It’s been two decades since President Bill Clinton signed the Family and Medical Leave Act into law, granting 12 weeks of job protection per year to workers recovering from an accident, tending to a sick loved one or caring for a new baby.
On the week the FMLA turned 20, Dr. Marc Downing, a pediatric surgeon from Kalamazoo, Mich., wrote us to criticize one of the law’s side-effects. Downing said he feels dropped into the middle of an antagonistic relationship between employer and employee. “As a physician,” he said, “I am happy to share the medical data that is available to me with both the employee and the employer, but I would prefer for them to negotiate the details of the employees’ leave from their duties.”
We found his to be a fresh perspective and asked other medical professionals in the Public Insight Network for their thoughts on how well the law is balancing “the demands of the workplace with the needs of families,” a key part of its stated purpose.
What we heard back was more dissatisfaction about the inefficiencies and common misuses of the legislation by both employers and employees.
“Bottom line is, my crystal ball is misty…”
Topping the list of doctors’ FMLA frustrations is paperwork – not just the amount of paperwork, but also the questions asked on the FMLA form. In one set of questions, medical professionals are asked to chart the time and progression an illness will take.
Dr. Pam Vnenchak, a family physician in Lancaster, Pa., says FMLA paperwork is “very frustrating and cumbersome to complete.” Her main frustration — one echoed again and again by the medical professionals who shared their stories — is that the FMLA form asks doctors to predetermine the course of an illness. This is something Vnenchak says she simply cannot predict with the specificity the form requires.
J.D. Wolfe, an office manager at a family practice in Manchester, Mo., puts it this way: “Bottom line is that my crystal ball is misty in predicting the future.”
“It’s not like we have a chart we can reference,” says Dr. Erik Sather, a general practitioner in Duluth, Minn. “Let’s see here: Pneumonia in a 60-year-old with diabetes and depression. Says here they should be all better in three weeks,” he adds sarcastically.
The problem is that these predictions have very real consequences: What a doctor writes on the form determines how much protected time off an employee/patient receives. “Since I am usually asked to fill these out before a scheduled procedure or surgery, it always feels like a guess,” Sather explains. “And the pressure is on because if I make a mistake, the patient could lose their job.”
“If I say two days per month, it means the patient can be off six weeks a year regardless of whether he or she is actually ill.”
This guessing game gets even trickier when it comes to chronic illnesses that might require an employee to take intermittent time off.
Dr. John Woo practices internal medicine in Portland, Ore. He says he is often at a loss when making recommendations for people with ongoing illnesses such as asthma or migraine headaches who need to stay home during acute attacks. “Predicting how much time is needed is very difficult. If I say two days per month, it means the patient can be off six weeks a year regardless of whether he or she is actually ill. If I say two days every two months, he or she is out of luck if there is more than one attack during that time period.”
Woo adds that this situation is pretty common, and he’s seen it cut both ways: sick employees left with unexcused absences and those who take leave when it’s not medically necessary. “The FMLA has been a mixed bag,” he says. “I suppose in the grand scheme of things, most employees use it as it was intended. However, there are enough abuses that it often makes me wonder.”
“If I don’t fill it out, the patient may lose his job. If I do fill it out, it is condoning the abuse of this form by the business.”
As a family practice physician in Lake Odessa, Mich., Dr. Laurie Braker told us she sees a different problem, namely employers inappropriately applying the FMLA.
She told the story of an employer in her area who requires any employee taking more than two consecutive days off to get FMLA paperwork from a doctor. “This is an enormous burden to physicians to fill out and very inappropriate for the standard upper respiratory condition or gastroenteritis,” she says.
Braker explains that this request puts her in an awkward position. “If I don’t fill it out, the patient may lose his job. If I do fill it out, it is condoning the abuse of this form by the business. I have always sided with the patient and filled out the form,” she says.
Dr. Blaise Vitale, who practices family medicine in rural Grantsburg, Wis., sees the same problem. “As I understand, [the FMLA] was originally only meant to be completed for a serious medical illness, which was defined as three days off work. Many states and employers have expanded the definition of serious medical illness to include only one day off from work. As a result, I have to fill in these forms far more frequently than [in only the cases of] the truly serious illnesses intended by the legislators who crafted this act.”
Vitale feels he shouldn’t have to waste his time filling out paperwork just because a company “wants to verify that the employee didn’t just take the day off because it was a good fishing day.”
>> Does this story resonate with you? If you’re a medical professional, share your experience with FMLA.
>> If you are an employer or employee, tell us how FMLA has affected your work and life.