Employers must have more trust or face rising costs – says Nova Scotia doctor

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Some HR professionals face a never ending battle with certain employees who insist on taking sick day after sick day but one Novia Scotia doctor is showing no sympathy and has decided to charge employers $30 for a worker’s sick note.

"If an employee said they are sick, their employer should probably trust that they are telling the truth if they have a good relationship with them," said Ether Cooper-Rosen, of Woodlawn Medical Clinic. "The patient doesn’t want to pay for the note and the employer generally doesn’t want to pay for the note."

The Nova Scotia physician revealed that she gets three to five requests for a doctor’s note each week, notes which are not covered by Medical Services Insurance.

On average, Canadian workers miss 7.4 days per year due to sickness (Nova Scotians miss slightly more at 8.5), so if the scheme takes off, employers who are particularly strict on tracking absenteeism will be hit with rising costs.

 Cooper-Rosen also spoke out to defend her decision and said; “We are taking the position that it’s an unnecessary medical visit taking up our time, exposing patients in the waiting room to illnesses, and it shouldn't be part of the system.”

Kevin Chapman, of director of health policy and promotion with Doctors Nova Scotia, backed Cooper-Rosen and said: “We don’t want patients to have to go to a doctor’s office to satisfy what is essentially an administrative requirement, because it ties up access.”

If you’re always chasing sickly staff members for that elusive doctor’s note, it might be time to reevaluate your absenteeism approach or face a hefty bill.

What do you think? Is it unfair to expect employers to foot the cost for simply doing their job?
  • DM on 2014-10-29 2:12:47 PM

    Why would the employer pay for the note? it's the employee who has to pay for the note to justify that they were away from work for a legitimate reason, otherwise they suffer being absent without authourization from their scheduled work day.

  • JL on 2014-10-29 2:25:14 PM

    I don't know how they would be able to enforce this since it is legal for employers to request medical documentation at the employees expense. Usually medical is only requested for excessive or "trend" absenteeism, so perhaps Doctors should push back on more patients and only provide them with a note based on their actual diagnosis of illness, and not "pencil whip" them for any reason at all solely based on whatever the patient says.

  • Joanne on 2014-10-29 2:27:18 PM

    This topic raising it's ugly head again...... DM is absolutely correct it is not the employer's cost for medical notes unless they ask for one. We have in our CA that a medical note must be produced after 3 days absence which we do not pay. If we ask for a note prior to the 3 days we do pay for the note. Except, when there is a problem with the employees attendance then the employee has to submit the note or face disciplinary action. If doctors would take some responsibility and not supply medical notes for patients that come in for a note for a day off unless the doctor examines them and gives the medical note for medical reasons only, not so the employee can have a "vacation" day.

  • Mary on 2014-10-29 2:53:57 PM

    To DM's point, the onus is on the employee to justify their absence. Without such a note, there may be a disciiplinary response, instead. Although I understand their point of view, I don't understand how a Doctor can bill an employer directly.

  • Laura on 2014-10-30 10:45:31 AM

    How is this so hard to understand? Requiring employees to obtain a sick note IS a drain on our already overly maxed out healthcare system. I cannot agree with anyone who supports DM's position.

    I think forcing the bill on the employer is meant to encourage less strict sick leave policies.
    For example, some employers require a sick note for even one day of absence, while others are more lenient, requiring a note only after 2, 3, or more days missed in a row. At that point, it makes sense to have the person get a sick note, but not after 1 day.

    Consider this: You wake up with a bad migraine, you call in sick. Your employer requires a sick note for a one day absence. So, the following day you take your lunch hour to get the note (because you can't possibly go out, drive, etc with a migraine the day of).
    Your migraine is now gone, and now you're in the waiting room, potentially exposed to contagious, sickly people.
    You tell your Dr. you had a migraine, he writes the note. He doesn't even need to look at you to do so! He just takes your word for it!

    JUST as the employer should, because now you've wasted the Dr's time, filled up the waiting room, AND have potentially exposed yourself to flu/cold viruses, which, in a few days to a week, could have you back on sick leave (and then back in the Dr's office, exposing other note seekers to your sickly-self).
    Congratulations, you're a drain on the healthcare system!

    So, if employers have to pay for it, they might think twice about their 1day policy. From a Drs POV, he/she is wasting his/her valuable time on stupidity, nonsense. Imagine if employers just increased their policy by one day - what a difference that would make on our healthcare system.
    You have to look at the BIGGER picture here, people. Clinic Drs accepting walk-ins have to book time off from their regular patients during the day for these note seekers, which in turn, backs up wait times for patients to get appointments. It is a TOTAL waste of resources. People already end up in clinics and the ER over nonsense - a little sniffle or single bout of diarrhea. Every person that does so takes away valuable resources from others that ACTUALLY NEED to see a DR.

    Most people do not realize how bad the healthcare system actually is until they really need it. I don't mean "need" as in get a flu vaccine or an annual physical. I mean "need" over serious, chronic or acute episodes that either threaten one's life or severely impair it.
    Ever have to wait over a year for a surgery? 6 months for specialist referral appointment?
    It's all about the best use of resources and clearly Dr. Cooper-Rosen should know when her time is being wasted.

    The argument over whether or not the employers should have to pay, I think that if it is clear that they are abusing the system, they should then become liable.

    One last thing to consider:
    An employee working for a business that requires a sick note after one day is deterred from actually taking the sick day, (because of the cost, the hassle, etc.) I will bet some of you will say, "Yes, and that's the whole point - fewer absences, higher productivity!"
    NO.
    No! Why not? Because far too many people "power through" colds and flus and come into work, only to infect 5 other people, and their productivity is really only around 40% of their usual ability because they feel like crap and are all doped up cough medicine!! So how is this more productive?
    Take one sicky out, you lose one sicky. Let that one sicky infect 3, now you're down 3 sickies.
    And, knowing that there are only X number of sick days granted per year, is it fair to other employees who may not have strong immune systems, or that have serious health conditions that require time off for appointments, to tax their days and make them pay for notes, when they should not have been exposed in the first place?
    The employee's understanding of their limited number of sick time should be enough for employers to be able to trust their workers. Don't forget, employees have the right to those days, they should be able to use them as they need them.

    This argument is not about employees abusing sick leave, or who should pay for notes. Really, it's about the abuse of healthcare resources by overzealous employers that can't see beyond their front doors.
    Dr. Cooper-Rosen has chosen a brilliant method for her argument, and that is to get the cause the most attention possible and threaten the corporations where it hurts the most - their bank accounts. Something has to be done about our crumbling healthcare system and she is putting herself out there to do just that. Good for her!

  • Laura on 2014-10-30 10:57:42 AM

    Joanne,
    Why should we be wasting a Dr's time with this nonsense? Are employers so incompetent that they lack the ability to handle employee attendance?
    Drs should NOT have this burden of responsibility. They can no better tell if a patient is telling the truth about having to take one day off because of a migraine than an employer can. It is a complete waste of their time.
    Instead, the onus should sit squarely on the employer's shoulders, and they should be able to handle any employees that appear to be abusing their sick time. At that point, the employee should have to prove their need for the time off.
    Getting the employer to pay for it is just passing back the buck that should never have been tossed to the MD's in the first place.

  • JL on 2014-10-30 11:13:53 AM

    Laura, you have contradicted yourself "and they should be able to handle any employees that appear to be abusing their sick time. At that point, the employee should have to prove their need for the time off" - that is exactly what asking for medical is doing, proving their time off. I don't agree with asking for a doctors absence after one absence, although I'm not aware of any organization that has this policy?! Most have 3 consecutive days, or if there is a trend of excessive absenteeism then my organization will begin to require documentation after each absence because we are attempting to manage the attendance. If their attendance is so poor because they are sick that much, they SHOULD be seen by a doctor.

  • DM on 2014-10-30 11:16:35 AM

    @ Laura - You have taken the issue and personalized it down to a migrane. The issue here is that the average Canadian worker was absent the equivalent of almost two full work weeks in 2011. These absences, which can range from time off for minor illnesses to longer-term leaves of absence, cost the Canadian economy an estimated $16.6 billion in 2012, according to a Conference Board of Canada.Lets be real here and acknowledge that abuse within the system exists and therefore it just unfortunate if a doctor has to write a few sick-notes during the year for employees that require a note for their employerand that an employee may be responsible for the cost of the note.

  • Laura on 2014-10-30 5:25:15 PM

    DM, clearly you did not read everything I said. The migraine was a basic example of ONE type of reason for sick time, and it is not personal at all.
    "These absences, which can range from time off for minor illnesses to longer-term leaves of absence, cost the Canadian economy an estimated $16.6 billion in 2012, according to a Conference Board of Canada"
    What is your point? Are you saying that the majority of those absentees are abusers? Could it not be that having sick people come into work before they are better only helps to SPREAD illness, resulting in more people getting becoming ill and having to take time off? What are you saying by throwing out statistics?
    You did nothing to support your disagreement with my points, you just quoted 2 statistics. So what do they mean?
    Are there any stats to prove one way or another that those employees were faking it? If you said, of the 2 weeks the average Canadian worker takes in sick leave, 4 of those days were for "fake sickness" then you would have an argument.

    You also said: "it just unfortunate if a doctor has to write a few sick-notes during the year"

    Did you even read the article? A FEW a year?! The article states:"she gets three to five requests for a doctor’s note each week".
    Close.
    I am not denying that people take advantage of sick leave - but that should not be up to Mds to police. Employers make the rules. Employers should be the ones to enforce them. If a worker always seems to get sick on Fridays or Mondays, is that not something the employer should address?
    And once again, I said the issue is not really about who pays for the note, even though you seem to argue with me about it.
    It's about the abuse of the healthcare system. I think before you close your mind to all arguments you should do some homework and find out what a mess our healthcare system is really like. Ask a nurse, md, etc. Take a look at the stats on wait times for walk in clinics!

    JL, just for clarification, my point was to say that employers should not require a sick note for any time less than 3 days off. My place of business requires a note after only 2 days off, but there are others that absolutely do expect one even after only one day off.
    So when I say employers should manage the absenteeism, (if there is such a fear of abuse), rather than expect the worker to provide a note after one day, they should loosen up and extend that to at least 3 days. Because if you are sick (as you stated) for at least that time, you should be seen by a dr. Well, some flus need to run their course, and going to see the dr. is pointless because its a virus and cannot be treated with a magic pill, but for other conditions its likely a good idea. I agree with you.
    Now when I said that the worker should have to provide a note if abuse is expected, it was in reference to the 1day note expectation, which is silly. I used the migraine as an example because its often at least a day long affliction, and once gone by the second day, cannot be "proved" to have happened by a dr, thus making the whole procedure of getting a note a vain effort. Because what is the point? To show that you went to the dr and paid for a note? If you really had a migraine you had to stay at home, but using up a drs time for a signature is a waste of resources.
    Medical professionals don't go to school for half their lives to write sick notes.

    (DM) I also used the example of a migraine because it was a common 24hr long affliction, and it was more polite than using "explosive diarrhea" or "an std flare up" - which are also sometimes one offs that happen to keep us home for just a day. But you implied I was personalizing my example, so, I have to be honest, there you have it.

  • DM on 2014-10-31 8:50:16 AM

    @Laura sounds to me there is a lot more going on here than you being concerned about a Doctor's note? Could it be you miss a lot of time and don't like that your employer is askingyou to verify it with a note ?

  • JL on 2014-10-31 10:08:50 AM

    Laura, so to clarify, you don't have a problem with employers asking for notes after 3 days, but you disagree if it's anything less - so you are saying Dr. Cooper-Rosen should charge to employer for the note if it's requested after one absence but not after 3? Or are you saying you agree with the article that the doctor should charge the employer for ALL?

  • Tom from Burnaby BC on 2014-11-02 1:50:56 PM

    Here we go again. everything has a cost.

    Private sector employer be sensible, we are. Give 3 paid sick days per year anything over that goes to short term disability after Dr. signs papers. Trust or get out of biz.

    Our public sector has more time off than private. Do your homework guys and girls.

  • M on 2014-11-05 10:09:25 AM

    This is a topic that frequently raises strong opinions. It is easy to read into the comments and determine who manages people - likely in an HR role - and who does not. There is no solution in a flat "number" policy - neither using a magic "3 days" nor creating another number. It depends on the big picture. Laura, you don't manage people, yet you have a strong opinion about how this should be handled. To be blunt, until you've walked in our shoes, your rant is dismissive and defensive. Sounds like someone has tried to attendance manage you, and your resistance leads you to simply to strike out.

  • JL on 2014-11-05 10:20:20 AM

    Well said M - I completely agree

  • Larry Dawson on 2014-11-13 4:09:07 PM

    The whole gamut of sick leave policies requiring medical notes, aggressive sick leave management practices and eroding the trust relationship when employees feel devalued and guilty for working sick is discussed in Cypress Health Region v. Service Employees International Union [2014] S.L.A.A. No. 13. Arbitrator Ish (former Dean of Law at U. of Saskatchewan) upheld the policy grievances relating to the sick leave management plan and provided extensive guidance on what constitutes reasonable sick leave policies. And doctor's notes after 1 day absences did not make the cut. Neither did withholding pay for sick days until "sufficient verification" was received make the cut. This was a unionized workplace but the employer clearly cherry picked their policies and procedures from a non-unionized setting. The extent of the "screening" devised to certify sick leave approval was clearly geared toward discouraging use of sick leave, even for short term illnesses of one day, as employees reportedly were being denied allegedly legitimate sick pay for weeks after taking a single day off. The most damning part of the employer's case was that the employer introduced this new policy on sick leave as "not a new policy" but a series of protocols to improve sick leave administration, yet it was clearly a new policy with new restrictions and new procedures. Additionally, although not reported in the award, there were a number of individual grievances on the denial or delay of sick leave benefits that had been won by the Union prior to filing and winning this policy grievance, so it's likely this debacle cost this employer ( a public health authority) at least a couple hundred thousand in legal fees, arb fees, prep time and manager time overall. An expensive lesson in how not to do it right, and letting the "get tough on sick leave" mentality run rampant.

  • NotRight on 2014-12-12 5:01:27 PM

    Your employer requires a note if you are sick, if no note, you are put on a program (attendance management) or it is put on your record as a 'black mark'. Some people may just take the day off, get a sick note to get paid and may not be as sick as the note indicates. Some are legit sick and a note is appreciated. I get sick notes so it wont go on my record as a 'black mark', not to get paid. Since it is my companies stance that any unexcused absence is marked, I will get a sick note, if there is a charge, the company can pay for the note or trust me that I am sick

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