Review your sick-leave policy before flu season hits

With influenza A(H1N1) circulating this season, in addition to the usual viruses, experts advise doctors to take a close look at how the practice reacts when employees get sick.

Physician-employers who don't have a sick-leave policy should come up with one quickly, experts say. If there is a policy, it's time to examine it and discuss it with employees.

But mainly, experts say, physicians should make sure one message is clear -- if you are sick, stay home.

In the end, a few extra days without one employee could prevent many extra days without multiple employees -- and maybe save you from getting sick as well.

"Health care organizations should provide nonpunitive time off or be willing to advertise to their patients that they are happy to expose their clients to infection," said Jonathan L. Temte, MD, PhD, associate professor of family medicine at the University of Wisconsin School of Medicine and Public Health in Madison. Dr. Temte also is a member of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

There is no agreement on exactly what sick-leave policies should be put in place, even though health care workers who get sick are being called on to stay away from work longer than is the general population.

Sick? Stay home

According to CDC recommendations issued Aug. 5, people who get H1N1 should stay home, on average, at least 24 hours after the fever ends. Health care personnel should be excluded from work for seven days or until symptoms have resolved, whichever is longer, although some science suggests the virus may be shed for longer periods and guidelines that take this into account may be issued in the immediate future.

"It is a moving target," said Ann Marie Pettis, RN, a spokesperson for the Assn. for Professionals in Infection Control and Epidemiology.

For now, the key is to have a policy in place and then apply it equitably.

"The most important thing is to have a well-thought-out program for paid or unpaid sick leave," said John Gilliland, a lawyer with Gilliland & Markette in Indianapolis, who advises medical practices on this issue. "Many small employers either don't have anything, or what they have is not well-drafted."

Questions to consider include:

• Can employees stay home not only when they are sick but also to take care of someone else who is?
• Do employees need to see a doctor to confirm their illness after two, three or four days to avoid abuse of the sick-leave policy, and how will that visit be paid for?
• If people are ill and run out of available paid sick days, will they have to take unpaid medical leave, can they use vacation time, and will they have a choice?
• What are the options for an employee who runs out of sick time and vacation days? Can an employee borrow from next year's leave?
• If short-term disability coverage is available, at what point does it kick in?
• Does the Family and Medical Leave Act, which covers companies with 50 or more employees, apply?

"Practices should encourage staff to use paid time off if they are truly sick. That is what it is there for," said Heather Bettridge, a practice management consultant with the Texas Medical Assn. "But [employees] should only take the amount of time that is necessary and not use it to excess."

In addition, it is important to consider the logistics for handling unscheduled absences. Should an office manager or medical director be called the minute an employee realizes he or she is sick and needs to stay away, even if that means calling someone at home outside of work hours?

When someone calls in to report an illness, will questions about symptoms be asked? Gathering this information can be important in detecting a local outbreak and taking steps to prevent further spread.

Under the Americans with Disabilities Act, employers may make these kind of inquiries if they are "job-related and consistent with business necessity." Such information must be kept confidential.

In addition, does your practice want to distinguish sick time from vacation time?

Smaller medical practices, like many small businesses, tend to offer two weeks of vacation a year without additional sick leave. Larger practices tend to offer more time off, but it's falling out of fashion to have designated sick days.

"A lot of places roll it all into one," said Pettis, who is also the director of infection prevention at the University of Rochester Medical Center in New York.

These questions don't have "right" answers, experts say. Rather, these are issues to consider when devising your policy.

Those who work in this area, however, say that getting health care workers to stay home has less to do with policies than workplace culture.

To make it more likely that sick health care workers will stay home, infection-control experts are advocating that all levels of management consistently state, in written and verbal communications, that this is the appropriate response to having the flu.

"We need to keep repeating the message," said Edward Sherwood, MD, chair of the Texas Medical Assn.'s committee on infectious diseases.

"The vast majority of people in health care are very committed. Physicians are often the worst culprits in this regard, but we're not doing patients any favors by coming in when we are sick," Dr. Sherwood said.

The CDC reported Sept. 18 that visits to doctors and hospitals for care of influenza-like illnesses are increasing nationwide, with most believed to be caused by the H1N1 virus. Flu prevalence was reported as widespread in 21 states.