For doctors across Canada, the arrival of cold and flu season coincides with a surge of sick note requests from employees and students. Most are related to short-term illnesses that don’t require diagnosis or treatment. In fact, illnesses have often been resolved by the time a patient visits a health care provider, making it impossible for the provider to verify that illness occurred.
Yet in one year alone doctors spend an estimated 1.5 million hours on sick notes – the equivalent of six million patient visits. At a time when one in five Canadians don’t have access to a family doctor and physicians are experiencing record burnout, this makes sick notes more than a nuisance. It makes them part of the larger health care crisis.
To address this issue at a national level, the Canadian Medical Association (CMA) is calling for the elimination of sick notes for short-term minor illnesses.
In a recent survey conducted by Abacus Data on behalf of the CMA, one-third of respondents said their employers required a sick note for a short-term absence in the past year. But the result can be poorer employee health (and presumably productivity) rather than a decrease in absenteeism.
Seeking a sick note for minor illnesses such as a common cold takes time away from at-home rest and recovery. For employees facing lost wages, limited transportation options, caregiving responsibilities or who are already struggling to access a provider, sick notes can exacerbate health inequities.
82 per cent of respondents said they’d go to work ill rather than getting a sick note from a health care professional.
It’s hardly surprising that in a 2018 survey, 82 per cent of respondents said they’d go to work ill rather than getting a sick note from a health care professional. This means employees are more likely to spread their illness to others, leading to more absenteeism from other employees, when an employer requires a sick note.
When organizations create sick note policies to manage human resources and tackle absenteeism, they also add to the pressure on the health system. Encouraging employees to go to a medical clinic for short-term minor illnesses puts more vulnerable patients at risk unnecessarily. People who have no doctor to go to, or can’t get an appointment quickly, end up in already overwhelmed emergency departments. (On one recent shift, a colleague had four sick note requests.
Scrapping sick notes is also a key strategy for improving physician wellbeing. Sick notes are part of the pile-up of paperwork driving providers’ burnout. The CMA’s 2021 National Physician Health Survey revealed that 53 per cent of physicians felt highly burned out, with administrative burden being one of the main contributors.
There is momentum for change. Nova Scotia passed legislation to restrict sick notes in 2023. Ontario and Quebec are following suit. In addition to calling for similar action from all governments, the CMA’s recently released a position paper on sick notes recommends that employers and educational institutions adopt alternatives including signed declarations (self-certification), employee check-ins or return-to-work interviews. Other options include accrued sick leave days, flexible wellness days or personal leave days that don’t require a medical sick note.
More broadly, we need to stop depending on physicians for problems that don’t require medical intervention or medical expertise. Sick notes are not a health systems issue; they are a human resources issue. Let’s treat them as such.
I speak from a Workforce Planning/Human Resource/Absenteeism standpoint and find this article hits all the nails on the head. There are very few, effective processes in place for reporting short-term sickness, no requirement for the employee to speak to a supervisor, no expecation that a manager follow-up, no apparent concern about return-to-work etc. Full responsibility rests with the employer to set up an effective call-in protocol, and investigate should abuse of a short term sickness is suspected. The cost of letting it slide is tremendous. Managers need to manage.