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• Re: Sickness absence in doctors
  Mika Kivimaki
  Published on: 27 April 2016
• Sickness absence in doctors
  Ian J Murphy
  Published on: 27 April 2016

• Published on: 27 April 2016

  Re: Sickness absence in doctors

  • Mika Kivimaki, Professor

  Dear Editor,

  In his electronic letter, Dr Murphy wrote that the 55% response rate from the doctors could have considerably biased the results reported in a study of sickness absence in Finnish hospital physicians.[1] According to the results, absence rate for doctors is low. The study also suggests that poor teamwork and traditional psychosocial risk factors, such as work overload and low job control, contribute to doctors'...

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  Dear Editor,

  In his electronic letter, Dr Murphy wrote that the 55% response rate from the doctors could have considerably biased the results reported in a study of sickness absence in Finnish hospital physicians.[1] According to the results, absence rate for doctors is low. The study also suggests that poor teamwork and traditional psychosocial risk factors, such as work overload and low job control, contribute to doctors' long-term sick leaves.

  As already reported in the article (p. 362), hospital registers show that low response rate did not affect the findings on absence rates. In those who responded to the survey, the rate of short-term (1-3 days) sickness absences was 38.0 spells per 100 person-years. The corresponding rate for the eligible population was 37.9 spells per 100 person-years. Regarding the rate of long-term (>3 days) sickness absences, the rate was exactly the same for the respondents and the eligible population, ie, 20.2 long sickness absence spells per 100 person-years.

  Bias due to low response rate seems also unlikely in relation to psychosocial factors. In work units with a response rate lower than 55%, the mean scores of teamwork and job control were 3.5 and 4.0, respectively. In work units with a response rate of 55% or higher, the corresponding mean scores were also 3.5 and 4.0, respectively. In the overload scale, the mean score of 3.8 in the low-response-rate units did not differ from the mean score of 3.6 in the high-response-rate units (P value 0.130).

  Dr Murphy acknowledges that incomplete recording of sickness absences could also affect the results and conclusions. However, at least the following points suggest that the recording of doctors' long-term sickness absences was reliable.

  First, Finnish hospitals receive compensation for loss of salary due to sick leaves longer than 10 days from the Social Insurance Institution, a body subordinate to Parliament. To receive all the compensations to which the hospitals are entitled, they are motivated to keep strict records of sick leaves. This was especially true during the study period. Hospitals had shortage of financial resources compared to the amount of services they were expected to provide.

  Second, indicators of health problems, such as poor self-rated health, presence of diagnosed chronic disease, and psychiatric morbidity (as indicated by GHQ-caseness), were associated with long spells of sickness absence (see Table 3 in the article).[1] For doctors, these associations were as strong as or stronger than those found for the controls. Only the opposite case, ie if the associations had been weaker for doctors, could have been an indication of unreliable measurement of doctors' sickness absence.

  Third, the finding of low recorded absence rate for hospital physicians is well in line with other research. Results on self-reported absences in a random sample of Finnish physicians suggest that physicians are on sick leave much less often than other employees.[2] According to a British study, over 80% of physicians had worked even when they felt too unwell to carry out their duties to the best of their ability.[3] A Norwegian study reports that 80% of the physicians had worked during an illness for which they would have sick-listed their patients.[4]

  In conclusion, evidence and additional analyses provide no support for the possibility that the issues listed by Dr Murphy would have added bias to the study on sickness absence in Finnish hospital physicians.

  Prof. Mika Kivimaki
  Department of Psychology
  University of Helsinki
  Finland

  References

  (1) Kivimaki M, Sutinen R, Elovainio M, et al. Sickness absence in hospital physicians: 2 year follow up study on determinants. Occup Environ Med 2001;58:361-366.
  (2) Toyry S, Rasanen K, Kujala S, et al. Self-reported health, illness, and self-care among Finnish physicians: a national survey. Arch Fam Med 2000;9:1079-1085.
  (3) McKevitt C, Morgan M, Dundas R, Holland WW. Sickness absence and 'working through' illness: a comparison of two professional groups. J Public Health Med 1997;19:295-300.
  (4) Rosvold EO, Bjertness E. Physicians who do not take sick leave: hazardous heroes. Scand J Public Health 2001;29:71-75.

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  Conflict of Interest:
  None declared.

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• Published on: 27 April 2016

  Sickness absence in doctors

  • Ian J Murphy

  Dear Editor,

  Kivimaki and colleagues [1] undertook research to identify some determinants of sickness absence in Finnish hospital physicians between 1997 and 1998. This was a questionnaire survey sent to 816 physicians and a control group of 542 senior nurses employed in one of 11 hospitals in Finland. Social circumstances, work characteristics and various measures of health were assessed by questionnaire and e...

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  Dear Editor,

  Kivimaki and colleagues [1] undertook research to identify some determinants of sickness absence in Finnish hospital physicians between 1997 and 1998. This was a questionnaire survey sent to 816 physicians and a control group of 542 senior nurses employed in one of 11 hospitals in Finland. Social circumstances, work characteristics and various measures of health were assessed by questionnaire and employers' registers were used to assess recorded sickness absence.

  There are some limitations in the study design and subsequent conclusions that are not acknowledged in the text.

  The response rate from the physicians was a disappointing 55%. Nearly half of the physicians approached did not participate in the study. This could bias the results considerably. The authors state that the response rate obtained in this study corresponds to that obtained in previous research. Seven references are cited as evidence. The response rates of doctors from six of the seven quoted papers are higher than 55% and are as follows: 82% [2]; 79% and 76% [3]; 63% [4]; 78% [5]; 58% [6]; and 87% to 94% [7]. The authors could have cited a further reference [8] that was used later in the paper, but chose not to (response rate 80%).

  The authors state that the recording of attendance is reliable in the Finnish public sector. This would be a very important factor in the context of this study of sickness absence in hospital physicians. The authors cite two references [9,10] to back up their statement. These two studies both concern local government workers in Raisio, Finland between 1990 and 1995 with the main outcome measure being recorded medically certificated absence held on computer by an occupational health unit. Both of these papers simply state that all sick certificates must be forwarded for recording, but provide no other evidence that the recording of sickness absence is reliable. The possibility that doctors might under report sickness absence, leading to incomplete recording, is not considered. This could add further bias to the study, thereby affecting the results and conclusions.

  Dr Ian J Murphy
  Specialist Registrar in Occupational Medicine
  Royal Berkshire and Battle Hospitals NHS Trust
  

  References

  (1) Kivimaki M, Sutinen R, Elovainio M, et al. Sickness absence in hospital physicians: 2 year follow up study on determinants. Occupational and Environmental Medicine 2001;58:361-6.
  (2) Chambers R, Belcher J. Comparison of the health and lifestyle of general practitioners and teachers. British Journal of General Practice 1993;43:378-82.
  (3) McKevitt C, Morgan M, Dundas R, et al. Sickness absence and "working through" illness: a comparison of two professional groups. Journal of Public Health Medicine 1997;19:295-300.
  (4) Waldron HA. Sickness in the medical profession. Annals of Occupational Hygiene 1996;40:391-6.
  (5) Ramirez AJ, Graham J, Richards MA, et al. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 1996;347:724-8.
  (6) Deckard G, Meterko M, Field D. Physician burnout: an examination of personal, professional and organisational factors. Medical Care 1994;32:745-54.
  (7) Johnson JV, Hall EM, Ford DE, et al. The psychosocial work environment of physicians. J Occup Environ Med 1995;37:1151-9.
  (8) Caplan RP. Stress, anxiety and depression in hospital consultants, general practitioners and senior health service managers. BMJ 1994;309:1261-3.
  (9) Kivimaki M, Vahtera J, Pentti J, et al. Factors underlying the effect of organisational downsizing on health of employees: longitudinal cohort study. BMJ 2000;320:971-5.
  (10) Vahtera J, Kivimaki M, Pentti J. Effect of organisational downsizing on health of employees. Lancet 1997;350:1124-8.

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  Conflict of Interest:
  None declared.

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