Two years ago, former Ontario Medical Assocation (OMA) president Dr. Scott Wooder, wrote a blog post asking employers to not require sick notes. He implored them to simply trust their employees (especially for brief absences) and asked them to recognize that sending a person who had a self-limited illness to a doctors office would only risk contaminating people in the waiting room.
For a brief period of time, a lot of attention was paid to this blog from various news media. I had hoped that this would be the start of a frank discussion between employers and the OMA, one that would lead to an improvement in the current system. Alas, that was not to be.
Many of these corporations that require sick notes continue to abuse the health care system ad infinitum at a time when resources are stretched thin.
Typically, they referred to how much money absenteeism cost THEIR businesses and used that to justify the cost of a sick note policy. The OMA never really followed up on this by providing a concrete step that could alleviate this burden on its members (and yes, it's a burden -- physicians HATE filling out sick notes). As a result, attention on the issue went away.
What hasn't gone away, unfortunately, is the fact that many of these corporations that require sick notes continue to abuse the health care system ad infinitum at a time when resources are stretched thin. The human resources types will say that sick notes are not covered by OHIP, which is Ontario's physician payment service. As a result, there is no cost to the health care system. However, they are (in many cases, knowingly) only telling you the half truth. Here's what really happens:
Suppose you have a really bad cold. You know as well as I do that there is no cure for the common cold. However, the cough/congestion is enough to keep you home for three days. Your boss demands a sick note. So, now you go to the doctor's office with $20 in hand (which seems to be the going rate for a sick note).
However, your doctor can't legally or ethically simply give you a note. He or she has to at the very least ask you questions about your illness and examine you if appropriate. The fee for that exam is approximately $30 for a family physician. Here's the rub -- because you were legitimately sick (you wouldn't try to cheat your employer, would you?), that service of assessing you is considered "medically necessary" and so is billed to OHIP. Guess who pays for OHIP? It's certainly NOT the company that asked for the sick note.
This is why it's so frustrating to hear responses like the Toronto Transit Commission's (TTC) go unchallenged by the government. They had perhaps the most vocal defence of requiring sick notes, stating that their policy reduced absenteeism.
You know another way of phrasing that? "Our human resources department wasn't capable of hiring hard-working employees who wouldn't abuse the sick day process, so we're going to download the cost of policing OUR policies onto the taxpayers of Ontario."
Lest you think I'm picking on the TTC only, EVERY corporation in Ontario, whether public or private, that has a sick note policy is taking advantage of YOU, the taxpayer, by offloading the cost of THEIR policy onto the health care system. You, dear taxpayer, are subsidizing the cost of their business.
So, how does one change that? The easiest way to do that is to do the same thing that was done with driver's medical exams in the mid-1990s. For those who need something more than a general car licence (e.g. school bus licence, truck driver's licence), there is a requirement to have a medical examination done by a physician to ensure that the driver is not a health risk.
These used to be covered by OHIP. However, the driver's medical exam was de-listed from OHIP in the 1990s, as it was deemed not medically necessary, but rather a work requirement. Additionally, physicians were now no longer allowed to bill OHIP for a service on the same day that they do the driver's medical exam.
So, let's do the same thing with EXAMINATIONS for a sick note. Make those exams a non-OHIP service. A physician will charge not just $20 for the note, but will now charge the OMA rate of $60 for the exam. Put in the same rule about not billing OHIP for a service on the same day as a sick note. Give a time frame to implement (say, Jan. 1, 2017) so that companies have a chance to prepare.
What will happen? Exactly the same thing as when driver's medical exams were de-listed. Employees will complain to their unions and employers. Employers will complain to the government. Expect some typical attacks from the usual sources on just how high doctor's fees are.
And then, after a few months of bluster... companies and unions will figure it out. Sick note policies will change. Requirements will be altered, while still respecting the legitimate business interests of employers.
Though there will always be some cases where sick notes will be needed, particularly for protracted illnesses, the current odious requirements will be altered. Life will go on. Only this time, corporations will no longer be taking advantage of the taxpayer and abusing the health care system at a time when it cannot afford it.
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