Frequency and nature of problems associated with sickness certification tasks: A cross-sectional questionnaire study of 5455 physicians

Figures & data

Table I.  Response rate and characteristics of the physicians in the study population.

	Study population	Respondents		Respondents having consultations concerning sickness certification at least a few times a year
	n	n	% of study population	n	% of the respondents
All	7665	5455	71	4019	74
County
Stockholm	6794	4827	71	3446	71
Östergötland	871	628	72	573	91
Sex
Women	3646	2710	74	2007	74
Men	4019	2745	68	2012	73
Educational level
Specialist^1		1381		1046	76
Non-specialist		3995		2947	74
No information		79		26	33
Main workplace
Primary health care		978		954	98
Internal medicine		396		363	92
Psychiatry		394		360	91
Surgery		318		294	93
Gynaecology / Obstetrics		315		282	90
Orthopaedics		200		189	95
Occupational health		124		123	99
Oncology		108		105	97
Rehabilitation care^2		75		58	77
Addiction medicine		47		39	83
Other^3		2368		1230	52
No information		132		22	20
Mean age (years)	48.2	48.3		47.7

¹Information on educational level was not available for the study population.

²Including physicians in social insurance office and insurance company.

³All other types of workplaces.

Table II.  Frequencies of consultations where sickness certification is considered and frequency of problems.

		More than 20 times a week		6–20 times a week		1–5 times a week		About once a month		A few times a year		Never or almost never		All
How often in their daily work did the physicians:	n	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%
Have consultations including consideration of sickness certification	4019	9.4	8.5–10.3	41.0	39.5–42.5	34.3	32.8–35.8	9.4	8.5–10.3	5.8	5.1–6.6	–	–	100
Find it problematic to handle sickness certification	3925	0.6	0.3–0.8	5.9	5.2–6.6	26.7	25.3–28.1	30.0	28.6–31.5	21.2	19.9–22.5	15.6	14.5–16.7	100

¹ Physicians who never had these consultations were not included in the analyses.

Table III.  Problems in physicians’ sickness certification.

Type of problem^1	n	Very problematic % (95% CI)	Fairly problematic % (95% CI)	Not very problematic % (95% CI)	Not problematic % (95% CI)	All %
i) Handling disagreements with patients	3892	18.2 (17.0–19.4)	42.8 (41.3–44.4)	30.6 (29.2–32.0)	8.4 (7.6–9.3)	100
g) Prolongation of other physician's certificate	3871	15.0 (13.9–16.2)	39.7 (38.1–41.2)	33.8 (32.3–35.3)	11.5 (10.5–12.5)	100
b) Assessing work ability	3908	11.5 (10.5–12.5)	42.1 (40.6–43.7)	35.8 (34.3–37.3)	10.6 (9.6–11.5)	100
h) Assessing duration and degree of absence	3895	10.8 (9.8–11.8)	42.8 (41.2–44.3)	36.8 (35.3–38.3)	9.7 (8.8–10.6)	100
f) Managing two different roles	3879	9.8 (8.9–10.8)	29.2 (27.8–30.6)	41.6 (40.0–43.1)	19.4 (18.2–20.7)	100
e) Suggesting plan of action	3856	7.1 (6.3–7.9)	30.5 (29.1–32.0)	43.6 (42.1–45.2)	18.7 (17.5–19.9)	100
a) Assessing functional capacity	3921	5.7 (4.9–6.4)	30.8 (29.4–32.3)	47.6 (46.1–49.2)	15.9 (14.8–17.1)	100
d) Filling out sickness certificates	3897	5.5 (4.8–6.2)	27.6 (26.2–29.0)	45.7 (44.1–47.2)	21.2 (19.9–22.5)	100
c) Discussing sickness certification with patients	3911	3.0 (2.5–3.5)	26.7 (25.3–28.1)	51.7 (50.1–53.3)	18.6 (17.4–19.8)	100

¹See box 2 for exact phrasing of each item.

Table IV.  Characteristics of the study population by demographic and work related factors.

			Mean age	Mean years of practice	Specialists	Women	Sickness certification ≥6 times/week^4	Problem with sickness certification ≥1 times/week
Main workplace	n	%	years	years	%	%	%	%
All	4019 ^1	100	47.7	17.6	73.8	49.9	50.4	33.2
Orthopaedics	189	4.7	48.1	19.2	79.3	20.1	82.5	53.0
Rehabilitation care^2	58	1.4	51.3	20.3	86.2	50.0	79.3	36.8
Occupational health services	123	3.1	54.9	24.1	93.4	48.8	78.0	41.8
Oncology	105	2.6	44.7	15.0	64.4	63.8	73.3	21.9
Psychiatry	360	9.0	49.0	17.3	76.8	58.1	64.4	40.6
Primary health care	954	23.7	48.1	16.6	70.8	54.8	62.2	60.1
Addiction medicine	39	1.0	52.1	18.4	82.1	51.3	53.8	44.7
Surgery	294	7.3	46.3	17.6	72.1	26.5	52.7	15.5
Gynaecology /Obstetrics	282	7.0	48.1	19.0	77.7	70.6	37.6	24.8
Internal medicine	363	9.0	43.0	13.9	56.7	45.2	33.1	17.2
Other^3	1230	30.6	47.9	18.6	77.1	49.4	34.0	17.1

¹Out of these, 22 did not indicate their main workplace.

²This group also include physicians in social insurance offices/insurance companies (n = 6).

³All other workplaces.

⁴Physicians who have consultations including consideration of sickness certification ≥6 times/week.

Table V.  Proportions of physicians at different clinics that rated four specific tasks of sickness certification as fairly or very problematic.

	Problems related to
		Assessing functional ability	Assessing work ability	Handling disagreements with patients	Filling out sickness certificates
Main workplace	n	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)
Primary health care	953	64.5 (61.5–67.5)	81.8 (79.3–84.3)	82.8 (80.4–85.2)	43.4 (40.2–46.6)
Psychiatry	353	40.8 (35.7–45.9)	54.3 (49.1–59.5)	59.0 (53.9–64.1)	28.2 (23.5–32.9)
Internal medicine	360	34.7 (29.8–39.6)	52.9 (47.7–58.1)	64.5 (59.5–69.5)	31.3 (26.5–36.1)
Addiction medicine	39	30.8 (16.3–45.3)	38.5 (23.2–53.8)	46.2 (30.6–61.8)	21.1 (8.1–34.1)
Gynaecology/Obstetrics	281	28.8 (23.5–34.1)	48.9 (43.0–54.8)	63.0 (57.4–68.6)	27.6 (22.4–32.8)
Oncology	105	24.8 (16.5–33.1)	45.7 (36.2–55.2)	54.8 (45.2–64.4)	27.6 (19.0–36.2)
Rehabilitation care^2	58	24.1 (13.1–35.1)	36.2 (23.8–48.6)	61.4 (48.8–74.0)	24.6 (13.4–35.8)
Orthopaedics	189	22.2 (16.3–28.1)	52.7 (45.6–59.8)	58.5 (51.5–65.5)	45.7 (38.6–52.8)
Occupational health services	122	22.1 (14.7–29.5)	32.5 (24.1–40.9)	39.7 (31.0–48.4)	17.4 (10.6–24.2)
Surgery	290	20.0 (15.4–24.6)	36.8 (31.3–42.3)	46.6 (40.9–52.3)	30.6 (25.3–35.9)
Other^1	1154	24.3 (21.8–26.8)	40.4 (37.6–43.2)	49.1 (46.2–52.0)	30.0 (27.3–32.7)

¹All other types of workplaces. ²Including physicians in social insurance office and insurance company.