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.
Highlights
Several studies have shown considerable differences in the way that physicians prescribe sick leave
The purpose of this study was to examine the prescribing of sick leave by occupational health care physicians, the extent of any variation in practices, and whether physician-related factors and local structural factors contribute to any variation
The total days of sick leave for the 19 patient cases prescribed by physicians working at a public health center was greater than by those working in private practice or at an employer clinic [Table 2]
Summary
Several 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. The. In the Finnish health care setting, all physicians (general physicians, occupational health care physicians, physicians in a service of an employer etc.) are qualified to prescribe sick leave, and it is a part of every physician’s daily clinical practice. In Finland occupational health care services are provided in public health centers to a limited extent determined by law. These physicians mainly perform regular checkups and treat uncomplicated cases. Physicians in private practice and in employer clinics provide these services and more comprehensive care than their colleagues in the public sector
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