Prolonged illness and reasonable accommodations

[scalpelplz23]

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I am a resident nearing completion of a rigorous surgical training program. I got the flu this year and worked through it for over a week (as we all do) until eventually I was sent home by my program director (I must have looked reall bad right?). I was required to provide clearance to return to work from my pcp which I obtained. I returned but developed a post flu complication (being vague here trying to avoid identification but was enough to be rushed into the ER when I sidelined one of the EM attendings). I was encouraged by program to once again go home and get clearance to return again. No one anticipated the prolonged workup that would ensue and eventually determine that I had a treatable complication of the illneas that does not have chronic implications.

No physician is willing to fill out either clearance to return at 100 % (long operations, 24/7 home call for Icu and Operations, occasional 24 hour first call) while I wait for the treatment to fully kick in which unfortunately takes weeks. Additionally when presented with FMLA paperwork no physician treating me believes that I’m so sick I need to be at home (and neither do I). An informal request to my PD for return with accommodation from my treeTing physician was denied stating that in our field one must be 100% or home.

The problem is we all know that isn’t true and I’ve worked sick many a time before. I want to be back at work. I can’t make a physician write the clearance letter however and guaranteeing that i won’t need a to even take a break seems impossible. Setting parameters to define when I will be at 100% health seems equally fraught with all the grey areas of human health. I’ve told many patients to return to work but that they will have to start a bit slower and ramp up to their baseline after a prolonged illness. Of course they weren’t surgeons....

Looking thru SDN there are countless posts about residents needing to work thru illness and dismay at time off ... I seem to have the opposite problem where I’m begging to come back and can’t get the documentation I need to do so.

Despite knowing that through the years I’ve worked sick as a dog and people just made on the fly accommodations (scrubbing out to puke and scrubbing back in, allowed to nap in call room between procedures, allowed to break and get a drink or redose zofran when usually I would never break scrub). In a world where everything must be documented and everyone is covering their rear ... and where concern for patients safety is very real, I find myself in a odd position for a surgical resident... I want to come back but can’t get cleared and simultaneously my doctors think I could go back with accommodations but the program wants all or nothing.

Prior to this I had never heard of formal accommodations, or been asked for formal clearance (I’ve never called out but have been sent home a time or two since no one wanted to catch what i had). Nor had I contemplated if a surgical resident should be able to come back at 80%...I thought we all worked sick and helped each other out when we could and did everything we could to keep the patients safe. We have an army of PAs so the work coverage isn’t the issue... and even if I did shorter days for a week or took breaks or chose to scrub the shorter cases ..... that would unburden those PAs for a period of time.

I am working with my institution but was curious of opinions here as well. I wish I was 100% already, I wish I could get someone to write that down, I wish the treatment went faster, I wish we’d come to the actual diagnosis faster....but that’s all out of my control. I am incredibly thankful this is temporary and treatable. Just a surgery resident who genuinely wants to return to work and do my best...and can’t seem to get any of the documentation one way or another.....

 

[mvenus929]

Not a surgeon, but I think you should be able to come back at partial capacity. We suffer when residents need to take a leave of absence, but we do what we can to help them, including putting them on outpatient rotations, etc. If you are physically able to do the work, just not at the workload expected of a full time resident, they should be able to accommodate that.

That said, I don't know if there are funding or board type issues that may be brought up if you're not working at full capacity. Will you not get the number of procedures you need to graduate or pass boards? Will you have to extend your training anyway and they don't have the funding to keep you on at 50%, so they want you all there or all gone? I dunno.

 

[NotAProgDirector]

This is a really complicated situation. To quickly summarize, you developed an illness which placed you out of work for some extended period of time, and has now left you with limitations such that you can't work your full surgical duties. You expect to make a full recovery, although guessing somewhat on what your problem might be there's no guarantee that your recovery will be complete. I assume you're currently out on pain short term disability. You mention FMLA -- depending on what state you live in, that could be paid leave but is usually combined with your STD and only guarantees that your employer needs to offer you your position back when you're better. With that, what are your options?

The first question to answer is whether you're covered by the ADA or not. The ADA has specific requirements and rules that much be followed. But, in order to have a disability as defined by the ADA, the problem must be permanent. Transitory problems are not covered. So, if your physicians maintain that you'll make a full recovery, your situation probably doesn't qualify for ADA. But this situation is very complicated, and I am not an expert that can determine if you are considered disabled per the ADA.

It's worth considering the options if you're covered by the ADA, as an example of how to frame the discussion. If you're covered by the ADA, then the institution is required to make reasonable accommodations to qualified individuals except when those accommodations create undue hardships. What's "reasonable" is left open to discussion, and is highly debatable. If there are rotations to which you could be assigned that surgical residents at your level of training are routinely assigned to where you could meet work requirements, that would certainly be considered reasonable. If you would require a change to schedule or duties, then whether they can accommodate depends upon the details. For example, let's say you could work day shifts but not night shifts (or not 24 hour shifts). Your program might decide that sort of accommodation is reasonable and return you to work. Or, they might consider 24 hour shifts to be an essential function of the position -- essential functions are the skills that are non-negotiable, you would need to be able to do them (with accommodation) to be employed.

If you're not covered by the ADA, then your employer is not required to make accommodations for you. They can insist that you are able to work 100% to return to work. They can let you come back at some modified schedule, but it's totally their call.

Given all this, advice:
1. I would avoid asking docs to say you're "cleared" to work. Instead, have them state what you can (and perhaps can't) do. This should be a two way dialog between you and your physicians. With that documentation, you perhaps can get away from a cleared/not cleared decision, although it may make no difference.
2. If your primary docs are having difficulty with this, a visit to Occ Med (assuming your institution has this) might be a great idea. This is their job.
3. You might want to visit with HR. You should claim ADA protection, make them prove that you don't qualify. If they decline you, you're no worse off.
4. Remember that if they allow you to come back to work, you may not get training credit. Is that what you want?
5. If you decide to go for ADA qualification, it will help your argument if your disease could be chronic. Would be better to have medical documentation that stresses the chronicity, rather than documentation that says you'll get all better.
6. You might be able to be hired to do research, if you're super bored.

Best of luck, and hope you return to a full and fulfilling career.

 

[rokshana]

I am a resident nearing completion of a rigorous surgical training program. I got the flu this year and worked through it for over a week (as we all do) until eventually I was sent home by my program director (I must have looked reall bad right?). I was required to provide clearance to return to work from my pcp which I obtained. I returned but developed a post flu complication (being vague here trying to avoid identification but was enough to be rushed into the ER when I sidelined one of the EM attendings). I was encouraged by program to once again go home and get clearance to return again. No one anticipated the prolonged workup that would ensue and eventually determine that I had a treatable complication of the illneas that does not have chronic implications.

No physician is willing to fill out either clearance to return at 100 % (long operations, 24/7 home call for Icu and Operations, occasional 24 hour first call) while I wait for the treatment to fully kick in which unfortunately takes weeks. Additionally when presented with FMLA paperwork no physician treating me believes that I’m so sick I need to be at home (and neither do I). An informal request to my PD for return with accommodation from my treeTing physician was denied stating that in our field one must be 100% or home.

The problem is we all know that isn’t true and I’ve worked sick many a time before. I want to be back at work. I can’t make a physician write the clearance letter however and guaranteeing that i won’t need a to even take a break seems impossible. Setting parameters to define when I will be at 100% health seems equally fraught with all the grey areas of human health. I’ve told many patients to return to work but that they will have to start a bit slower and ramp up to their baseline after a prolonged illness. Of course they weren’t surgeons....

Looking thru SDN there are countless posts about residents needing to work thru illness and dismay at time off ... I seem to have the opposite problem where I’m begging to come back and can’t get the documentation I need to do so.

Despite knowing that through the years I’ve worked sick as a dog and people just made on the fly accommodations (scrubbing out to puke and scrubbing back in, allowed to nap in call room between procedures, allowed to break and get a drink or redose zofran when usually I would never break scrub). In a world where everything must be documented and everyone is covering their rear ... and where concern for patients safety is very real, I find myself in a odd position for a surgical resident... I want to come back but can’t get cleared and simultaneously my doctors think I could go back with accommodations but the program wants all or nothing.

Prior to this I had never heard of formal accommodations, or been asked for formal clearance (I’ve never called out but have been sent home a time or two since no one wanted to catch what i had). Nor had I contemplated if a surgical resident should be able to come back at 80%...I thought we all worked sick and helped each other out when we could and did everything we could to keep the patients safe. We have an army of PAs so the work coverage isn’t the issue... and even if I did shorter days for a week or took breaks or chose to scrub the shorter cases ..... that would unburden those PAs for a period of time.

I am working with my institution but was curious of opinions here as well. I wish I was 100% already, I wish I could get someone to write that down, I wish the treatment went faster, I wish we’d come to the actual diagnosis faster....but that’s all out of my control. I am incredibly thankful this is temporary and treatable. Just a surgery resident who genuinely wants to return to work and do my best...and can’t seem to get any of the documentation one way or another.....

Can they not put you a research or elective to accommodate for a lighter load? I take it you have used all of your sick and vacation leave? Is there a sick bank that you are able to utilize? Not quite sure why the pushback for fmla...heck when I had knee surgery my program made me fill out the paperwork and go on it for the week I though I would be out (needed 2weeks post op so good call on their part).

 

[Crayola227]

you can consult an attorney familiar with employment law/ADA

you don't have to tell your program

I am NOT suggesting you sue the program, become adversarial, etc

Docs and even HR don't tend to be experts on how everyone can cover their ass and move forward satisfactorily from a legal standpoint, so an attorney shedding light here could actually benefit all parties in checkboxing what needs done here to get you back to work.

 

[Crayola227]

for the record, issues with accommodations for illness aren't just about people being ill and wanting time off

equally challenging for many is dealing with chronic or prolonged illness in training, and trying to find a way to continue their careers

the barriers are multifactorial and come from a variety of angles

 

[WingedOx]

The first question to answer is whether you're covered by the ADA or not. The ADA has specific requirements and rules that much be followed. But, in order to have a disability as defined by the ADA, the problem must be permanent. Transitory problems are not covered. So, if your physicians maintain that you'll make a full recovery, your situation probably doesn't qualify for ADA. But this situation is very complicated, and I am not an expert that can determine if you are considered disabled per the ADA.

So this is an unrelated spinoff question, but does the ADA differentiate between "permanent" and "treatable"? Has a lot of mental health implications depending on how that's framed.

 

[NotAProgDirector]

So this is an unrelated spinoff question, but does the ADA differentiate between "permanent" and "treatable"? Has a lot of mental health implications depending on how that's framed.

Chronic illnesses that tend to flare and remit are covered by the ADA, and the accommodations are based upon when the disease is at its most severe.

 

[doc05]

The point is that in surgery there are no "outpatient" rotations and rarely electives. And the American Board of Surgery says you must do at least 48 weeks of clinical work per year.

Sounds like you'll need to graduate off cycle, if you're lucky. Do something academic, maybe write a paper or three until you're back to clinical work. Good luck