Factors affecting sick leave prescribing in occupational health care: a survey based on hypothetical patient cases

Abstract

BackgroundSeveral studies have shown considerable differences in the way that physicians prescribe sick leave. The aim of this study was to examine the sick leave prescribing practices of occupational health care physicians and factors affecting these practices.MethodsA questionnaire study with 19 hypothetical patient cases was conducted among 356 Finnish occupational health care physicians. The effects of both physician-related and local structural background variables on sick leave prescribing were studied using regression models. Economic consequences of the variation in sick leave prescribing were estimated.ResultsWhen the cases were considered individually, the variation in prescribed sick leave days was relatively small. However, when considered together, variation in prescribing practice became apparent. On average, the overall number of days of sick leave prescribed for the entire group of 19 patient cases was 85.8, varying between 21 and 170 days. The physicians working at a public health center and those with more than 20 years experience as an occupational health physician tended to prescribe more days of sick leave than others. The quartile of physicians who prescribed the fewest days of sick leave would have resulted in mean production losses (17,100 euro, 95% CI 16,400-17,700) that were half those in the quartile with the most days of sick leave (34,800 euro, 95% CI 33,600-35,900).ConclusionsThere was variation in the sick leave prescribing practices of occupational health care physicians. The most significant factor affecting this variation was the health care sector (public, private or employer clinic) employing the physicians. Variation in sick leave prescribing patterns can lead to inequality between patients.

Association between Sick Leave Prescribing Practices and Physician Burnout and Empathy

“…To our knowledge, this is the first study to investigate the association between physician burnout and empathy and sick leave prescribing practices. One Spanish article analyzed the factors determining patient sick leave[ 39 ] but did not investigate physician-related factors, and while more recent studies have analyzed the association between sick leave prescribing habits and professional factors, such as physician sex[ 40 ] and place of practice[ 41 ], they did not investigate burnout or empathy. The present study is the first in an ongoing project evaluating empathy and professional burnout in primary health care professionals.…”

Diagnoses have the greatest impact on variation in sick-leave certification rate among primary-care patients in Sweden: A multilevel analysis including patient, physician and primary health-care centre levels

“…Other studies using hypothetical patient cases showed that the specialty of the physicians as well as local structural factors affected the variation in sick-leave certification. Clinical specialists reported shorter sick leave compared to general practitioners (GP), and specialists in occupational health also showed a large variation depending on experience and employment [11,12]. Therapeutic traditions in primary health-care centres (PHCC) play a role in variation in, for instance, pharmacological treatment [13].…”

Sick Leave Patterns in Common Rheumatological Diseases

“…It was observed that insurance physicians were stricter in assessing sick leave than occupational physicians [ 46 ]. Similarly, clinical specialists were demonstrated to prescribe shorter sick leaves than general practitioners [ 47 ], while older physicians tended to authorize more days of sick leave than younger physicians [ 48 ]. This highlights the importance of the human factor in the heterogeneity of sick leave prescribing, indicating the absence of standardized, evidence-based clinical practice guidelines.…”