When a third party covers health insurance, they feel they can call the shots. They are also easily corrupted by special interests and under no obligation to base decisions on sound science.
Smokers need not apply. That’s the word from Orlando Health, which announced this evening that it will start a tobacco-free hiring policy at seven of its hospitals starting in April. The move is part of a controversial nationwide trend, in which hospitals are leading the way.
“Our new tobacco-free hiring rule reinforces our culture of prevention and wellness for team members, patients and the Central Florida community,” said Christy Pearson, a human resources executive for Orlando Health. “It is our way of leading by example.” Job candidates who get an offer will continue to take a urine test that screens for drugs, but starting April 1, the test will also screen for cotinine, a by-product of nicotine. The test will detect all tobacco substances, including pipe tobacco, snuff, chew, smokeless tobacco and patches. “If you’re a regular user, it will show up,” said Lewis.
The cotinine level can determine whether an individual is a primary tobacco user, which would block a hire, or is simply being exposed to second-hand smoke. If a job candidate gets an offer, then tests positive for tobacco use, the offer will be rescinded….
The University of Pennsylvania Health System has also announced that, beginning on July 1, it will ban residents, medical students and post-doctural candidates who use nicotine from working in its approximately 18,000-employee health system. Dr. Michael Siegel and his readers questioned the rationale behind the initiative and the exaggerated claims of higher health care costs among people exposed to nicotine:
The primary reason given for the implementation of employment discrimination by the University of Pennsylvania Health System is that it will save health care costs. I believe that employment discrimination is wrong. Employees should be hired based on their bona fide qualifications for a job, not based on a group to which they happen to belong when that group membership does not relate to a specific job qualification. Once employment discrimination is justified on the grounds of saving money, then the same reasoning would justify discriminating against obese people, persons who consume alcohol, individuals who do not wear seat belts, persons who talk on their cell phones while driving, motorcyclists, and virtually any other group that an employer does not want to hire…
Is this the start of a slippery slope of third parties controlling private lifestyles and behaviors — and not always based on balanced or sound scientific grounds (such as nonideal weights, alcohol and certain foods)? “Wellness” programs and pop media are riffe with pseudoscience concerning near magical benefits of eating, acting and looking certain ways in preventing chronic disease of aging and saving money, for instance. Hospitals aren’t the only ones “leading the way,” as alternative medicine programs and other non-evidence-based beliefs bring more money into medical schools and have been widely adopted into medical curriculums. Smokers are easy first targets and widely demonized. Arthur Caplan wrote an OpEd this weekend, arguing ethical concerns surrounding these initiatives and the need to keep private activities separate from work:
The University of Pennsylvania Health System in Philadelphia recently announced that it will no longer hire smokers. A job applicant must be tobacco-free for six months to qualify for a position there….But, keeping smokers out of the hospital work force unless it protects patients makes me very nervous. Ethically, it is hard to digest….
So the two big reasons are making a dent in a costly bad lifestyle choice and saving money for the health care system by hiring tobacco-free employees…. But the obese, the gamblers, rugby players, skiers, the sedentary, the promiscuous who don’t practice safe sex, those who won’t wear helmets on motorcycles and bikes, horseback riders, pool owners, all-terrain-vehicle operators, small-plane pilots, sunbathers, scuba divers, and surfers — all of whom cost us money and incur higher than average health care costs — are still on the job. Picking on the smokers alone is simply not fair. And what message does a no-smokers-are-welcome policy send? We don’t want you in our health care system?
Shouldn’t doctors and nurses learn to work with those who sin and stray from the dictates of good health? As long as those who have bad habits are not compromising the quality of health care being provided on hospital ground, then let’s not exclude smoking nurses, fat physical therapists, and scuba diving pharmacists from work…