The financial and employment effects of coronavirus disease 2019 on physicians in the United States.

Although the coronavirus disease 2019 (COVID-19) pandemic has created havoc with the U.S healthcare system and physicians, the financial and contractual implications for physicians are now beginning to come to the forefront. Financial assistance from the federal government has mainly been received by hospitals, which have borne the brunt of the COVID-19 illness. Some physician groups have, or are, receiving assistance through a few programs, although the accelerated and advance payments have been suspended. Employed surgeons are now being furloughed, terminated, or persuaded to agree to a significant cut in pay, forego bonuses, or take leave without pay as healthcare systems and some physician groups have started to experience the consequences of halting elective procedures. Newly hired surgeons might be forced in a few cases to agree to delays in starting their employment, new amendments, changes in employment status, and other terms for fear of losing their employment. In the present report, we have explained some agreement terminology and options available to allow physicians to understand the terms of their employment agreement and make their decisions after consulting with an expert healthcare attorney.

Some legal aspects of epilepsy.

INTRODUCTION: Legal aspects of epilepsy are jurisdiction-dependent, and this analysis has focused on an Australian context;however, the reader can extrapolate to his/her local jurisdiction and/or legal system. EPILEPSY AND DRIVING: The AUSTROADS Guidelines have codified the fitness to drive restrictions to be imposed for both private and commercial drivers. They set out the default positions and the considerations that can be applied to deviate from the default of at least 1year seizure freedom for private license holders and 10years seizure freedom for commercial drivers. EPILEPSY AND EMPLOYMENT: People with epilepsy are broadly excluded from all employment requiring the wearing of a uniform. Only where preemployment medical examination mandates disclosure does the person with epilepsy has to disclose epilepsy to a prospective employer. There are specific laws that control workplace and employment standards that cover occupational health and safety, protection for the disabled, and antidiscrimination. NEGLIGENCE: Negligence relies on establishing: duty of care; breach of that duty; and damage that is not too remote. Once ascertained, liability is established by the relative causation. The Civil Liability Acts served to redefine negligence, causation, and liability. Added consideration attaches to vicarious liability of the employer for the employee and nondelegable duty of care. CONCLUSIONS: This overview has examined three legal aspects of epilepsy, namely, driving, employment, and negligence. The concepts and interpretations should have relative applicability well beyond any narrow confines, limited to a single jurisdiction.

How Medicaid work requirements could exacerbate the opioid epidemic.

In 2018, the Trump Administration took the unprecedented step of allowing states to impose work requirements as a condition of Medicaid eligibility. States can apply for a demonstration waiver to require Medicaid beneficiaries aged 19-64 who do not meet exemption criteria (e.g., disability, caring for a sick relative) to participate in "community engagement" activities, which include employment, volunteering, and enrollment in a qualifying education or job training program. Debate thus far has focused primarily around the important issue of whether such requirements are legal. Less attention has focused on another serious concern - namely, that work requirements could exacerbate the nation's most urgent public health crisis: the opioid epidemic. Many enrollees with opioid use disorder who are unable to meet states' community engagement criteria will not qualify for an exemption from the work requirements, and risk being dropped from Medicaid enrollment. Refusing health insurance to individuals who are unable to meet work requirements could result in significant losses in coverage among a highly vulnerable population. Implementing new barriers to Medicaid coverage will hinder the effectiveness of massive state and federal investments in improving access to evidence-based addiction treatment.

The Workplace Discrimination Experiences of Individuals with Cancer in the Americans with Disabilities Act Amendments Act Era.

Background The purpose of this study was to investigate the patterns in allegations of workplace discrimination filed by individuals with cancer. Objective The goal of the research was to describe discrimination, both actual and perceived, that has occurred against individuals with cancer in comparison to a group of individuals with other general disabilities (GENDIS) through analyses of the United States Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database. Methods An ex post facto, causal comparative quantitative design was used to examine Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints received by the EEOC from people with cancer from 2009 through 2016 (n = 10,848) in comparison to the GENDIS group over the same time period (n = 13,338). Results Results revealed statistically significant differences in the patterns of issues alleged by the two groups. When compared to the GENDIS group, the cancer group was significantly older and had proportionally more individuals who identified as Asian than the GENDIS group. People with cancer were more likely to allege discrimination in the areas of unlawful discharge, demotion, wages, layoff, benefits, and referrals. They were less likely to allege discrimination in areas of reasonable accommodation, hiring, and suspension. Also, the cancer group was more likely than the GENDIS group to file allegations against smaller employers and employers in the Southeast region of the United States, while employers in the Mid-Atlantic and Rocky Mountain regions were less likely to be named in allegations by people with cancer. The cancer group was also significantly more likely than the GENDIS group to find that EEOC investigations of their allegations resulted in merit-based case resolution, that is, discrimination had indeed occurred. Owing to the large sample size, some of these between-group differences were small in magnitude. Conclusion The workplace discrimination experiences of people with cancer are substantially different from those of people with other disabilities.

Levels of Employment and Community Engagement among Low-Income Adults: Implications for Medicaid Work Requirements.

CONTEXT: Twenty states are pursuing community engagement requirements ("work requirements") in Medicaid, though legal challenges are ongoing. While most nondisabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities and what heterogeneity may exist by race/ethnicity, age, and gender. The authors' objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries. METHODS: The authors analyzed the US Census Bureau's national time-use survey data for the years 2015 through 2018. Their main sample consisted of nondisabled adults between 19 and 64 years with family incomes less than 138% of the federal poverty level (N = 2,551). FINDINGS: Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population-particularly women, older adults, and those with less education-would not currently satisfy a 20-hour-per-week requirement. CONCLUSIONS: Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per-week requirement and therefore could be at risk for losing coverage.

Analysis of Pregnancy Anti-Discrimination Policy in Kentucky: Application of Kingdon's Multiple Streams Framework.

While several federal laws including the Pregnancy Discrimination Act, Family Medical Leave Act, and the Americans with Disabilities Act provide some freedom from discrimination due to pregnancy and breastfeeding-related conditions, many pregnant workers in Kentucky were not covered under these existing laws. The intent of Senate Bill 18, the Kentucky Pregnant Workers Act, was to provide clarity to employers about the protections afforded to pregnant workers by law as well as the need for employers to provide the same level of accommodations for pregnant workers that are available for those who are disabled. Similar bills had been filed during the 2015 to 2018 legislative sessions, and in 2019, Senate Bill 18 passed 87-5 and was signed by the Governor on April 9, 2019. The purpose of this article is to analyze a pregnancy anti-discrimination bill that passed during the 2019 Kentucky General Assembly utilizing Kingdon's Multiple Streams Framework. This article also contains multiple policy alternatives, interest group involvement related to pregnancy anti-discrimination policy, unintended consequences of policy implementation as well as potential issues with enforcement of the Kentucky Pregnant Workers Act.

[Medico-legal considerations and occupational medicine issues regarding the targeted employment of disabled persons: regulatory review, current social and medical operational guidelines and current application phenomena]. / Considerazioni medico-legali e di medicina del lavoro in merito al collocamento lavorativo mirato dei soggetti disabili: disamina normativa, attuali orientamenti operativi socio-sanitari ed odierne fattualità applicative.

SUMMARY: The Authors examine developments in Italian legislation concerning compulsory work placements for disabled people, comparing them to those of other countries, and focusing in particular on the operational aspects of the assessment committees set up under Italian legislative decree 68/1999; these commissions are tasked with a global assessment of the disabled individual, using multiple socio-health and occupational medicine perspectives, as well as through a conclusive medico-legal assessment. The work focuses on the delicate role played by these committees in adequately weighing up the residual working capacity of the disabled individual in order to place him/her in the most appropriate and least aggravating workplace in terms of the disorders they are affected by; this is possible by transferring the socio-work profile drawn up by the evaluation committee into the context of the labour market. Finally, the Authors try to highlight how this task has become even more difficult due to the economic and labour crises that have affected several of the employment sectors in Italy in recent years.

Halting the Vicarious Liability Juggernaut: Barclays Bank PLC v Various Claimants.

In Barclays Bank plc v Various Claimants [2020] UKSC 13, the Supreme Court rejected the claimants' argument that Barclays should be vicariously liable for the sexual assaults of a doctor hired on as a contractor to perform medical examinations on employees and job candidates at the bank. It upheld the traditional rule that a defendant is not vicariously liable for the torts of independent contractors. This commentary examines the law on liability for independent contractors and considers whether the Supreme Court decision is consistent with modern employment trends. The implications of the decision for medical law are then discussed.

State Governments and Judges May Moderate the Impact of the Trump Administration's Promotion of Medicaid Work Requirements.

In January 2018, the Center for Medicare and Medicaid Services (CMS) released guidance that encouraged states to submit Section 1115 waivers that impose work requirements on some Medicaid beneficiaries. To evaluate the potential impact of a policy, we need to accurately predict both how far a policy will spread and how durable it will prove over time. This commentary draws upon recent political science scholarship to describe potential constraints that changes in state-level partisan control can impose on CMS's current waiver strategy, as well as how state-level constraints might interact with judicial review to further limit the policy's spread.

Impact of US Smoke-free Air Laws on Restaurant and Bar Employment, 1990-2015.

INTRODUCTION: Secondhand smoke exposure is responsible for an estimated 50000 deaths per year among nonsmokers in the United States. Smoke-free air laws reduce secondhand smoke exposure but often encounter opposition over concerns about their economic impact. Expansion of these laws has stagnated and efforts to weaken existing laws may exacerbate existing disparities in exposure. Studies at the state and local levels have found that smoke-free air laws do not generally have an adverse effect, but there are no recent estimates of the impact of these laws nationally. METHODS: Employment and sales are two measures commonly used to estimate the economic impact of smoke-free air laws. Sales data are gathered by state and local taxing authorities but not uniformly across jurisdictions. Dynamic panel models are used to estimate a population-weighted national average treatment effect of smoke-free air laws on restaurant and bar employment using data from the Quarterly Census of Employment and Wages for 1990 to 2015. RESULTS: A one-percentage point increase in population covered by a restaurant smoke-free air law is associated with a small increase (approximately 0.01%) in restaurant employment (b = .0001, p < .001). The percentage of state population covered by a bar smoke-free air law was not associated with bar employment. DISCUSSION: Smoke-free air laws are a powerful tool for protecting hospitality workers and patrons from the dangers of secondhand smoke. Using data from over more than two decades, these results suggest that smoke-free air laws in the United States do not generally have any meaningful effect on restaurant and bar employment. IMPLICATIONS: Smoke-free air laws are associated with reductions in negative health outcomes and decreased smoking prevalence. Despite this clear public health argument and strong public support, passage of new laws has stagnated and exemptions are being used to weaken existing laws. The ability to make both a health and business case in support of existing laws may also bolster the case for expansion. This study provides an updated look at the economic impact of smoke-free air laws nationally through 2015. The lack of adverse findings provides additional support for these laws as public health win-win.

Not just a policy; this is for real. An affirmative action policy to encourage Aboriginal and Torres Strait Islander peoples to seek employment in the health workforce.

Delivery of culturally safe healthcare is critical to ensuring access to high-quality care for indigenous people. A key component of this is for Aboriginal and Torres Strait Islander people to be participants in the health workforce. The proportion of indigenous people in the health workforce should at least equate to the proportion in the population served. We describe the development and implementation of a successful affirmative action employment policy at Monash Health, one of Australia's largest Academic Health Centres, and provide perspective on its adoption.

[On the strategic objectives of Russia and Japan's experience in creating jobs for citizens of a new age of working capacity: Economic and legal research.]

The increase in the duration of employment cannot but entail consequences that objectively reflect the realities of the labor market for the category of workers of pre-retirement age. The analysis of the situation in the labor market in modern economic realities allows us to highlight the global problem of obtaining and maintaining a job for the category of workers aged 50+. The prospects of its growth by the end of the transition period of change in the retirement age say experts from different industry areas. At the same time, there is currently an increase in the number of people who are actively looking for work and do not have a chance in employment as unpromising workers for the interests of the employer. Attempts to solve the problem of providing jobs for older workers at the state level are assessed as ineffective and not able to dramatically affect the improvement of the tasks of protecting the rights of people from unemployment and poverty. Referring to the experience of Japan, which has many intersections in the legislative and social aspects in solving the problems of creating and maintaining jobs for older workers with Russia, we will outline the possible prospects for solving this problem as an important strategic task of the state.

Workers not Paid for Sick Leave after Implementation of the New York City Paid Sick Leave Law.

This study examined factors associated with being paid for sick leave after implementation of the New York City (NYC) paid sick leave law. A random sample of NYC residents was surveyed by telephone multiple times over a 2-year period. Participants (n = 1195) reported socio-demographics, awareness of the law, income, work hours per week, and payment for sick time off work. In the year after implementation of the law, part-time workers were significantly more likely to attend work while sick than full-time workers (relative risk = 1.25, 95% CI = 1.1, 1.4). Seventy percent of workers who missed work due to illness (n = 249) were paid for sick leave. Part-time workers, respondents not aware of the benefit (30% of workers), and workers without a college degree were the least likely to be paid for sick days. More than one third (37%) of persons not paid for sick leave worked in retail, food service, or health care. Although 70% of respondents were paid for sick leave after implementation of the law, part-time workers and workers with low education were least likely to access the benefit and more likely to work while sick. The disparity in paid sick leave may have public health consequences as many persons not paid for sick leave had occupations that carry a high risk of disease transmission to others.

Welfare-to-work interventions and their effects on the mental and physical health of lone parents and their children.

BACKGROUND: Lone parents in high-income countries have high rates of poverty (including in-work poverty) and poor health. Employment requirements for these parents are increasingly common. 'Welfare-to-work' (WtW) interventions involving financial sanctions and incentives, training, childcare subsidies and lifetime limits on benefit receipt have been used to support or mandate employment among lone parents. These and other interventions that affect employment and income may also affect people's health, and it is important to understand the available evidence on these effects in lone parents. OBJECTIVES: To assess the effects of WtW interventions on mental and physical health in lone parents and their children living in high-income countries. The secondary objective is to assess the effects of welfare-to-work interventions on employment and income. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, PsycINFO EBSCO, ERIC EBSCO, SocINDEX EBSCO, CINAHL EBSCO, Econlit EBSCO, Web of Science ISI, Applied Social Sciences Index and Abstracts (ASSIA) via Proquest, International Bibliography of the Social Sciences (IBSS) via ProQuest, Social Services Abstracts via Proquest, Sociological Abstracts via Proquest, Campbell Library, NHS Economic Evaluation Database (NHS EED) (CRD York), Turning Research into Practice (TRIP), OpenGrey and Planex. We also searched bibliographies of included publications and relevant reviews, in addition to many relevant websites. We identified many included publications by handsearching. We performed the searches in 2011, 2013 and April 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) of mandatory or voluntary WtW interventions for lone parents in high-income countries, reporting impacts on parental mental health, parental physical health, child mental health or child physical health. DATA COLLECTION AND ANALYSIS: One review author extracted data using a standardised extraction form, and another checked them. Two authors independently assessed risk of bias and the quality of the evidence. We contacted study authors to obtain measures of variance and conducted meta-analyses where possible. We synthesised data at three time points: 18 to 24 months (T1), 25 to 48 months (T2) and 49 to 72 months (T3). MAIN RESULTS: Twelve studies involving 27,482 participants met the inclusion criteria. Interventions were either mandatory or voluntary and included up to 10 discrete components in varying combinations. All but one study took place in North America. Although we searched for parental health outcomes, the vast majority of the sample in all included studies were female. Therefore, we describe adult health outcomes as 'maternal' throughout the results section. We downgraded the quality of all evidence at least one level because outcome assessors were not blinded. Follow-up ranged from 18 months to six years. The effects of welfare-to-work interventions on health were generally positive but of a magnitude unlikely to have any tangible effects.At T1 there was moderate-quality evidence of a very small negative impact on maternal mental health (standardised mean difference (SMD) 0.07, 95% Confidence Interval (CI) 0.00 to 0.14; N = 3352; studies = 2)); at T2, moderate-quality evidence of no effect (SMD 0.00, 95% CI 0.05 to 0.05; N = 7091; studies = 3); and at T3, low-quality evidence of a very small positive effect (SMD -0.07, 95% CI -0.15 to 0.00; N = 8873; studies = 4). There was evidence of very small positive effects on maternal physical health at T1 (risk ratio (RR) 0.85, 95% CI 0.54 to 1.36; N = 311; 1 study, low quality) and T2 (RR 1.06, 95% CI 0.95 to 1.18; N = 2551; 2 studies, moderate quality), and of a very small negative effect at T3 (RR 0.97, 95% CI 0.91 to 1.04; N = 1854; 1 study, low quality).At T1, there was moderate-quality evidence of a very small negative impact on child mental health (SMD 0.01, 95% CI -0.06 to 0.09; N = 2762; studies = 1); at T2, of a very small positive effect (SMD -0.04, 95% CI -0.08 to 0.01; N = 7560; studies = 5), and at T3, there was low-quality evidence of a very small positive effect (SMD -0.05, 95% CI -0.16 to 0.05; N = 3643; studies = 3). Moderate-quality evidence for effects on child physical health showed a very small negative effect at T1 (SMD -0.05, 95% CI -0.12 to 0.03; N = 2762; studies = 1), a very small positive effect at T2 (SMD 0.07, 95% CI 0.01 to 0.12; N = 7195; studies = 3), and a very small positive effect at T3 (SMD 0.01, 95% CI -0.04 to 0.06; N = 8083; studies = 5). There was some evidence of larger negative effects on health, but this was of low or very low quality.There were small positive effects on employment and income at 18 to 48 months (moderate-quality evidence), but these were largely absent at 49 to 72 months (very low to moderate-quality evidence), often due to control group members moving into work independently. Since the majority of the studies were conducted in North America before the year 2000, generalisabilty may be limited. However, all study sites were similar in that they were high-income countries with developed social welfare systems. AUTHORS' CONCLUSIONS: The effects of WtW on health are largely of a magnitude that is unlikely to have tangible impacts. Since income and employment are hypothesised to mediate effects on health, it is possible that these negligible health impacts result from the small effects on economic outcomes. Even where employment and income were higher for the lone parents in WtW, poverty was still high for the majority of the lone parents in many of the studies. Perhaps because of this, depression also remained very high for lone parents whether they were in WtW or not. There is a lack of robust evidence on the health effects of WtW for lone parents outside North America.

Measuring Geographic Migration Patterns Using Matrículas Consulares.

In this article, we show how to use administrative data from the Matrícula Consular de Alta Seguridad (MCAS) identification card program to measure the joint distribution of sending and receiving locations for migrants from Mexico to the United States. Whereas other data sources cover only a small fraction of source or destination locations or include only very coarse geographic information, the MCAS data provide complete geographic coverage of both countries, detailed information on migrants' sources and destinations, and a very large sample size. We first confirm the quality and representativeness of the MCAS data by comparing them with well-known household surveys in Mexico and the United States, finding strong agreement on the migrant location distributions available across data sets. We then document substantial differences in the mix of destinations for migrants from different places within the same source state, demonstrating the importance of detailed substate geographical information. We conclude with an example of how these detailed data can be used to study the effects of destination-specific conditions on migration patterns. We find that an Arizona law reducing employment opportunities for unauthorized migrants decreased emigration from and increased return migration to Mexican source regions with strong initial ties to Arizona.

Sustained return to work and work participation after a new legislation obligating employers to notify prolonged sickness absence.

AIMS: Return to work (RTW) after prolonged sickness absence benefits both the individual and society. However, the effectiveness of legislation aiming to improve RTW remains uncertain. We examined whether sustained RTW and work participation were different before and after a legislative change enacted in 2012 (i.e. an intervention) that obligated employers to give notice of prolonged sickness absence to occupational health services. METHODS: Two random samples (2010 and 2013) of the Finnish working aged population (70%, ~2.6 million each) were drawn. Using survival analysis, we assessed sustained RTW (≥28 consecutive working days) during a two-month follow-up after a sickness absence minimum of 30 calendar days in the pre- and post-intervention period. We also identified pathways for RTW with cluster analysis and calculated relative gain in work participation in the total sample and by several population subgroups. RESULTS: In the total sample, sustained RTW was 4% higher and the mean time to sustained RTW was 0.42 days shorter in the post- than in the pre-intervention period. The estimates were larger among women than men and among those with mental disorders compared with other diagnoses. Changes in the pathways for sustained RTW indicated a 4.9% relative gain in work participation in the total sample. The gain was larger among those who lived in areas of low unemployment rate (20.6%) or worked in the public sector (11.9%). CONCLUSIONS: From 2010 to 2013, RTW and work participation increased among the employees with prolonged sickness absence, suggesting that the legislative change enhanced RTW. The change in work participation varied by population subgroup.

Comparing medical and recreational cannabis use among employees: associations with health and work-related outcomes.

Nearly one in five US employees reports having used cannabis in the past year. As policies and laws regarding cannabis use rapidly change, concerns have arisen over employees' use of cannabis, for both medical and recreational purposes. While extant workplace research has not distinguished between types of cannabis users, other studies have found that medical users are clinically and socio-demographically different from non-medical users. This study utilized a sample of employed National Survey on Drug Use and Health (NSDUH) respondents to examine differences in workplace characteristics and health outcomes among employed medical, recreational, and mixed-use cannabis users. While some differences were initially seen when examining health and work-related outcomes between the groups, several changed after controlling for other important health-related factors. One key difference between the user groups is the higher percentages of medical and mixed-use cannabis users in the construction and mining industries. This study discusses future research needs, as well as practical implications for workers and employers.

[On the correlation of guarantees of the labor rights of the elderly in Russia and Europe.]

Many lawyers, referring to the topic of guarantees for ensuring the labor rights of elderly people who receive a pension, begin the analysis from the provisions of Art. 19 of the Russian Constitution on the prohibition of discrimination and art. 3 of the Labor Code of the Russian Federation on the prohibition of discrimination. ILO Convention № 111 on Discrimination in Employment and Occupation [8] also does not mention the age as a discriminatory motive. At the same time, among the listed elements of Article 19 of the Constitution of the Russian Federation, there is no direct indication of age. Therefore, the issue of employment and retention of the workplace for an elderly employee, the payments due to dismissal, including in connection with the liquidation of the organization or the reduction of staff, is related in one way or another to the understanding of the essence of the labor rights of such persons by the bodies that protect labor rights of workers and justice. Controversial aspects often have fundamentally different approaches to application, thus requiring careful and cautious treatment without generalizations and formalism. Based on the analysis of judicial practice, ILO recommendations, WHO reports and other materials, we will reveal common and distinctive features in ensuring the labor rights of elderly people and old age pensioners and the quality of life in Russia and European countries.