Do everyone a favor when you’re sick: Stay home!

Presenteeism is a major thief of productivity

What’s more contagious than the flu carried by the co-worker who comes in to work sick? Maybe the pressure to be at work even though sick. American workers don’t stay home enough when they’re sick, and that’s costing businesses millions in lost wages and unproductive workdays, report researchers at Cornell University.

The Cornell study is the first to include an employer’s costs from unproductive days at work caused by health problems. Ron Goetzel, director of Cornell’s Institute for Health and Productivity Studies in Washington, DC, says he and his colleagues looked at the costs associated with employees who came to work sick. The researchers determined that the practice of not staying home when sick costs about $255 per employee per year — perhaps more than absenteeism does, he adds.

Factors included lack of concentration due to sickness; work done more slowly and with more repeated tasks; and generally slowing down of productivity. The potential cost of infecting co-workers was not included in the Cornell findings.

Goetzel adds that expenses related to presenteeism are even exceeding the costs of absenteeism and medical and disability benefits, and part of the problem is that employers have not yet fully recognized the financial impact it can have on their business.

Why bring the misery to work?

A Dutch survey found that the reason workers tend to go to work rather than stay home and get well is due to "working under pressure," meaning, employees feel pressure from their workplace to be at their desks, day in and day out. Presenteeism was low among those working part-time (eight hours or fewer per week), and also among workers who are satisfied with their pay.1

Other factors include:

  • male;
  • young;
  • having low or very high autonomy;
  • having low job security;
  • coping with financial concerns;
  • dealing with uncertainty (e.g., a company merger);
  • facilitating parental/family responsibilities.

"The question is not how much does it cost to keep employees healthy," says Scott Sullivan, president and CEO of the Scottsdale, AZ-based Institute for Health and Productivity Management. "The question is, What does it cost when they’re not healthy?’"

Employers need to look at the total burden of illness, says Sullivan, which includes not only direct costs of medicine and physicians, but also the indirect costs of lost productivity, decreased quality, and effects on co-workers and customers. Then employers should educate their employees about the wisdom of staying home when they are ill, and the long-term benefits of doing so.

Many of the illnesses that employees bring to work could be managed more quickly and with less ripple effect if the employee stayed home or received primary medical care. Common maladies such as the cold can be treated at home, with patients benefiting from rest rather than prolonging the illness by working. Others, such as migraines, can cause lost productivity but are easily treated and managed under a physician’s care.

Not all causes of presenteeism are infectious. Psychological maladies, such as depression, are common causes of lost productivity. A recent study published in the American Journal of Psychiatry draws a correlation between major depression and loss of focus and productivity, with the strongest depressive symptoms coming in the evening.2

Jeffrey P. Kahn, MD, clinical associate professor of psychiatry at Cornell University in New York City, says the study shows depression is associated with "a significant reduction in task focus" and productivity. "[Researchers] calculated that the lost productivity from depression while at work was about 2.3 days per month, as compared to other studies reporting a typical loss of one day per month due to work absence," he points out. "Together, these lost productivity causes resulted in an ongoing effective lost salary of $300 per month [other costs such as turnover, health care costs, and others were not included]. That would be enough to pay for a fair amount of treatment, and then some," he says.

Integrated strategy called for

Goetzel says making employees stay home is not really the solution. The answer, he says, is to focus on wellness so the employees don’t get sick in the first place.

Combatting presenteeism requires an integrated approach, experts say. If employees are suffering from chronic illness or injury, occupational health professionals can work with the employee toward a solution, such as an ergonomic evaluation and changes to a workstation. In the case of chronic medical conditions, disease management techniques and employee wellness programs can be beneficial. If the problem is personal, workers can tap into their employers’ employee assistance program for referrals or counseling.


1. Aronnson G, et al. Sick but yet at work,’ An empirical study of sickness presenteeism. J Epidemiol Comm Health 2000; 54:502-509.

2. Wang PS, et al. Effects of major depression on moment-in-time work performance. Am J Psychiatry 2004; 161:1,885-1,891.

For more information, contact:

Jeffrey P. Kahn, MD, Clinical Associate Professor of Psychiatry, Cornell University, New York City. Phone: (212) 362-4099.

Scott Sullivan, President and CEO, Institute for Health and Productivity Management, Gainey Ranch Center, 7702 E. Doubletree Ranch Road, Suite 300, Scottsdale, AZ 85258. Phone: (480) 607-2660.