Factors that influence occupational physicians' decision to issue an employer warning in Japan.

OBJECTIVES: To elucidate the factors that influence occupational physicians' decision to issue an employer warning. METHODS: The interview was conducted with 10 Japan Society for Occupational Health certified occupational physicians (COPs) and certified senior occupational physicians (CSOPs) to create nine fictive scenarios in which an occupational physician may need to consider issuing a warning. Sixteen CSOPs assessed the seriousness of the problem in each of nine scenarios where they may need to consider issuing an employer warning. Next, using a survey questionnaire, 597 COPs and CSOPs were asked to rate how likely they were to issue a warning in each of the nine scenarios, and answer items on their characteristics and number of previously issued warnings. A multilevel logistic regression analysis nested for various scenarios was used to assess the odds ratio (OR) of being likely to issue a warning. RESULTS: Valid questionnaires were obtained from 117 participants (19.6%). The ORs and 95% confidence intervals (CIs) were as follows: mean score of seriousness of the problem, 5.90 (4.50-7.75); years of experience as occupational physician, 1.04 (1.02-1.06); women, 1.75 (1.20-2.54); being a part-time occupational physician without in-house experience, 2.08 (1.31-3.29); and having previously issued two or more times warnings, 1.99 (1.29-3.06), compared with those who had never issued a warning. CONCLUSIONS: Occupational physicians' likelihood to issue a warning was associated with the seriousness of the problem as assessed in various scenarios, years of experience as occupational physician, gender, employment type, experience as in-house occupational physician, and number of past warnings.

Comparative study on the activities of part-time occupational physicians in Japan between 2008 and 2016: effects of the stress-check program.

The Ministry of Health, Labor, and Welfare of Japan recommends that an occupational physician (OP) play an important role in implementing the stress-check program since 2015. This study aimed to compare the activities and encountered difficulties of Japanese part-time OPs in 2008 and 2016, and to investigate the effects of the stress-check program. Questionnaires were sent via mail to 946 part-time OPs in Kyoto prefecture in 2016. Completed questionnaires were returned by 181 OPs who were private practitioners or physicians in hospitals, and served as OPs on a part-time basis. In 2016, OPs utilized long hours for activities related to general health examination and to stress-check. Hours for specific health examination, health and hygiene education, health promotion activity, development of a comfortable workplace, and guidance of workers on sick leave reduced from 2008 to 2016. A total of 62% OPs frequently encountered difficulties in the stress-check-related activities in 2016. Many OPs also reported difficulties in the mental health care and the prevention of health hazard due to overwork both in 2008 and 2016. Enforcement of the stress-check program in 2015 changed the activities of part-time OPs in Japan. OPs should be given opportunities to gain more information in this area.

Research and teaching activity in UK occupational physicians.

BACKGROUND: For all doctors, including occupational physicians (OPs), research and teaching are considered core requirements of medical education and continuing professional development. Academic skills are also vital to evidence-based practice and advancement of occupational health (OH) as a specialty. In recent years, attention has focussed on the declining UK OH academic base and the research- practice gap, and increased practitioner participation in research is encouraged. AIMS: To establish a baseline of research and teaching activity among UK OPs, identify related barriers and inform strategies to overcome them. METHODS: An online survey including specific career profile questions derived from consensus following expert panel discussions. It formed part of a larger Delphi study on UK OH research priorities. RESULTS: We received 213 responses, about 18% of 1207 practising UK OPs. Of these, 162 (76%) undertook research at some career-point, of which 44 (27%) were currently research-active. Similarly, 154 (72%) undertook teaching at some career-point, of which 99 (64%) were currently teaching-active. Of those who had never undertaken research (n = 51) or teaching (n = 59), 40 and 42% were interested in doing so, respectively. Key barriers were lack of time and opportunity, the former particularly for respondents practising in industry, where 'commercial' demands take priority, rather than healthcare. CONCLUSIONS: This study establishes a benchmark of academic activity among UK OPs and identifies related barriers. These 'target' barriers can shape research funding priorities and education to increase participation and develop the UK OH academic base.

Retention among full-time occupational physicians in Japan.

BACKGROUND: To secure human resources for occupational medicine, it is important to analyse occupational physician retention trends and the factors associated with retention. However, little is currently known about this topic. AIMS: To identify occupational physician retention trends, to identify factors associated with this retention and to discuss the policy implications of the findings. METHODS: We analysed data from the biannual national physician census surveys conducted by the government of Japan from 2002 to 2014. In this study, those who chose 'working as an occupational physician' as their workplace/type of work from a pre-determined list in the survey questionnaire were considered full-time occupational physicians. We presented retention trends by calculating the annual retention rate for each set of two consecutive surveys. We then used logistic regression to identify factors associated with retention among occupational physicians. RESULTS: The annual retention rate of full-time occupational physicians from 2012 to 2014 was estimated as 76%, which represents a 6% improvement in retention over the study period. The odds of continuing to practise as an occupational physician were higher for occupational physicians working in cities compared with those working in towns or villages. CONCLUSIONS: Improving and facilitating smooth transitions between clinical practice and occupational medicine would help to secure human resources in occupational medicine, even if the current trend of low retention continues.

Work ability meetings-a survey of Finnish occupational physicians.

BACKGROUND: Work ability meetings (WAMs) are planned discussions between an employee, a manager and an occupational physician (OP) to support work ability and return to work (RTW). During the last decade, WAMs become a popular intervention in Finnish occupational healthcare, although research on their content is lacking. AIMS: To describe the practice of WAMs in Finland. METHODS: We sent an internet survey by e-mail to members of the Finnish Society of Occupational Health Physicians in August 2014. We asked them to describe the last WAM they had attended, the employee the meeting concerned, the reason why it was convened, the content of the meeting and the action plan developed. RESULTS: A total of 303 of 1304 OPs responded (24%) to the survey. The meetings were most often arranged for employees in manual or clerical work (71%). There were several overlapping reasons for convening a WAM, including a worker's reduced work ability (57%), functional ability (42%) or long-term sickness absence (38%). The meetings consisted of RTW planning, clarification of the situation and a dialogue between the three parties. In half of the cases, the action plans dealt with modifications of work tasks. A third of cases were forwarded to vocational rehabilitation, while permanent disability pension was considered in 6% of cases. CONCLUSIONS: The focus of WAMs was on workplace adjustments to support workers to remain at work. The WAMs dealt mostly with early interventions for RTW: work modifications, adjustments and vocational rehabilitation.

Stakeholders' views on vocational rehabilitation programs: a call for collaboration with Occupational Health Physicians.

BACKGROUND: The triple-dip recession taking place in Italy in 2008-2014 impacted negatively on health, mainly by increasing the rate of unemployment. This increased the prevalence of mental health disorders, while reducing the number of available places on vocational rehabilitation programs (VRPs) delivered by the psychiatric services. OBJECTIVES: To explore the different points of views of stakeholders (namely, users and professionals) involved in VRPs developed inside an Italian Community Mental Health Center (CMHC). METHODS: A sample of users, psychiatrists, educators and nurses of an Italian CMHC involved in VRPs took part in a focus group. Content analysis was performed with MAXQDA 12, by developing a hierarchical code system a posteriori (i.e., derived from the data). The respondent validation phase was carried out by means of a multiple-choice questionnaire, administered to all participants. RESULTS: A total of 86 emerging issues were coded, divided into two macro-areas: Positive and Negative Reinforcements (48 contributions, 56%, and 38 contributions, 44%, respectively), further subdivided into three areas: professional (service) factors, personal (i.e, user-related) factors, and work environment features (including relationships in the workplace). Some contributions raised issues concerning occupational health protection (e.g. need of information about the rights and duties of the users-workers, as well as the risks they are exposed to in the workplace). CONCLUSIONS: The analysis suggested to address specific issues concerning work and VRPs by means of psycho-education group interventions currently carried out at CMHCs, and pointed to the need to foster collaboration between mental health professionals and the occupational health physician of the company where the VRP is started and where the user might be employed.

[Occupational Health Physicians and Rehabilitation - A Cross-sectional Study on Occupational Health Care in Schleswig-Holstein and Baden-Württemberg]. / Betriebsärzte und Rehabilitation ­ Eine Querschnittsstudie zum betriebsärztlichen Handeln in Schleswig-Holstein und Baden-Württemberg.

Objective Description and explanation of involvement of occupational health physicians in rehabilitation Methods Data were collected by a survey of occupational health physicians in Schleswig-Holstein and Baden-Württemberg. Logistic regression models were calculated to identify determinants of the involvement of occupational health physicians before, during and after rehabilitation. Results During the last year 70% of the occupational health physicians have supported at least one worker when applying for medical rehabilitation. About a half has had at least once contact to a rehabilitation facility during the rehabilitation treatment of an employee, and 9 out of 10 physicians have supported at least one employee after her or his rehabilitation when returning to work. Support by occupational health physicians is more likely when they feel responsible for rehabilitation, are well informed and frequently involved in occupational reintegration management. Conclusions Occupational health physicians may be important stakeholders for preparing and supporting rehabilitation.

Collaboration of occupational physicians with national health system and general practitioners in Italy.

A good cooperation between occupational physicians and other healthcare professionals is essential in order to achieve an overall improvement of workers/patients' well-being. Unfortunately, collaboration between occupational physicians and other physicians is often lacking or very poor. In this context, using a self-administered questionnaire, we investigated the cooperation of Italian occupational physicians with the National Health System (NHS) facilities and with the general practitioners in order to identify any potential critical issues that may hinder an effective and collaborative relationships between these professionals. The survey was conducted from October 2013 to January 2014. Nearly all of the interviewed occupational physicians have had contacts with colleagues of the Departments for Prevention and Occupational Health and Safety of the NHS. Regarding the relationship between occupational physicians and general practitioners findings showed that their cooperation is quite difficult and it would not seem a two-way collaboration. Cooperation between occupational physicians and NHS would benefit from the development of communication strategies and tools enhancing the support and assistance functions of the NHS facilities. The elaboration and subsequent application of operational guidelines and standardized procedures of communication would also improve collaboration between occupational physicians and general practitioners that is currently considered rather insufficient and incomplete.

[Problems in Providing Care to Young Workers with Mental Health Disturbance - A Survey Using of the Cases of Workers Who Had Taken Sick Leave Due to Mental Health Disturbance].

In this study we discuss the measures of providing care to young workers with mental health disturbance by analyzing the cases of workers who had taken sick leave due to mental health disturbance. We analyzed 36 cases, collected from 11 occupational physicians, of workers who had taken sick leave due to mental health disturbance, and discuss measures for providing care to such young workers. We organized and classified data containing the details of the care provided to the workers and analyzed the main aspects and problems in providing it. We compared two age groups of workers: a below age 30 group, and an age 30 and above group. We observed that occupational nurses were more frequently the primary persons who dealt with workplace consultations in the below age 30 group (before sick leave: 38.9%; during sick leave: 38.9%) compared to the age 30 and above group (before sick leave: 16.7%, during sick leave: 11.1%). Most of the case providers expressed the opinion that a support system is necessary to help the workers return to work and it is an important factor in providing care to workers who have taken sick leave due to mental health disturbance. Coordination with the families of the workers was also important in the below age 30 group. It might be difficult to assign young workers to suitable workplaces or duties because of their inadequate job skills, lack of sufficient experience, and influence of personal factors on mental health. Our results suggest that it is important to provide appropriate care for young workers with mental health disturbance, such as support by occupational nurses, and to strengthen the collaboration between their families and the workplace staff.

Occupational health physicians and the impact of the Great Recession on the health of workers: a qualitative study.

BACKGROUND: Italy is one of the Eurozone members where the 2008 "Great Recession" struck worst, with a 9% drop in national GDP between 2008 and 2013. The negative effects of the recession on the health of the Italian population were documented on a nation-wide level. However, few local or regional studies are currently available in the scientific literature. OBJECTIVES: To assess the impact on workers' health of the economic recession in the industrial area of Sassuolo (Modena, Northern Italy), and to provide recommendations for targeted interventions. METHODS: Two focus groups were conducted, involving 8 occupational health physicians (OHPs) active in the area. Rough descriptions were analyzed using MAXQDA 11, according to the principles of grounded theory. RESULTS: 261 segments were coded, divided into four areas. The first, "changes in contemporary world", pointed out that the recession may have just made pre-existing problems worse, accelerating reductions in staff and workers' benefits. The second, "social area", highlighted a decrease in vertical social capital and the beginning of new trends in emigration. The third, "work area", covered workers' fear of losing their jobs if they were ill and a reduction in horizontal social capital, namely difficult relations between co-workers. The fourth, "medical area", indicated a general worsening of workers' health in the Sassuolo ceramic district compared to previous years. The OHPs reported an increase in muscular-skeletal complaints, gastritis, tension-type headache, irritable bowel syndrome symptoms, back pain, panic attacks, insomnia, tachycardia, and other medically unexplained symptoms. Anxiety problems seemed to prevail over depressive manifestations. An increase was reported for antidepressants and benzodiazepines consumption. CONCLUSIONS: The local impact of the economic crisis on health was mainly negative, consistent with available national data. Mental health professionals could work together with OHPs, e.g., through Balint Group-like meetings, to develop targeted psychosocial and clinical interventions addressing the medical, psychological and social needs of workers, also involving advocacy and fostering workers' empowerment.

Investigation of occupational asthma: Do clinicians fail to identify relevant occupational exposures?

BACKGROUND: Specific inhalation challenges (SIC) enable the identification of the agent responsible of occupational asthma (OA). A clinician may fail to identify a specific agent in the workplace, which may potentially lead to a misdiagnosis. The expert assessment method performed by an occupational hygienist has been used to evaluate occupational exposures in epidemiological studies. OBJECTIVE: The broad aim of the present study was to evaluate the contribution of an expert assessment performed by an occupational hygienist to the diagnosis of OA. The specific aim was to compare workplace exposures identified by an occupational hygienist and by chest physicians in subjects with positive SICs and subjects with asthma, but with a negative SIC. METHODS: SICs were performed in 120 cases: 67 were positive and 53 were negative. A clinician assessed occupational exposures to sensitizers during a routine clinical evaluation preceding the performance of the SIC. An expert assessment of occupational exposures was performed by an occupational hygienist blind to the result of the SIC. RESULTS: The occupational hygienist identified the causal agent in 96.7% of the 61 cases of positive SIC. In 33 (62.3%) cases of negative SICs, the occupational hygienist identified ≥1 sensitizing agent(s) that had not been identified by the clinician. CONCLUSION: The hygienist identified the causal agent in almost all subjects with OA. In contrast, the clinician failed to identify potential exposures to sensitizers in >60% of the negative SIC subjects, which may have resulted in some subjects being misdiagnosed as not having OA.

Occupational health physicians have better work conditions for handling sickness certification compared with general practitioners: results from a nationwide survey in Sweden.

AIMS: To study whether occupational health physicians (OPs) have a better work situation regarding handling of sickness certification compared with other physicians, in particular general practitioners (GPs), and to analyze associations between OPs' experiences of assessing and providing a long-term prognosis of patients' work capacity and some potentially interrelated factors. METHODS: Answers to a nationwide survey from physicians who had sickness certification consultations at least once monthly were analyzed. Differences among OPs (n=481), GPs (n=4257) and physicians working in other clinical settings (n=9452) were estimated by chi square tests. Associations between OPs' experiences as above and potentially interrelated factors were estimated using logistic regression analyses. RESULTS: Among OPs, a lower proportion experienced clinical work situations related to sickness certifications as 'very problematic', compared with the other physicians, and especially so compared with GPs. A higher proportion of OPs also had organizational support for handling sickness certifications. For OPs, experience of sickness certification consultations as problematic once a month or less often, not experiencing sickness certification tasks as a work environment problem, and having a well-established workplace policy regarding sickness certification matters were significantly positively associated with finding assessing and providing a long-term prognosis of work capacity as 'not at all/somewhat problematic'. CONCLUSIONS: OPs' work situation regarding sickness certifications was favorable compared with that of other physicians, and especially compared with that of GPS. Our results underline the importance of organizational support for ensuring physicians' experience of having professional competence in handling assessments of patients' work capacity.

Duties performed by occupational physicians in Norway.

BACKGROUND: Occupational health care for all is a global aim but has not yet been achieved. Further development should be based on knowledge of specific alternative models of occupational health services (OHS). Little is published on different OHS models and work as a physician in these services. AIMS: To describe duties for Norwegian physicians working in two different OHS models: internal and external. In the internal model, the physician is employed in an OHS located at the company served, whereas in the external model, OHS time is shared between several companies and the physician is often located outside the companies. METHODS: A web-based survey was sent to all members of the Norwegian Occupational Medicine Association. RESULTS: There were 206 responses (response rate of 73%). Only those working as OHS physicians were included (54%). Physicians in external OHS performed individual health examinations to a greater extent, otherwise few differences between physicians working in internal and external OHS were found. Changes in the priority of the physicians' duties through a period of 20 years seem to be related to changes in legislation and official guidelines related to OHS practice. CONCLUSIONS: In this study, OHS physicians in Norway performed a large number of individual-based health examinations but this was seen more in the external OHS model. Otherwise physicians' duties had similar priority in the external and internal models. Legislation and official guidelines seem to be of major importance to the duties performed.

Doctors' reports of work-related hearing loss.

BACKGROUND: Noise-induced hearing loss is the diagnosis that is most frequently reported to the Norwegian Labour Inspection Authority. The objective of this study was to describe the doctors' reports on noise-induced hearing loss and assess the quality of the information. MATERIAL AND METHOD: The study is based on reports to the Labour Inspection Authority for the years 2005-09. We grouped the reporting incidence according to industry, gender and age on the basis of Statistics Norway's employment statistics. The reports were compared to data from Statistics Norway's living conditions survey from 2009. RESULTS: A total of 7,888 reports had been submitted in the study period (2005-2009), 96% of which concerned men. The annual reporting incidence amounted to 66 per 100,000 employees; six and 120 for women and men respectively. The reporting incidence was highest in the age group 55-74 years and for the construction and manufacturing industries. Altogether 52% of the reports pertained to employees who were no longer working in the enterprise where they had been exposed to noise. The proportion of reports pertaining to employees aged under 40 years was lower than the corresponding proportion of those who reported work-related hearing loss in Statistics Norway's living conditions survey from 2009. Occupational health physicians submitted 85% of the reports. INTERPRETATION: Of those exposed to noise, only a small proportion of women, younger employees and employees in enterprises with no access to occupational health services are captured by the reporting system. The same may apply to employees in industries such as transport and retail trade, but this will require further investigation.

[University of Occupational and Environmental Health, Japan: 2013 alumni physician statistics].

The University of Occupational and Environmental Health, Japan (UOEH) is a publically funded medical school for occupational health physician and researchers. All students are funded through six years of medical school and commit to a nine-year health services of occupational medicine after graduation. Between 1984 and 2013, the number of physicians graduating from UOEH was 2,875. Of these, 473 were medical residents in our postgraduate residency programs and 526 were occupational health physicians affiliated with different companies. A total of 252 graduates became UOEH research/teaching staff, 219 obtained employment as physicians at Rousai hospital (hospital operated by Japan Labour Health and Welfare Organization), and 84 entered industrial hygiene and health check organizations. UOEH alumni are distributed throughout Japan in large workplaces/ business establishments. Many physicians continued in their job after the nine-year obligation, thus contributing to the increasing number of occupational health physicians during recent decades. We suggest that funding and postgraduate residency programs contribute to the increasing numbers of physicians, but further analysis needs to be done.

Management of work-related stress by Finnish occupational physicians.

BACKGROUND: Occupational stress is a serious threat to the well-being of employees and organizations and may cause ill-health and loss of productivity. Determining the methods that occupational health (OH) services and employers use to manage work-related stress can help to detect both barriers and facilitating factors for effective stress management. AIMS: To examine stress management methods used by OH physicians in Finland. METHODS: Anonymous, self-administered e-mail questionnaire to Finnish OH physicians. RESULTS: A total of 222 OH physicians responded. Neither OH services nor their client organizations used standardized tools to assess or manage work-related stress. Work-related stress was assessed using patient interviews. Physicians reported that the main method used to manage occupational stress was supporting the individual employee. Half of the physicians attempted to involve workplaces in stress management by asking their patients to contact their supervisors regarding stress issues. CONCLUSIONS: In order to tackle work-related stress consistently and effectively employers and OH services should have agreed standardized protocols for managing stress in the workplace.

Use of health services by Finnish employees in regard to health-related factors: the population-based health 2000 study.

OBJECTIVES: The aims of this study were to describe the use of occupational health services and other health care of Finnish employees and to examine associations between health problems and risks, and primary care visits to occupational health nurses and physicians and other health care. METHODS: A nationally representative sample of 3,126 employees aged 30-64 participated in the Health 2000 study, which consisted of a health interview, questionnaires, a clinical health examination, and the Composite International Diagnostic Interview. The use of health services was measured by self-reported visits. RESULTS: During the previous 12 months, 74 % of the employees visited occupational health services or municipal health centers, 52 % visited only occupational health services. From a third to a half of employees with lifestyle risks, depressive disorders or other health problems visited occupational health professionals. Obesity, burnout, insomnia, depressive mood, chronic impairing illnesses, and poor work ability were associated with visits to occupational health nurses. Among women, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to occupational health physicians. Lower educational level, smoking, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to health center physicians. CONCLUSIONS: This study showed the importance of occupational health services in the primary health care of Finnish employees. However, a considerable proportion of employees with lifestyle risks, depressive mood, and other health problems did not use health services. Occupational health professionals are in an advantageous position to detect health risks in primary care visits.

Survey of vaccination policies in French healthcare institutions.

OBJECTIVE: The survey was implemented to describe vaccination policies for healthcare professionals in French healthcare institutions. METHODS: A cross-sectional survey based on questionnaires was sent to occupational physicians and chairpersons of hospital infection prevention and control committees (HIPC) of 38 institutions between November 2010 and January 2011. RESULTS: Twenty-nine occupational physicians and 26 hospital infection prevention and control committees chairpersons (HIPC), from 30 institutions answered (response rate: 79%), 70% of the institutions were university hospitals. Overall, 76% of occupational physicians and 85% of HIPC chairpersons reported that information and awareness campaigns about vaccination recommendations for healthcare professionals were usually conducted in their establishment. Fifty-nine percent of occupational physicians and 31% of HIPC chairpersons reported that they were aware of the vaccine coverage rates of professionals in their institution. The occupational physicians reported that they suggested diphtheria, tetanus, polio, influenza, and acellular pertussis vaccination to all staff at their annual visit in 100%, 97%, and 62% of cases, respectively. Varicella and measles vaccinations were never suggested in 31% and 17% of cases, respectively. Among respondents, 55% of physicians reported that they had already managed a pertussis epidemic, and 42% a measles epidemic, and in both of these cases an awareness campaigns were usually conducted (93% and 96%). CONCLUSIONS: The vaccine coverage rates of healthcare professionals in French healthcare institutions remain insufficiently documented and could be improved.

[Relationship between organisational structure and worksite health management in the information technology and communications sector]. / Zusammenhänge zwischen der Betriebsstruktur und Betrieblichem Gesundheitsmanagement in der Informationstechnologie- und Kommunikationsbranche.

AIM OF THE STUDY: Worksite health management (WHM) can positively influence employee health and performance. However, it has not yet been comprehensively implemented in companies. This study aims to identify the role of organisational structures in the implementation of WHM. METHODS: In this cross-sectional study, data were collected on the companies' WHM and the organisational structure. Out of 522 randomly selected companies within the German information technology and communication (ITC) sector, one managing director for each company was being questioned through telephone interviews. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: The results of the study reveal that the implementation of WHM is positively correlated with a large company size (OR 2.75; 95%-CI 1.10-6.88) and with the existence of an employee representation (OR 2.48; 95%-CI 1.54-3.98). Other structural characteristics, such as the employment of a company physician, the percentage of temporary workers as well as the staff's age and sex distribution do not seem to have a significant impact on the implementation of WHM. CONCLUSIONS: The results indicate that the implementation of WHM can only be explained to a certain degree by organisational structures. However, the findings highlight the fact that companies with few structural resources are in particular need of tailored support when implementing WHM.

Sick-listed employees with severe medically unexplained physical symptoms: burden or routine for the occupational health physician? A cross sectional study.

BACKGROUND: The two primary objectives of this study were to the assess consultation load of occupational health physicians (OHPs), and their difficulties and needs with regard to their sickness certification tasks in sick-listed employees with severe medical unexplained physical symptoms (MUPS). Third objective was to determine which disease-, patient-, doctor- and practice-related factors are associated with the difficulties and needs of the OHPs. METHODS: In this cross-sectional study, 43 participating OHPs from 5 group practices assessed 489 sick-listed employees with and without severe MUPS. The OHPs filled in a questionnaire about difficulties concerning sickness certification tasks, consultation time, their needs with regard to consultation with or referral to a psychiatrist or psychologist, and communication with GPs. The OHPs also completed a questionnaire about their personal characteristics. RESULTS: OHPs only experienced task difficulties in employees with severe MUPS in relation to their communication with the treating physician. This only occured in cases in which the OHP attributed the physical symptoms to somatoform causes. If they attributed the physical symptoms to mental causes, the OHPs reported a need to consultate a psychiatrist about the diagnosis and treatment. CONCLUSIONS: OHPs experience few difficulties with their sickness certification tasks and consultation load concerning employees with severe MUPS. However, they encounter problems if the diagnostic uncertainties of the treating physician interfere with the return to work process. OHPs have a need for psychiatric expertise whenever they are uncertain about the psychiatric causes of a delayed return to work process. We recommend further training programs for OHPs. They should also have more opportunity for consultation and referral to a psychiatrist, and their communication with treating physicians should be improved.