Reducing mandatory sick notes

One slip of paper, enormous pressure on the health system

More than 40% of Canadians polled by the Canadian Medical Association (CMA) and Abacus Data say their employer has a sick note policy for short-term absences due to minor illnesses. But sick notes have their own ill effects – on patients, doctors and the health system. Here’s why the CMA is calling for their elimination across the country.

How widespread are mandatory sick notes in Canada?

An estimated 8.8 MILLION CANADIANS have a short-term leave sick note policy

In the last year alone, approximately 12.5 MILLION SICK NOTE REQUESTS have been made by working Canadians

1/2 of those workers are required to produce a sick note for any length of time off

Sick note policies are MOST COMMON in unionized and in-person workplaces

Source: CMA/Abacus Data survey, October 2024

What’s the impact of mandatory sick notes on patients?

Increased risk of spreading infections to co-workers as well as other more vulnerable patients in medical clinics and hospital emergency departments such as the frail, elderly, very young children and those who are immunocompromised.
Financial strain from transportation to physicians’ offices, potential charges for a sick note and, for workers who must take time off from work for appointments, lost wages.

82% of employed Canadians would likely go into work ill rather than get a sick note from a health care provider.

Source: Ipsos poll, November 2018

What’s the impact of sick notes on the health care system?

Sick notes put additional strain on already overburdened providers, reducing access to care and potentially leading to longer wait times for appointments.

1.5 million

53%

1 in 4

22%

Sources: Doctors Manitoba, Physician Survey, November 2023, CMA 2021 National Physician Health Survey, 2023 Commonwealth Fund Survey, OurCare survey, October 2022

Canadians want to reduce or prohibit mandatory sick notes

Source: CMA/Abacus Data survey, October 2024

Source: CFIB, Your voice survey, November 2022

Momentum for change on sick notes

Some provinces are already recognizing the negative impact of sick notes on access to care and physician wellbeing.

In October 2024, the Quebec government introduced legislation to reduce the administrative burden of physicians, including prohibiting employers from requiring a medical note to explain the reasons for an absence due to illness.
In May 2024, the Ontario government introduced legislation that would prevent employers from seeking a doctor’s note for the first three sick days an employee takes each year.
In July 2023, Nova Scotia enacted legislation to limit the circumstance in which employers can require employees to provide sick notes from a physician or other qualified health care professional.
Doctors Manitoba, in partnership with the Manitoba Government, has released a set of recommendations to reduce excessive and unnecessary administrative burden faced by physicians, including the elimination of sick notes to verify illness-related absences.

CMA calls for action on sick notes

The CMA believes the responsibility for overseeing absenteeism lies with employers and educators, not physicians. We are recommending that:

Governments enact legislation to restrict employers and educational institutions from requiring sick notes for short-term minor illnesses.
Employers and educational institutions adopt alternatives to doctor’s notes, such as signed declarations from employees (self-certification) or personal leave days that do not require a medical certificate.
Governments, employers, educational institutions and society stop relying on physicians as a default when seeking validation for tasks – like writing sick notes – that do not necessarily require medical intervention nor expertise.