title: Evaluation of work capacity in Switzerland: a survey among psychiatrists about practice and problems.
abstract: OBJECTIVE
  In Switzerland, psychiatric evaluations of work capacity for determining a person's eligibility for disability benefits are being criticised for a lack of transparency and high inter-rater variability. The aims of this study were to learn about the current practice of psychiatrists, to explore possible sources for lack of transparency and variability, and to contrast practice with current professional guidance.
  
  
  METHODS
  A national online-survey among psychiatrists who performed five or more evaluations of work capacity per year. Based on discussions with experts and a literature review, we structured questions focusing on reporting on work capacity, the description of a claimant's previous job, and measures of quality assurance.
  
  
  RESULTS
  A total of 129 psychiatrists responded (31% of estimated 412 eligible psychiatrists). The majority reported using instructions of the insurers (77%), peer consulting (65%) and process guidelines (51%). They expressed a claimant's work capacity as free text and percentage work capacity (49%), percentage only (23%), or free text only (14%). A total of 13% used instruments to document work capacity. Psychiatrists considered three different interpretations of percentage work capacity as equally applicable. A job description was regarded as mandatory to determine work capacity by 90% but only 26% received it and found it mostly deficient.
  
  
  CONCLUSIONS
  The transparency and reliability of Swiss psychiatrists' conclusions on a claimant's work capacity may be reduced by unsystematic reporting, variable interpretation of the percentage work capacity, lack of a detailed job description and insufficient quality control. Education, engagement of insurers and new guidelines might be effective means of implementing improvements.
authors: University Hospital Basel, SWITZERLAND; stefan.schandelmaier@usb.ch.
authors: Stefan
authors: S
authors: Schandelmaier
authors: Katrin
authors: K
authors: Fischer
authors: Ralph
authors: R
authors: Mager
authors: Ulrike
authors: U
authors: Hoffmann-Richter
authors: Andrea
authors: A
authors: Leibold
authors: Monica S
authors: MS
authors: Bachmann
authors: Sarah
authors: S
authors: Kedzia
authors: Jeger
authors: J
authors: Jeger
authors: Renato
authors: R
authors: Marelli
authors: Regina
authors: R
authors: Kunz
authors: Wout E L
authors: WE
authors: De Boer
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011570:Psychiatry / Q000379:methods*; D013557:Switzerland; D014938:Work Capacity Evaluation