (disposed butts) actually made the place look, well, not so pretty.

After consulting with the community about the best ways to handle this, St. Luke's made the draconian step of banning cigarettes and adopted the policy to not hire smokers.

From what I have heard about this--it was pretty big news in Pennsylvania when official, was that this applies to all staff--except residents, since there is no way to control this with the pre-employment physical exam.

Supposedly the rate of false positives is "zero." From the claims, you can live with a smoker, inhale 2nd hand smoke all day everyday and still not test positive. I don't know the details, and frankly didn't care to look into it, but the hospital stands by the claims from the company making the test.

 

[tegs15]

Just out of principle, though I think smoking is "nassy" as my 4yr old son would say, I don't think I would have applied to this program. It would be interesting to see how a dismissal would work within the legal contract of the Match. My guess is there is probably some stipulation that you must past the substance abuse criteria for a given residency and failing nicotine test is within St. Lukes substance abuse policy?

 

[GeneralVeers]

I have no problem with this policy as it's not the Federal government hiring you. If you don't like the policy, then you should seek residency elsewhere.

If I was a PD I would probably have a nicotine-free policy as well, for several reasons:

1. Smokers tend to get more respiratory illnesses and would require more sick days off (this creates coverage problems).

2. Smokers cost more to insure.

3. Smokers have to frequently take "smoke breaks" while on shifts. I worked with several residents during residency who had to do this, and my one partner who smokes now has to take frequent breaks to "go outside".

I would also drug test any residents who joined the program. Unless they are on prescription narcotics for a legitimate chronic illness, they would not be employed if they failed.

 

[deleted109597]

I think it should be more frequent. Remember, this is the free market they're talking about here. Nobody forces anybody to apply there, and I've hated the "smoke break" since I was in college working. Why don't I get a 15 minute "sit on my ass" break. Just because I don't smoke?


Although I differ from Veers and think the fed should also be allowed to test. They drug test you for the military. Frequently and without warning. And it's not some "get some good urine and pass" testing. They will watch you whip it out, and damn near shake it off for you they're so close.

 

[Cerberus]

Well, I am also opposed to the smoke break, and agree with McNinja that it has always pissed me off when my coworkers were off taking smoke breaks while I had to work (I worked in a restaraunt in college so I know how annoying it is to be one of the few nonsmokers). I think a reasonable policy would be "No smoking at work". Although this is a free market, I am generally opposed to employers sticking their nose into my personal business if it is something entirely legal that I chose to do on my freetime. Smokers do get sick more often but so do the fatties yet I don't see anyone requiring people to have a set BMI to get a job. I really dislike the health police.

 

[peppy]

I believe the Cleveland Clinic has a similar policy.
I don't smoke but I do feel like this is heavy-handed. Even though it doesn't affect me I would resent the idea that they want to control someone's legal lifestyle choice that way.

 

[WilcoWorld]

It's illegal to ask an applicant if he or she is married, plans to have children in the following three years, or needs religious holidays off, but it's OK to drug test for a legal activity? Seems inconsistent to me.

 

[Cerberus]

It's illegal to ask an applicant if he or she is married, plans to have children in the following three years, or needs religious holidays off, but it's OK to drug test for a legal activity? Seems inconsistent to me.

Well, maybe they should just start "drug testing" for bhcg

 

[VA Hopeful Dr]

I have no problem with this policy as it's not the Federal government hiring you. If you don't like the policy, then you should seek residency elsewhere.

If I was a PD I would probably have a nicotine-free policy as well, for several reasons:

1. Smokers tend to get more respiratory illnesses and would require more sick days off (this creates coverage problems).

2. Smokers cost more to insure.

3. Smokers have to frequently take "smoke breaks" while on shifts. I worked with several residents during residency who had to do this, and my one partner who smokes now has to take frequent breaks to "go outside".

I would also drug test any residents who joined the program. Unless they are on prescription narcotics for a legitimate chronic illness, they would not be employed if they failed.

Really? I would have a hard time hiring anyone on chronic narcotics. I've never been on long-term pain control before, but wouldn't that cloud your mind a touch?

I'd be much more OK with people on short-term drugs (broke my leg, horrific cough, and so forth).

 

[Venko]

I have no problem with this policy as it's not the Federal government hiring you. If you don't like the policy, then you should seek residency elsewhere.

If I was a PD I would probably have a nicotine-free policy as well, for several reasons:

1. Smokers tend to get more respiratory illnesses and would require more sick days off (this creates coverage problems).

2. Smokers cost more to insure.

3. Smokers have to frequently take "smoke breaks" while on shifts. I worked with several residents during residency who had to do this, and my one partner who smokes now has to take frequent breaks to "go outside".

I would also drug test any residents who joined the program. Unless they are on prescription narcotics for a legitimate chronic illness, they would not be employed if they failed.

I agree entirely. Just my opinion that as a healthcare industry and a private employer they should have the right to take a stance that is in favor of better health practices.

 

[Cerberus]

I agree entirely. Just my opinion that as a healthcare industry and a private employer they should have the right to take a stance that is in favor of better health practices.

Then they should be consistent and not hire fatties. The morbidity/mortality for both is pretty bad. While I rarely see many doctors that smoke, I've seen a whole lot with a keg in the midsection.

 

[Venko]

Then they should be consistent and not hire fatties. The morbidity/mortality for both is pretty bad. While I rarely see many doctors that smoke, I've seen a whole lot with a keg in the midsection.

I agree that they can do that if they wish. I would say, your use of the word "fatties" is not a very appropriate one. You can say those who are overweight, obese, etc, but Fatties is a very unprofessional and disrespectful descriptor.

To the point at hand, a private institution should have the right to not hire someone who smokes in my opinion. Not only does their choice / disease (depending on how you look at it) hurt themselves, take time away from work (smoke breaks), litter the ground (sometimes), but also affects the health and well being of those around them.

I am in support.

 

[GeneralVeers]

While I agree that the "fatties" also have health issues, I don't think they have to stop work and take a 15 minute "donut break" several times during the day.

While obesity is unpleasant and a health risk, it doesn't interfere with the work day like a "smoke break" does.

As an employer my main concern would be that employees were being treated equally and putting in equal time on the job.

 

[Coastie]

Wow...did not know residencies did this:

http://www.mystlukesonline.org/for-...on/residents/nicotine-free-hiring-policy.aspx

found this when looking at EM programs today. Not a problem for me but interesting-did not know these policies exist.

LOL, commies.

 

[roja]

"the rate of false positives is "zero."

I find this to be statistically improbable.
😀

 

[gutonc]

"the rate of false positives is "zero."

I find this to be statistically improbable.
😀

Well...on the one hand, you have a very large sample size, so, you know, it's plausible-ish. On the other hand, you have total bull***t. The latter is far more likely.

 

[EMCC]

"the rate of false positives is "zero."

I find this to be statistically improbable.
😀

I agree wholeheartedly. BUT, that is the line the manufacturer of the test sold to the hospital admin hook, line, and sinker... Probably because Cleveland Clinic uses the same test.

 

[roja]

http://www.metafilter.com/96785/Lies-Damned-Lies-and-Medical-Science

 

[bonesawz]

While I agree that the "fatties" also have health issues, I don't think they have to stop work and take a 15 minute "donut break" several times during the day.

While obesity is unpleasant and a health risk, it doesn't interfere with the work day like a "smoke break" does.

As an employer my main concern would be that employees were being treated equally and putting in equal time on the job.

And being Fat doesn't pollute the air for a 50 yard radius. Few things as annoying as stepping outside on a nice night and only getting a few breaths of nice crisp air before it is ruined by the smokers in the parking lot who all throw their butts on the ground. I have a right to clean air. I don't care if you poison your air, but quit ruining mine. Until the "fatties" start getting the jelly from their donuts on me, it isn't the same issue.

 

[Perrotfish]

One of my school's hospitals recently adopted a zero tolerance for nicotine (grandfathering in current employees) and I happened to work with the attending who authored the policy. According to him there was exactly one reason for the policy: it reduced the cost of health insurance. They didn't give a **** about smoke breaks, sick days, employee moral, setting an example, or anything else. Apparently at most hospitals employee health insurance is about 15% of the budget, and generally (considering the health risks of our profession) is considered an absolute requirement for hospitals to provide health insurance for their employees. Hospitals that have instituted a no smoking policy have cut the cost of their employee health budgets in half. There is nothing else you could do, including a 'no fatties' policy, that would save nearly that much cash. There are also, I think, significant legal issues with regulating things like employee weight, where as regulating employee substance abuse is aparently not a problem.

I support that decision, BTW. I'd much rather only hire nonsmokers than lay off some of our staff so that we can pay for the smokers' insurance.

 

[scrubs421]

While I agree that the "fatties" also have health issues, I don't think they have to stop work and take a 15 minute "donut break" several times during the day.

While obesity is unpleasant and a health risk, it doesn't interfere with the work day like a "smoke break" does.

As an employer my main concern would be that employees were being treated equally and putting in equal time on the job.

N/A

 

[MountainEM]

This is missing the point entirely.

Majority of residents aren't smoking every day but some (as mentioned here) might enjoy a cigar once a year/6 months for a wedding, special occasion.

To be unable to do so and enjoy myself for an evening so the hospital can save some $$ is ridiculous.

Secondly, I hear everyone saying "no one is forcing you to go here".... well thats wonderful, except with this example--if the hospital can get away with it, and the hospital can save some serious cash the policy will be continuously expanded to other hospitals and our choices will dwindle and dwindle.

You don't see how this could easily continue to get out of control?

Let's measure metabolites to determine your weekly meat intake versus vegetable intake.... How is your LDL, HDL, and TAG? If they are out of place, you have 6 months to get them lower or your fired? You are going to be fitted with an ankle bracelet to see your average alcohol consumption per a month? (granted my examples get more and more dramatic but when you give people an inch they are likely to take a mile).

Hello...original poster here...
I agree with this. This policy is a slippery slope. Employers should not be dictating our lives if we are doing legal activities. No one is arguing that smokers should have more breaks or be able to smoke on a healthcare campus. The argument is whether you can smoke cigarettes at home legally. I hate cigs but I think if it is legal in this country...then it is legal for healthcare employees.

 

[Perrotfish]

To be unable to do so and enjoy myself for an evening so the hospital can save some $$ is ridiculous.).

'Some' $$? At the hospital I mentioned they were looking at hundreds of millions of dollars in savings. That's more than 'some' $$, that a whole LOT of $$.

Also I think the idea that other physicians should have to work with inadequate support staff and give up their bonuses so that you can enjoy yourself for an evening is ridiculous. Ideally I'd like to see some kind of smoker buy in, where smokers can still be employed by the hospital but need to pay the extra thousands for health insurance out of their salaries. However this is, in my opinion, still a better alternative than everyone having to suffer to fund the bad habits of a few employees.

 

[Perrotfish]

Smoker Buy in? Wait, so your telling me that 1-2 cigars (IF THAT) a year should make me "buy in" a separate insurance plan? I really want you to pause and think about that.....statistically, with that level of smoking, I am just as likely to die of just about ANYTHING...

And you did not address any of the issues raised by how this policy could be further extrapolated....

You know Perrotfish, did you have a drink this weekend? Or last weekend? Alcohol can leading to squamous cancer of the throat, mouth/liver failure/heart failure/obesity with possibily type II diabetes with your beer gut.

I think if you drink at all, I shouldn't have to pay for that and you should have to buy into a insurance plan.... sounds a bit ridiculous for that glass of red wine you had 3 weekends ago right?

On top of that, if you do admit to drinking at all, I think you should have to submit to random drug tests.... because you might be drinking at work.... we have no evidence of that.... but hey, who cares of individual rights and freedoms? It's much better that we are told what to do... right? 🙂

As always, I'm fine with your individual rights as long as they don't impact my individual rights. I just have no interest whatsoever in paying for your individual rights. I want my job to provide me with health insurance and adequate pay. I want adequate staff so that I don't need to do social and nursing work on top of my job. I want my hospital and the equiptment in it maintined. I don't want the budget for that to go to paying for your overpriced smoker's health insurance.

If you can think of a way that you can have your 1-2 cigars/year without the hospital having to pay for it, of course, I'm all ears. Maybe there's some kind of long term nicotine test that can gauge how much you've smoked in a month? I honestly have no idea. However, if the solution is that we need to scrap the nicotine testing and lose the hundreds of millions so that you can have your two cigars a year then I think you need a new plan.

BTW I think employers have the right to drug test you whenever they want, mine (the Navy) does, and more hospitals should. Thievery is caused by unlocked foot lockers, and drunk doctors are caused by shoddy drug testing.

 

[Perrotfish]

So why not do alcohol testing? It is not far behind cigarettes in terms of damage?

Cancer, accidents, heart/liver failure, obesity, type II diabetes etc etc. Now, if you got that route, would you be willing to lose your job for ever having alcohol in your system? or paying a higher insurance premium (more realistic)

Finally, you think that the system is "screwed" up by people 1-2 Cigars a year.... than you need to understanding smoking more.... chronic bronchitis, emphysema and other problems don't develop with that level of smoking.....people aren't missing work cause they had a cigar at their brothers wedding.. please, lets try to keep it realistic

The alcohol thing is an interesting question. I actually don't drink (ever) but I understand that a strong majority of the staff does drink, and furthermore considers drinking a major part of their social life. So I guess the answer is, yes, I think the reason that we shouldn't tell people not to drink is because the hospital as a whole would probably rather make due with fewer resources and less pay than cut alcohol out of their lives. However a majority of the hospital doesn't smoke, and I see no reason why the employess and patients should have to pay for the bad habits of the minority. If they want the bad habit let them pay the cost.

I'm aware that 1-2 cigars/year don't do anything to you medically, but there's no way I know of to only keep more regular smokers off the payroll while giving the 1-2 cigar crowd a pass. The only test we have (that I know of) is a test to see if you've smoked at all, so either you scrap the entire nicotine testing and keep the higher premiums or you tell everyone that they can't smoke, not even a little. Honestly I think that you can skip the two cigars a year if it means making this plan work.

 

[Dwindlin]

I'm actually a little surprised this is still being debated so heavily. I believe it was Perrot that mentioned the health savings, that's all this amounts too. Yes long term use of all drugs has bad outcomes for health, but preventing most of them doesn't lower your bottom line. Preventing nicotine use does. End of story. Is it right or fair? Probably not. But that isn't even being considered, and likely won't be considered at other places that begin to adopt these types of policies.

On a more personal note I actually agree with Perrot in that I would rather piss people off than have to lay off staff. If it were something else that needed to be banned I would, the issue has nothing to do with nicotine in my eyes.

 

[meliora27]

I'm certainly anti-smoking but I'm wondering if there could be a possible legal challenge to this. While the hospital is private property the sheer fact that residents are paid via medicare dollars, I'm wondering if that adds a layer of complexity to this? I'm not a lawyer but I could see if you were in a private enterprise your employer could impose such a policy but since residencies use federal dollars I'm wondering if this sort of policy would withstand litigation?

 

[pseudoknot]

I'm certainly anti-smoking but I'm wondering if there could be a possible legal challenge to this. While the hospital is private property the sheer fact that residents are paid via medicare dollars, I'm wondering if that adds a layer of complexity to this? I'm not a lawyer but I could see if you were in a private enterprise your employer could impose such a policy but since residencies use federal dollars I'm wondering if this sort of policy would withstand litigation?

Many if not all fire departments in Southern California ban smoking for all firefighters, on and off the job. Clearly this is legal for government agencies as well.

I think a lot of people in this thread are losing sight of the fact that it is legal to discriminate in employment for anything that is not specifically prohibited. The reason you can't refuse to hire someone because of race is NOT because of some general concept of fairness, or because any arbitrary discrimination is illegal, or whatever. It's because it is specifically illegal to discriminate based on that particular factor. Smokers are not a protected class, and they can be discriminated against. (Just like gay people in many jurisdictions.) In some places there are apartment buildings that will not take smokers, and this too has been legally upheld.

Freedom goes both ways here--you are free to find another job where they will hire you despite your habit.

 

[GeneralVeers]

I hate to agree with Pseudoknot (the apocalypse has come?), but what he says is correct. You are still free to do stupid behaviors like smoke, and drink, no one is preventing you. Just acknowledge that there are certain jobs where your personal choices may prevent you from working. If that's the case you are free to find a work place that tolerates your stupidity, or another career entirely.

BTW smoking does not equal drinking. Many studies including NEJM have concluded that moderate drinking is in fact beneficial to your health. No amount of smoking is beneficial and all of it is harmful even an occasional cigar.

 

[Perrotfish]

So an interesting update, the hospital I mentioned earlier that enacted the no smoking policy is apparently enacting a version of the 'no fatties' policy. Apparently you can now get a 'discount' on your healthcare by consistently having a healthy blood pressure, and another discount by attaching a hospital issued pedometer to your shoe and consistently walking a certain number of steps.

I'm certainly anti-smoking but I'm wondering if there could be a possible legal challenge to this. While the hospital is private property the sheer fact that residents are paid via medicare dollars, I'm wondering if that adds a layer of complexity to this? I'm not a lawyer but I could see if you were in a private enterprise your employer could impose such a policy but since residencies use federal dollars I'm wondering if this sort of policy would withstand litigation?

According to my attending the reason why they focused on smoking (it's the only thing that can actually keep you from working there) is because their legal department assures them litigation is impossible. Apparently they're showing much more caution with weight because of the litigation risks involved.

 

[Zanegray]

I wonder if a smoker who had tried to quit and was unable... "an addict"... could sue under the ADA....

 

[Zanegray]

You know, if employers didn't pay for insurance, if people then got higher salaries ( or a set amount specifically for purchasing insurance) and were then in charge of picking their own plans, it wouldn't be a "group" issue.

If you smoked, it would be your habit to "pay for" and nobody else could comment on that basis. PLUS insurance companies would have to compete at an individual level and people might better choose plans consistent with their own needs and possibly decrease costs.

 

[Apollyon]

BTW smoking does not equal drinking. Many studies including NEJM have concluded that moderate drinking is in fact beneficial to your health. No amount of smoking is beneficial and all of it is harmful even an occasional cigar.

Actually...not so.

Inflammatory bowel disease: Is there any relation between smoking status and disease presentation?

Inflammatory bowel disease and smoking. A review of epidemiology, pathophysiology, and therapeutic implications

The influence of cigarette smoking on cytokine levels in patients with inflammatory bowel disease

Smoking affirmatively makes Crohn's disease worse, but affirmatively improves ulcerative colitis. More research is needed.

 

[LeapofFaith]

1. I have a Swedish friend who uses Snus. He no longer smokes. I only mention this to encourage everyone to keep an open mind when considering nicotine because every post in this thread refers to "smoking".

Interesting health information:
http://en.wikipedia.org/wiki/Snus

2. Many smokers will tell you they do their best thinking while on a smoke break. While this may not benefit those coworkers in a service industry it is possible these detestable breaks serve a purpose other than feeding an addiction.

Silly humans...

I am not looking for an argument. I just wanted to share these two thoughts. I have enjoyed reading this discussion. Thank you for sharing your thoughts.

 

[deleted109597]

2. Many smokers will tell you they do their best thinking while on a smoke break. While this may not benefit those coworkers in a service industry it is possible these detestable breaks serve a purpose other than feeding an addiction.

Alcoholics only function when drunk as well. Because it's an addiction. Just like caffeine, and all the other legal things.

I bet I could clear my mind a little by walking outside and avoiding work for 15 minutes as well.

 

[docB]

1. I have a Swedish friend who uses Snus. He no longer smokes. I only mention this to encourage everyone to keep an open mind when considering nicotine because every post in this thread refers to "smoking".

Interesting health information:
http://en.wikipedia.org/wiki/Snus

Actually they have forbidden all forms of tobacco. Because they test for nicotine metabolites, which will be there regardless of the mechanisim of ingestion, Snus would be prohibited as well.

From the program's website:

The cotinine test will detect the presence of nicotine in all forms of tobacco.

 

[ILikeDrugs]

What if someone is on the nicotine patch? Shouldn't the employer make an exception for them?

I have a right to clean air. I don't care if you poison your air, but quit ruining mine.

Do you drive a car? I'm sure your car emits vitamin C from the exhaust pipe, right? Nothing is more pathetic than someone who drives a car that emits smog and tries to talk down on people who smoke cigarettes. If you drive a gas powered vehicle, you're a smoker too. You smoke several packs on your way to and from work. So if your city air is unhealthy, it's because of you as well. Get off your high horse.