How consistent are sick leave assessments? Variation among primary care physicians in Sweden

Assessing work capacity and determining appropriate sick leave is a complex process. Despite the importance of fair and consistent assessments, evidence suggests that evaluations may vary. However, previous studies have been inconclusive and have mainly focused on whether sick leave should be recommended or not. The present study examined the medical reliability and consistency of physicians' assessments of work capacity, as indicated by the reported percentage of reduced work capacity and the recommended length of sick leave.

A cross-sectional survey was conducted with 142 primary care physicians from four Swedish counties. Participants assessed six anonymised, authentic medical certificates related to mental health and pain-related conditions. For each case, they estimated the degree of reduced work capacity and the recommended sick leave duration, which were combined into a sick leave score. Physician characteristics (e.g. gender, professional status) and perceived managerial support were also measured.

There was considerable variation in sick leave scores, both across physicians and between certificates. Male physicians and those with more years of experience recommended longer sick leave for pain-related cases, while specialists showed less variation in their assessments. Perceived support from frontline managers was associated with lower scores. No significant associations were found for patient involvement.

The findings suggest that sick leave assessments may lack consistency and be influenced by physician-related factors, particularly for pain-related conditions. Stronger support structures, opportunities for knowledge exchange, and clearer guidelines may help reduce unwarranted variation and promote more reliable assessments.