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Health reform will aggravate doctor shortage and delay workers comp care

Injured workers face delayed treatment


Millions of additional U.S. residents seeking medical attention under the Patient Protection and Affordable Care Act are likely to delay treatment for workers compensation and disability insurance claimants by aggravating a nationwide doctor shortage.

Delayed medical treatment, which affects return-to-work outcomes and thus employer costs, now is the leading expectation about how the health care reform law will affect care for occupational and nonoccupational employee injuries and illnesses, workers comp and employee absence experts say.

The workers comp and absence consultants are not alone in their expectation that the law will aggravate an already existing doctor shortage.

“We have a shortage right now and it is only going to grow more and more significant,” said Christiane A. Mitchell, director of federal affairs in Washington for the Association of American Medical Colleges.

The shortage is driven by baby boomers rapidly needing more medical care, including greater attention from specialists such as orthopedic doctors, she said.

Simultaneously, one in three doctors practicing is 60 or older. They are reaching retirement age without an adequate pipeline of new doctors to replace them, Ms. Mitchell said. Under the health care reform law, more people will have access to health care, many seeking treatment for illnesses previously untreated.

The Congressional Budget Office estimated in a March 2012 report the health care reform law will increase the number of nonelderly people with health insurance by about 30 million in 2016 and beyond.

Meanwhile, the association expects the United States will experience a shortage of 91,000 doctors by 2020, split evenly between specialist and primary care physicians.

“What having a shortage means is that people will have to wait longer for an appointment or people may have to travel farther for an appointment,” Ms. Mitchell said.


Yet workers comp and employee absence professionals have for years advocated the importance of getting injured or ill employees attention early to reduce claims durations and time away from work.

“A primary concern (for employers) is going to be timely access to care, particularly when you are talking about workers comp or short-term disability on the (nonoccupational) side,” said Pat Purdy, Simsbury, Conn.-based vice president of core benefits solutions for Pacific Resources Benefits Advisors L.L.C.

She expects slight delays in each step of the medical care process, such as in getting an initial doctor appointment followed by delays in subsequent care.

“There might be slight delays in all parts of the process, but if you have slight delays in every part of the process, are you increasing the average absence or the average duration of that disability?” Ms. Purdy asked rhetorically.

There are also potential costs for injured employees, said Bruce Hockman, executive vice president and workers comp practice leader in Philadelphia for Towers Watson & Co.

“We need to get (injured workers) diagnosed quickly and treated quickly and returned to work as quickly as possible or the cost of the system will grow more than anybody cares for it to,” Mr. Hockman said.

There may be other implications as well. For instance, companies providing employers and insurers with medical provider networks may find fewer physicians with which to contract.

Although the health care reform law's effect remains somewhat speculative, “monoline” provider network companies specializing in workers comp could be particularly susceptible to a doctor shortage, a network provider expert who asked not to be identified said.

Already, employment recruiters report that it is more challenging for physician groups with which network companies contract to find new doctors to hire, Ms. Mitchell said.