Explaining variations in general practitioners’ experiences of doing medically based assessments of work ability in disability benefit claims. A survey-based analysis

Abstract

Purpose: Assessing patients’ work ability is a task that many general practitioners consider challenging. Increase of mental and musculoskeletal disorders further complicate the assessments. The purpose of this paper is to explain variation between general practitioners related to how they experience the assessment of work ability in disability cases. Methods: Combining data from an original postal survey among all general practitioners in Norway (N = 1,466; response rate = 32.5%) with characteristics of the municipality where they work, we use multilevel logistic regression to estimate the relationship between a set of dependent variables measuring how confident general practitioners feel when assessing patients’ work ability in disability cases, physician-related characteristics and structural factors. Results: A main finding is that length of service explains most of the variation between general practitioners (B = 0.492 [0.015, 0.970]–2.127 [1.457, 2.798]); in most of the regressions, this variable turns out as positive and significant (p < 0.01). The general practitioners’ knowledge of possibilities of workplace adaptations in different occupations (B = 0.309 [0.026, 0.592]–0.461 [0.154, 0.768]), as well as the importance they assign to tasks related to sick-listing (B = 0.239 [0.003, 0.475]–0.639 [0.336, 0.941]), were also significantly associated with the general practitioners’ experience of assessing work capacity. The structural variables in the model provided few significant results. Conclusions: Better education and training in doing work ability assessments could be a proper measure to increase general practitioners’ confidence in doing these assessments in connection with disability benefit applications.

Keywords:

• disability benefit
• work ability
• medically based assessment
• general practitioner (GP)

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Corrigendum

Public Interest Statement

With western countries experiencing high disability rates and future labour shortages in many industries, it is important to ensure that those who can work are given the opportunity to do so. In Norway, doctors have a responsibility to prevent the receipt of disability benefits and promote labour market inclusion. Partly this is ensured through medically based assessments of work ability—a task many doctors, however, consider as challenging. Analyzing answers from doctors in Norway, we find that length of service is the most important factor in explaining variations between doctors, in terms of how confident and reassured they are when doing these assessments. A better system of education and more practically oriented training in doing work ability assessments could be proper measures to strengthen the skills of doctors when it comes to making sound assessments of work ability. In turn, this could support labour market inclusion of various groups in society.

Competing Interests

The authors declare no competing interest.

Corrigendum

This article was originally published with errors. This version has been corrected. Please see Corrigendum (https://doi.org/10.1080/2331205X.2017.1380745).

Notes

1. Source: The Norwegian Labour and Welfare Administration (NAV) https://www.nav.no/no/NAV+og+samfunn/Statistikk/AAP+nedsatt+arbeidsevne+og+uforetrygd+-+statistikk/Tabeller/mottakere-av-uf%C3%B8retrygd-etter-kj%C3%B8nn-og-alder.pr.30.06.2007–2016.antall. [Accessed 19 October 2016].

2. Source: Statistics from NAV, see https://www.nav.no/no/NAV+og+samfunn/Statistikk/AAP+nedsatt+arbeidsevne+og+uforetrygd+-+statistikk/Tabeller/mottakere-av-uf%C3%B8retrygd-etter-hoveddiagnose-prim%C3%A6rdiagnose-alder-og-kj%C3%B8nn.pr.31.12.2013.kvinne. [Accessed 19 October 2016].

3. As a robustness check, we also treated the original Likert scale items as quasi-continuous and used hierarchical ordinary least square (OLS) regression. This alternative specification produced some minor changes in the results, but did not alter the main findings. Simple (non-hierarchical) OLS and logit regressions yielded approximately the same results as the hierarchical models.

Additional information

Notes on contributors

Roland Mandal

Roland Mandal and Karin Dyrstad are researchers at Department of Health Research in SINTEF Technology and Society, sited in Trondheim, Norway. Mandal’s research interests include the functioning of welfare services, inclusion in working life, vocational rehabilitation programs, receipt of social security benefits, and cooperation between the labour, welfare and health services. Dyrstad’s research interests include welfare politics, global health and development, and the provision of welfare services and health care. The research presented in the article in a fine manner embodies the research carried out by this research environment—through its interdisciplinary character, and due to its explicit focus on the professional and collaborative challenges that arise in the interfaces between the health and welfare services.