Pre-employment Drug Testing

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Does Kaiser require a pre-employment drug screen for new physician hires?
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Just don't take or eat anything the week before that may accidentally trip one of the tests.
 
Rendar5 said:
Just don't take or eat anything the week before that may accidentally trip one of the tests.
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And be sure to list EVERY medication (OTC, naturopathic, herbal, etc.) that you took during the week leading up to the test. Don't leave out cough syrup or an OTC cold medication, and then have a false positive pop up.
 
On a related note, did everyone else just pee into a cup for their drug test? I know an MS4 who just got their internship contract, and the hospital will be doing their drug test on a hair sample. 😕 I'd never heard of hospitals doing that; it sounds kind of inefficient.
 
smq123 said:
On a related note, did everyone else just pee into a cup for their drug test? I know an MS4 who just got their internship contract, and the hospital will be doing their drug test on a hair sample. 😕 I'd never heard of hospitals doing that; it sounds kind of inefficient.
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I've not seen this done, but you can check for drug use far more remote than with urine. Marijuana use can be tested for for many months back this way.
 
smq123 said:
On a related note, did everyone else just pee into a cup for their drug test? I know an MS4 who just got their internship contract, and the hospital will be doing their drug test on a hair sample. 😕 I'd never heard of hospitals doing that; it sounds kind of inefficient.
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Time to get a buzz cut! 😛
 
Damn pot-smoking menaces.
 
aProgDirector said:
I would assume that all physician hiring requires a drug test, including most residency programs.
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i will tell you this, i know of many residency programs that do not test ANY incoming residents nor do they test any of the residents as they progress forward.

i was STUNNED when i heard this. i was even more stunned when i heard about residents smoking up every weekend, going bar hopping until 3 am when they had call the next morning at 7 am.

one resident was kicked out for PCP use after the police found him breaking into a home (true story).

How would you not drug screen all these individuals.
 
PharmaTope said:
i will tell you this, i know of many residency programs that do not test ANY incoming residents nor do they test any of the residents as they progress forward.

i was STUNNED when i heard this. i was even more stunned when i heard about residents smoking up every weekend, going bar hopping until 3 am when they had call the next morning at 7 am.

one resident was kicked out for PCP use after the police found him breaking into a home (true story).

How would you not drug screen all these individuals.
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Cause it's expensive, misses stuff (e.g. alcoholics, certain benzo's and opiates), and has false positives that can cause a lot of serious allegations and cost even more money to test properly with non-screening tests.

You really want to spend $700 a pop on a urine test that the very people you're looking to catch can easily look up the info to beat the test online?
 
Smq is referring to me. Not only do I have to have a hair drug test but I have to have it done on site a week before orientation starts to make sure it comes back negative. Awesome. Wouldn't be so bad if I didn't live 1000+ miles from my internship.
 
Neuronix said:
Smq is referring to me. Not only do I have to have a hair drug test but I have to have it done on site a week before orientation starts to make sure it comes back negative. Awesome. Wouldn't be so bad if I didn't live 1000+ miles from my internship.
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don't get what the big deal is, were you planning on waiting until the day before orientation starts to move? (although I do agree that testing hair samples is ridiculous)
 
Kaiser absolutely requires a preemployment drug test for full time employees and per diems. There was no requirement to list medications. I had taken claritin -D (with pseudoephedrine the day of the test with no issues.) Don't drink too much fluid before the test. My first test was "too dilute" and I had to repeat it within 3 days after being NPO for 12 hours.
 
I have only heard of hair tests for business jobs. One of my more interesting friends coincidently (and suddenly) found a better offer when he found out his to-be-new employer required a hair test.
 
Gute said:
how is drug testing going to address this?
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If they schedule drug testing at 6am on a Sunday morning, then they will literally come stumbling in drunk and let the cougar out of the satchel.
 
proman said:
I was tested for alcohol as part of my pre-employment test.
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I'd imagine that while screening for alcohol at a scheduled drug test would not be a very sensitive test for alcohol problems, it should be pretty darn specific 🙂
 
residency programs probably realize that if you've gotten to residency with a drug problem, an announced piss test is probably not going to be the thing that does you in. I had a chemical analysis class as an undergrad and we learned a lot about drug testing- the pee test is a screen, basically. If you were trying to work at office depot or something, a positive result just means they go to their next applicant and no big deal. Trying to replace a new resident a week or so before start is next to impossible. I could see why some programs would just assume that no prior problems is good to go.
 
Cleveland Clinic does a nicotine test, they have a zero tolerance smoking policy
 
Mattchiavelli said:
residency programs probably realize that if you've gotten to residency with a drug problem, an announced piss test is probably not going to be the thing that does you in. I had a chemical analysis class as an undergrad and we learned a lot about drug testing- the pee test is a screen, basically. If you were trying to work at office depot or something, a positive result just means they go to their next applicant and no big deal. Trying to replace a new resident a week or so before start is next to impossible. I could see why some programs would just assume that no prior problems is good to go.
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It's still a heck of a lot easier to replace a resident in a week than to deal with the liability if the resident is someone who shouldn't be given a training license allowing him/her to prescribe controlled meds, or access to the pharmacy cabinets, or responsibility over patients, etc. Not really sure every drug they test for is of the same concern for this, but yeah, residencies, like Home Depot, will still absolutely "go to their next applicant and no big deal" even if you are a resident they ranked highly, if you come up positive for recent use of controlled substances.
 
LHUEMT911 said:
Cleveland Clinic does a nicotine test, they have a zero tolerance smoking policy
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How is this even legal? It just something in the job contract and if you want the job, you sign/agree?
 
Neuronix said:
http://www.nytimes.com/2011/02/11/us/11smoking.html

Cleveland Clinic isn't the only place that's done this, though perhaps the most high profile.
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Don't get me wrong, it's awful for you and I 'get' why hospitals would want to discourage it as much as possible, but essentially banning you from using perfectly legal substances on your own time with fear of some type of random screening just seems so big-brother, scary to me.

I guess I just don't see the correlation between a great physician who kicks ass in the ER all day, then goes home and has a few ciggies before going to bed and starting the whole thing all over again. I don't see it affecting his job performance, I highly doubt it's going to alter the advice he gives to patients (do as I say, not as I do), and he's a full grown adult living in a democratic country where cigarettes, chewing tobacco, etc, are perfectly legal substances.

Does this apply to all staff as well? When I worked at a hospital for a few years, there were a TON of people who smoked - techs, sanitation staff, kitchen staff, some nurses, hell, even a few doctors.

And can you imagine losing your job or residency spot because you failed a 'nicotine test' (zero tolerance policy). I don't even know how you could explain that to someone - yeah, I split a cigarette with a friend last night, so I can no longer practice medicine (kicked out of residency).

What about nicotine gum? Could I lose my residency position for chewing gum?

What about second hand smoke? We've been told our whole lives it's a 'killer,' so what if your roommate smokes in the car before he drops you off at work in the morning???
 
JaggerPlate said:
How is this even legal? It just something in the job contract and if you want the job, you sign/agree?
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When it comes to private businesses (and not a gov't entity) then they can really choose to require anything and I support that 100%.

In fact, it is 'big brother-ish' to make it illegal to choose to run a private business as you wish with the employees that you prefer to hire.
 
Law2Doc said:
It's still a heck of a lot easier to replace a resident in a week than to deal with the liability if the resident is someone who shouldn't be given a training license allowing him/her to prescribe controlled meds, or access to the pharmacy cabinets, or responsibility over patients, etc. Not really sure every drug they test for is of the same concern for this, but yeah, residencies, like Home Depot, will still absolutely "go to their next applicant and no big deal" even if you are a resident they ranked highly, if you come up positive for recent use of controlled substances.
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why then is the drug screen not earlier in the process?

e.g. before you interview with the program director, you get escorted to the bathroom where the chief resident watches you pee in the cup. (this could be just part of the interview process, get to know your future chief very intimately, and prove that you are in fact not a drug user or a cheater)

I would really like to see some evidence that drug screening isn't just an expensive dog-and-pony show. If someone is motivated enough to make it to the point of entering residency, I imagine they'd be smart enough to figure out a way to pass the drug test. After all, its a much easier test to pass than the USMLE.
 
Gute said:
how is drug testing going to address this?
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If positive points towards a longstanding history of bad problematic behavior. Perhaps it's unfair but the kind of guy that's out drinking until 2am on a day when his call starts at 7am, is also probably the kind of guy who might indulge in a few other interesting substances.
 
McGillGrad said:
When it comes to private businesses (and not a gov't entity) then they can really choose to require anything and I support that 100%.

In fact, it is 'big brother-ish' to make it illegal to choose to run a private business as you wish with the employees that you prefer to hire.
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That's what I was essentially saying and I agree ... it's a businesses right to put something into a contract and if you sign it to work for the private business, then it's whatever.

However, it does make me wonder as to certain issues like NPO-hospitals receiving government support, Medicare (govt) paying for the residency spots and still having some of these 'private business' type clauses you're referring to.

Plus, it's my complete guess that there is still some legality as to what you can put in a private business contract and not end up with a lawsuit on your hands.
 
Rendar5 said:
Cause it's expensive, misses stuff (e.g. alcoholics, certain benzo's and opiates), and has false positives that can cause a lot of serious allegations and cost even more money to test properly with non-screening tests.

You really want to spend $700 a pop on a urine test that the very people you're looking to catch can easily look up the info to beat the test online?
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those urine tests are $10 dollars. yes there are false positives but that is why the urine sample is split. if you test positive, they request your medications to compare against and can send the sample out for further testing. this is typical employment screening for all other hospital workers. i wish they would do this with the people in charge of patient care. some hospitals do not which is rather strange to me.
 
PharmaTope said:
those urine tests are $10 dollars. yes there are false positives but that is why the urine sample is split. if you test positive, they request your medications to compare against and can send the sample out for further testing. this is typical employment screening for all other hospital workers. i wish they would do this with the people in charge of patient care. some hospitals do not which is rather strange to me.
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I'm not well versed in the accuracy of those cheaper urine dipstick tests, and I'm sure my $700 at my institution is more what they charge patients, so I'd have to look further into it. But if you look up even in SDN itself, you'll find the story of a resident who was accused multiple times of being a drug addict (amphetamine positive, on Claritin-D), took 2 months and a lot of distress to prove the drug screen wrong and almost was not allowed to start because the hospital administration had absolutely no clue about the proper utility of the test. i suspect the first "confirmatory" test which was positive in her case was not a proper confirmatory test at that but another screen. Luckily, iirc, there was a third split sample that went to a completely different lab and was properly looked into.

Find me a hospital administration that can actually properly recognize cross-reacting meds and the limitations of testing, and I'll find you a place that is appropriate for a drug screen of residents. But I'm willing to bet that there are very few out there.
 
Rendar5 said:
I'm not well versed in the accuracy of those cheaper urine dipstick tests, and I'm sure my $700 at my institution is more what they charge patients, so I'd have to look further into it. But if you look up even in SDN itself, you'll find the story of a resident who was accused multiple times of being a drug addict (amphetamine positive, on Claritin-D), took 2 months and a lot of distress to prove the drug screen wrong and almost was not allowed to start because the hospital administration had absolutely no clue about the proper utility of the test. i suspect the first "confirmatory" test which was positive in her case was not a proper confirmatory test at that but another screen. Luckily, iirc, there was a third split sample that went to a completely different lab and was properly looked into.

Find me a hospital administration that can actually properly recognize cross-reacting meds and the limitations of testing, and I'll find you a place that is appropriate for a drug screen of residents. But I'm willing to bet that there are very few out there.
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before giving a urine test, ask the center if they split the sample. if they do not split the sample, request that they do and tell them you only will give a sample if they agree to split it. that way if you do test positive on these junk screen exams, they can send the backup sample to the real lab for testing and you will be validated.

i wouldnt trust my career on a 10 dollar test.
 
PharmaTope said:
i wouldnt trust my career on a 10 dollar test.
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that was part of what I was trying to get at- a urine drug SCREEN is a highly sensitive test, and as we all should know high sensitivity test will give false positives. I'm hoping residents will get a follow up test using GC-MS. Lay employers are under no obligation to confirm the test with a more specific method but if you're being tested for legal reasons [probation perhaps] you need GC-MS because a $10 UDS isn't going to hold up in court.
 
Here's a question...if there is nothing in my contract or pre-employment packet about drug testing, is it fair to assume that I probably won't be drug tested at my program?

I would ask my program coordinator, but it probably looks a little fishy if my first contact with her is asking about drug tests.
 
Mattchiavelli said:
that was part of what I was trying to get at- a urine drug SCREEN is a highly sensitive test, and as we all should know high sensitivity test will give false positives. I'm hoping residents will get a follow up test using GC-MS. Lay employers are under no obligation to confirm the test with a more specific method but if you're being tested for legal reasons [probation perhaps] you need GC-MS because a $10 UDS isn't going to hold up in court.
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It is absolutely standard to do a confirmatory test after a positive. Firing or refusing to employ someone based on an unconfirmed drug test will almost certainly result in a successful legal suit.
 
DarknightX said:
Here's a question...if there is nothing in my contract or pre-employment packet about drug testing, is it fair to assume that I probably won't be drug tested at my program?
...
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No. The majority of residencies will drug test, because you are going to be using "their" DEA training license numbers to prescribe drugs. There's often just some vague language in your packet about agreeing to comply with provisions of some hospital manual you can access someplace.

Plan on getting tested if you are going to have a job where you prescribe and administer controlled substances. It's common sense.
 
JaggerPlate said:
That's what I was essentially saying and I agree ... it's a businesses right to put something into a contract and if you sign it to work for the private business, then it's whatever.

However, it does make me wonder as to certain issues like NPO-hospitals receiving government support, Medicare (govt) paying for the residency spots and still having some of these 'private business' type clauses you're referring to.

Plus, it's my complete guess that there is still some legality as to what you can put in a private business contract and not end up with a lawsuit on your hands.
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There is no legal way for government funded institutions to prohibit use of legal substances outside of the hospital. They can "tell you" prohibit it, and in most cases few people would give up their residency to test the issue, but if you ever got in trouble and sued them on it, you would almost assuredly win.
 
Law2Doc said:
There is no legal way for government funded institutions to prohibit use of legal substances outside of the hospital. They can "tell you" prohibit it, and in most cases few people would give up their residency to test the issue, but if you ever got in trouble and sued them on it, you would almost assuredly win.
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I'm not so certain it's as black and white as this. I'm happy to concede that you've got a JD and I don't, hence I probably shouldn't be arguing, but it is an anonymous web forum, so how much trouble can I get into?

Let's start here:http://no-smoking.org/jan05/01-27-05-6.html

Admittedly, this is a very biased non-smoking viewpoint. The interesting point they make is that although smoking is legal, there is no legal right to smoke. This sounds crazy, but I guess it makes sense.

One of the best examples on that website is the one about working for PETA and hunting. Hunting is legal -- assuming you have permits / follow the law. However, PETA has the right to not hire / fire employees that hunt, because it clashes with their mission.

Now PETA doesn't get money from the gov't, so perhaps their legal position is somewhat different. Still, hospitals don't exactly get money directly from the gov't either. They get money from Medicare, which is managed by the gov't.

And as stated on the website above, employers could argue that smoking increases health risks and hence health care costs, and hence this gives them the right to not hire those that smoke. Hospitals could also argue that one of their core missions is to get people to stop smoking and that the best way to do that is to have role models that don't smoke, hence none of their employees can smoke (even off the job).

It is a slippery slope, though. One could argue that older people also get sicker more and hence you might not hire based upon age -- except that's specifically protected so can't happen. If this is really successful, weight will be next. Or genetic profiling.

Yet, I see the other side. I'm not a smoker, never have (never even a single cig). I take care of end stage COPD every day. I see those visiting their loved ones with COPD go out for a smoking break. Apparently even cancer and death doesn't scare them. Do I really want to pay for their health care costs? No easy answer.
 
aProgDirector said:
...The interesting point they make is that although smoking is legal, there is no legal right to smoke. This sounds crazy, but I guess it makes sense.

One of the best examples on that website is the one about working for PETA and hunting. Hunting is legal -- assuming you have permits / follow the law. However, PETA has the right to not hire / fire employees that hunt, because it clashes with their mission.

Now PETA doesn't get money from the gov't, so perhaps their legal position is somewhat different. Still, hospitals don't exactly get money directly from the gov't either. They get money from Medicare, which is managed by the gov't.

And as stated on the website above, employers could argue that smoking increases health risks and hence health care costs, and hence this gives them the right to not hire those that smoke. Hospitals could also argue that one of their core missions is to get people to stop smoking and that the best way to do that is to have role models that don't smoke, hence none of their employees can smoke (even off the job).

It is a slippery slope, though. One could argue that older people also get sicker more and hence you might not hire based upon age -- except that's specifically protected so can't happen. If this is really successful, weight will be next. Or genetic profiling.

Yet, I see the other side. I'm not a smoker, never have (never even a single cig). I take care of end stage COPD every day. I see those visiting their loved ones with COPD go out for a smoking break. Apparently even cancer and death doesn't scare them. Do I really want to pay for their health care costs? No easy answer.
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I think you are basing your conclusions on arguments that also aren't defensible. You aren't going to be able to base this conclusion on lack of existence of some stated legal right to smoke. In this country, you basically have the right to do anything that is legal. It's legal to drink, so in your spare time you can drink, so long as it's not in your system by the time you come to work. So too smoking. Or having promiscuous sex. Or going to Las Vegas to gamble. Or growing old, gaining weight, watching Fox News or whatever other awful things you like to do in your spare time. A private organization can prohibit some of these from it's members (not the age, but anything else that doesn't involve a "protected class"). A program that subsists and pays your salary with government money can't. This argument has everything to do with government subsidization, which absolutely includes Medicare subsidization.
 
Law2Doc said:
I think you are basing your conclusions on arguments that also aren't defensible. You aren't going to be able to base this conclusion on lack of existence of some stated legal right to smoke. In this country, you basically have the right to do anything that is legal. It's legal to drink, so in your spare time you can drink, so long as it's not in your system by the time you come to work. So too smoking. Or having promiscuous sex. Or going to Las Vegas to gamble. Or growing old, gaining weight, watching Fox News or whatever other awful things you like to do in your spare time. A private organization can prohibit some of these from it's members (not the age, but anything else that doesn't involve a "protected class"). A program that subsists and pays your salary with government money can't. This argument has everything to do with government subsidization, which absolutely includes Medicare subsidization.
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The Department of Defense says you're wrong.
 
Law2Doc said:
There is no legal way for government funded institutions to prohibit use of legal substances outside of the hospital. They can "tell you" prohibit it, and in most cases few people would give up their residency to test the issue, but if you ever got in trouble and sued them on it, you would almost assuredly win.
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I'm definitely not saying it isn't an innovative and health focused program, but this is kind of what I assumed as well.
 
JaggerPlate said:
I'm definitely not saying it isn't an innovative and health focused program, but this is kind of what I assumed as well.
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The hospital could be a private entity that 'just happens' to have a Medicare funded residency program. There's your loophole.
 
lol, I wish when we hired someone we could know if they went onto the internet and randomly asked about drug testing. Because the only people who ask anonymously about drug testing are drug addicts and people on lots of cross-reacting medications. And no offense personally to people in the latter group, but a lot of them can be hell to work with as colleagues.
 
BADMD said:
It is absolutely standard to do a confirmatory test after a positive. Firing or refusing to employ someone based on an unconfirmed drug test will almost certainly result in a successful legal suit.
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Not if you are in a state with "at-will employment" and the job is non-union.

EDIT: I am referring to non-medical jobs, mileage may vary depending on state
 
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