Journal of Occupational Rehabilitation

, Volume 22, Issue 1, pp 78–87 | Cite as

Education and Benchmarking Among Physicians May Facilitate Sick-Listing Practice

  • A. B. Bremander
  • J. Hubertsson
  • I. F. Petersson
  • B. Grahn


Introduction Assessing work ability and sickness certification are considered problematic by many physicians and education and implementation of guidelines to improve knowledge and skills has been requested. Our aim was to study the association between such interventions and physicians’ sick-listing practices. Methods A web-based questionnaire was sent to all physicians working in primary care, psychiatry, orthopedics/rheumatology in the southern region of Sweden before (in 2007 to 1,063 physicians) and after (in 2009 to 1,164 physicians) educational interventions in insurance medicine were offered. Results With a response rate of 58%, half of the physicians (51%) reported to work at a clinic with a sick-listing policy in 2009 compared with 31% in 2007. Primary care physicians (OR 12.4) and physicians who had participated in educational interventions in insurance medicine (OR 2.4) more often had a sick-listing policy at the clinic. Physicians with a longer medical experience (OR 0.7) and those with support at the clinic (OR 0.3) and the possibility to extend time if needed (OR 0.4) were less likely to report of problematic cases while primary care physicians were (OR 2.9). On the contrary, physicians who reported to rarely have the possibility to extend time when handling problematic cases were more likely to issue a higher number of sickness certificates. Conclusions The sick-listing process is often viewed as problematic and more often by primary care physicians. Benchmarking and education in insurance medicine together with the possibility to allocate extra time if encountering problematic cases may facilitate sick-listing practice.


Physicians Sick-listing Work ability Education Gender 



Thanks to all physicians who answered the questionnaire. We would also like to thank Louise Roberts and Ronny Wain for excellent technical support with the web based questionnaire and Ulf Hallgårde for valuable input and support.


  1. 1.
    Stone DA. Physicians as gatekeepers: illness certification as a rationing device. Public Policy. 1979;27(2):227–54.PubMedGoogle Scholar
  2. 2.
    Arrelov B, Alexanderson K, Hagberg J, Lofgren A, Nilsson G, Ponzer S. Dealing with sickness certification—a survey of problems and strategies among general practitioners and orthopaedic surgeons. BMC Public Health. 2007;7(147):273.PubMedCrossRefGoogle Scholar
  3. 3.
    Wynne-Jones G, Mallen CD, Mottram S, Main CJ, Dunn KM. Identification of UK sickness certification rates, standardised for age and sex. Br J Gen Pract. 2009;59(564):510–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Bishop A, Foster NE, Thomas E, Hay EM. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008;135(1–2):187–95.PubMedCrossRefGoogle Scholar
  5. 5.
    Persson G, Danielsson M, Rosen M, Alexanderson K, Lundberg O, Lundgren B, et al. Health in Sweden: the National Public Health Report 2005. Scand J Public Health Suppl. 2006;67:3–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Tellnes G. Days lost by sickness certification. Scand J Prim Health Care. 1989;7(4):245–51.PubMedCrossRefGoogle Scholar
  7. 7.
    Wahlstrom R, Alexanderson K. Swedish council on technology assessment in health care (SBU). Chapter 11. Physicians’ sick-listing practices. Scand J Public Health Suppl. 2004;63:222–55.PubMedCrossRefGoogle Scholar
  8. 8.
    Swartling MS, Alexanderson KA, Wahlstrom RA. Barriers to good sickness certification—an interview study with Swedish general practitioners. Scand J Public Health. 2008;36(4):408–14.PubMedCrossRefGoogle Scholar
  9. 9.
    von Knorring M, Sundberg L, Lofgren A, Alexanderson K. Problems in sickness certification of patients: a qualitative study on views of 26 physicians in Sweden. Scand J Prim Health Care. 2008;26(1):22–8.CrossRefGoogle Scholar
  10. 10.
    Ilmarinen J. Work ability–a comprehensive concept for occupational health research and prevention. Scand J Work Environ Health. 2009;35(1):1–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Norrmen G, Svardsudd K, Andersson DK. How primary health care physicians make sick listing decisions: the impact of medical factors and functioning. BMC Fam Pract. 2008;9:3.PubMedCrossRefGoogle Scholar
  12. 12.
    Stigmar K, Grahn B, Ekdahl C. Work ability–experiences and perceptions among physicians. Disabil Rehabil. 2010;32(21):1780–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Money A, Hussey L, Thorley K, Turner S, Agius R. Work-related sickness absence negotiations: GPs’ qualitative perspectives. Br J Gen Pract. 2010;60(579):721–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Hussey S, Hoddinott P, Wilson P, Dowell J, Barbour R. Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland. BMJ. 2004;328(7431):88.PubMedCrossRefGoogle Scholar
  15. 15.
    Lofgren A, Hagberg J, Arrelov B, Ponzer S, Alexanderson K. Frequency and nature of problems associated with sickness certification tasks: a cross-sectional questionnaire study of 5455 physicians. Scand J Prim Health Care. 2007;25(3):178–85.PubMedCrossRefGoogle Scholar
  16. 16.
    Wynne-Jones G, Mallen CD, Main CJ, Dunn KM. Sickness certification and the GP: what really happens in practice? Fam Pract. 2010;27(3):344–50.PubMedCrossRefGoogle Scholar
  17. 17.
    Roope R, Parker G, Turner S. General practitioners’ use of sickness certificates. Occup Med (Lond). 2009;59(8):580–5.CrossRefGoogle Scholar
  18. 18.
    Englund L, Tibblin G, Svardsudd K. Variations in sick-listing practice among male and female physicians of different specialities based on case vignettes. Scand J Prim Health Care. 2000;18(1):48–52.PubMedCrossRefGoogle Scholar
  19. 19.
    Norrmen G, Svardsudd K, Andersson D. Impact of physician-related factors on sickness certification in primary health care. Scand J Prim Health Care. 2006;24(2):104–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Swartling MS, Hagberg J, Alexanderson K, Wahlstrom RA. Sick-listing as a psychosocial work problem: a survey of 3997 Swedish physicians. J Occup Rehabil. 2007;17(3):398–408.PubMedCrossRefGoogle Scholar
  21. 21.
    Gerner U, Alexanderson K. Issuing sickness certificates: a difficult task for physicians: a qualitative analysis of written statements in a Swedish survey. Scand J Public Health. 2009;37(1):57–63.PubMedCrossRefGoogle Scholar
  22. 22.
    Socialstyrelsen (The National Board of Health and Welfare). Försäkringsmedicinskt beslutstöd (National Guidelines). Available from
  23. 23.
    Alexanderson KA. Läkares arbete med sjukskrivning (Physician’s sick-listing practice). Report 2009, Karolinska Institutet. 2009.Google Scholar
  24. 24.
    Altman C. Practical statistics for medical research. London: Chapman & Hall; 1991.Google Scholar
  25. 25.
    Reed P. The medical disability advisor. Workplace guidelines for disability duration. Singapore: Reed group holdings Ltd.; 2004.Google Scholar
  26. 26.
    Reed M, Devers K, Landon B. Physicians and care management: more acceptance than you think. Issue Brief Cent Stud Health Syst Change. 2003; (60):1–4.Google Scholar
  27. 27.
    Satterlee WG, Eggers RG, Grimes DA. Effective medical education: insights from the Cochrane library. Obstet Gynecol Surv. 2008;63(5):329–33.PubMedCrossRefGoogle Scholar
  28. 28.
    Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev (Online). 2009; (2): CD003030.Google Scholar
  29. 29.
    Lofgren A, Hagberg J, Alexanderson K. What physicians want to learn about sickness certification: analyses of questionnaire data from 4019 physicians. BMC Public Health. 2010;10:61.PubMedCrossRefGoogle Scholar
  30. 30.
    Wynne-Jones G, Mallen CD, Main CJ, Dunn KM. What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care. 2010;28(2):67–75.PubMedCrossRefGoogle Scholar
  31. 31.
    Soderberg E, Alexanderson K. Sickness certification practices of physicians: a review of the literature. Scand J Public Health. 2003;31(6):460–74.PubMedCrossRefGoogle Scholar
  32. 32.
    Alexanderson K, Brommels M, Ekenvall L, Karlsryd E, Löfgren A, Sundberg L, et al. Problem inom hälso- och sjukvården kring handläggning av patienters sjukskrivning. (Problems in health care regarding management of patietns’ sickness certification). Stockholm, Karolonska Institutet. 2005.Google Scholar
  33. 33.
    Hamberg K, Risberg G, Johansson EE. Male and female physicians show different patterns of gender bias: a paper-case study of management of irritable bowel syndrome. Scand J Public Health. 2004;32(2):144–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • A. B. Bremander
    • 1
    • 2
  • J. Hubertsson
    • 1
  • I. F. Petersson
    • 1
  • B. Grahn
    • 3
    • 4
  1. 1.Musculoskeletal Sciences, Department of Orthopedics, Clinical SciencesLund UniversityLundSweden
  2. 2.Research and Development Center, Spenshult Hospital for Rheumatic DiseasesOskarstromSweden
  3. 3.R&D KronobergKronoberg County CouncilVäxjöSweden
  4. 4.Department of Health Sciences, Division of PhysiotherapyLund UniversityLundSweden

Personalised recommendations