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Sick leave assessments of people with persistent ‘medically unexplained’ physical symptoms (PPS) can be difficult for physicians, and may show a variation in outcome.This variation can be a result of a different working context or medical background of the assessor, or due to the objective of the assessment. To obtain more insight in the extent and reasons for assessment differences related to this group of patients we explored sick leave assessments of physicians working in the same health care field, with similar tasks, but with different objectives for the assessments.A cross sectional study was conducted among 50 occupational health physicians (OPs) and 43 insurance physicians (IPs) from the Netherlands. They attended a full day training on PPS, and were asked to assess the sick leave of nine video case vignettes of patients with PPS. Data were analysed using multinomial regression approach in SPSS.Sick leave was less likely to be advised by IPs compared to OPs (OR 0.74, 95% CI: 0.56 to 0.97). For all physicians the sick leave assessment was influenced by their opinion on perceived limited work-related functioning, the cause of the health complaints, the diagnosis, and treatment options. For OPs, private life issues influencing the cause of the health complaints was taken into account more than for IPs.Although, the differences in the sick leave assessment were small among these physicians it seems that the objective of the assessment is of influence on the outcome. OPs may be more focussed on sick leave guidance and vocational rehabilitation options, whereas IPs may have a stricter objective with their assessments focussing on the certification of a sickness benefit.