Title: Tipping in Health Care: Appreciation or a Sign the System Is Failing?

By: Colleen Naglee, MD, JD (Anesthesiologist)

It began with a QR code.

During a recent hotel check-in, I came across a sign near the front desk that included a warm thank-you message and a QR code encouraging guests to tip the front desk personnel. In a time where we rely on apps for booking, checking in, and checking out, the idea of tipping someone I hadn’t personally engaged with was bewildering, to say the least.

This experience prompted a larger inquiry: Has the tipping culture become excessive? Or are we merely changing the way we express gratitude in a world that is progressively cashless and less personal? If it’s the latter, then maybe we ought to extend this approach to the area most overlooked — health care.

Why Consider Tipping Nurses and Doctors?

Tipping has permeated industries where direct interaction is minimal, yet the practice continues to proliferate. Customers now leave tips at coffee shops even before tasting their drink. Certainly, a well-crafted espresso deserves acknowledgment, but how about the nurses and doctors who stabilize critical conditions, stitch wounds, or safely deliver babies?

At first glance, this notion might appear ridiculous, even disrespectful to some. Healthcare professionals are skilled individuals, often highly educated and paid salaries. Why would we consider tipping them? Isn’t it part of their responsibilities?

Yet, so are serving tables, mixing drinks, and providing rides through apps — occupations where tips are not just welcomed; they’re essential.

The Gap Between Risk and Acknowledgment

The rationale for tipping health care professionals becomes increasingly persuasive when compared to the realities they endure. Take this alarming statistic: healthcare workers are five times as likely to face workplace violence compared to those in other sectors. Nurses and aides are particularly at risk, frequently encountering both verbal and physical assault. In one shocking case, a nurse suffered fractures to nearly every bone in her face while on duty.

Clapping from windows and displaying “Heroes Work Here” signage may have lifted spirits early in the COVID-19 pandemic, but those gestures have since dwindled. What persists is chaos: chronic understaffing, burnout, and rising hostility from patients and families. This violence is not solely physical — it’s ingrained in the system.

Navigating a Risky Environment

Inpatient hospital care today is rife with danger — for staff and patients alike. Studies indicate that about one in four hospitalized patients experience an adverse event. Compounding this issue, the financialization of healthcare, notably through private equity buyouts, has been associated with increased patient harm and complications. Despite deteriorating conditions, the pressures on healthcare providers continue to escalate.

At the same time, physician compensation, particularly from Medicare, keeps declining — including a recent 2.83 percent cut — while inflation, documentation demands, and clinical complexity rise. Primary care physicians, especially in rural areas, confront some of the most severe challenges. Numerous stories circulate of physicians accepting payments in the form of eggs or baked goods because insurance reimburses inadequately or not at all.

In such a flawed system, perhaps we should entertain a new notion: tip jars at clinic front desks. Or QR codes at nursing stations.

The Increase in Temporary Staffing Is a Warning Sign

Another troubling trend is the growing dependence on locum tenens — temporary staffing for doctors and nurses. Instead of investing in sustainable staffing models, institutions opt for short-term contracts that foster high turnover and inconsistency in patient care. While these arrangements are advantageous for individual clinicians in terms of flexibility and pay, they do a disservice to patients.

Predictably, hospitals that frequently use short-term staff experience more negative outcomes. The decline of team cohesion and continuity of care is significant — and the current framework undermines both. In this scenario, what does a Venmo tip amount to in comparison to the health of our loved ones?

Is Tipping a Remedy or a Reflection of Deeper Issues?

The incorporation of tipping culture into healthcare might initially seem farcical, yet there’s a more serious underpinning to the proposal. Tipping serves as a substitute for gratitude and, crucially, financial support. The very fact that we contemplate tipping a nurse or physician reveals how dysfunctional the system has become—where acknowledgment for vital, life-saving work struggles to find a voice amid bureaucratic and financially constrained institutions.

So, should we begin tipping healthcare workers? Possibly, but not because it’s a genuine solution. It’s a temporary fix — a symptom of a more profound problem in the system. Nurses don’t require gifts or tips as much as they need safeguarding against workplace violence, equitable pay, and adequate staffing levels. Physicians don’t crave cupcakes in the break room—they need time with their patients and reimbursement that accurately reflects the intricacies of their role.

Final Thoughts: Looking Beyond the QR Code

Modern tipping culture, characterized by QR codes and personalized gratuities, provides ease. It conveys a message