Doctors don’t take snow days

Editor’s note: This post was originally written this past winter.

Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I’ve driven home in snow like that, and I find it terrifying. Your car won’t do what you want it to, and worse, other people can’t be counted on to be either careful or able to control their vehicles or even able to see you.

I texted my chief to see if there was any chance the O.R. would close and cases would be cancelled for non-call personnel, but it was business as usual.

So I went back to the hospital to spend the night last night before the snow started. My husband and I had been planning a quiet evening together, but all he could do was wave sadly at me from the window as my car pulled away.

My chief, worried that the bridges connecting his area to the hospitals would be closed, drove to the hospital at 2 a.m. and set up an air mattress in the anesthesia office.

My other colleagues left their homes at least an hour earlier than usual to brave the blizzard and arrive at work on time.

100% of the doctors in our practice made sure they reported for duty at the appointed time, literally come hell or high water.

How many of the nurses and nurse anesthetists did the same?

To be fair, one of the nurses had the honor and dedication to trudge through the snow from her house in order to make it. I don’t mean to imply that there aren’t dedicated, hard-working nurses. But several of the nurses called in “sick” and only one of the nurse anesthetists who were scheduled to work this morning actually bothered to come. What was their excuse? Too much snow.

It has become common for nurses to seek to be recognized as equal to physicians in much of the work that they do (even publishing articles to that effect in newspapers and journals). But on days like this, it’s impossible for the docs to gather around the water cooler without noticing and commenting on the vast difference in work ethic between M.D.’s and non-M.D.’s. It’s just not possible to get through med school and residency making excuses for not showing up and meeting your duties to patients, just because conditions are inconvenient. Nor do we get to feel entitled to extra pay or time off for the extra time and effort spent getting to work hours and hours early due to a snow storm.

Moreover, with our verbal Socratic oath I believe most of us take an attitudinal, internal oath to be there for our patients whether or not we feel like it, have had enough breaks during the day, etc. Why else be a physician, if you don’t have this kind of commitment to taking care of your patients?

So it grates. I hate to admit it, but it grates when what you think of as the practice of medicine, not only a duty but also a calling to be there to heal others, gets generically lumped in with the practice of other “health care providers.” There is a difference, generally speaking, not only in training but also in the overall attitude to the work. Doctors don’t take snow days.

Anesthesioboist T is an anesthesiologist who blogs at Notes of an Anesthesioboist.

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  • Chris

    I guess you can lump me in with those slacker nurses you seem to have your panties in a twist about. One of the ones who has worked for 33 years in the hospital setting, and not often missing a night shift (yes, I worked for 33 years on nights).

    I live in a very remote area outside of the Asheville, NC area. Mountain terrain. And it snows several times a winter, and in addition we have the pleasure of ice storms, leaving treacherous stretches of black ice on the roads.

    Yes, I’ve called in occasionally when its simply too dangerous for my 4WD truck to make the 45 mile journey to the hospital. It will do no one any good if I start out in some misguided attempt to make it to the hospital at any cost, and get in an accident due to the treacherous conditions. I drive as carefully as I can, but as you pointed out in the article, you can’t account for the driving habits of others. Or skidding on the nearly invisible black ice that can form here. If I’m wrapped around a tree truck, and fire/rescue has to venture out to extract and package me up for transport to the hospital, severely injured, I won’t be at work for quite some time, now will I?

    You sound very smug that you ventured out in dangerous conditions and luckily, made it to the hospital without incident. Luck is the key word here. Your hospital should have cancelled non-emergent surgical cases due to the severe weather. Anesthesiologists closer to the hospital could have perhaps stayed or otherwise been encouraged to come in to cover for those who would be in danger (or endanger others) by trekking through the snow and ice.

    You get no points from me for what you did. You were lucky, plain and simple. You would not be writing the same article if you had been involved in a serious accident while en route to your work place. We have a responsibility to our patients, yes. If at all possible, we as health care providers should try to get to work if safely possible. But if not…well, you spend the rest of your days perhaps with a traumatic brain injury and learn to tie your shoes again. I’ll be at work when its safe for me and others to do so. The hospital will still be there. So will the patients. And so will the staff who live in a closer proximity.

    Chris, RN

  • Chris

    Going in early, ahead of a storm, is not always possible, either. Perhaps Boston has some sort of 100% accurate weather forecasting, but here in the South, storms often come up unpredictably and fiercely. If I’m at the hospital, I stay there rather than go home during one. I’ve been at the hospital for 3 days straight rather than drive on ice.
    I’ve come to the hospital in advance of severe storms, too, as have many co-workers (lowly and unprincipled nurses).

    But its not always possible to predict storms, and not everyone follows the weather closely and might be caught unawares. I still state that if it is unsafe to drive, you ought not to be driving.

    Thanks,
    Chris

  • http://www.picumd.com PICU MD

    In my ICU we had several nurses who actually stayed overnight in the hospital so they could work their shift the next day during the blizzard that occurred this past winter.

    With regard to the broader issue, I wonder if professionalizing nurses would change the attitude both from the field and towards the field. i.e. if nurses worked on salary. The whole issue of breaks, lunches, and extra time here and there would not be an issue. I see nurses who have a busy day with a sick kid who are “made” to take a break by union rules. Or nurses who are “made” to leave at the end of the day so they do not rack up overtime that mgmt has to pay even if they are not done.

  • Andrew R

    I also have seen many nurses with amazing “hell or high water” approaches to coming in to work, having lived in both Minneapolis and Boston (I consider myself soft now that I’m living on the east coast), and I have seen doctors who could barely be bothered to come into work on time on your average sunny day. I think that it can go either way, though I might (grudgingly) admit that I usually find doctors to be the ones who are more dedicated on average.

    Not to make everything about money, but wouldn’t you also be less inclined to make it in to work if you were making half or less of what you do now?

    • Primary Care Internist

      “wouldn’t you also be less inclined to make it in to work if you were making half or less of what you do now?”

      possibly, or were given union-negotiated insane amounts of paid “sick” leave.

  • stathappenz

    Well, hold on there a minute, sister!(or brother!)
    Ahem, where to start??
    I have TWO huge issues here, one involving the lightly veiled disgust at nurses DARING to be viewed as “equals” , and the other: labeling a whole profession as lazy, wimpy and non-committed because of a couple “slackers.”
    As a RN living in Colorado, I can assure you I, and many of my fellow nurses, have had to get to work in the dangerous conditions you describe, and then some. I pride myself on my strong work ethic and dedication, not only to my profession, but to my patients and coworkers. So I personally take great offense at the sweeping generalizations in your articlce, that somehow nurses are “less than” in their work eithic and committment!
    Yes, there will be “bad apples” in any bunch!
    But for the most part, I don’t think a nurse would even make it through school if he/she were the type to “wimp out” and call off for clinicals, classes, etc. over weather (or even illness)
    As a matter of fact, in my schooling career, students who were late once (to class, clincal, report, you name it) were put on academic probabtion, and by the third “late”, well you were out. For good. (Pretty “old school” old school, but I hear they are still strict like that!)
    As for the water cooler absences: that can be prettily easily explained. When was the last time a nurse had TIME to “hang around” the water cooler??!! Umm, how about, NEVER?! (my attempt at a little humor, so yes, I am exaggerating a bit there)(but not much)
    Seriously, your smug, self-righteous proclammation of , “…it’s impossible for the docs to gather around the water cooler without noticing and commenting on the vast difference in work ethic between M.D.’s and non-M.D.’s.”
    WHAT? Ha ha, you have GOT to be kidding me!! Seriously? Really? Follow a nurse around for a day and you will get a new, refreshing viewpoint of “work ethic.” (more like “work your ass off ” ethic)
    Tell me, how many docs were at patient bedsides hand-bagging their vent patients after hurricane Katrina? For DAYS on end, hmmm??
    I am not complaining, I LOVE my job, my chosen profession, (more like a “calling”) and would not have it any other way: to work my “ass” off! LOVE it!
    And I could tell YOU stories of getting to my location, staying overnight, all that, (my fellow nurses at my side) but there IS something nurses are not wont to do: self-pity, self-agrandizement and “score keeping” of everyone else’s actions.
    Back when H1N1 was going around, once the docs where I work found out managment had decided to give a MIN. of 4 days off, (so as to avoid spreading the dreaded disease) dozens of docs (even the chief!) called in “sick”, within a 3 week period!
    So yes, there can be bad apples even with MD’s!
    Now, as for this little quote of yours:
    “It has become common for nurses to seek to be recognized as equal to physicians in much of the work that they do (even publishing articles to that effect in newspapers and journals).”
    If you have that little respect for nurses, our profession, our duty to our patients (see hurricane Katrina ref above) …then really, your uneducated and outrageously misinformed attitude really doesn’t deserve the effort of a retort.
    You have made up your mind, and apparently, so have your collegues at the water cooler.
    Nurses don’t take water cooler breaks.

    PS: YES, I welcome feedback :)
    starbeams23@hotmail.com

  • Kristin

    The thing that kills me about the MD/nurse debates is that nobody seems really invested in testing these hypotheses with cold, hard research.

    MDs say: Nurses can’t do what we do. Nurses say: Yes we can. Sometimes they pick a specific issue, sometimes it seems like they’re talking in broad generalities, but there are definitely two sides with competing economic interests, and somebody’s right, and somebody’s wrong.

    So if we want to settle this, we should a) institute EMRs, b) collect data about patients seeing nurses at varying levels versus patients seeing doctors, and c) analyze the data.

    Otherwise, there’s just so much jaw-flapping going on. Maybe the nursing culture at hospital X is just lazier than at hospital Y. Maybe nurses who having NDs, or nurses who have more than a certain number of hours of training, or experience, really are capable of taking on some physician duties. We won’t know until we study it–on a huge scale–and we aren’t doing that.

    Of course everyone is taking everything personally; that’s what people do, especially when there’s money at stake. But it isn’t helpful. It doesn’t add anything useful to the argument. We might as well be yelling “Are not!” and “Are too!” at each other, for all the good it does.

  • Patricia

    Oh, wow. I speak from the perspective of a critical care nurse with over 30 years experience when I say, you are absolutely right, and unforgivably wrong! Many nurses are as committed and responsible as their physician colleagues; others are not.

    One important point, however, is if a unit nurse was to come in early to miss the snow storm, where, exactly, would s/he set up his or her air mattress to sleep? We do not have offices, changing rooms, on call rooms, or any other space to call our own. Maybe she could find an empty patient bed, which would undoubtedly be full before long. Anyway, someone would complain that the bed was used and housekeeping needed to clean it again. We simply do not have the luxury to sleep at the hospital, which forces us into the position of driving in dangerous conditions.

    Many nurses with school age children do not have child care arrangements when school is cancelled abruptly. It is simply a fact of life.

    Because we do shift work, covering 24 hours, we often stay and work to cover another shift for an absent nurse because leaving a unit short-staffed is dangerous for both the nurses and the patients. This represents really hard work for very long hours. It is often easier to stay than to go home and come back again.

    I am pretty disappointed, given the snowstorms in the Boston area this year, that the hospital did not try to cancel some of the surgeries. It was a “bottom line” decision, I am sure, but what about the patients who unnecessarily risked life and limb to get to the hospital for their surgeries?

    Finally, nurses are viewed by administration as fungible commodities. As long as there is a living, breathing body on site, they do not care about our individual skills and talents or our committment to a patient or group of patients. We are often pushed and pulled according to the administration’s demands without a say in the decision- making process. If your unit happens to be unusually slow, you may be sent home without pay or, you can be put in the untenable position of being floated to an unfamiliar environment, which is short staffed, and be expected to perform with high standards. We nurses do not think we are on the same “level” (?) as physicians; we simply want to be treated with the same respect as a valued member of the health care team.

    None of us do the work we do because we expect to be praised or applauded for our efforts. Nursing administration, however, can often go out of their way to remind you how un-appreciated you really are. Some years ago, during a blizzard, I had the day off. I received a call asking if I would come in since so many nurses had called in. I agreed. I walked outside to find that I was unable to locate my car in the parking lot, much less drive it. I decided to walk the two miles to work. On the way, I stopped to get a warm drink and called in to explain why I was late. I was admonished by the supervisor for being late…. on my day off …. during a blizzard …. while walking to work. Sometimes, it just doesn’t pay to be dedicated!

  • Molly Ciliberti, RN

    Never took a snow day or called in sick due to snow (ICU/CCU). We used to joke that calling in dead wouldn’t work unless you gave them 2 weeks notice. Please don’t judge all nurses from this experience and we won’t judge all physicians from the bad ones in our experience.

  • A.

    I’m a second-year medical student, and quite frankly I find the tone of this post offensive. I have encountered nurses (both professionally and personally) who have shown all the skill and dedication in the world. I’m sure there are some nurses out there who don’t “bother to come in,” but that can be said of any profession. I think the stereotyping of nurses in this post is untrue, unprofessional, and not helpful in creating a positive workplace environment. It seems to me that you are annoyed by nurses seeking “to be recognized as equal to physicians in much of the work that they do” and you are trying to use this one particular snowy day as some kind of proof that they shouldn’t be equal. Really?

    When I enter my clinical rotations, I hope to be on the floors working with the nurses, rather than standing around the water cooler talking about them.

  • CD

    I’m neither a physician or a nurse, in fact, I’m not in the clinical field at all. However, I’ve spent 15 years as a PR professional IN the hospitals with clinicians at all levels and I can honestly say that when I read this article, I was disgusted at this physician’s tone – that doctors are somehow “better” than all the other caregivers in the hospital because they “show up” and have a different “overall attitude to the work”. Of course they have a different attitude… a more arrogant one.

    I have a lot of friends who are physicians, I’m the daughter of one, I’m also the niece of two nurses. All of who I think are the epitome of professionalism and healers. However, I can also say that there are so many physicians who ARE slackers, who DO cut corners, who DON’T show up and if anything, I’ve observed that NURSES, and all the other clinical professionals who have WAAAAAAY better work ethic as a whole than the physicians.

    So sir (or madam), get off your high horse and start respecting your NON-physician colleagues. Yes, they ARE equal to you (even if they may not have boatloads of school loans)… because without them, you wouldn’t be able to do your job.