A growing number of health care systems are denying employment to smokers.  David A. Asch, M.D. and colleagues explain why in the New England Journal of Medicine:

Tobacco use is responsible for approximately 440,000 deaths in the United States each year — about one death out of every five. This number is more than the annual number of deaths caused by HIV infection, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined and more than the number of American servicemen who died during World War II.


Medical centers such as the Cleveland Clinic, Geisinger, Baylor, and the University of Pennsylvania Health System are not hiring smokers, and this is beginning to create some controversy:

 These employers might justify such hiring policies in many ways — arguing, for instance, that they’re taking a stand against a habit that causes death and disability, that they’re sending an important message to young people and others within their communities about the harms of smoking, or that they’re reducing their future costs, given that smokers, on average, cost employers several thousand dollars more each year than nonsmokers in health care expenses and lost productivity.

These policies engender controversy, and we recognize that they risk creating or perpetuating injustices. One set of concerns arises from the fact that tobacco use is more concentrated in groups with lower socioeconomic status. Hospitals do better than most institutions at creating employment and advancement opportunities for disadvantaged populations. So even though most members of lower socioeconomic groups do not use tobacco, and even though anti-tobacco hiring policies are not intended to reduce jobs for these populations, they are likely to do so inadvertently, at least somewhat.


Still, the authors justify the policy by saying that, in addition to sparing hospital patients the terrible stench of tobacco on the clothes of employees, lives will be saved.  Harald Schmidt, Ph.D., and colleagues are not convinced:

We believe that employers should consider more constructive approaches than punishing smokers. In hiring decisions, they should focus on whether candidates meet the job requirements; then they should provide genuine support to employees who wish to quit smoking. And health care organizations in particular should show compassion for their workers. This approach may even be a win–win economic solution, since employees who feel supported will probably be more productive than will those who live in fear of penalties.


They advocate incentives for smokers to quit:

We believe that offering support for healthful behaviors is the best approach. Central in this regard is assisting employees by providing evidence-based smoking-cessation programs, removing cost barriers, facilitating access, and providing necessary psychological counseling and other support. For example, many employers, such as Walgreens, provide free nicotine-replacement therapy and smoking-cessation counseling to employees.


Whether you agree with the policy not to hire smokers or not, it is a trend.  It wasn’t too long ago that people actually were allowed to smoke on airplanes (can you believe that?) or smoke in a restaurant (they even had areas called “smoking sections!”).  Not anymore.

A word to young smokers:  not only is tobacco harmful to your health, it may also put a damper on your future expectations of earning a living.  You may want to seriously reconsider this dreadful addiction and kick the habit.