It is common for junior doctors to work while they are unwell with infectious respiratory illnesses because they feel they can’t let colleagues and patients down, according to a new Australian study – conducted before the COVID-19 pandemic.

But far from changing the sick leave culture in hospitals, the pandemic means junior doctors are under even greater pressure to turn up to work when they are ill with anything other than COVID-19, said Dr Hashim Abdeen, Chair of the AMA Council of Doctors in Training.

Researchers asked junior doctors working in Canberra Health Services about taking sick leave via an anonymous online survey in November 2019.

Of 54 responses, 50 doctors said they had worked while unwell with respiratory illnesses in the areas of medicine, surgery, critical care and women’s or children’s units.

The response of those 50 doctors were analysed:  almost three-quarters (72%) believed were infectious at the time they worked while unwell and one-third (32%) said they had a fever at the time.

The majority of doctors– 86% – said they did not feel supported by their workplace to take leave when they were sick, according to findings published online ahead of print in Infection, Disease and Health.

When asked to select reasons that deterred them from taking sick leave, 96% of doctors said they were concerned about burdening their colleagues with extra workload, and the same proportion were concerned about a lack of available cover.

Other reasons included not feeling sick enough (52%), that other colleagues worked when they were similarly unwell (50%) and they were unsure or concerned about the impact on their attendance requirements for registration (48%).

Two in five doctors (44%) were concerned about judgement from colleagues, 36% felt a sense of duty towards their patients and a concern that patient outcomes would be poorer if they were away, while one in 10 were unsure how to access sick leave.

Three-quarters of doctors (76%) suggested there was a need for more accessible sick leave cover, including having more doctors as designated sick relief rather than requiring other doctors to work double shifts, or existing staff to take on the extra workload.

“Numerous junior doctors were worried that a lack of cover meant that if they took sick leave it would burden their teammates, who they felt were already working in understaffed environments with high workloads,” wrote the study authors from The Canberra Hospital.

Other suggested changes to make sick leave more accessible included clarifying guidelines about how much sick leave could be taken without it affecting registration and more leadership from senior staff, who could set an example by sending sick junior staff home.

The study authors suggested the COVID-19 pandemic could be an opportunity to change attitudes about sick leave.

“In the era of COVID-19 there is a unique opportunity to use the heightened awareness of the implications of working whilst unwell to change the culture around presenteeism and improve accessibility of sick leave for doctors,” they wrote.

Pandemic makes problem worse

However, Dr Abdeen – who was on a rare day’s sick leave when he spoke to thelimbic – said COVID-19 was actually having the opposite effect.

“The problem at the moment is that many staff are furloughed for 14 days, the hospitals are stressed already, so it is even more difficult to take leave,” he said.

Doctors who received a negative COVID-19 test result felt pressure to return to work immediately, even if they were still sick with other potentially infectious illnesses, said Dr Abdeen.

Dr Abdeen, who is a rheumatology and general medicine advanced trainee in Queensland, said the study findings reflected the experience of junior doctors Australia-wide.

Some hospitals had extremely onerous systems for doctors to call in sick and doctors could be required find their own replacements, he said.

He said the reluctance to take sick leave put junior doctors at risk of burnout and poor wellbeing, as well as jeopardising safe, quality patient care.

Hospitals should to have a pool of qualified medical staff not already rostered on shifts, who could provide cover when needed, he suggested.

“It will take investment, but we need to find innovative, tangible solutions to provide cover for doctors who are sick,” he said.