Doctor’s notes: a practice overdue for cancellation

It is becoming increasingly clear that the battle to recruit physicians within Canada — and across North America — may come down to the quality of life a jurisdiction can offer, and not the size of the paycheque.

Case in point: in the recent throne speech delivered by Manitoba’s NDP government, there was a pledge to pass legislation banning employers from seeking sick notes for employee absences of one week or less. Although this may seem like a small, bordering on insignificant, gesture, it is directly connected to a major campaign to streamline the practice of medicine by reducing the administrative burden faced by physicians.

Doctors Manitoba, the organization that represents physicians in contract talks with the province, has long argued that indiscriminate demands for sick notes was adding an unnecessary burden on physicians. Physicians claim that sick notes for employees who miss a week or less of work are a waste of time; one in three people seeking notes for short-term absences are actually symptom free by the time they get in to see a doctor. Requiring the notes seems more like a litmus test for trust in employees than it does an actual barometer of employee health.

Earlier this year, Doctors Manitoba estimated more than 36,000 hours of primary care time was consumed writing 600,000 sick notes at a cost of $8 million annually to the health-care system. The organization said putting limits on sick notes would free up doctors to offer up to 300,000 additional patient visits. That, Doctors Manitoba argued, would be equivalent to adding 50 new physicians to the province’s total roster.

Doctors Manitoba said this change on its own had helped move Manitoba from “worst to first” in limiting sick note abuses. Even better, in a province that still needs 250 physicians to provide adequate access to primary care medicine, the organization believes this small gesture is expected to produce huge dividends as well to efforts to the retention and recruitment of physicians.

Doctors Manitoba president Nichelle Desilets, a family physician practising in Neepawa, wrote in a commentary published recently in the Free Press that reducing administrative burden to create a more positive experience for physicians is particularly important in a province like Manitoba that has had trouble retaining the physicians it recruits.

Doctors Manitoba says while the province does well recruiting new physicians, it also sits near the top in physicians lost to other provinces. “Manitoba cannot afford to rely solely on financial incentives while ignoring the working conditions that are driving physicians away,” Desilets wrote in her commentary.

All of which is to say that while progress on sick notes is promising, it will not be enough to make Manitoba a destination of choice for physicians.

Physicians in Manitoba want additional measures taken to reduce paperwork, including agreements with private insurance companies on how much documentation is needed for a claim and a wholesale migration to digital documentation and away from paper records. They would also like to do more outpatient procedures in their own offices.

Finally, physicians would like to ensure they are fully consulted about any changes to the administration of health care that affects their practices directly, a gesture from government that can be expected to boost retention.

Market forces in other jurisdictions, particularly the United States, have created the opportunity for Manitoba to erase its physician shortage and reduce the loss of doctors to other places. The movement on sick notes was a positive sign and a valuable first step.

Doctors, and Manitobans in general, hope the NDP government continues to check boxes on the list it has been provided.