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To Work or Not to Work: Factors that Influence Presenteeism among Physicians and Medical Trainees

Reisinger HS, Shinkunas L, Polacco M, Perencevich EN, Kaldjian L. To Work or Not to Work: Factors that Influence Presenteeism among Physicians and Medical Trainees. Paper presented at: Infectious Diseases Week; 2013 Oct 3; San Francisco, CA.


Background: Healthcare workers (HCWs) who come to work while sick have the potential to spread illness to patients and other healthcare workers. Yet, HCWs often work when ill. The objective of this study was to understand the factors physicians and trainees consider when deciding whether to come to work when ill. Methods: This 20-item internet survey covered three areas of professionalism among attending physicians, interns, and medical students at a university hospital, including: 1) HCW hand hygiene, 2) HCW vaccination, and 3) presenteeism. Here we focus on the 5-item Likert scale and open-response questions related to presenteeism. The open-response question was coded based on inductive codes derived from the thematic content of the responses. Three members of the research team developed a 29-item codebook for fine-grained analysis of responses. Results: 147 attending physicians, first-year interns, and third-year medical students completed the survey for a response rate of 48.8%. When asked about coming to work when not feeling well, 96.4% agreed they would come to work with a cold, while responses were more evenly distributed regarding the flu with 40.7% disagreeing, 31.4% agreeing, and 27.9% unsure of whether they would come into work. Framed in terms of professionalism, 62.9% agreed that it was their professional obligation to come to work even when feeling ill. Yet, when framed as a professional responsibility to remain home with an infectious illness, 63.6% agreed with the statement they would stay home. For the open-response question, respondents were asked about the primary factors they consider when deciding whether or not to come into work. Overall, responses related to severity of illness, concerns regarding coverage of clinical duties, threat to patient safety, and professional obligations and expectations. Conclusion: This survey of attending physicians, residents, and medical students suggests severity of illness and threat of infection factor into decisions about coming to work when ill. However, professional obligation, responsibility, and expectations also weigh heavily into decisions to work, suggesting that a culture of presenteeism exists among physicians and trainees. Incorporating these findings into interventions designed to limit presenteeism could improve their effectiveness.

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