Medical association says sick notes for minor illnesses 'no longer acceptable'
The Canadian Medical Association (CMA) is urging an end to the requirement for sick notes for short-term minor illnesses, arguing that the practice places unnecessary burdens on physicians and strains an already overstretched healthcare system.
In a recently released policy paper, the CMA recommends legislative action to limit sick note requirements, calling instead for more practical solutions such as self-certification and flexible leave policies.
“While we understand that employers and educational establishments are looking for a way to manage abuse of sick leave, the responsibility for overseeing employee or student absenteeism lies with the employer or educational establishment, not with the physician or the health care system,” the CMA report states.
The report draws on data from various studies and regional findings to emphasize the cumulative toll of employers requiring sick notes for minor illnesses.
Physicians in Nova Scotia, for instance, are estimated to spend 100,000 hours annually writing sick notes, while in Manitoba, that figure is around 36,400 hours.
Drawing on these figures, the CMA estimates that physicians spend more than 1.15 million hours a year on sick notes. “Eliminating the need for sick notes could potentially free up between 3.5 to 5 million patient visits and up to $180 million” in patient expenses, according to the report.
Additionally, the CMA report calls out the discriminatory potential of requiring sick notes for minor illnesses, stating such practices “Discriminate against employees or students who are unable to get a timely appointment with their family doctor or do not have access to a family doctor at all, both increasingly common situations.”
A strong majority of business owners and physicians appear to support a reduction in the administrative load on healthcare providers, according to the report.
The Canadian Federation of Independent Business (CFIB) surveyed 3,030 business owners in November 2022 and found that 89% supported efforts to reduce unnecessary paperwork for doctors.
However, employers' support for the elimination of sick notes is mixed: a July 2023 CFIB survey found that while 54% of business owners do not require sick notes for short-term absences, 84% believe they should retain the right to request them under certain conditions, such as in cases of suspected abuse.
Physicians, meanwhile, continue to report high levels of burnout, with 53% feeling burdened by administrative tasks, including the requirement to issue sick notes, according to the CMA’s 2021 National Physician Health Survey. “Sick notes are generally ineffectual as a mechanism to police absenteeism,” the report states, noting that many doctors cannot confirm if an employee or student was ill after they have already recovered.
Some provinces have already taken steps to address the issue. Nova Scotia enacted legislation on July 1, 2023, restricting employers from requiring sick notes unless an employee is absent for more than five working days or has had two absences of five or fewer days in the past year.
The policy, aimed at reducing administrative burdens on physicians, reflects similar calls from other medical associations, including Doctors of BC, which recently advocated for limiting sick note requirements to extended absences.
“While we understand that employers and educational establishments are looking for a way to manage abuse of sick leave, the responsibility for overseeing employee or student absenteeism lies with the employer or educational establishment, not with the physician or the health care system,” the CMA emphasizes.
