Marcelino Flores delivers food at Picos restaurant in Houston. Only about half the service workers in the U.S. receive paid sick leave.
Recently, a patient walked into my clinic complaining of diarrhea and crampy abdominal pain. It was clear she had gastroenteritis, a “stomach bug,” and that she should stay home, hydrate and rest. Her symptoms had already begun to improve so I was puzzled as to why she had even bothered to come in, but the answer soon became obvious.
“Do you think I can get a doctor’s note so that I can take today and tomorrow off?” she asked.
Her question hit me with a pang of annoyance — not at her, but at the fact that she was forced to come in to get a note.
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In my several years of practice, my wealthy patients working in tech have yet to ask me for a doctor’s note. When I worked at a health startup, I never even thought of asking for a note from a doctor, as my, “I’m sick so I will be out today” was never met with anything but wishes for a speedy recovery.
But as practically any urgent care physician will tell you, blue-collar workers like this patient (who worked in a cafeteria) are frequently asked to provide a doctor’s approval for their right to take a sick day.
With no federal law mandating paid sick leave, access to paid sick time varies substantially by state and industry. California is one of 14 states, along with Washington, D.C., that mandate paid sick leave. Though service workers are more likely to get sick because they are required to be around many other people, only about half of these workers nationwide have paid sick time, in contrast to 96% of those in management, business or finance who do get it, according to the Bureau of Labor Statistics.
The requirement for a doctor’s note is disproportionately applied to blue-collar workers and inevitably worsens existing inequities in access to paid sick days.
Some may argue that a doctor’s note is needed to prevent workers from misusing sick days for other purposes. Yet, when a paid sick leave policy with no requirement for notes for absences of two days or less was implemented in Connecticut in 2011, misuse of these benefits seldom happened. In fact, only a third of eligible employees even used the benefit.
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The requirement is also a huge waste of precious recovery time for workers subject to it. People who come into my urgent care clinic often have to wait two or more hours for their turn. When driving and visit times are factored in, a clinic visit can take four hours, or half of a regular working day, just to get a note.
Besides, in California, demanding a doctor’s note as a requirement to take a paid sick leave might be illegal. The California Labor Commissioner’s Office has opined that an employee can file a paid sick leave claim against their employer when they are “(denied) sick leave due to a failure to provide details.” Yet, this statement is far from being definitive, and an average worker is unlikely to be aware of such legal nuances or feel empowered to push back to their manager. A paid sick leave information poster mandated to be displayed in a workplace states “an employer shall provide paid sick days upon the oral or written request of an employee,” but missing is any information about whether employers can require a doctor’s note.
The perceived need for a doctor’s note, legal or not, combined with difficulty accessing a clinician may compel an average worker to show up sick. “Presenteeism,” or working while sick, may seem attractive to employers, but in the long run, everyone loses. Working while sick not only decreases productivity but also increases the risk of injury.
When more than half of restaurant-related foodborne illnesses are caused by employees showing up sick, we wouldn’t want these workers — like the one who came to my clinic — to prepare our food before they feel better. Studies suggest that access to paid sick days cuts down the transmission of respiratory illnesses like influenza and COVID-19 and can lead to significant savings just from reduced absences from flu-like illnesses alone.
We need to help workers fully utilize their paid sick leave to get the care they need and recover — with minimal hoops to jump through — because when they do, everyone wins.
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To do so, first, we must make known what is already true: A new law signed by Gov. Gavin Newsom increases paid sick leave from three to five days per year starting in 2024. Furthermore, the Labor Commissioner’s Office can and should clarify and publicize its stance on employers requiring a doctor’s note as a precondition to using paid sick leave, including on its mandated posters in workplaces. Finally, Congress can pass the Healthy Families Act, which mandates paid sick leave to all workers regardless of where they live or for whom they work.
In the meantime, I hope all sick workers can get some rest and go back to work when they are healthy.
Jason Bae is an urgent care physician practicing in Palo Alto, a senior scholar at the Stanford Clinical Excellence Research Center, and he runs a health education account on TikTok: @YourDoctorFriends. He is also a Paul and Daisy Soros Fellow and Public Voices Fellow with the OpEd Project.
California mandates paid sick leave. Why do blue-collar workers need a doctor’s note to access it?
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22.12.2023
Marcelino Flores delivers food at Picos restaurant in Houston. Only about half the service workers in the U.S. receive paid sick leave.
Recently, a patient walked into my clinic complaining of diarrhea and crampy abdominal pain. It was clear she had gastroenteritis, a “stomach bug,” and that she should stay home, hydrate and rest. Her symptoms had already begun to improve so I was puzzled as to why she had even bothered to come in, but the answer soon became obvious.
“Do you think I can get a doctor’s note so that I can take today and tomorrow off?” she asked.
Her question hit me with a pang of annoyance — not at her, but at the fact that she was forced to come in to get a note.
Advertisement
Article continues below this ad
In my several years of practice, my wealthy patients working in tech have yet to ask me for a doctor’s note. When I worked at a health startup, I never even thought of asking for a note from a doctor, as my, “I’m sick so I will be out today” was never met with anything but wishes for a speedy recovery.
But as practically any urgent care physician will tell you, blue-collar workers like this patient (who worked in a cafeteria) are frequently asked to provide a doctor’s approval for their right to take a sick day.
With no federal law mandating paid sick leave, access to paid sick time varies........
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