Working for better health care in New Zealand

The Association of Salaried Medical Specialists (ASMS) is the professional association and union uniting doctors and dentists in New Zealand.

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Presenteeism in the senior medical workforce

19 November 2015 ASMS - Media release

Senior doctors and dentists in New Zealand’s public hospitals are routinely going to work when they are ill, a major study published today by the Association of Salaried Medical Specialists (ASMS) has found.

“Sometimes they’re the ones that really need to be tucked up in bed at home or, in the worst cases, in a hospital bed,” says ASMS Executive Director Ian Powell.

“The fact they’re forcing themselves to go into work, often to the detriment of their own health and wellbeing let alone that of their patients, reflects the immense pressure that doctors and other health professionals are under to keep the public health system functioning.”

The report published today is called Superheroes don’t take sick leave – Presenteeism in the New Zealand senior medical workforce; a mixed-method study and is by Dr Charlotte Chambers, ASMS Principal Analyst (Policy & Research).  A copy can be found on the ASMS website at

The study describes the results of a national survey of ASMS members employed by district health boards (DHBs) carried out in September 2015.  Of the 3740 senior doctors and dentists invited to take part, 1806 (48%) completed the survey, made up of 41% females and 59% males.  A total of 660 people also left comments about their own experiences and thoughts on presenteeism in the senior medical workforce.

Presenteeism is defined as turning up to work when too unwell, fatigued or stressed to be productive.

The survey found:

  • 88% of senior doctors and dentists often or sometimes went to work while unwell during a 24-month period
  • 75% went to work while unwell with an infectious illness over the same period
  • 47% went to work while unwell three or more times a year
  • the problem of presenteeism was common across the country – no single DHB stood out statistically as having more of a problem than any other
  • doctors attributed their presenteeism to a strong sense of duty to patients and colleagues, the fact clinic and theatre sessions were already booked, and not wanting to burden their colleagues
  • analysis of the comments left in the survey also found structural factors such as a lack of workplace cover for any unexpected short term absences, cultural norms such as the view of sick leave as a sign of weakness, and uncertainty about when an illness was serious enough to warrant taking time off work.

Comments left by senior doctors and dentists included:

  • “Recently I tried to challenge our culture of working despite being sick, and was told by my colleagues that if the SMOs (senior medical officers – doctors and dentists) stayed at home when they were sick there would be no one to look after the patients.  Our unit has a strong ‘SMO superhero’ culture where SMOs are expected to work when sick, and not thought to need sleep.”
  • “It is hard to know whether you should stay home or not and I have worked a whole weekend feeling suboptimal but not terrible, only to discover that I actually had Whooping Cough!”
  • “I had very bad pneumonia last winter but managed to do a full outpatient clinic while being seen myself in ED (emergency department).   Not something to be proud of, I know, but I didn’t feel like I could call in sick.  It was the middle of winter, a super busy time for our department and I kept thinking: ‘I am not TOO bad, put it this way, I am not needing ICU (Intensive Care Unit) so…’”
  • “I have done ward rounds and clinics wearing respiratory isolation masks in an attempt to mitigate risks to patients but am aware that working efficiently under these circumstances is very low. There was a (prolonged period of workforce shortage) where I would find myself locking the office door and hiding under the desk in the dark which suggests that longer periods without additional cover are psychologically quite damaging.”

The study recommends greater investment in the senior medical workforce to enable DHBs to ‘staff up’, reframing legitimate sick leave as responsible and healthy behaviour, formalising both the accounting processes for and the availability of short-term leave cover, and developing clear written guidelines stating the threshold and process for staying home when unwell.

Ian Powell says there have been smaller studies of presenteeism involving the senior medical workforce carried out at individual DHBs (eg, Capital & Coast, and Otago) but this is the first research of its kind to be undertaken nationally in New Zealand.

“It’s a really significant piece of research that deserves thoughtful consideration by health policy and decision-makers,” he says. “The situation reported in this study is simply not sustainable for our members.  They are holding the health system together at the expense of their own wellbeing, and they cannot do that indefinitely.”

The study findings were presented at the ASMS Annual Conference in Wellington today, and Dr Charlotte Chambers is available for media interviews.