I was flipping through the pages of this paper when I spotted a small “blink and you’ll miss it” sized update from Garnet Health. 

The hospital announced it had just handed out a perfect attendance award for 2025, rewarding one of its doctors with a cash prize for not missing a single day of work last year. The CEO offered a quote about reliability and dedication. Everyone at the hospital, presumably, applauded.

Sitting on my couch, I groaned.

We’ve been here before, and clearly, we haven’t learned a thing. 

For decades, schools across the country have been handing out perfect attendance awards to the kids who never take a sick day or a mental health day. These kids are often held up as paragons of virtue during year-end assemblies as school administrators tout their dedication and work ethic. 

These awards have come under increasing scrutiny in recent years, and it’s not just from the parents of the kids with chronic illness who get a front row view of their children bearing the dual stress of an uncontrollable disease and fear that they’ll cost their class the perfect attendance pizza party this month.

Researchers have actually studied whether these awards accomplish what they're supposed to.

The verdict is not great.

A landmark study out of Harvard tracked more than 15,000 middle and high school students and found that kids who received perfect attendance awards actually had worse attendance in the weeks that followed. The awards backfired. Researchers figured out that getting the certificate sent an unintended message — that the student was attending more than expected, more than their peers — and so they felt they'd earned a little slack.

The negative effect hit hardest among the lowest-achieving students. The kids who most needed to be in school were the ones most likely to start skipping after getting the gold star.

And that's before we get to the kids who show up anyway — the ones whose parents, or whose own anxiety about losing the award, push them through the door with a low-grade fever, a stomach that's been threatening to explode all morning or that hacking cough they can’t control. These are the Typhoid Marys, the patient zeroes of your classic schoolwide outbreak of the latest bug that’s been going around.

The CDC has funded research into how students spread illness through close contact in schools, and has gone so far as to officially discourage attendance awards because they incentivize sick students to attend. 

Schools have been quietly rethinking these awards for years, acknowledging that rewarding bodies in seats ignores the complicated reality of what it actually takes for kids to walk through the doors every single morning of the school year.

Which brings me back to Garnet Health, and my couch, and my groan.

Everything that's wrong with handing a certificate to a 10-year-old for never calling in sick is amplified when you hand a cash prize to a healthcare worker for the same thing.

The problem in hospitals isn't that staff call out too often. Research consistently finds that between 50 and 90 percent of healthcare workers report coming to work while they were sick — not because they're dedicated, but because the culture of medicine has spent generations telling them that calling out is a betrayal. 

Of their patients. Of their colleagues. Of the profession itself. 

That pressure already exists without any award to reinforce it. Garnet Health has now added a cash prize.

And the stakes in a hospital are not the same as the stakes in a fifth grade classroom. Studies link working-while-sick to increased medication errors and patient falls, and researchers have identified sick healthcare workers as primary sources of hospital outbreaks of influenza, MRSA, and norovirus. 

When a sick healthcare worker comes to work, the people around them aren't just fellow students who might catch a cold. They're immunocompromised patients, post-surgical patients, elderly patients and people whose bodies are already fighting something. They’re you and me, the people who depend on our small rural healthcare system to care for us in our time of need. 

The winner of Garnet Health's 2025 award is a third-year medical resident. Residency is well-known to be one of the most punishing jobs in the country with brutal hours, genuine sleep deprivation, emotional weight that is hard to overstate. The fact that she went an entire year without a single absence might reflect extraordinary good health and good luck. It might also reflect a workplace culture that made her feel she couldn't afford to stay home. I don't know which. 

That's sort of the point. The award doesn't ask.

Garnet Health's CEO said in the press release that "reliability in healthcare is more than just showing up."

He's right. It is. A doctor who rests when she's sick and comes back sharp is more reliable than one who powers through a fever and makes an error she otherwise wouldn't have made. A nurse who takes a mental health day and returns steadier is more reliable than one who white-knuckles through burnout until something breaks in her, or in her patient's care.

Schools across the country have figured this out for kids. They’ve cut the perfect attendance award and told kids that rest isn't weakness, that health comes first, that perfect presence doesn't equal perfect performance.

Our local hospital might consider catching up.