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Want a Job at the Cleveland Clinic?: Smokers Need Not Apply

Posted Jul 02 2009 6:32pm

I am generally supportive of anti-smoking legislation and rules. However, I have a feeling that we may be approaching a point where the rights of smokers are being seriously trampled. After all, smokers at work are already relegated to practicing their vice outdoors so second-hand smoke ceases to be a problem for the non-addicted. The Cleveland Clinic has now taken the step of refusing to even hire smokers. The details of this plan are presented in what appears to be a personal message posted on the web from Dr. Delos Cosgrove, Chief Executive Officer and President of the Cleveland Clinic (see: A Message About Smoking ). Below is an excerpt from it with boldface emphasis mine:

While we are on the topic of smoking, I understand that there are differences of opinion about our recently announced policy to stop hiring smokers as of September 1st. Many people have told me that they totally agree with the idea. I have also seen and heard comments that what we are doing is discriminatory....Some have questioned the wisdom of our new hiring policy.... But we are not the first organization to implement such a policy.The World Health Organization, American Cancer Society and more than 6,000 companies across the country have adopted similar policies in an effort to promote a healthy workplace. It's a growing trend; one that will likely keep gaining momentum. ... Some also have claimed that our new policy is not really about health, but about saving money.... First, with our new policy, any applicant who fails the nicotine screening will be referred to a free tobacco cessation program that we pay for. Those who are successful in quitting will be encouraged to reapply after 90 days....We also are committed to taking a lead role in shifting the national focus from "sick" care to "health" care. As a true "health care" provider, we must create a culture of wellness that permeates the entire institution, from the care we provide, to our physical environment, to the food we offer, and yes, even to our employees.....Secondly, no one can deny the staggering cost smoking places on society. The U.S. Centers for Disease Control and Prevention estimates that smoking costs more than $75 billion annually in direct and indirect medical costs, and that businesses lose approximately $3,400 each year for every employee who uses tobacco because of increases in health costs and decreases in productivity related to smoking breaks.... While current employees will not be tested, I encourage any employee who smokes to please consider enrolling in a tobacco-cessation class.

I suspect that the Cleveland Clinic would not have pursued a hiring policy that bars smokers unless they were convinced that it would withstand a legal challenge. Note that he cites other organizations that have employed a similar policy. I further suspect that legal issues may have been the reason that they decided not to fire existing employees who smoke. To do so would have made the new policy retroactive, which may have been grounds for legal action.

For me, the most interesting point in the rationale for barring smokers as employees is the following statement: We also are committed to taking a lead role in shifting the national focus from "sick" care to "health" care. I strongly believe in this concept and have published a number of previous notes about wellness versus the classic disease model (see: Wellness, Preventive Medicine, and the Classic Disease Model, Moving LISs Toward Greater Support for Preventive and Predictive Medicine, The Relationship Between Predictive and Preventive Medicine, How Predictive/Preventive Medicine Will Change Healthcare Delivery and the IT That Drives It ). It's refreshing to see a large health system taking positive steps in this direction.

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