Like many U.S. workplaces, the medical group MEDNAX last week asked employees to stay home if they were experiencing fever, respiratory distress, or other symptoms of the novel coronavirus. But the message had a caveat: MEDNAX told any clinician exposed to the virus, or experiencing symptoms, to take the required two-week quarantine out of their sick leave or vacation time. Anyone without 14 days of leave saved up would have to “borrow” from future paid time off.

Even as other workplaces let employees work from home, and Congress mulls legislation to cover other workers' sick leave, medical professionals across the country are facing a difficult choice: Either they go to work sick, and endanger their patients, or risk using up all of their personal time and going into a perverse form of debt.

“People on the frontlines of this should be provided with all the resources that they need and all the support they need if they get sick,” said one MEDNAX employee, who asked not to be named for fear of retaliation. “The House has passed this bill that’s supposed to help waiters and waitresses, but here are the people on the front lines being told, ‘You’re just shit out of luck.’”

MEDNAX is a national medical group that employs more than 2,800 health care providers across 38 states. On Friday, in an email reviewed by The Daily Beast, the company’s chief human resource officer instructed staff with COVID-19 symptoms to stay home. Staff with a known exposure to the virus would be “evaluated for work availability on a case by case basis,” she wrote, but could also be required to quarantine.

“If an employee is unable to work while at home, pay will be provided through PTO to the degree the employee has accrued PTO,” the email read.

“ My coworkers who still work there full-time are terrified right now. The hospitals in our town are doing nothing to prepare … It’s a complete shitshow, is what it is right now, and it’s just going to get worse. ” — MEDNAX employee

Further down, under a subsection called “PTO Borrowing,” it continued: “To the degree that an employee does not have PTO to use for the above scenarios, the company will allow the borrowing of up to 5 days of PTO against future year PTO accruals.”

The company did not respond to requests for comment.

One MEDNAX employee, who works for the company part-time at a hospital in Tennessee, told The Daily Beast that her facility was nowhere near prepared for a coronavirus outbreak. The hospital was still performing elective surgeries, she said—against the advice of the surgeon general—and allowing for full visitation. (Many other hospitals have cracked down on visitors, even limiting the number allowed in labor and delivery wards.)

“My coworkers who still work there full-time are terrified right now,” the employee said. “The hospitals in our town are doing nothing to prepare … It’s a complete shitshow, is what it is right now, and it’s just going to get worse.”

MEDNAX also told employees that their workers compensation carrier would likely not cover any time lost due to coronavirus exposure at work. And they instructed employees who missed work for three days or more to apply for job protection benefits under the Family and Medical Leave Act.

“Are they implying that we would lose our jobs if we got sick?” the employee asked. “Why would we have to apply for FMLA? Are you really going to fire me while I’m on a ventilator?”

The Daily Beast has identified at least one other national health care group with similar leave policies. They also appear to be standard at many hospitals around the country.

At Envision Healthcare, a physician group with more than 57,000 employees, clinicians were told Thursday that anyone exposed to the virus through non-work-related activities would need to use all available PTO to self-quarantine. Once their PTO was used up, the rest of their time in isolation would be unpaid, the company said in an email reviewed by The Daily Beast. Employees exposed through work would have their missed shifts paid for—but only after going through their full balance of PTO.

“We understand the risk clinicians are taking on during the coronavirus pandemic,” an Envision spokesperson said in a statement. “All of our clinicians who are quarantined for the CDC recommended time period as a result of on-the-job COVID-19 exposure will continue to receive compensation.”

Hospitals that are already operating on thin margins—and hemorrhaging money due to the current crisis—could find it hard to stomach paying employees for two weeks of leave, said Doug Diekema, an attending physician and bioethicist at Seattle Children's Hospital. But he added that forcing health care workers to take PTO posed both ethical and public health issues.

“It’s always been interesting to me that the messaging we get as health care providers is, ‘Don’t come to work if you’re sick,’” he said. “That’s much easier to follow if there isn’t some kind of penalty being paid.”

Diekema said this system could lead to employees coming in sick later in the year, if they used up all of their paid leave on quarantine, or even lying about their symptoms during the current crisis. By asking workers to use up their personal time, he added, hospitals had “given employees an incentive to be untruthful.”

“ Even if we have enough ventilators, we won’t have enough people to work them. So I think people will feel pressure to keep working even if they’re sick. You know, why would I stay home with the sniffles if people are dying? ” — Health-care worker in Salt Lake City

Jane Hopkins, the executive vice president of the Washington state nurses and health care workers union, echoed this sentiment. She argued that workers put on leave without pay by one hospital could simply seek work at another facility. (“The bills don’t stop needing to be paid because they went to work, got exposed, and now their employer says, ‘Just figure it out,’” she noted.)

The union, SEIU Healthcare 1199NW, reached out to every major health care provider in the state about providing fully paid, administrative leave to quarantined workers. So far, Hopkins said, only one has agreed.

Health care workers are already facing the grim effects of the pandemic. A 70-year-old physician in New Jersey was hospitalized with respiratory symptoms last week and remains in intensive care, according to the American College of Emergency Physicians. A second doctor—an emergency physician in Washington state—was in stable but critical condition. Health care workers at Brigham and Women's Hospital and Mass. Eye and Ear have also tested positive.

One health care worker in Salt Lake City said employees at under-staffed, under-resourced hospitals will likely feel pressure to come in to work while sick—especially if the pandemic gets even worse in the coming weeks.

“Even if we have enough ventilators, we won’t have enough people to work them,” said the employee, who asked not to be named for fear of retaliation. said. “So I think people will feel pressure to keep working even if they’re sick. You know, why would I stay home with the sniffles if people are dying?"

“We’re all just bracing ourselves for that reality — especially if it’s our own coworkers on the ventilator, which could definitely happen,” she said.

The employee said her hospital group also required employees to use personal time if they were quarantined, though they were offered up to two weeks of “negative PTO” if they had not accrued enough. The unaccommodating leave policies, she added, would only compound her coworkers’ sense of guilt.

“They’re gonna be the frontline workers constantly in those rooms, constantly exposed to everyone,” she said. “And they’re being treated like it’s their fault they’re getting sick.”