Federal office mandate burdens Ottawa doctors as officials seek medical certificates

Family doctors in Ottawa are seeing an influx of public servants seeking medical certificates to support work-from-home requests, putting additional pressure on an already overburdened health care system.

Dr. Roozbeh Matin, who works in Barrhaven, said he has noticed the trend for months, since the federal government announced plans to require civil servants to work from the office more often.

“This is a systemic problem that all of us physicians in the Ottawa region are noticing,” he said. “We have actually been inundated with requests from our civil service patients asking for different types of accommodations.”

The actual numbers may not seem so daunting: Matin gets about two to four requests a week, while Dr. Alex Duong has seen several dozen since the spring at his family medicine practice in Vanier.

We get completely bogged down in these requests and feel completely overwhelmed by them.-Dr. Roozbeh Matin

But the doctors say the problem is widespread in the Ottawa region, and they see the visits — and the pages and pages of forms they generate — as a waste of scarce resources that could be going toward patient care.

“We are being asked to oversee this return-to-work policy for the federal government, which is frankly not an effective use of our time,” Duong said.

He said the federal government has essentially “downloaded” its own housing problems onto GPs in a city where they are few and far between.

“It comes just as the health care system itself is bursting at the seams and we are desperately trying to keep our heads up,” Matin said. “We are completely bogged down by these requests and feel completely overwhelmed by them.”

Paperwork ‘the bane of our existence’

It takes a full day every week for Dr. Derek McLellan to deal with all the paperwork at his GP practice in Riverside South.

In recent months, more and more patients have attempted to circumvent the return-to-office mandate.

“Their manager said, ‘The only way around that is a medical certificate, so make sure you get one,’” he said.

When he writes one, it doesn’t end there. Patients return with three- or six-page forms for him to fill out. Sometimes even that isn’t enough and they come back with yet another document.

“It’s a hugely important thing because it’s just another task added to our plate and, in a sense, done without any medical benefit,” McLellan said.

He said some of the paperwork seems all the more pointless because patients already had remote work options available before the pandemic. With the return-to-office mandate, they are now being asked to start all over again.

“This is something that is largely an HR issue that we are in the middle of, and it just piles on additional administrative hours,” he said.

Duong described a similar burden. According to him, he is being asked to do ‘administrative medicine’ instead of ‘real medicine’.

“The more time I spend on these forms, the less time I can spend with patients,” he said.

Matin said all that extra work contributes to doctors’ burnout and affects their ability to care for patients.

“This has created significant amounts of paperwork, and this is the bane of our existence right now,” he said.

Doctors do not want to play ‘gatekeeper’ for the government

Matin said the reasons for the requests vary widely and include social anxiety, back pain, introversion, concerns about contracting COVID-19 and gastrointestinal complaints that create an aversion to public restrooms. He said the concerns are legitimate for patients, but they also put doctors in a difficult position.

“It puts the doctor in the situation where he almost has to make a legal ruling, not make a diagnosis and come up with a care plan,” Matin said.

Duong said few primary care physicians have much training in occupational medicine, and asking them to play that role can “create friction in the doctor-patient relationship.” McLellan agrees.

“You get into a conflict because we are in the middle as a gatekeeper for this matter, when there is no medical basis for it. We have nothing to do with this conversation,” he said. “So it certainly creates some animosity.”

The Treasury Board of Canada Secretariat (TBS) said it does not centrally collect information on how many civil servants have requested work-from-home accommodations, how many have been granted, nor how many civil servants have had medical notes taken.

It pointed to the federal government’s directive on the duty to accommodate, which states that employees who face obstacles in the workplace should be accommodated to the point where they experience unnecessary hardship.

“The adoption of hybrid work has not changed our approach or our commitment to supporting employees,” a TBS spokesperson said in a statement.

The guidance directs managers to attempt to accommodate work-related needs without resorting to a formal request for accommodation, to the extent reasonable, but there may still be instances where doctor’s notes are necessary.

“If the barrier the employee faces is not clear, or the possible accommodation measures are not known, supporting documentation such as medical notes may be necessary,” the TBS statement said. “Required documentation should be determined on a case-by-case basis depending on the specific circumstances and complexity of the request.”

Duong said there is a simple solution: The government should hire people to produce the documents it needs

“If the federal government wants to do occupational assessments, they should consider hiring their own doctors trained in occupational medicine,” he said.

McLellan has the same suggestion.

“I think that would be a much more appropriate use of the resources because it would be their own resources,” he said. “It’s not that of our health care system.”