QD: News Every Day--obesity, H1N1 and faking illness vs. "presenteeism"

ACP Internist's daily digest of internal medicine in the news continues with obesity programs, H1N1 updates and employees who fake calling in sick vs. those who won't when they really are.

Obesity
Schools, workplaces, food retailers and food and beverage makers are chipping in for the Healthy Weight Commitment Foundation, an effort to reduce obesity by balancing calorie consumption through physical activity. As just a few examples, food manufacturers will change product offerings, packaging, and labeling. Companies may provide exercise activities or facilities, offer weight management programs, and provide healthier foods in workplace cafeterias and vending machines. The Robert Wood Johnson Foundation, The National Business Group on Health and the University of California, Berkeley Center for Weight and Health will evaluate progress.

An internist is developing recommendations for physicians on how to guide and treat overweight patients on behalf of the STOP Obesity Alliance, a coalition of professional and labor groups, businesses, insurers and health care providers. The internist outlines his success in a case study.

H1N1 Flu
Health and Human Services Secretary Kathleen Sebelius further encouraged H1N1 vaccination, calling it "safe and secure" and adding that it's made the same way as seasonal flu vaccines.

Although H1N1 vaccination in the U.S. is slowly starting, states have ordered more than 2 million doses, mostly of nasal spray, for the first patients, according to Thomas Frieden, MD, director of the CDC. In Chicago, John Segreti, ACP Member, an infectious diseases expert at Rush University Medical Center, told Reuters his facility will distribute its first 2,000 doses to children and will wait for inactivated vaccine for health workers.

Emory University doctors licensed their interactive Web site to allow patients with potential H1N1 cases to self-screen using the same triage calculations their doctors and the CDC use. Questions about fever, symptoms and underlying health help patients determine whether they've got H1N1 flu, and what to do next--rest, call their doctor or seek immediate treatment. This site and related hot lines have been developed to keep people from flooding emergency departments. The materials, known as Strategy for Off-Site Rapid Triage (SORT) and Real-time Epidemiological Assessment for Community Health (REACH), were created and developed at Emory University. Ruth Parker, FACP, was one of the developers.

In case you missed it ...
The proportion of employees calling in sick when they're not hasn't changed among U.S. workers--at about one-third and holding--but fewer are getting fired for it, according to CareerBuilder.com as reported by Reuters. Of employers surveyed, 15% said they fired an employee for missing work without a legitimate excuse this year, compared to 18% last year.

The survey showed that most employers typically don't typically question absences (29% in 2009, 31% in 2008, 35% in 2007) and two-thirds of them let workers use sick days as "mental health days." The one-third of employers who do check on absenteeism require a doctor's note, call the person at home or have another worker call or drive by the employee's home. Employers cited stress and burnout from the recession as a reason they think employees fake illness.

The bigger fear is "presenteeism," those who show up to work no matter how sick they are. (They're also called "mucus troopers.")

Labels: H1N1, Nutrition, obesity, QD, Workplace issues

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posted by Ryan DuBosar at 12:18 PM   0 Comments

Nurse shortage turns into a glut

For years we have heard there is a shortage of nurses and as recently as today, the California Senate Education Committee approved a bill (AB867) to "address a severe nursing shortage in California." The Health Resources and Services Administration (HRSA) projects that 90% more RNs must be produced in order to meet the predicted need for one million new nurses in the American health care system by 2020.

So if there is such a shortage ... why can't new nurse graduates find a position? I was pleased to pass on the name of a new RN school graduate who had great references from previous allied health care work and was told by the hospital:

"Virtually no one is doing a new grad training program at this time. We have made the commitment to "trickle in" some new grads this fall and received over 1,000 applications for five positions. I might suggest this individual get their foot in the door as a nurse's aide, phlebotomist or some other non-nursing job. Unfortunately, the economy has turned our profound nursing shortage into a glut, virtually overnight."

Upon investigation I find that there is actually an overabundance of nurses in Canada, the Philippines as well as across the United States. There may be openings for experienced critical care nurses, but medical-surgical nurses are pounding the pavement looking for work and finding few or no jobs available. There are hundreds of nurses vying for every opening. The jobs just aren't there.

The downturn in the economy means more older nurses are keeping their jobs and delaying retirement. Hospital census is down and staffing is lean. Is that enough to turn a shortage into a glut? Apparently it is, or the prior predictions just weren't true.

Experts are still saying there will be a shortage after the recession is over that will only get worse in coming years. But for now, it looks like nurses are not in demand and there are thousands of unemployed RNs looking for work.

Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Labels: hospital medicine, Workplace issues

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posted by Toni Brayer MD at 1:26 AM   2 Comments

Time for something besides medicine

This afternoon, I attended an ACR session on part-time medicine. A lot of the described advantages and disadvantages were ones you might have guessed (advantage: more free time, disadvantage: less money), but one speaker made some interesting points about the relative merits of working part-time vs. job sharing.

A lot of it comes down to overhead and benefits. Part-timers may be expected by their partners to continue covering an equal share of the overhead, but job-sharers may not be able to get full benefits. The speaker was a fan of job sharing, which she herself does, but she noted that finding a very compatible partner is of course a pre-requisite to making it work.

Both speakers said that it's usually better to cut back on the number of days you work rather than the number of hours, because a half-day will easily slide into a full day as patients and paperwork pile up. All in all, they made part-time work sound pretty lovely. Anyone want to be half of a medical reporter?

(Just kidding, unless you're willing to do half the work while I get all the salary.)

Labels: rheumatology, Workplace issues

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posted by Stacey Butterfield at 5:00 PM   0 Comments

Very different conferences

Attending two conferences in a row can be confusing, but I'm pretty sure the rheumatology session I just attended came out of a MGMA attendee's nightmare.

The purpose of the session was to convince rheumatology health professionals (who are co-meeting with the ACR) to refer their arthritis patients to occupational, vocational and physical therapy if they report any effects of their illness on work performance. The speakers made important points about how early interventions and workplace accomodations can lower overall costs by reducing absenteeism and disability payments.

But I think it's no coincidence that 3 of the 4 presenters were from countries with socialized medicine (England, Canada and the Netherlands). For example, the British speaker described the accomodations required for an office clerk with rheumatoid arthritis, which included a flat-screen computer, a customized ergonomic chair, speech-recognition software and construction of a ramp.

In the UK, she explained, the government will cover a signficant chunk of the modification costs. In the US, I thought, the manager of that office would be cringing even at the recommendation to buy an electric stapler.

Labels: rheumatology, Workplace issues

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posted by Stacey Butterfield at 7:19 PM   2 Comments

Millennials: demanding what all workers want?

It's only been a few years since the so-called Millennials (born 1980-2001) entered the workforce but their 'boomer' bosses are already pegging them as spoiled brats with inflated views of their own importance. Not surpisingly, that's causing tension in the workplace, according to an article in Tuesday's Wall Street Journal based on "The Trophy Kids Grow Up: How the Millennial Generation Is Shaking Up the Workplace," by WSJ contributor Ron Alsop. (ACP Internist has covered this issue from a medical perspective).

Aslop goes on to make some perceptive observations about how Millennials' proclivities are playing out in the workplace (jumping from job-to-job, expecting instant promotions, sending brash emails to the CEO) as well as possible sources of their elevated self-esteem (coddling by the boomers who are now their bosses). But in the end, what the Millennials want doesn't seem all that outrageous and in fact it's a bit sad that extending a few basic courtesies is viewed as "adapting" to unreasonable expectations. Tips for bosses include:

• Show new hires how their work makes a difference and why it's of value to the company.
• Listen to young employees' opinions, and give them some say in decisions.
• Detail the career opportunities available to millennials if they'll just stick around awhile.

Labels: Workplace issues

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posted by Janet Colwell at 9:41 AM   0 Comments