The Canadian Medical Association is calling for the elimination of employers’ requirement for sick notes for short-term minor illnesses, a move a Saanich family physician says is necessary given the current family doctor shortage.
The CMA in a new position paper is recommending legislative changes to restrict the requirement for sick notes to reduce the burden on health-care providers.
CMA president Joss Reimer said on the association’s website that physicians need to focus on caring for patients, especially when 6.5 million Canadians don’t have access to a family doctor and patients are waiting too long for specialty care.
It said only in certain circumstances, such as a prolonged absence from work, or if a doctor can provide meaningful insight into an employee’s condition, would a sick note be appropriate.
In those instances, the cost of the sick note should be covered by the employer, not the employee, said the CMA.
Saanich family physician Dr. Jennifer Lush said given the family-doctor shortage, it’s important to closely examine any paperwork that is medically unnecessary “or that could be completed by someone other than a medical doctor.”
Lush said while writing the sick note might take only five minutes, the person requesting it is using a medical visit “that could have gone to a patient with actual medical need.”
“It also uses staff time and resources in an already overworked family doctor’s office,” said Lush.
While the number of sick-note requests has dropped since COVID, Lush said it’s within governments’ purview to legislate that sick notes are not required.
Lush said in her experience, the requests generally come from smaller employers, or involve employees with more frequent absences.
If the requests come from government employees, it often involves an “unsympathetic” boss or manager, who wants a note even though there is no official policy requiring one, she said.
“Legislation would take the pressure off employees and doctors by making it abundantly clear that there is no medical or administrative necessity for these notes,” she said.
The BC College of Family Physicians and B.C. Family Doctors is also requesting “an end to this medically unnecessary drain on physician time and resources once and for all,” Lush said.
Doctors of B.C., which represents more than 16,000 physicians in the province, started advocating for a no-sick-note policy in 2014. In May, the board of directors approved a policy resolution that recommends the provincial government restrict the ability of employers to request that staff obtain a sick note.
Dr. Ahmer Karimuddin, president of the Doctors of B.C., said Monday the association applauds the strong stance the CMA has taken on an issue he calls “untenable.”
The notes are often requested by patients who have viral illnesses or musculoskeletal injury that generally requires 48 hours of rest and recovery, he said. Sometimes they don’t get an appointment until after the issue has resolved.
“We really feel that in B.C., this is having a huge impact on employees and our patients and it really [negatively] impacts the physician-patient relationship as well,” said Karimuddin. “It’s placing an unnecessary burden on the health-care system.
“We need the provincial government to have legislation, to make policy on this issue, where this becomes a non-issue.”
Karimuddin said employers are generally using sick notes as a “gatekeeping” measure to ensure employees are not taking undue days off.
“But we know that’s not the case — most of the time when employees are taking time off they are unwell enough that they can’t leave their home,” said Karimuddin. “And in the midst of that, [they’re] asking them to go to a doctor’s office to get a note, potentially putting themselves and others at risk when they’re probably better off to rest and recover.”
Karimuddin said sick-note requests come from medium-to-large corporations and all three levels of government, but aren’t as common for small businesses where there’s a good close working relationship.
Frequently, they involve employees in lower-level jobs at larger corporations, he said.
“No one is asking an executive for a sick note,” said Karimuddin. “This is predominantly affecting people in a lower socioeconomic status, who are struggling as it is.”
With respiratory illnesses set to surge in the next three months, now is not the time for people with viral illnesses to head to physicians’ offices solely for a doctor’s note, he said. “That doesn’t make any sense at all.”
Since July 1, 2023, Nova Scotia employers have not been allowed to request a sick note unless an employee is absent for more than five working days due to sickness or injury, or has already had two absences of five or fewer working days in the previous 12-month period.
The legislation also allows professionals other than doctors to issue required sick notes, such as nurses, dentists, pharmacists, physiotherapists or social workers.
The CMA, which represents doctors across the country, said eliminating the sick-note requirement could prevent as many as 12.5 million unnecessary health-care interactions across the country in a single year.
From Oct. 7-10, Abacus Data surveyed 1,500 working adults in Canada on the CMA’s behalf and found approximately one-third were asked by their employers to produce a sick note for a short-term absence at least once in the last year.
