Do GPs sick-list patients to a lesser extent than other physician categories? A population-based study

Large differences between physicians in their use of the sickness certification instrument have been described. There are also indications of differences between different categories of physicians, for instance that occupational health physicians and GPs are less generous with certificates of long duration.

We therefore decided to test the hypothesis that GPs and occupational health physicians issue more short-term certificates and use partial sick-listing more often than other physicians.

Certificates for sickness absence during 4 months in 1995 and 2 months in 1996 were collected in eight Swedish counties; a total of 57 563 certificates. From the certificates, a number of variables were extracted.

Sickness certificates issued by GPs were on average for a shorter period of time than those issued by other physicians, for the individual certificate as well as for the total sickness period. Occupational health physicians had longer certification periods than GPs but used partial sick-listing more frequently. However, the patients of the various categories of physicians differed regarding age, sex, diagnosis distribution, etc. When the influence of these factors on the duration of the certification periods was taken into account, the GPs still issued significantly shorter periods of sick-leave than the other physicians, followed by the occupational health physicians.

The results may be indicative of a different way of handling the sickness certification instrument among different categories of physicians, especially GPs.