Vaccine Mandates for New Medical Office Hires

September 25, 2021

COVID is not going away. As much as we hoped the vaccine would make life a little easier, it made it more complicated. Or maybe confusing is a better word. There are so many different attitudes and beliefs regarding the vaccine in our society, not to mention the often contrasting laws, mandates, and recommendations we need to keep track of. Meanwhile, cases are climbing, and healthcare workers are running full speed to keep up.

Hiring is critical right now. Recent studies show that the industry will face a shortage of up to 122,000 physicians by 2032 and will need to hire at least 200,000 nurses every year to meet increased demand and replace retiring nurses. There also are critical shortages of allied health and behavioral health professionals, especially in rural and urban communities.

Many healthcare systems are mandating vaccines for all employees, including new hires. But what about private medical offices or smaller healthcare systems? Should they require vaccines? They are experiencing the same hiring issues as the hospitals. However, many of them don’t have a large hiring pool or the wiggle room to lose existing staff.

There has been little clarification on vaccine mandates for these types of medical providers. This blog will give you more information on possible strategies leaders could take to address the issue.

First, let’s break down the rules, recommendations, laws, and mandates our various government entities have issued.

Federal vs. State vs. City

On September 9, President Biden outlined a plan to increase vaccination rates nationwide by recommending that the U.S Department of Labor mandate private employers with more than 100 employees to require vaccines or weekly testing. He put in place vaccine mandates for federal employees and contractors. He also instructed the Centers for Medicare & Medicaid Services (CMS) to require vaccinations for staff in most healthcare operations that receive Medicare or Medicaid reimbursement, including but not limited to hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies. This mandate seems to include staff who are not involved in direct patient, resident, or client care.

In Arizona, Governor Ducey has issued a proclamation that NO government entity can mandate vaccines. Healthcare institutions are exempt from this rule and are permitted to implement a vaccine mandate. However, they must provide “reasonable accommodation” for any employees who have “sincerely held religious beliefs, practices or observances that prevent the employee from getting the COVID-19 vaccine unless the accommodation would pose an undue hardship to the operation of the business”.

There are some cities in Arizona testing these state policies. Tucson mandated vaccines for their employees and was given 30 days by Arizona’s Attorney General to repeal it or risk losing millions of dollars in state funding.

Needless to say, the confusion deepens every day. We hope for more clarification from our government leaders soon. But what about our industry leaders? What do they say?

Industry/Associations Viewpoints

Almost universally, public health and healthcare organizations are pro-vaccine for their workers. Here are some quotes from leaders of these entities.

“Universal vaccination of healthcare workers is the single most important step healthcare institutions can do to stop the spread of COVID-19. It is essential for protecting the health of their workers, the safety of their patients, and ultimately the health of their communities,” said Georges C. Benjamin, MD, executive director, American Public Health Association.

“We need to do everything possible to help children, adolescents, and their families safely emerge from the global pandemic,” said Gabrielle A. Carlson, MD, President, American Academy of Child and Adolescent Psychiatry. “It is imperative that those who can receive a COVID-19 vaccine do so, especially those who work in a healthcare facility where care is provided to the unvaccinated, including vulnerable children for whom a COVID-19 vaccine is not yet approved.”

“Requiring COVID-19 vaccination as a condition of employment is a powerful tool for protecting frontline workers and patients against highly contagious variants and in communities with significant numbers of unvaccinated people. Health care organizations have an opportunity to lead by example, setting a precedent for other organizations to require vaccination to safeguard the health of employees and entire communities,” said Daniel P. McQuillen, MD, FIDSA, president-elect, Infectious Diseases Society of America.

“Patients with cancer need to know that their environment, including the people who care for them, is as safe as possible,” said Everett E. Vokes, MD, FASCO, president, American Society of Clinical Oncology. “Mandatory vaccination is entirely consistent with ASCO’s core values of evidence, care, and impact.”

You can see that some of these leaders represent healthcare workers who work outside the traditional hospital setting. While many hospital systems have already mandated vaccines, some are still struggling to implement them, especially in states like Arizona where the state is not on board with mandates. But what about the smaller healthcare systems or private medical offices? What do they do?

Aren’t Medical Offices Different Environments?

There is the argument that there is less risk in private medical offices or smaller treatment facilities. But does it really matter? The Hippocratic Oath states: “First, do no harm“. It should be important to all healthcare leaders that their patients and employees are safe from a highly contagious virus. Not only that, leaders should want their patients and employees to FEEL safe in their offices and buildings.

The federal government has weighed in. “There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health,” Xavier Becerra, Secretary of the U.S. Department of Health and Human Services, said in the announcement. “Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential.” If the White House’s recommendation to mandate vaccines for CMS-funded organizations AND companies that employ more than 100 people move forward, that will probably cover many smaller healthcare organizations and offices. And even with Arizona’s ban on mandates, it’s assumed that the Federal mandates will stand.

What’s Next for Current Employees and New Hires?

Of course, it would be wonderful if every employee got vaccinated on their own. Unfortunately, for many offices that is not likely to happen. The best practice seems to be to listen and educate employees on the vaccine first before deploying a mandate. Mandates can be perceived as a form of punishment, and losing employees is costly. Even providing incentives like paid time off or bonuses may be less expensive.

But when you have to hire, can vaccination be included as a job requirement? There is evidence that it can. In August, the share of job postings per million requiring vaccination increased 40% month over month, Indeed data showed. Vaccination requirements in personal care and home healthcare job postings increased 333%. Vaccine requirements in legal and administrative assistance job postings grew as well. The most interesting data point is that Arizona led the nation in job postings requiring vaccination. In the seven days ending August 30, 1.3% of job postings in Arizona required a vaccine.

But is it Legal?

Normally, employers can not make a job contingent on a health or disability status. However, the Equal Employment Opportunity Commission announced this year that employers can require all workers to be vaccinated against COVID-19.

However, there are guardrails. “It’s critical, though, that employers and their hiring teams don’t overstep,” Carolyn Rashby, an attorney with Covington & Burling in San Francisco said. “While asking about the vaccination itself will usually be permissible, follow-up questions that may reveal a disability can be asked only if they are job-related and consistent with business necessity.”

It is best to be as transparent as possible. If the requirement is not in the job posting, let applicants know immediately upon follow-up. Make sure to mention how your organization will handle exceptions for religious or health reasons and outline the required timeline for immunization.

Be careful about requiring proof in the interview process. That might be considered an indication that you are more interested in an applicant’s health status than their qualifications for the job. It is appropriate to ask for proof at the time of hiring. Just make sure to treat it as a confidential medical record.

Conclusion

Hiring in the time of COVID and social discord around vaccines can be challenging. But as a necessary part of doing business, keep focused on your company’s culture and search for new hires that will enhance the workplace.