At this year’s Southern Association of Workers’ Compensation Administrators (SAWCA) Annual Convention, one theme surfaced repeatedly across multiple sessions: access to care. It wasn’t discussed simply as a healthcare issue or a reimbursement issue. It was presented as one of the defining challenges facing the future of workers’ compensation itself, and its implications were discussed from multiple perspectives throughout the week.
The theme was top of mind at the event’s inception in the Medical Forum, a 90-minute discussion with a full house of interested attendees. The session was moderated by Rosalie Faris (OMCA) and featuring Dr. Paul Nanda (TGH Urgent Care), Dan Sung (Colorado Department of Labor and Employment), and Greg Gilbert (Concentra). Rather than formal presentations with polished slides, the session felt more like sitting around a table with experienced professionals who spend every day wrestling with the realities of our healthcare system.
The issues they described aren’t coming. They’re already here. And unless we begin thinking differently about healthcare delivery, provider engagement, and system design, access to care may become the single greatest barrier to successful workers’ compensation outcomes.
The problem isn’t paying for care. It’s finding it.
When most people hear “access to care,” they immediately think about reimbursement.
Certainly, reimbursement matters.
But the panel made an important distinction. Before we can worry about paying physicians, we first have to make sure physicians actually exist and are willing to treat injured workers.
Greg shared sobering workforce trends. Medical school enrollment has improved somewhat, but it still isn’t keeping pace with population growth. Younger physicians are choosing different lifestyles than previous generations, often preferring fewer working hours. At the same time, a significant percentage of today’s physician workforce is approaching retirement. The result is simple: demand is growing faster than supply.
Workers’ compensation feels this shortage even more acutely.
Occupational medicine represents only a small slice of healthcare. From estimates I’ve heard, there are currently only 1,400 occupational medicine physicians in the entire US. Specialists who understand workers’ compensation, impairment, return-to-work, causation, and disability are even harder to find. Behavioral health providers, neurologists, pain specialists, ENTs, and other specialties are becoming increasingly difficult to recruit into a system that sees many long-tenured professionals leaving.
This isn’t just an inconvenience. Fewer physicians and clinicians, generalists and specialists alike, means real consequences for injured workers. Delayed appointments become delayed diagnoses. Delayed diagnoses become delayed treatment. Delayed treatment becomes delayed recovery. Each level of delay that occurs has a compounding negative effect on the clinical and financial outcomes.
Relationships matter more than networks
One of my favorite observations came from Dr. Nanda. Rather than talking about provider networks, he talked about provider relationships.
Urgent care centers now see approximately 200 million patient visits annually across the United States. For many workplace injuries, they represent an ideal alternative to overcrowded emergency departments. But simply having an urgent care center nearby isn’t enough. Employers should proactively build relationships with local occupational health providers, educate them about available modified-duty positions, and ensure clinicians understand the physical demands of specific jobs before injuries occur.
That last point really resonated with me. You can’t effectively return someone to work if you don’t understand the work. A broad concern I’ve heard for many years is that the job descriptions supplied by an employer to the injured worker’s clinical team are either inaccurate or incomplete. Dr. Nanda described working closely with employers so physicians know exactly what modified duty looked like, what essential job functions required, and when someone could safely return without unnecessary restrictions. In other words, if you don’t know what the target is, you can’t aim at it. The kind of collaboration Dr. Nanda described benefits everyone, but it starts with the employer. An accurate, detailed job description is on them to provide so all the stakeholders involved can agree upon what victory looks like.
Education may be our greatest recruitment tool
Another recurring theme was education.
Dan described Colorado’s long-standing philosophy that workers’ compensation providers aren’t born but developed. Medical school teaches physicians how to practice medicine. It does not teach impairment ratings, causation analysis, treatment guidelines, maximum medical improvement, return-to-work principles, or the many administrative nuances unique to workers’ compensation.
Colorado responded by investing heavily in provider education. They have expanded accreditation programs. They have also created a dedicated provider relations unit whose sole mission is recruiting physicians into workers’ compensation, actively mentoring new providers, and even exposing residents to occupational medicine early in their training. Early results have been encouraging, particularly in rural areas where provider shortages are often most severe.
They’re not just asking, “Why won’t physicians treat workers’ compensation patients?” They’re asking a deeper question, “How can we help physicians become comfortable treating workers’ compensation patients?”
We may need to rethink who delivers care
One of the liveliest discussions centered around nurse practitioners (NP) and physician assistants (PA). Almost everyone in the room admitted that when they go to a doctor’s office, they’re almost exclusively working with a PA or NP, not an MD or DO.
Historically, workers’ compensation has relied heavily on physicians serving as the gatekeepers of care. But as physician shortages continue, many jurisdictions are reconsidering whether advanced practice providers should assume larger roles.
The conversation was refreshingly balanced. Nobody suggested abandoning physician oversight overnight. In fact, it was underscored that oversight is required. Instead, the panel emphasized thoughtful, evidence-based evolution.
Greg referenced recent research showing increasing use of advanced practice providers with outcomes comparable to physicians for many types of workers’ compensation care, particularly in rural communities where physician shortages are most pronounced.
Dan echoed that perspective while cautioning against dramatic change. Healthcare systems don’t transform simply because regulations change. Professional roles, expectations, supervision models, and stakeholder confidence all evolve gradually. Meaningful reform often happens one carefully considered step at a time.
The biggest barriers aren’t always clinical
Perhaps the most revealing part of the discussion focused on why physicians sometimes choose not to participate in workers’ compensation. The reasons weren’t surprising:
- Administrative complexity
- Documentation requests
- Repeated status reports
- Utilization review
- Preauthorization
- Questions about causation
- Questions about relatedness
- Requests for information that simply don’t exist in traditional healthcare
Rosalie summarized it well when she noted that physicians often feel they’re being asked to do far more than simply care for patients. They’re expected to communicate with employers, adjusters, attorneys, nurse case managers, utilization review organizations, and regulators. That is on top of navigating a system that operates very differently from group health. I’ve argued before that we should make it easier, not harder, for providers who consistently get injured workers back to work quickly and keep them there.
The irony, of course, is that every additional administrative hurdle becomes another reason for providers to say, “I’d rather not treat workers’ compensation.”
That’s not a reimbursement problem. That’s a system design problem.
Healthcare is changing. Workers’ compensation must change with it.
As I reflected on the discussion afterward, I realized the Medical Forum wasn’t really about physician shortages. It was about adaptation.
Healthcare continues to evolve at a remarkable pace. Technology changes. Workforce demographics change. Provider expectations change. Care delivery models change. Workers’ compensation cannot remain frozen while the rest of healthcare moves forward.
That doesn’t mean abandoning the principles that have made workers’ compensation successful for more than a century. But it does mean asking uncomfortable questions, like:
- Are we making it easy, or unnecessarily difficult, for clinicians to participate?
- Are we educating providers instead of assuming they already understand our system?
- Are we building relationships with healthcare partners before we need them?
- Are we removing administrative friction whenever possible?
- Are we designing a system that makes clinicians want to care for injured workers?
For employers and adjusters, the process can start small. For example, poll three local occupational health providers and ask what modified duty positions you have on file with them. Check whether your corresponding job descriptions reflect the actual physical demands or are just boilerplate. That exercise might confirm you are letting your clinical partners (which also include case managers) know precisely what level of function is required so they can work towards that goal. Or, it might uncover an unknown gap in information that is handicapping the process.
The future of workers’ compensation will not be determined solely by legislation, reimbursement schedules, or emerging technologies. Instead, it will be determined by whether injured workers can access the right clinician, at the right time, with the right expertise.
Because without access to care, every other conversation we have about workers’ compensation becomes considerably more difficult.
