Objective: To study the frequency and nature of problems associated with physicians' sickness certification practices.
Design: Cross-sectional questionnaire study.
Setting: Stockholm and Ostergötland Counties in Sweden.
Subjects: Physicians aged < or = 64 years, n =7665, response rate 71% (n =5455).
Main outcome measures: The frequency of consultations involving sickness certification, the frequency and nature of problems related to sickness certification.
Results: A total of 74% (n =4019) of the respondents had consultations including sickness certification at least a few times a year. About half of these physicians had sickness certification cases at least six times a week, and 1 out of 10 (9.4%) had this more than 20 times a week. The items that the highest percentage of physicians rated as very or fairly problematic included: handling conflicts with patients over certification, assessing work ability, estimating optimal length and degree of absence, and managing prolongation of sick leave initially certified by another physician. There were large differences in frequency and nature of problems between different types of clinics/practices. General practitioners had the highest frequency of problems concerning sickness certification while the lowest was found among specialists in internal medicine and surgery.
Conclusion: Sickness certification should be recognized as an important task also for physicians other than general practitioners. The physicians experienced problems with numerous tasks related to sickness certification and these varied considerably between types of clinics. The high rate of problems experienced may have consequences for the physicians' work situation, for patients, and for society.