September 16, 2010 — Although there have been major residency reforms during the past decade, rates of presenteeism (working while sick) among resident physicians are high and similar to rates seen in 1999, according to the results of a research letter reported in the September 15 issue of the Journal of the American Medical Association.
"Despite recent Centers for Disease Control and Prevention guidelines urging health care personnel with flu-like illness to avoid working, presenteeism (working while sick) is prevalent among health care workers," write Anupam B. Jena, MD, PhD, from Massachusetts General Hospital in Boston, and colleagues. "Ill health care workers can endanger patients and colleagues due to decline in performance or spread of disease. Resident physicians may face unique pressures to work when sick and lack time to seek health care."
The study goal was to evaluate self-reported presenteeism rates and associated factors among residents in a sample of programs selected for varied geographic, size, and governance characteristics. A 50-item survey was administered anonymously in August 2009 to 744 residents in postgraduate year (PGY) 2 and 3 in general surgery, obstetrics/gynecology, internal medicine, and pediatrics at 35 programs in 12 hospitals regarding presenteeism during the prior year. Overall response rate was 72.2% (range among hospitals, 48% - 100%).
More than half of responders (57.9%; 95% confidence interval [CI], 53.6% - 62.1%) reported working at least once while sick in the previous year, and nearly one third (31.3%; 95% CI, 27.2% - 35.2%) reported working more than once while sick. More than half (52.9%; 95% CI, 48.5% - 57.1%) reported having insufficient time to visit a physician during the previous academic year.
Presenteeism was reported more often during PGY-2 (62.3%; 95% CI, 57.1% - 68.4%) than during PGY-1 (51.7%; 95% CI, 45.6% - 57.9%; P = .01). Sex, specialty, or medical school location did not affect reported rates of presenteeism or of having time to see a physician. Presenteeism rates did not vary significantly by hospital response rate or across hospitals, except for 1 outlier hospital in which 100% of residents reported working when sick.
"Despite major residency reforms over the last decade to ensure resident and patient health, rates of resident presenteeism were high and similar to rates observed in 1999," the study authors write. "The higher rate of reporting working when ill among PGY-2 vs. PGY-1 residents may reflect a greater responsibility toward patient care, consistent with higher presenteeism rates among workers who believe their duties are not easily substituted. The lack of factors associated with presenteeism suggests it may be pervasive."
Limitations of this study include reliance on self-report, lack of distinction between infectious and noninfectious illness, and potential bias associated with H1N1 influenza cases during survey development.
"Residents may work when sick for several reasons, including misplaced dedication, lack of an adequate coverage system, or fear of letting down teammates," the study authors conclude. "Regardless of reason, given the potential risks to patients related to illness and errors, resident presenteeism should be discouraged by program directors."
This study was funded by the Accreditation Council for Graduate Medical Education. Several of the study authors report various financial relationships with the Agency for Health Care Research and Quality, the National Institutes of Health, the Accreditation Council for Graduate Medical Education, the American Board of Internal Medicine Foundation, and/or the Institute of Medicine.