Why are sick days so frowned upon in EM residency?

[odyssey2]

There’s a culture of pushing through illness throughout medicine but it seems EM really takes the cake. A friend of mine asked to leave her shift early for severe abdominal pain and fever but was told “we don’t do that here.” She goes straight to the other ER in town after her shift and turns out she’s septic with gangrenous appendicitis. She was hours away from having a burst appendix. Returns after her surgery and doesn’t get so much as an apology, gets a total of 2 days off which she has to make up the following week.
Anyone else think this is f’ed up?

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[RustedFox]

Yeah, so similar thing happened to me in residency.

Fever. Abdominal pain. Bright red blood per rectum. For a few days.

I took a sick day.

"Suck it up", I was told.

Near syncope on shift.

Colonoscopy next day.

Severe ulcerative colitis.

"What good is a sick day if you aren't allowed to take one?" - I asked the PD.

 

[GassYous]

That is totally ****ed wow

And I am the most anti-resident sick day guy because so many of my classmates abused it but I still think that the response was callous and absurd.

 

[Zebra Hunter]

The culture of “anti-sick day” in EM is there primarily because it is so much of a pain in the *** to get a shift filled last second and frequently leads to prolonged shifts for others, as well. Even more so when you are working at single coverage or lightly covered sites. So there is an expectation that unless you need to be in an ER, you suck it up. It’s not like you’re in clinic where you can just shut down the clinic for the day if you don’t show up. The show must go on.

So I get why there is push back against taking sick days, but that being said, I also trust that when a colleague states they are too sick to go into work, they truly are, and we shouldn’t be giving push back unless it becomes a common occurrence.

 

[DeadCactus]

It is too easy to have a back-up call schedule and encourage people to call out when ill or some other emergency comes up. But medical culture makes excuses and pretend it's admiral to come in spreading plague and making impaired decisions to avoid calling out. I think the root is probably that people would rather be sick at work and healthy at home than vice versa which certainly would explain why EM tends to be worse.

 

[RustedFox]

It is too easy to have a back-up call schedule and encourage people to call out when ill or some other emergency comes up. But medical culture makes excuses and pretend it's admiral to come in spreading plague and making impaired decisions to avoid calling out. I think the root is probably that people would rather be sick at work and healthy at home than vice versa which certainly would explain why EM tends to be worse.

For friggin' real.
My director is out with COVID right now, and they're scrambling to fill those shifts for this week.
Nobody wants to.
Why?
Because thru continuous barebones staffing, they've created this workplace environment where "nobody wants to be there more than they have to be" because its an onslaught from start to finish.

Similarly, when "surge" gets called, nobody ever comes. Nobody. Ever. Comes.

I hope the CMGs read this message.
Listen to me: "Yer doin' it rong, you greedy fuxx."

 

[Dr Mantis Toboggan]

There’s a culture of pushing through illness throughout medicine but it seems EM really takes the cake. A friend of mine asked to leave her shift early for severe abdominal pain and fever but was told “we don’t do that here.” She goes straight to the other ER in town after her shift and turns out she’s septic with gangrenous appendicitis. She was hours away from having a burst appendix. Returns after her surgery and doesn’t get so much as an apology, gets a total of 2 days off which she has to make up the following week.
Anyone else think this is f’ed up?

ER is nothing compared to residencies like neurosurgery. I’d venture to say most of those folks are never off a single day their entire residency. Most EM programs have a jeopardy or sick call schedule. It’s often abused but better that than shenanigans like this.

 

[DeadCactus]

I would argue that if a jeopardy system is being "abused", it's a design (inadequate compensation for being called in) and/or cultural problem (people mad they are called in because they worked when they should have called off).

 

[Rekt]

Because it means the attending has to get off their ass for once and see patients if the resident is sick. Why do that when you can gas light residents instead?

 

[PianoMedic]

At the program I work at, residents are a nice thing when they’re on, but the ED is not resident run at all. I have a resident maybe one in four or one in five shifts. I’m community faculty though. The academic faculty almost always have a resident scheduled with them. They are capable of working on their own, and if a resident is sick they are expected to. Covid changed the culture into it being more ok to call off. My group culture is “next man up” if something happens. Had one of our docs go out with appendicitis, his wife delivered like 5 days later so he ended up being out two weeks. We all filled in shifts for him, he picked up a shift here and there when he got back but we have PTO for a reason in our group. No official backup schedule, we just make sure to cover for each other. SDG obviously.

 

[JacobMcCandles]

The issue is that there's sick and there's 'sick'. Residency is different than the real world. In residency, there will be somebody to cover for you whether that is a resident or attending. Outside of residency, many times (especially single coverage places) there's nobody. People are going to get sick or have last minute emergencies and I think everyone understands that. There's also always a few people who will try to abuse this so when they're actually sick, nobody really believes them. There is some 'suck it up' in emergency medicine but you've also got to use common sense. If you've got a good group then things will typically even out in the end since everybody will need to take off at the last minute at some point.

 

[Dr Mantis Toboggan]

I would argue that if a jeopardy system is being "abused", it's a design (inadequate compensation for being called in) and/or cultural problem (people mad they are called in because they worked when they should have called off).

This is more on the resident side of things but I’ve seen situations where healthy folks in their mid to late 20s literally called off every month or two. This was well before covid where if you had a minor URI you just worked through it. Maybe there was more to it but probability wise it didn’t meet the sniff test.

In fact, one medicine resident I knew became so angry at one of her co-residents (who would miss one call night a rotation minimum) that she essentially became a chief with the sole purpose of trying to institute a payback system for jeopardy. Which her PD refused to allow her to do, lol.

 

[Birdstrike]

“Why are sick days so frowned upon in EM residency?”​

It’s to support the central lie of EM, which is, “If you aren’t here people will die.” The truth is, “If you’re not here, the 80% unsick in the waiting room might have to wait so long some will leave and we will lose money.”

 

[RustedFox]

“Why are sick days so frowned upon in EM residency?”​

It’s to support the central lie of EM, which is, “If you aren’t here people will die.” The truth is, “If you’re not here, the 80% unsick in the waiting room might have to wait so long some will leave and we will lose money.”

Boom goes the Birdstrike.

 

[Birdstrike]

Boom goes the Birdstrike.

More EM lies:

"EM is a lifestyle specialty."

"When you're off, you're off."

"Burnout is not caused by EM, it's caused by the person."

"Taking care of the emergencies is what's most important."

 

[RuralEDDoc]

“Why are sick days so frowned upon in EM residency?”​

It’s to support the central lie of EM, which is, “If you aren’t here people will die.” The truth is, “If you’re not here, the 80% unsick in the waiting room might have to wait so long some will leave and we will lose money.”

Maybe it’s just my sites, or my perception is skewed, but the days of low acuity and worried well filling ERs seem to be over.
Kernel of truth to your point of course but it’s not 2015 anymore. Drug seekers and new Obama care recipients have been played out. COVID still scares aware sick people until they are SICK. Just a different world now.

 

[turkeyjerky]

I think you’ve been out of the game for too long. Maybe it’s just my sites, or my perception is skewed, but the days of low acuity and worried well filling ERs seem to be over.
Kernel of truth to your point of course but it’s not 2015 anymore. Drug seekers and new Obama care recipients have been played out. COVID still scares aware sick people until they are SICK. Just a different world now.

Man I wish. Ultra low acuity in general up here. Insane amount of anxiety driven asymptomatic hypertension.

 

[RuralEDDoc]

Man I wish. Ultra low acuity in general up here. Insane amount of anxiety driven asymptomatic hypertension.

Maybe I’m lucky (unlucky?) with acuity. Our worried well disappeared and just never came back. I’ll get the occasional “I’m here cause I can’t see my doctor” but that’s more rare now than prepandemic (n of 1).
Goes to show the enormous variability in practice environment.

 

[thegenius]

There’s a culture of pushing through illness throughout medicine but it seems EM really takes the cake. A friend of mine asked to leave her shift early for severe abdominal pain and fever but was told “we don’t do that here.” She goes straight to the other ER in town after her shift and turns out she’s septic with gangrenous appendicitis. She was hours away from having a burst appendix. Returns after her surgery and doesn’t get so much as an apology, gets a total of 2 days off which she has to make up the following week.
Anyone else think this is f’ed up?

I mean I believe you...there is no point lying about this kind of stuff....but it's hard to believe that is true.

I've never had any pushback on sick days (not that I ever take them, maybe once every 5 years)

 

[GonnaBeADoc2222]

I think people should call out whenever they want. Sometimes you need a day off. Nurses do it, why not us? As long as its not too frequent, I have no issue with this. It's the corporations (CMGs and Hospital systems) that don't want us to. Nevermind that we get no paid sick time or PTO.

 

[Groove]

Hmm, I may be in the minority on here but I actually don't think we should call in that much. I mean, don't get me wrong...I called in all the time in my previous IT career. If you didn't use the days up by the end of the year, you lost them and EVERYBODY used their sick days. Then again, I was making ~65K/yr. My boss made 130K/yr and probably used 1 or 2 sick days a year. My CEO probably made 400K/yr and I don't ever remember him taking a sick day. I kind of feel that once you are deemed important enough to make hundreds of thousands of dollars/yr, regardless of field, the expectation of not abusing sick days goes up. How many days are we truly too sick to show up for work? Even when I've got the flu, 1g of Tylenol, 800mg of ibuprofen and 25mg dextromethorphan pretty much makes me feel like a new man for at least 6 hours...almost enough to get me through my shift. Although I do think we should be able to use them more often, I don't actually think most of us are too sick to go to work very many days out of the year unless we're truly dealing with a major health issue.

If you've got something serious going on, that's different and I absolutely think we should be able to take off to deal with any major health issues whenever we want. I'd also have no problem covering for a colleague under those circumstances.

 

[gamerEMdoc]

The question is, how often does someone have a true emergency they are calling off for, and how often are people calling off when they could come to work? True emergencies are incredibly rare, and I've never had an attending in a decade fail to send the resident home when a significant medical illness happens while on shift; this is just incredibly rare. In my 10 years of academics, our residents have always vehemently opposed any kind of backup call system to account for sick days, which leads to the mentality of you only call off when really sick, because then it becomes difficult to fill it. Whether residents rampantly use sick days and the program uses a jeopardy system, or whether the residents only use them for truly emergent stuff and there's no jeopardy doesn't matter to me. But in my experience, the residents are always going to choose "no jeopardy call, we'll just suck it up". Re: what good are "sick days" if you can't use them, residents get PTO days. They are sick/vacation days. No one wants to give up their vacation in order to be out for a few days with a cold. That's why they don't use them.

 

[Tiger26]

It's mainly because we can't close the clinic for the day and cancel patient's appointments. Ultimately, someone has to cover that shift, whether on their day off or just by going short staffed (or extra short staffed).

A backup system helps but only if done well enough that the same person doesn't keep taking advantage of it. The best thing to do is screen out those people in the hiring process as much as you can do so you're getting the type of people who only call in when they need to.

I've been lucky enough to avoid serious issues but I've never called in over a 12 year span since starting EM.

 

[JacobMcCandles]

I think people should call out whenever they want. Sometimes you need a day off. Nurses do it, why not us? As long as its not too frequent, I have no issue with this. It's the corporations (CMGs and Hospital systems) that don't want us to. Nevermind that we get no paid sick time or PTO.

There is always going to be several nurses at work, even in low volume places. That isn't the case with docs. If a nurse calls out, you don't necessarily have to replace them. If a doc calls out, you typically have to replace them. I think you'd get tired of getting called in on your day off at the last minute when your colleagues decide the morning of their shift that they need a day off.

 

[xaelia]

Had one of our docs go out with appendicitis, his wife delivered like 5 days later so he ended up being out two weeks. We all filled in shifts for him, he picked up a shift here and there when he got back but we have PTO for a reason in our group.

Wow, a whole two weeks off to have surgery and a new baby. What a great work/life balance.

It's mainly because we can't close the clinic for the day and cancel patient's appointments. Ultimately, someone has to cover that shift, whether on their day off or just by going short staffed (or extra short staffed).

We are replaceable cogs of no true value to the institution. If no physicians show up to staff an ED due to illness or emergency, tough beans – the ED will simply have to close/fail to provide care, and the responsibility is squarely on the shoulders of the institution. It's this mindset that has everyone locked into burning ourselves out for "the people who need us", when, the reality is the administration is perfectly happy to stretch you over the rack as long as you're willing to do it.

 

[JacobMcCandles]

We are replaceable cogs of no true value to the institution. If no physicians show up to staff an ED due to illness or emergency, tough beans – the ED will simply have to close/fail to provide care, and the responsibility is squarely on the shoulders of the institution. It's this mindset that has everyone locked into burning ourselves out for "the people who need us", when, the reality is the administration is perfectly happy to stretch you over the rack as long as you're willing to do it.

It’s not quite that black and white for everyone. Maybe if you work for a CMG where you don’t have a sense of ownership and you just clock in and clock out but if you’re in a SDG then that’s your business and contract. Not having someone there for a shift is basically the last resort and isn’t a contract you’ll have long.

 

[Tenk]

It’s funny, up until about a year and a half ago we had double pay for last minute coverage. We never had a spot go unfilled for last minute emergencies.

Post Covid, that’s gone. Now I’m working 3 extra hours Saturday. WOOO!

The lesson: If you pay people appropriately for their time off, you won’t have any problems filling sick spots.

 

[cyanide12345678]

My uncle just died a week ago and i thought of how impossible it is for me to take a week off to attend a funeral in another county/city even if i really wanted to. My brother was able to leave everything and be with my dad who was really close to his brother.

If there’s ever an issue at my child’s daycare, then it’s always my wife going home because she can just cancel the appointment for her patients. I can almost never leave the ER at my single coverage shop. I dread the day that i have a family emergency where I’m at work and I’m just stuck and can’t leave.

This is another reason why EM is not lifestyle friendly.

 

[RuralEDDoc]

My uncle just died a week ago and i thought of how impossible it is for me to take a week off to attend a funeral in another county/city even if i really wanted to. My brother was able to leave everything and be with my dad who was really close to his brother.

If there’s ever an issue at my child’s daycare, then it’s always my wife going home because she can just cancel the appointment for her patients. I can almost never leave the ER at my single coverage shop. I dread the day that i have a family emergency where I’m at work and I’m just stuck and can’t leave.

This is another reason why EM is not lifestyle friendly.

Absolutely love this post. So true.
Also… kind of hate the post earlier in the thread where someone says that we should just take days off “because sometimes you need a day off, nurses do it!”
You won’t be fired for this, mostly. But you’ll be hated, which honestly might be worse.

 

[xaelia]

My uncle just died a week ago and i thought of how impossible it is for me to take a week off to attend a funeral in another county/city even if i really wanted to. My brother was able to leave everything and be with my dad who was really close to his brother.

If there’s ever an issue at my child’s daycare, then it’s always my wife going home because she can just cancel the appointment for her patients. I can almost never leave the ER at my single coverage shop. I dread the day that i have a family emergency where I’m at work and I’m just stuck and can’t leave.

This is another reason why EM is not lifestyle friendly.

If we've all collectively convinced ourselves we are in in this prison of our own making, then so we shall be.

It's one thing to deal with issues of patient abandonment that will affect your ability to keep your medical license by not being able to leave for a spectrum of personal emergencies. It's another thing entirely to feel as though you're trapped to the extent your family is less important that showing up for work.

It's not your responsibility to cover for an institution whose workforce planning isn't resilient to the expected unscheduled demands of the Real World.

 

[Dred Pirate]

I think in healthcare in general we look down on people that can't "suck it up" and come in. I know I am personally guilty (I have used 4 sick days in 18 years. Honestly, three of the days I was sick as hell, and the fourth I was in mgmt- and just annoyed with life and took a mental health day and went and drank beers and hit golf balls with my buddy. That day kind of is microcosm of why we don't use our sick days that much. We don't want to (or conversely don't want others) to call out sick and put more work on us. That day nobody had to cover for me, the work just stayed there until the next day for me. For many of our non-healthcare friends, that is common place (obvious exceptions such as retail, etc).

Secondly, with all of our time off (at least for me) in one bank (vacation, holiday, sick) - if I am able to work, I am gonna come in because I would rather save my time off for when I feel good and doing something fun (I know for most doc's this isn't necessarily the case as many are not direct employees of a the hospital and you don't necessarily have dedicated PDO)

edit- for one year when I was right out of school I was an employee of a super small hospital where I was the only pharmacist. I had sick days that were use them or lose them at the end of the year. Knowing I wasn't going to be able to just randomly call out, I had a few prn semi-retired rphs, I conveniently was sick every other friday for the last two months of the year and had an agreement for one of them to cover me. I worked for a staffing agency, and felt zero remorse taking what I was due based on my employment contract.

 

[SeekerOfTheTree]

Medicine is a joke. We always compare ourselves to other specialties or the days gone by and say it's not that bad. "I walked around with an IV pole because I had a kidney stone..." blah blah blah. Instead of comparing ourselves to the worst (like a group of abusive spouses meeting up and saying we aren't that bad), we should compare ourselves to the normal workforce. We should not have barebones staffing. This is the main problem. We should be able to cover if a colleague calls in for being ill. Life happens. All these arguments about people abusing sick days....lets take away benefits of many because of a few.