Last year, several hospitals in Pennsylvania began testing incoming employment candidates for nicotine, in addition to routine drug and alcohol screening. Apparently, if a candidate has been given a job offer, gets tested at the employer’s occupational health clinic and screens positive for nicotine, he or she is deemed not medically cleared to begin work and, effectively, does not get the job.
As an occupational health physician, I am all for wellness programs and healthy lifestyles. And as a primary care physician schooled in patient-centered medicine, I understand how hard it is can be to make certain lifestyle changes, such as opting for healthier food and quitting smoking. In fact, one of the hardest clinical challenges for me has been to get my patients to quit smoking.
Although I stand behind smoking cessation counseling as a key role for physicians, I am conflicted by such an aggressive maneuver by employers to essentially weed out candidates based on whether they smoke cigarettes. Shouldn’t an employer provide the tools necessary for incoming employees to achieve the best possible wellness opportunities, without turning away quality candidates who may be struggling with their nicotine habits? Why should a more qualified candidate be turned down for a job simply because they smoke cigarettes, other than the fact that their health-care costs would likely be higher for the employer?
Some of you may be questioning the difference between a nicotine addiction or other addictions, like to drugs and alcohol. Most hospitals have a firm drug and alcohol policy with a zero tolerance for impairment in the workplace. Hospital work is usually safety-sensitive—that is, any impairment of judgment poses safety issues for patients, patrons and staff—so those types of addictions are different.
But we have so many vices in society: food, cigarettes, drugs, alcohol, caffeine. Some are socially acceptable, others frowned upon and other still, totally illegal. Good on employers for weeding out candidates who are participating in illegal activity, however, employers should not overlook quality potential employees who smoke cigarettes, but give them the tools up front to quit, including support, a path for success and access to resources for the most successful outcome. In my opinion, it is up to the individual to quit, adhere to a cigarette-free lifestyle and reap all the benefits that come with such a decision. Without the willingness to change, even a nicotine screening test at a future employer’s will not be enough to sway smokers to butt-out.
Bindu Kumar, M.D., is a Philadelphia-area physician with expertise in primary care and occupational medicine. She maintains her family medicine board certification in both the United States and Canada.