While the amount of time a practitioner spends on a case is not always a measure of their value, it is a measurable input that can be compared to the outcomes achieved in the management of people with work-related injury and illness. The desired outcome depends on the perspective of the observer, but most people would agree that full recovery and ability to return to the workforce in a productive role, at a reasonable cost, is the most important objective where a worker suffers an injury.
In Tasmania WorkCover has placed emphasis on the role of ‘Primary Treating Medical Practitioner‘ or PTMP. This is a legislated role. This is usually the general practitioner chosen by the worker who co-ordinates medical management, liaises with the rehabilitation provider and sometimes directly with the workplace and the insurer. Sometimes a specialist medical practitioner temporarily takes on this role.
A conscientious PTMP will be proactive in co-ordinating the treatment programme by actively engaging with the other treaters, putting forward treatment plans and communicating with the other parties to the management of the worker’s rehabilitation. They will attempt to anticipate and circumvent barriers to treatment and rehabilitation. All this involves the practitioners time, not only in consultations with the worker, but on the telephone and using email, as well as participating in formal meetings and preparing clinical correspondence and reports.
Workers compensation insurers are usually content to fund the PTMP’s time for consultations with the worker, face to face meetings with other parties, visits by the practitioner to the workplace and formal reports, but there is often little recognition of the time involved ‘behind the scenes’ on activities that make the difference between effective treatment from an integrated team and disjointed ineffective management.
On the other hand, doctors engaged for claims management purposes to provide independent medical reports are often paid handsomely with little accountability for what actual input of time and effort goes into their reports and associated activities. There activities often disrupt rather than support or add value to the role of the treating practitioners.
Luckily there are other incentives to doctors to be involved in the actual treatment and management of injured workers i.e. the satisfaction of helping an injured worker recover and the recognition from clinical colleagues of the importance of the role. Without these factors more specialist doctors would gravitate towards independent medical roles, where a good income can be made with little clinical responsibility, little need to keep abreast of current clinical practice and, in same cases, a relatively small input of their time.
I am unsure whether any workers compensation system measures the relative value of doctors involved in treatment/management compared to the value of input from independent doctors. Perhaps some insurers and claims agents have measured the value of independent medical opinions in terms of their own ‘bottom line’!
WorkCover Authorities should consider this issue to determine how to get the best value from our limited medical resources to achieve desirable outcomes for the community as a whole in circumstances where people are unfortunate to be injured or become ill in the course of their work.