Curbside Consult with Dr. Jayne 1/31/22

A physician friend has been waiting patiently to have a surgical procedure, which has been cancelled multiple times due to COVID. The first time it was due to the rapidly rising omicron peak, and the second time due to overall staffing challenges.

She has been patiently dealing with the delays despite the fact that she’s in a great deal of pain, and also despite the disruptions it’s causing to her practice, when she had to cancel and reschedule six weeks’ worth of patient visits, only to have to try to get them back on her schedule after the procedure gets canceled. Her patients love her and have been accommodating, but now that some of them have been through the cycle twice, I’m sure their patience is wearing thin.

In addition to moving her work schedule, she’s had to rearrange the schedules of others who had planned to come stay with her post-op, rearrange planned meal deliveries, rearrange delivery of durable medical equipment, and more. People who don’t understand what goes into procedure scheduling might not understand all the dominoes that fall when there’s a change to what should be a standardized process. Labor shortages in healthcare continue to be an issue, and she’s hoping the surgery goes ahead this week as planned so she can start recovering and getting back to the things she liked to do before her injury.

Her experience has made her more aware of what’s going on in her health system and how both individuals and the organization are responding to those who need to take medical leave. From talking to others in similar positions, it’s a reflection on what’s happening in the workplace as a whole, and why so many people are choosing to be part of the Great Resignation that’s under way.

When she first tried to schedule surgery, she had immense push-back from her department. It sounded out of proportion given that she’s a 20+ year employee who has never taken more than her usual accrued vacation time – no family leaves, no medical leaves, no bereavement leave.

Even though it’s not department policy, her department chair expected her to make up her on-call days, and went as far as to tell her she should double-up on call before she goes out (despite the fact that she is already having difficulty doing her very physical job due to her injury). She had to check her contract and threaten to get an attorney involved before they backed down. The contract clearly says that she’s not on the hook for call that she can’t take during a time of disability or incapacity. Her department is large, and she’s certainly done enough coverage for her colleagues for their various leaves over the years, so I encouraged her to not feel guilty about taking the time she needs to recover.

One colleague went to far as to tell her that since they can do some visits via telemedicine, she shouldn’t take a medical leave and should just work remotely and cover her own inbox and messages. I guess that colleague thinks it’s OK to practice medicine while taking post-operative opioid pain medications. Apparently, they also missed the part in medical school where we’re supposed to understand that patients need to rest and recover for optimal healing.

We were chatting about this on a virtual happy hour with a couple of other physicians when another friend mentioned that her hospital-owned group had told women who were on maternity leave that they had the option of coming in to see hospital consultations that had been requested. The administrators felt those visits were quick and shouldn’t take too much time each day. I thought she was kidding until she shared her screen on Zoom and showed the proof. They weren’t even subtle about the fact that they were addressing women only. Maybe that was a rogue manager, but even so, their boss should be all over them.

That certainly seems contrary to all the messaging that healthcare providers are getting from their administrators about the need to practice self-care and build resilience. I guess those suggestions only go so far until they interfere with the hospital’s ability to move patients through the system, and at that point, self-care (or care for an infant) isn’t important.

I’m not a labor attorney, but it feels like trying to coerce someone who is on family or medical leave into performing work probably isn’t the right thing to do, regardless of what your human resources department might have suggested. Those kinds of behaviors aren’t the kind of thing that makes an organization the employer of choice in a tight labor market, either.

As physicians, we’re wired to do our best to help our patients, but I hope that physicians and other clinicians continue to just say no when those suggestions are made. I don’t think having a sleep-deprived parent who would rather be home with their newborn leads to the highest quality care. Nor does having a clinician who is in a rush to get home before their childcare resource has to leave. There are plenty of studies that show that at a certain level of sleep deprivation that people are as cognitively impaired as they would be if they were under the influence of alcohol.

If this level of pressure is being applied to physicians who have a high level of education, autonomy, financial resources, and insight, it makes me wonder what strategies administrators might be using on staff members who might have less understanding of their rights or who are more afraid to push back.

What makes this even more shocking is how starkly it contrasts with what I’m seeing in other parts of the industry, where companies pride themselves on their culture and on making sure their employees feel valued. Being able to recover properly after surgery shouldn’t be a boutique ask from a culture-centric employer, it should be a basic human right. Similarly, being able to take one’s federally protected family or medical leave shouldn’t involve coercion, pressure, or the guilt treatment.

It will be interesting to see whether these organizations figure out that their tactics are counterproductive, or whether they continue to run their workforce into the ground.

Have you seen any unusual HR tactics during the labor shortage? Leave a comment or email me.

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