Abstract
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.