Why doctors don’t take sick leaveBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6719 (Published 09 December 2015) Cite this as: BMJ 2015;351:h6719
- Kathy Oxtoby, freelance journalist
Doctors are much less likely than other healthcare workers to take days off sick, with official figures from the Health and Social Care Information Centre showing that they take a third as many sick days as other NHS staff and a fifth the number taken by healthcare assistants and ambulance staff.1
It may be that doctors are less prone to becoming ill, rather than being less likely to take sick leave when ill. The high socioeconomic status of doctors might put them at lower risk of illness, and perhaps their frequent exposure to common colds and viruses helps their immune systems to resist illness.
But Keith Hopcroft, a GP in Essex, says that there is a culture in medicine of not taking time off when sick. “Battling on through illness and not letting the side down has traditionally been seen as an attribute—and therefore taking time off as a weakness—particularly in the days of onerous on-call rotas,” he says. “This attitude is changing somewhat, and ‘self awareness’ and ‘fitness to practise’ are more meaningful concepts than they used to be.”
“Desperate that nobody finds out”
Many doctors work despite being unwell because they are concerned that taking time off will negatively affect their career. Cosmo Hallstrom, a consultant psychiatrist who is based in London and working in private practice after 25 years in the NHS, has doctors attending his clinic with anxiety and depression who are “desperate that nobody finds out,” he says.
Hopcroft says that another reason why doctors don’t take sick leave is that some treat themselves or use their contacts to help treat them. “Doctors may have a better idea of what’s wrong with them or how significant, or insignificant, it is and therefore may not need to worry themselves with appointments or requests for treatment,” he says. “Similarly, when they do need treatment, their status and contacts may mean it is easier for them to get help without having to take time off—or they might even treat themselves.”
Hannah MacDonald, a trainee in paediatrics at the Royal London Hospital, says that doctors are often wary of the adverse effect that sick leave might have on colleagues’ workloads. “We are reluctant to take sick leave because a lot of the rotas we work on are quite stretched, and we are often short of doctors—even on a good day. And people worry that if they don’t go to work the burden on everyone else will be too great,” she says.
Concern about letting down colleagues
Keir Shiels, a paediatric registrar at Queen’s Hospital, Romford, says that he has worked while ill to avoid making colleagues’ lives more difficult. “When you ring in an hour before work, and nobody is there to cover your shift and you know they will have to find someone at short notice, it’s a pain for everyone, and so you think twice about taking sick leave,” he says. He believes that doctors who are starting out in their careers are particularly prone to viewing being off sick “as some sort of moral failure and that you’re letting your colleagues down.”
Clare Gerada, medical director of the Practitioner Health Programme, a health service aimed specifically at doctors,2 says that the feeling of letting people down applies to patients as well as colleagues. “If I was sick now, how would I leave a morning surgery when 25 patients are there to see me and there is nobody to cover you?”
Hopcroft says that doctors may see themselves as being difficult to replace at short notice. “Doctors often have very specific roles: replacing a cardiac surgeon isn’t actually as easy as replacing a staff nurse and so may obviously impact on the threshold of that person to take time off sick,” he says.
Self employed GPs must also consider the practical aspects of taking time off sick, he adds. “Being self employed, and working in relatively small teams with appointments booked ahead, being off has a significant impact on our immediate colleagues,” he says. “There are also the financial and logistical implications of finding locums, too, all of which means we try to avoid being off sick when we can.”
For some doctors, not taking time off sick is simply because they enjoy their role so much they would prefer to be at work, says Hallstrom. “Doctors are highly motivated in their work and highly rewarded emotionally,” he says. “It’s a way of life.”
● See also on careers.bmj.com Why doctors need to resist “presenteeism” (http://careers.bmj.com/careers/advice/Why_doctors_need_to_resist_%E2%80%9Cpresenteeism%E2%80%9D); The wounded healer—why we need to rethink how we support doctors (http://careers.bmj.com/careers/advice/The_wounded_healer%E2%80%94why_we_need_to_rethink_how_we_support_doctors)
Cite this as: BMJ 2015;351:h6719
Competing interests: I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.