Variations in sick-listing practice among male and female physicians of different specialities based on case vignettes

Englund, Lars; Tibblin, Gösta; Svärdsudd, Kurt

doi:10.1080/02813430050202569

Cited by 66 publications

(22 citation statements)

References 5 publications

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“…However, there is no strong medical evidence of the benefit of rest or staying at home from work [4,11]. In Finland, there are no guidelines for physicians on appropriate prescribing of sick leave, and estimating the need for or adequate length of sick leave is not included in the curriculum of medical students.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies indicate that if a patient initiated the discussion around sickness certification, the physician nearly always sick-listed the patient [4,8-10]. The most important factor for sick-listing was the patient’s way of presenting his or her problem [11]. In most cases, the physician has to rely on the patient’s description of work tasks.…”

Section: Introductionmentioning

confidence: 99%

“…The few studies that have analyzed sick leave prescribing practices have shown variation between physicians [1,3,4,11,13,14]. A Swedish population-based study showed that GPs sick-listed patients for shorter periods than other physicians [3].…”

Section: Introductionmentioning

confidence: 99%

“…Primary care physicians practicing in large municipalities prescribed shorter sick leaves than others in a Finnish study [13], but a Swedish study reported contradictory findings [14]. The effect of the gender of a physician on sick leave prescribing practices has been ambiguous: in most studies male and female physicians prescribed equal amounts of sick leave [1,2,13,15], but variation has also been found [9,11]. The effect of physician-related factors and local structural factors on prescribing practices also appears to be ambiguous.…”

Section: Introductionmentioning

confidence: 99%

“…The effect of physician-related factors and local structural factors on prescribing practices also appears to be ambiguous. Some studies suggest that these factors may influence the length of sick leave [2-4,8,9,11,13-16], but other studies have found no associations [1,2,4,13,15]. …”

Section: Introductionmentioning

confidence: 99%

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

Kankaanpää

Putus

Tuominen

2014

BMC Health Serv Res

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Kankaanpää

Putus

Tuominen

2014

BMC Health Serv Res

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Why physicians are lousy gatekeepers: Sicklisting decisions when patients have private information on symptoms

2020

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In social insurance systems that grant workers paid sick leave, physicians act as gatekeepers, supposedly granting sickness certificates to the sick and not to shirkers. Previous research has emphasized the physician's superior ability to judge patients' need of treatment and potential collusion with the patient vis-ávis an insurer. What is less well understood is the role of patients' private information. We explore the case where patients have private information about the presence of nonverifiable symptoms. Anyone can then claim to experience such symptoms, reducing physicians' ability to distinguish between sick patients and shirkers. Doubting a patients' reported symptoms may prevent good medical treatment of the truly sick. We show that for all parameter values, the Bayesian Nash equilibrium is that some physicians trust all claims of nonverifiable symptoms, sicklisting shirkers as well as sick; for many values, every physician is trusting. In particular, if physician strategies are observable by patients, extremely strong gatekeeping preferences are required to make physicians mistrust. To limit unwarranted sicklisting, policies reducing the benefits of shirking for healthy workers may be better suited than attempts to convince physicians to be strict. K E Y W O R D S moral hazard, physician gatekeeper, sick leave J E L C L A S S I F I C A T I O N D11; D21; H42; I11; I18

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Sickness certification in primary care

et al. 2001

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Variations in sick-listing practice among male and female physicians of different specialities based on case vignettes

Cited by 66 publications

References 5 publications

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

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

Why physicians are lousy gatekeepers: Sicklisting decisions when patients have private information on symptoms

Sickness certification in primary care

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