The release of an Ontario Medical Association (OMA) position paper on the role of family physicians in the timely return to work process has put the spotlight on an issue that regularly raises the blood pressure of Ontario doctors.
The position paper on the Role of the Primary Care Physician in Timely Return to Work, published in December 2008, warns “the burden of third-party requests for information has become so great that it may contribute to a family physician’s decision to change careers or retire early from practice.”
The paper goes on to say that general practitioners in Ontario spend an average of 11.5 hours per week completing forms and filling out reports, often “with no offer of financial remuneration by the requesting third party.”
The authors of the paper also offer a glimpse of the strained relationships between the parties involved. “Physicians are perceived as reluctant participants in the process, often unwilling to understand the needs of employers and the workplace and too often willing to inappropriately certify disability.” Employers, on the other hand, are seen as less than co-operative in offering injured workers modified work opportunities.
The patient-physician relationship can also go off the rails “when employers/insurers receive information they consider inadequate and deny or delay the provision of benefits; when employers/insurers require repeat services and the patient has to assume the costs; and/or when employers blame doctors for delays in approval, thereby pitting patient against physician.”
Dr. Joel Andersen, a Sudbury physician and past chair of the OMA’s Section of Occupational and Environmental Medicine, acknowledges that family physicians have a role to play in the timely return to work process, but takes issue with the OMA’s endorsement of family physicians taking on the role of a return to work co-ordinator.
“It’s not a criticism of family physicians,” said Andersen. “It’s just the reality that family physicians either poorly understand their role, are not trained to do it and don’t have the time.”
In larger companies, the role of a return to work co-ordinator is usually performed by occupational health nurses, who liaise with the employee, the union, family physicians, physiotherapists, psychiatrists and other health-care providers. They have access to the workplace and are able to assess the physical requirements of the employee’s job. Disability management companies may also be contracted to fill the role of a return to work co-ordinator.
According to the OMA Section of Occupational and Environmental Medicine, it’s not a role for family physicians.
Delegating the return to work co-ordinator’s role along with the paperwork burden to nurse practitioners in family health team practices may be one possible solution, said Andersen.
Education
Everyone agrees on the need to educate family physicians about fulfilling their obligations regarding third party requests for information.
“As a practicing occupational physician, I regularly adjudicate notes from physicians that have nothing in them,” said Andersen. “I have to make phone call after phone call to doctors to get more information, and I often have to recommend a specialist referral or an independent medical examination to get the information I need to facilitate the process.”
Family physicians, said Andersen, “don’t have the time to provide the kind of information that’s required to make the process work, and it doesn’t matter whether you pay them generously for it. They just don’t have the time. The information needs to be accurate, timely and within the scope of the physician’s domain of competence. The work overload kills the timeliness and the lack of training kills the accuracy.”
The OMA paper also recommends more stringent patient consent requirements for the release of medical information and comes out in favour of billing employers and insurers – not patients - for services related to the certification of disability and the timely return to work program.
Productivity
Delays in returning employees to work following an injury or medical condition cost billions of dollars in lost productivity and impact the province’s competitiveness. Research proves that a timely return to work has a major impact on an employee’s rehabilitation, said Andersen.
“After three months, despair sets in. You’re sitting around at home dragging the rest of the family down and it just becomes a nightmare. You’re out of work, out of money, your wife’s leaving you, you’re into the booze and on narcotics.”
The position paper was accepted by the OMA’s Council and serves as a reference and standard of practice for physicians dealing with return to work cases, but the OMA Section of Occupational and Environmental Medicine has refused to support it “in its current state.”
