I recently had a patient with an unexpectedly complicated labor and delivery course. On top of the usual stress and pain related to the delivery process, their employer was requiring they return to work sooner than medically recommended, and they feared losing their job.

Another patient, with a severe illness requiring routine monthly monitoring, was unable to come to visits at the frequency required because of their shift schedule and limited time off from work. Their condition was unstable and worsening, but they were more afraid of losing their job than their health issues.

These are not just two individual patient stories – each one is actually the story of multiple patients, all experiencing the same barriers to care. I have had dozens of patients whose medical care was restricted for arbitrary work requirements, leading to poorer health outcomes not just for them, but for our health care system as a whole as well.

As a doctor, I know how vital it is for people to have protections to care for themselves or their family members. Access to routine primary care visits is vital in improving health outcomes for entire communities. But what I have learned is that access on paper is not the same as true access – people face a myriad of barriers to care every day. From patients who can only make visits in the evening but don’t have child care during that time, to workplaces that do not reimburse for time off or even allow time, to a lack of reliable transportation, these are just a few examples of barriers I encounter on a daily basis.

Workplaces limiting access to care is perhaps the most egregious example of a barrier to care I’ve encountered.

It is unconscionable to force people to choose between work or the health of their family. I have had multiple patients unable to attend visits with me for severe, life-threatening and chronic conditions because of restrictive work policies and the income sacrificed for multiple health care visits. I will never forget my joy when I filled out paperwork for a patient of mine with a serious condition, allowing him to qualify for medical leave. For the first time, they were able to come regularly and improve their health. But many other Mainers are not so lucky. And still, while that patient was able to make visits, it was without pay, resulting in financial stress.

Many of my patients who are underemployed lack even that freedom – they have minimal, if any, opportunities for medical leave available to them. I have other patients with severe conditions like dangerously high blood pressure, currently untreated because they or their partner are unable to take time away from work to come to their appointments and care for their children.

The current system of unpaid leave is damaging and stressful to our patients, but health care providers are also horribly frustrated by a lack of care because of the inability to make even routine appointments. People should never have to choose between their work and health. I am a family physician, and I will continue to fight for paid family medical leave to improve the health of all Mainers.