Why Do Employees Call in Sick So Much?

April 6, 2012 in Health Policy by RangelMD

The following is purely anecdotal. When I used to have an outpatient practice I was always impressed at how many times one of the office staff “called in sick”. We were not a large practice and it seemed that every other day one or more of the staff were too sick to come to work.  Until recently my wife worked in the OR of a large hospital and has noticed the same pattern among nurses, technical support staff, and custodial staff. There didn’t seem to be any seasonal variation – i.e. heavy flu periods – and the majority of sick days were brief only 1-2 days and didn’t involve employees who had chronic illnesses.

The glaring contrast was between employees with different education and training background – and incomes. Physicians, advanced nurse practitioners, and certified nurse anesthetists all seemed to have a far lower rate of absenteeism due to illness than those with less education and training. Even the mid level management and department heads had higher rates of sick leave.  Why?

Does it have to do with getting paid for sick leave? Workers with more training and benefits – those in government jobs especially – are more likely to receive paid time off than unskilled workers. What about income?  Are you more likely to come to work if you make more money? The answer is yes but the reasons are complex. High income means more money lost for unpaid absenteeism (health care providers usually do not have PTO benefits) and a sense of obligation to work harder as a return on what they see as a “gift” from their employer (gift-exchange model).

To be more specific, higher paid workers tend to have more education and training which inversely correlates with absenteeism.

Research by Koopmanschap et al. (1993) found that lower educational levels correlate with a higher risk of becoming disabled. A recent study appearing in the BMJ-Open delved even further into this issue by examining the correlation between innate childhood intelligence and the long term risk of becoming disabled with chronic medical problems. The results were dramatic. Of children tested in 1946, almost 50% of those in the bottom quartile of cognitive ability ended up on long term sick leave compared with only 13% of the top quartile performers. These differences decreased over time as social status became less of a barrier to educational opportunities but significant differences remained.

It’s not clear why intelligence and educational levels correlate like this. Contrary to popular belief, it is not necessarily because of unhealthy lifestyle differences among groups of different education levels.  For example, obesity rates do not correlate well with education or income level. I have known plenty of doctors who are overweight and smoke and substance abuse rates among doctors do not appear to be much different than the population at large.

Rather then being a case of more people with lower educational levels making worse lifestyle choices than those with more education and higher incomes, it’s more likely that people of lower socioeconomic status have far less ability to absorb and to rebound from the negative consequences of harmful lifestyle choices than those with higher education levels and/or more financial resources.

And they might be less likely to appreciate the near and long term consequences that poor health choices have on their overall health and ability to work. The frequent absenteeism among employees with lower rates of education and training are likely a harbinger of a higher risk of developing permanent disability and illnesses. There is not any good data on this phenomenon but the risk is certainly there. In the end, it is simply and relatively easier to go on disability than to continue to work at an unskilled and low paying job while in poor health and in chronic pain.

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