“Employers, stop asking for medical notes”: ON top doctor

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Employers should stop asking for a doctor’s note when employees take sick leave because it’s wasting doctors’ time and putting others at risk.
That’s the message from Ontario Medical Association (OMA) president Scott Wooder, who said employees should stay home and avoid spreading their germs.

“First of all, you don’t want to encourage people who have infectious diseases to go to their doctor’s office when it’s not necessary,” said Wooder, who works as a family physician in Southern Ontario.

“They’re in a waiting room with other people, (and) some of them have very serious illnesses like cancer. There are pregnant mothers and children. They’re putting those people at risk.”

He estimated that Ontario sees “tens of thousands” of daily doctor visits just to get medical notes.

“(These visits) are expensive, they’re unnecessary and they put other people at risk,” said Wooder. “We don’t have resources in the health care system to police absenteeism for employers.”

Most organizations only require a medical note after a certain number of days off as a way of reducing the risk of people abusing the sick leave system.
“You’re running a business. You’ve got some expectations for people to show up, and rightly so,” John Kiru, executive director of the Toronto Association of Business Improvement Areas said. “After a certain point, I think the expectation should continue to be: a sick note, a note indicating that the individual was truly ill rather than somebody that wanted to take three days off.”

Wooder said employers should be more trusting of workers who call in sick, freeing up health resources for patients who need them.
“I’m not an expert in workplace absenteeism, but I am an expert in health care,” he said. “I think employers are going to have to adopt other policies.”

What is your sick leave policy? How trusting are you of those who take a number of consecutive days off?
  • Andrew on 2014-01-09 7:37:08 AM

    This is an interesting article. I've worked for companies in the past who are so distrustful of their employees that they demand a doctors note after a 1 day absence. Maybe after a few days it's ok to ask, but for 1 day off I think Scott Wooder is correct. It's not the best use of health care resources. Maybe there is a way to get doctors notes online so sick employees don't risk affecting others in a waiting room?

  • Chris on 2014-01-09 8:59:04 AM

    This is a breath of fresh thinking that I personally applaud. Excellent points made about sending people with infectious illnesses to doctors' offices unnecessarily. I rarely ask for a doctor's note and it's usually if recovery doesn't seem to be imminent. If an employer suspects an employee is mis-using sick time then a conversation with the employee is needed. Start with a simple question like "How can I help you reduce your sick time because, when you're away, your contribution to the organization is missed." The unspoken message here is, if your job is that unimportant that you don't need to show up for work every day, maybe we don't really need this position after all.

  • Bob on 2014-01-09 9:08:26 AM

    I am sure this is a topic we could debate. My impression is that Canada employees have a high use of sick leave and many of our workplaces provide a equally high amount of paid sick leave that some take advantage of the benefit and the result is employers seek confirmation that abuse does not occur. I remember a time when there was a "UIC"ski team that had members who were off sick and then yesterday some 100 "911" victums were found to be employed or employeable when they and their doctors said they were not. I suggest having employees go off to doctors mildly works but then we all want our employees to be healthy and only Doctors can quaterback a sick employee back to health

  • Shelly on 2014-01-09 9:33:22 AM

    I have witnessed substantial abuse of sick leave by employees and over the last couple of years as our federal government organization has undergone significant changes (which has caused tremendous stress to employees) the rate of absenteeism is even higher.

    I have experienced cases when an employee's abuse of sick leave has resulted in the employer insisting on a medical note for each absence, and then the employee's attendance rate improves significantly - and no, they are not coming to work really sick all the time either, we are keeping an eye on that too.

    The Canadian federal government has put an emphasis on revamping sick leave in the government and in my opinon, one of the pillars for strong disability management is reliable information from an employee's health care professional. If the employee isn't really sick or is capable of modified work duties, the employer has the right to this information and should be able to expect its employees and their health care professionals (under CMA's own polciy The Physician’s Role in Helping Patients Return to Work After an Illness or Injury“ (2010)) to cooperate in this process.

    And I'm sorry but I think that the idea that patients can get a doctor's note online doesn't seem to be very credulous to me.

    Perhaps doctor's need to be on time for their appointment schedules (fewer people in the waiting room), have more regimented cleaning protocols of waiting rooms to prevent the spread of diseases, segregate sick patients from people who are there for wellness check ups (i.e. pregnant woment) through different waiting rooms, different time slots for each type of visit or use other methods to help their patients stay healthy rather than laying the blame at the feet of employers who require medical notes from their employees.

    I don't know if most medical offices have advanced practitioner nurses or other sorts of professionals who can take on this function, but perhaps there are other options that the medical community can also consider.

  • Joanne on 2014-01-09 9:49:56 AM

    As someone who has been in the HR field for numerous years I feel this is a situation that doctors have brought on themselves. If doctors would only issue medical notes to patients that are truly sick rather than "hi doctor I was off yesterday so I need a sick note" to patients who will pay them the $10-$20 for the medical note. In my last company I had a folder for 3 doctors who issued medical notes like candy to everyone and anyone. I swear there must have been a line up with employees from my company to these 3 doctors. We were unionized and it was very difficult to terminate because the CA stated if they brought in a medical note their absenteeism was covered so they brought in a medical note each and every time they were off. Now the doctors are crying wolf. I'm sorry but I have had to put up with difficult times because it was easier for the doctor just to give the notes. These doctors had them pre-printed and all the receptionist had to do was fill in the patients name and date and collect the fee. What goes around comes around.

  • Shelly on 2014-01-09 9:58:23 AM

    Joanne...I have had very similar experiences....glad you brought this point forward. I agree that doctors also need to take on some of the responsibility and not dole sick notes out like candy. from an outsider this seems like a good money making idea - perhaps a doctor will comment to let me know if it truly is as I don't know.

  • Don on 2014-01-09 10:25:27 AM

    As Wooder puts it this visits are expensive , perhaps doctor's could stop charging the patient for the note, to cut costs. Obviously notes in extreme caeses or where abuse is supsected are required, the real problem is the unnecessary visits to doctors that are not required when an employee is simply trying to justify their absence from work with the note. Some doctors clearly write the note as dictated by the patient, how about he address this problem rather than trying to manage a profession he clearly knows nothing about.

  • Susan on 2014-01-09 11:32:04 AM

    I agree with both sides of the coin. Having a policy that requires a Dr. note for every absence is a poor practice. Telling your employees that you reserve the right to require notes when absenteeism is an issue is a better process. In BC very many people do not have a family doctor at all. They go to drop-in clinics and see a strange doctor every visit. This is not health care at all. Let's not forget that a doctor is an advocate for the patient. They are not doing their job to help businesses. Medical notes have a time and place, but I do not believe that every absence should require one.

  • Mary on 2014-01-09 11:57:13 AM

    I fully agree with the arguments from both sides. Our medical system is overburdened as it is, and the writing of medical notes for brief absences is not an effective use of medical resources. At the same time, as an HR professional with 25+ years experience I have become very jaded when it comes to medical notes and agree with Joanne that they are handed out by doctors like candy and hence for the most part are meaningless, especially since most of them are written after the absence has taken place. Unfortunately, in the current system of sick leave administration medical notes are a necessity. The answer then likely lies in an overhauled sick leave administration system, something along the lines of what Canada Post recently did. I don't have all the details, but essentially, employees are given x number of "personal days" per year. These days can be used for various casual absences be they for the employee's sickness, because the kids are sick, the dog is under the weather or because the employee is moving. Any casual time off in excess of these days is unpaid unless the person has vacation entitlement. Any longer sick leave absences fall under an insured sick leave plan and medical notes are handled by the insurer. This completely solves the problem of having to obtain medical notes for casual absences and saves the sanity of HR staff who are currently having to administer over generous, ineffective, in-house sick leave plans.

  • Anna on 2014-01-09 6:39:26 PM

    I agree with Shelly. Employers have a valid expectation that employees should come to work on a regular basis and only access sick leave when they are ill. Sick leave should not be used as additional time off with pay. The only way that employers can protect the integrity of their disability management program is by verifying absences. Medical professionals know their patience the best and therefore we as employers can only ask you. Medical professionals should also refuse to write doctor's note for patients that are not ill and should be direct and honest with their patients in terms of when a patient should be going back to work.
    What employees forget is that absences cost the employers dollars and eventually jobs.

  • Chris on 2014-01-10 8:09:27 AM

    This is a slippery slope for sure and my next comments are not intended to offend anyone only to keep an excellent discussion going. I have an employee who is the mother of a 2-year-old and pregnant with her second. Her sick time has gone up in the last couple of months and I'm fully supportive. Another employee has MS and is often "indisposed" requiring sometimes whole days of sick leave and sometimes just a few hours. Are they misrepresenting their medical conditions to justify more time off from work? I have no idea however they are both exemplary employees and I would never trade them for an "always present sub-performer". Obviously there are many factors to consider with each individual employee but as far as company policy is concerned, I prefer to treat adult employees as adults who will make the right decision (and sometimes that means staying home with a sick child). I also choose to solve problems appropriately and immediately when they arise rather than punishing employees for crimes they haven't yet committed. Peer pressure also goes a long way to help this situation - having employees pressure each other to get their work done and to be a positive reflection of the team is very powerful.

  • kb on 2014-01-10 8:11:39 AM

    I understand the concern about have infectious employees spreading illness to other vulnerable patients in the waiting room, and I agree that generally having a policy of requiring a doctor's note for every absence of even a single day is excessive, but I do think it essential to be able to ask for note in the case of longer (say 3 day) absences, and for single day absences that keep occurring. For example and employee that has taken 20 single day absences in the past year, many on Mondays or Fridays, is not presenting a convincing appearance of having been too ill to work. I would want a note for every single day missed over a certain threshold, or have them know that we reserved the right to request one - this does curb the impulse to call in sick just for a day off. And I agree with the other comments that doctors should not be willing to provide notes to everyone who asks for one, just to be nice. This undermines the whole process.

  • pd on 2014-01-10 9:00:44 AM

    As a fellow HR professional, I am all too well experienced with sick leave abuse and unfortunately many employees choose to get away with whatever they can unless you put parameters to make them work a bit harder to make them think about calling in sick again. We used to have a poor policy where there was a lot of abuse. We changed it to be up to 8 days paid sick leave and employees could use it for almost any situation such as kid's illness, unforseen circumstances, parent's illness, etc. Employees can not use it for going to kid's soccer games, etc. It was rolled out with a 'lets see if this gets abused and change it if so" mentality and so far it is not being abused; it has been 3 years since implementation. For some reason if my employees want to use sick leave for other than sick, they always ask if they can use for that reason. So trusting employees is working for us. They also know once they use the 8 days that is it, the rest is unpaid. We have 365 employees.

  • klaw on 2014-01-10 9:34:54 AM

    Wow...8 Personal days is generous in my opinion. Thats potentially 2920 lost days of productivity over and above any allowed vacation time. At one point to do you try to manage / discipline for accessive time off of work?
    For as long as I have been an HR professional (15yrs), sick days have been a bone of contention. From how many an employer should provide (this is an added benefit and not a requirement), to when they should ask for notes. In my opinion, there will always be abusers of Sick Day policies and generally speaking you can see the patterns to recongnize them and address, rather than using a blanket punishment for all by requesting a doctors note for every absence. Again in my opinion, if an employee is away from work for 3 days or more, they should be seeking a medical opinion, to ensure the condition does not require medication and to document / excuse the absence for work purposes.
    I have found when an employer uses Personal Days rather than Sick days, more days tend to be used, as the employee will just consider them as extra days to take off, and ensure that they do, vs a policy that strictly refers to Sick days. Again, this goes hand in hand with whatever culture an employer is trying to build.
    Medical providers need to take ownership as well for when they excuse an absence for medical reasons, and ensure they are recognizing any patterns of abuse with patients that cronicaly request notes for sick days taken, to ensure there are not really other underlying reasons that they occur - ie depression, disengagement, etc so that the situation can be best addressed based on the situation.
    In the long run, this situation will always exist. We just need to start finding cost and time effective ways to manage it.

  • Chris on 2014-01-10 10:15:31 AM

    Congratulations pd and thanks for sharing your success story!

  • pd on 2014-01-10 12:45:43 PM

    I chose 6 days as a starting point, based on statistics from Conference Board of Canada on average # of sick days provided by industry, and then of course had to bargain with union and got to 8 days. My position was always to end at 8 days anyways. Our demographics are older too and we have virtually no turnover, so with age inevitably comes illness and it's something that we need to keep in mind to accommodate our culture as we want to retain our older workforce due to the experience, unique technical skill sets and work ethic put forward. Younger workforce is good too but we don't have much of it due to low turnover. I failed to mention that we don't ask for any Dr's notes unless there are clear patterns.

  • Hotel Industry on 2014-01-12 11:15:41 AM

    If the medical field would like to see the numbers go down than i would highly suggest that they stop handing out notes for people not sick. i know many employees abuse teh system. they are off sick, get a doctors note saying they should be off and bingo, no consequences. Doctors hand out notes even a few days after teh employee was sick. How do they know? To me its a cash grab for the doctors.

  • John Fleck on 2014-01-12 12:45:07 PM

    Manage the employees that have a sick leave problem; the abusers. And leave the 95% alone!

  • Tom from Burnaby BC on 2014-01-12 1:45:19 PM

    At work we have a cafeteria benefit plan approach were you buy the benefits you need from cradle to grave concept. Your choices.

    Benefits are not taxable to you. We have additional $$ in wages to accommodate this plan.

    If you do not have sick leave plan offered then you get ROE to collect EI sick benefits.

    Most people are healthy when young and this valued plan approach becomes more evident later in work life as your body starts to fall apart naturally and you opt for other benefits you can purchase in this plan.

    Some progressive employers see the value of this benefit plan approach.

  • Joe on 2014-01-14 8:58:25 AM

    I have successfully implemented attendance systems where the threshold for submitting doctor's notes (or evidence reasonable in the circumstances for other absences) is triggered by the plant average absenteeism rate. So if 5 is the average, any absence over 5 requires evidence. Over time, the absence rate then trends down... those who were under the rate and 'always' at work... will continue to do so, the ones on the high end, know it, and need to abide by the rules. A firm policy on termination when attendance exceeds another threshold is also important (excluding the Disability related causes), as is using it… even if you have to pay termination costs.
    Doctors have challenging jobs, and don't want to see people for the common cold... but abusers of attendance systems need forms of control and limits, unfortunately this is an avenue employers need to use. I know there are doctors who refuse to issue notes without appointments, and would ‘push-back’ if asked to justify an absence that was not legitimate. Doctors are as varied as employees.
    My guess is that the emergency leave system in Ontario has impacted absenteeism, where many employees now know they have 10 protected days… the question is, how many are really needed?

  • Janice on 2014-01-14 6:23:29 PM

    Physicians are a huge part of the problem. I administer sick leave for a large organization, and it's so common for physicians to put employees on extended sick leave (up to 6 months) for stress, and then have the employee make a remarkable recovery once the sick leave expires. Physicians themselves are the WORST employers and would not tolerate their own employees being away from the office.

  • Joanne on 2014-01-15 6:47:30 AM

    Janice I so agree with your statement. We have a very generous sick leave allowance = 1.25 days per month (of course we have a Collective Agreement) where they can bank 90 days which is supposed to cover the waiting period for genuine illnesses before they go onto LTD. There is no cash value to banked sick leave. If you leave the company and you have banked sick leave you lose it. In the past 2 years I have had 3 employees go on 4-6 months stress leave and once the banked sick leave is used up they resign. As I said in my previous comment this problem originated with the doctors but I also have to add the unions pushing for more sick leave add to the problem.

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