May 15, 2025 • 31 mins
A healthcare crisis is hitting workers’ compensation: fewer doctors are treating injured workers. Why are physicians leaving, and what can be done?
Woodruff Sawyer, VP | Specialty Claims Consultant, Debbie Hammer, with 35 years of experience, breaks down the complex reasons behind the shortage—from fallout of the Dobbs decision to burdensome paperwork—and its real-world impact on recovery times, disability claims, and costs.
Hammer also shares actionable solutions for employers, insurers, and injured workers to navigate this growing challenge and improve care access and outcomes.
Whether you're in HR, claims, or healthcare, this episode offers crucial insights into one of the industry’s most urgent issues.
Subscribe for more expert discussions on workers’ compensation and return-to-work strategies.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
How do you get better at what you do?
Speaker 2 (00:02):
Time management assistance.
Speaker 3 (00:03):
AI.
Speaker 2 (00:03):
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live course Live training.
Speaker 1 (00:07):
Live course, live training Live training Live
training, live training, livetraining, live training, live
training, live training, livetraining, live training, live
training.
Speaker 3 (00:26):
Whoa, tell me a little bit about what you've
been up to.
You've been a guest with REAAudio a couple times in the past
.
We've done some webinarstogether and I just so
appreciate your take on thingsand kind of your position on
things.
You're able to take some ofthese work comp issues that we
talk about and go really deep onthem, and so I'm really glad
(00:48):
that you've come back as a guestand really interested in what
you're up to now.
Debbie at Woodruff Sawyer.
Speaker 2 (00:53):
Great, yeah, thanks, todd.
Thanks for having me on again.
I love your show and I lovebeing on and talking about all
of these important issues andgoing into deep dives and so
yeah, so let's see where can Istart.
You know, I know you'refamiliar with my background a
little bit.
I've been in workers' comp forabout 35 years.
(01:19):
I've been with Woodruff Sawyerfor 19 of those years and what I
do at Woodruff Sawyer is I'm aclaims consultant and advocate
for our clients.
I'm basically a liaison betweenour clients and their claims
adjusters on the carrier side,and I get involved anywhere from
(01:39):
the onboarding process when wehave a new client or we have a
client who is changing carriers,and I get the team together to
make sure that we've got specialhandling instructions in place
and everybody understands themand is comfortable with them to
then getting involved in claimoversight and management.
(02:01):
I help out with reservestrategy, settlement strategy,
return to work strategy.
As you know, I have someclients who are involved with
re-employability and yournot-for-profit programs, and so
basically, we have claim reviewswith our clients and meetings
to discuss statuses and actionplans on the open claims.
(02:22):
And then we also get involvedwith, or I get involved with
XMOD projections to help ourclients with forecasting and
budgeting, understanding wheretheir premium might lay on the
next year, based on their claims, and so that's basically what I
do here.
Speaker 3 (02:41):
There's a lot of things that are involved with
what you do.
Obviously, do you work inspecific industries, or is there
a specific type of client thatyou work with at Woodruff Shore?
Speaker 2 (02:53):
Not really.
We have some claims consultantshere who are a little bit more
specialized in their focus.
We have someone who does a lotof construction accounts and
then we have people who areinvolved in tech accounts.
I tend to be sort of themulti-practice person here.
(03:15):
I have a lot of different areasand I love that.
I love being able to handleconstruction accounts, and then
I have a handful of tech riskmanagement very large deductible
accounts or accounts that areself-insured, and that's very
different from working onsmaller accounts who are on, say
, a guaranteed cost program andthere's different strategies
(03:38):
involved.
And I love working with thedifferent personalities, with
different types of clients small, large and whatever their
industry area is.
It's it makes it more fun and Ithink I learn more as well Just
seeing how different types ofcompanies and industries handle
things differently, and that's,you know, that's really
(04:01):
interesting to me.
That's really interesting to me.
Illuminating.
Speaker 3 (04:04):
And I'm sure you learn, right, that's one of the
things I like about being ableto travel and talk to our
clients that are in verydifferent industries is that you
can learn so much just fromlearning what one organization
does and you can then help, kindof be a resource to other
people as you talk to, even indifferent industries, right?
A lot of best practices goacross industries and I'm sure
(04:30):
through your experiences and thetime that you've been there.
Speaker 2 (04:32):
You've been able to absorb a lot of things and share
that information with yourclients, haven't you?
Absolutely, Completely agreewith you on that?
Speaker 3 (04:35):
So what are you seeing as trends now in workers'
comp as you're talking to yourclients?
Are there specific things thatare creeping up that maybe
you've seen creep up in yearspast, or new things happening
that are starting to kind ofdraw your attention to?
Speaker 2 (04:50):
So one of the things our team has been talking about
lately is an uptick in physicianshortages in workers' comp, and
that has got me reallyinterested in why why that's
occurring and where is itoccurring.
Is it geographically specificor is it type of specialty?
(05:15):
So there's a lot going on withthat and, you know, I think
there's a lot of interestingreasons and maybe a convergence
of factors that are all causingthis.
Speaker 3 (05:28):
So if we step back for a second, can you explain a
little bit?
And it may seem obvious, but ifyou could just kind of lay out
like how does that negativelyimpact a claim and from a you
know, risk manager standpointsomebody who is trying to keep
their X mod as low as possibleand trying to move claims to
closure as quickly as possibleand safely as possible and get
(05:50):
their employees back to work anddo all the right things how
does a physician shortage affectthat?
Speaker 2 (05:57):
So I think it affects both injured workers and
employers negatively, and themost significant impact is going
to be felt by the employeesbecause they need to rely on
prompt and effective medicalcare to recover from their
injuries and return to work.
(06:18):
Without an adequate number ofphysicians that are willing to
provide treatment, employees areforced to wait longer for
appointments, they getinadequate or, in some cases, no
care at all.
And the other thing I find isthe lack of quality care can
result in misdiagnosis andinappropriate treatment for the
(06:39):
wrong condition.
I've seen cases where aninjured employee was provided
physical therapy for theirshoulder and then it turns out
much later that the problem wasactually not the shoulder at all
but a herniated disc in theneck, causing radiating pain
down the upper extremity.
That could have been caughtearly on if there had been
(07:01):
proper triage, diagnostics andspecialty consultation.
So that's one area, and I thinkyou know that it's important to
note that the delay intreatment is also affecting not
just the injured worker'sphysical recovery but their
financial stability and theirmental health.
(07:21):
So many employees are unable toreturn to work for extended
periods.
It puts their livelihoods atrisk and you know it can lead to
long-term disability, prolongedsuffering chronic pain and then
a feeling of hopelessness andfrustration starts to set in.
So that's the other thing we'vebeen seeing.
Related is and there's manyreasons for this not just the
(07:45):
physician shortage, but the morecomplex an injury is and lack
of care and all these otherfactors it can lead into site
claims.
So we have seen another.
You know another problem there.
That's probably the subject ofanother conversation.
Speaker 3 (08:03):
Yeah, yeah, I mean, it is all connected.
So are you seeing more peoplejust not get the treatment that
they need, or are they gettingtreatment from you know, like I
know myself, I've gone to.
I got a new doctor a couple ofyears ago and I've never seen
him.
I always see the EA, which isfine, she's wonderful, she's
(08:25):
super nice, she seems veryknowledgeable.
I'm in pretty good health, sothat's okay.
But it's not just in workers'comp, right?
I'm in Florida and there's alot of people here and I've seen
it too.
Growing up as a kid we went tothe local doctor.
His office was in the firstfloor of an old house, right,
great guy.
His office was in the firstfloor of an old house, right,
great guy.
Family doctor.
(08:45):
But now it seems like it's allcorporately owned, or you're
going to an urgent care orsomething like that.
So you know, I've seen it justin my own, in my own life.
And so in work comp and forpeople that might not understand
this at this point, in mostcases I am asked to go to a
specific doctor by my employer.
(09:07):
Is that correct?
Speaker 2 (09:08):
Yes In workers' compensation.
If you are injured, you wouldbe directed, if it's handled
appropriately like it should be,to an occupational physician,
not your personal care physician.
That is true in, as far as Iknow, all states across the
country.
There's varying regulations anddifferences there across states
(09:33):
.
But yeah, employees do not seetheir personal care doctors and
workers comp anywhere.
Speaker 3 (09:40):
They're not supposed to.
Right, they're not supposed to,but why is that?
And why is that?
They're not supposed to?
Right, they're not supposed to,but why is that?
Speaker 2 (09:45):
That is just the way that the system is set up, so
that there is cost containmentand there's medical control.
I don't know that that meansthat there isn't medical control
and cost containment outsidethe work comp system, but work
comp is just a unique area ofspecialty, and so the whole
(10:07):
reason behind having medicalprovider networks is to control
costs and control the system andbe balanced and fair for both
employers and their injuredworkers.
Speaker 3 (10:24):
So do you feel like this lack or the physician
shortage is due to physiciansjust not wanting to get into the
workers comp world, or is it anissue of, like, fewer
physicians coming out of schoolnow?
Speaker 2 (10:39):
I think it's a lot of different reasons and it's
interesting.
I mean, I could talk a longtime on this and you can feel
free to cut me off?
Speaker 3 (10:50):
No, not at all, it's interesting.
Speaker 2 (10:52):
So I think again there's multiple reasons and
they are all converging at once.
One of the things that peopledon't talk about much in comp in
terms of the physician shortageis how there's a domino effect
from the Dobbs decision, whichoverturned Roe v Wade.
So obviously this has decreasedstudent motivation to pursue
(11:16):
medical careers in the OBGYNarea.
But did anybody think thisdecision would be so far
reaching as to extend toworkers' comp medical care?
And the link is the Dobbsdecision decreased student
motivation to apply to medicalschools in states with severely
(11:37):
restrictive abortion rights, forexample the Midwestern, central
and Southern states that weknow of and in turn, this has
reduced medical schoolenrollment and residency
training, leading to the lack ofavailability of practicing
physicians in those states.
So the most significant impactfrom my research has been on
(11:59):
family medicine and emergencyroom care, which affects
treatment for occupationalinjuries, especially when severe
injuries require an emergencyroom visit.
And then there's other areas ofmedicine that have been
affected by this as well,including occupational and
orthopedic specialty care.
(12:19):
So, essentially, physiciandemographics and workforce
patterns have shifted as aresult of this.
But, aside from the Dobbsdecision, the physician shortage
has already been in the makingfor decades because of shifting
demographics.
For other reasons, due to acombination of population growth
(12:41):
, we have an aging population.
Due to a combination ofpopulation growth, we have an
aging population.
We have an aging, nearretirement physician workforce
that is experiencing burnout.
So there's now a higherpercentage of the population
being older the baby boomers,including those older working
physicians, entering theirtwilight years and having
(13:02):
greater and more varied medicalneeds.
And I just want to go back towhat you said.
You know the physician burnout.
Why people are not entering themedical field is because of red
tape.
So and this is both inoccupational and
non-occupational medicinethere's more medical practice
(13:23):
and patient care regulations.
There's more insurance andadministration regulations.
So people enter the medicalprofession to care for patients,
not complete time-consumingreports, right?
So for many physicians, theadministrative hurdles outweigh
the financial and professionalrewards of providing direct care
(13:45):
and advocacy for patients.
The other problem isreimbursement rates.
Reimbursement rates are lessthan they used to be and they
are less in workers' comp thanthey are for general, you know,
non-occupational practice.
There's significantly morephysician regulations in
workers' comp.
(14:05):
And, getting back to what wewere talking about earlier, that
is because the system'sdesigned to be fair and balanced
and protect both injuredworkers and employers and to
contain the costs.
But yeah, there's definitelymore.
There's utilization reviewguidelines, evidence-based
(14:27):
treatment guidelines In workers'comp.
Doctors must provide detaileddocumentation about injury
causation and permanentdisability A lot of complex
factors in workers' comp that wejust don't see on the
non-occupational side.
So there's just a lot ofbureaucracy and legalities that
(14:51):
don't help attract and retainphysicians to the field.
Speaker 3 (14:56):
Yeah, and you know, I feel like just that going to
see a doctor now is muchdifferent than what it used to
be, as I recall the just thewhole appointment process and
this is outside of the work compworld, right, this is just
personal experience, you know, Iremember full physicals and you
(15:17):
know more of the experience ofa doctor was less about what
they're seeing in the blood testand more about what you're
actually feeling andexperiencing.
And I feel like it's changed.
And again, I'm not a doctor.
If I was a doctor, I wouldn'tbe doing this interview right
now, right, but I feel like it'sbecome again.
(15:38):
This is just personalexperience, less personal and it
is, and I would imagine, evenso, in a work comp atmosphere,
when there is so much more redtape, so much more reporting
that has to be done, it isalmost like an assembly line and
there's not that personal care,right.
Speaker 2 (15:59):
Yeah, that's a good analogy.
It's an assembly line.
Speaker 3 (16:02):
Yeah, that's a good analogy.
It's an assembly line.
Yeah, so what's being done toovercome this in the short term
from a work comp perspective?
Speaker 2 (16:11):
Well, I think that there's a lot that needs to be
done.
I'm not sure what's actuallybeing done but, I think that
this is a collective effort.
It has to be.
It can't just be one singlegroup alone.
I think that insurers,employers and healthcare
(16:32):
providers, as well aspolicymakers, need to come
together to collaborate and findsolutions, and starting with
employers.
I think that many of them areunprepared.
When an employee suffers aninjury, they don't know where to
direct their employees fortreatment.
Maybe they don't even have theeducation and the knowledge to
(16:54):
know that the treatment can'thappen with that employee's
personal care physician, that ithas to be through a provider
network.
So I think that employers needto be proactive and work with
their carriers up front toobtain provider listings prior
to injuries occurring, so thatthey can educate their workforce
(17:16):
.
If you get injured, here iswhere you go, here is where you
access medical providers forworkers' comp injuries.
So that's one thing I think.
Long term, I feel I'm reallyinto wellness, that whole field,
and I see a connection betweenwellness and workers' comp, and
(17:36):
I know that wellness is hotright now.
I wish more employers wouldconsider offering robust
wellness programs, because theycan reduce the risk of injuries
in the first place, they canreduce the severity of injuries
when they happen and that isgoing to reduce the strain on
workers' comp.
(17:57):
So I think that's one area.
Nurse triage services is anotherpopular area.
I think that can be effective.
These nurse triage services areoffered through either work
comp carriers A lot of them arestarting at their own in-house
program or third-party vendors,and these nurses can assist in
(18:21):
proper diagnosis at the time ofinjury and help determine the
best medical care.
A lot of times they canestablish that an injury is not
severe as initially thought andthat the injury really may only
require over-the-counter orat-home treatment and avoid the
need to find a doctor altogether.
Telehealth is another goodoption, and not in all cases,
(18:45):
but sometimes we find thatinjuries that used to be
required to be evaluated by anin-person physician could be
addressed by telehealth and orby a physician assistant.
You know that can improve theappropriateness of treatment
based on accurate diagnostictesting and referrals to
(19:07):
specialty consultations.
I think on the carrier side,what insurers can do and allow
(19:27):
greater leniency for adjustersto approve medical treatment and
diagnostics and related to that, another possibility is to
amend the Request for TreatmentAuthorization form, the RFA
requirements.
Now, not all states have this.
California is a big one thatrelies on this designated
(19:49):
mandated form.
Doctors are required to submitit to the claims adjusters when
they make a recommendation fortreatment, but some of these
doctors aren't even aware of theexistence of the form, so part
of that solution is to traindoctors.
But, at the same time, why notallow doctors to make a request
(20:10):
using their standard medicalreport form, as long as they
provide the rationale for thetreatment right?
And many doctors are doing thisalready, but adjusters are
denying treatment because therequest isn't made on a specific
form in a specific format.
So some of these things likethe carriers will push back and
(20:32):
say, well, this is ourregulation, you know we have to
do this, and sometimes that'strue.
So some of these things maytake legislative reform before
insurers can make changes.
And I would say one more thingfor insurers is investing in
technology such as electronicmedical records and automated
(20:57):
claim processing platforms, youknow, to help speed up the
system, reduce administrativeoverhead, using integrated
platforms that allow physiciansto quickly submit claims to
check on the status of theirreimbursements, communicate with
the adjusters.
(21:18):
California's Division ofWorkers' Comp e-form system.
This is a state rather than aninsurer system, but it's a
unique shared online portalwhich integrates with insurer
claim management platforms, sothat is something that can help
reduce the burden on you knowthe administrative burden on
(21:39):
physicians.
Speaker 3 (21:41):
Yeah, Okay, this is just pulling right out of the
thin air.
What do you think about anational work comp system rather
than 50 individual ones?
Speaker 2 (21:50):
I have not reflected on that before, todd.
You know you talk about all thedifferent jurisdictions.
Speaker 3 (21:57):
I mean, I understand how it was set up.
I've done I understand, know,100 years ago, when workers work
comp was set up, you know, withall the right intentions, and
it was a much different worldthen, right.
But we work in all 50 stateshere at reemployability and so
we have 50 different bona fidejob offer letters that we sent
(22:18):
out, so that it's everything isjurisdictionally in line with
what it's supposed to be.
And you talk about therequirements of California
versus the requirements of astate like Florida, where we are
, and you talk about red tapeand just doing what makes sense.
It seems like sometimes there'sso many things that hold us up
(22:40):
that could so benefit humanbeings that we hold up because
and I understand we want to makesure that the right thing's
being done and people are beingtaken care of and that there's
less fraud than than could be.
Right, that this, as you, asyou pull back restrictions, the
more opportunity there is forhuman beings to be human beings
(23:01):
and fraud to creep up and peopletake advantage of the system.
But but at the end of the day,it seems like what you're saying
is it's red tape on the side ofthe doctors that is prohibiting
them from doing what they'resupposed to be doing, and it's
red tape on the side of theinsurance adjusters that are
prohibiting them from being ableto do.
(23:21):
What seems like the right thingto do is if we could come
together and just kind of freethat up.
It seems like we'd be doing alot of good for a lot of
different people.
Speaker 2 (23:31):
I think in theory, that is an awesome idea.
Speaker 3 (23:35):
I'm not sure.
Let you and I get together anddo it.
What do you say?
We?
Speaker 2 (23:40):
need to come up with something, todd to help our
legislators across the country.
Yeah, that would definitelyhelp streamline, for sure.
Speaker 3 (23:51):
So what about tips and tricks?
You had mentioned some thingsthat you talked to I'm sure you
talked to your clients about, totry to smooth this issue out a
little bit.
Are those mainly the focusesthat you use with your clients
when they're trying to overcomethese hurdles of the physician
shortage?
Speaker 2 (24:11):
Yeah, I would just say, going back to what I said
about what employers can do,that's part of my job is to try
to educate them barriers claimaccount manager to discuss what
their medical provider networklooks like and ask for provider.
(24:41):
You know physician panels ineach of the employer.
You know my client'sgeographical location so that
they can make sure to educatetheir employees before the
renewal date, because you knowthey're going to have an injury
on day one and they're not goingto know what to do.
They're going to be scrambling.
So it's about proactivemeasures and education and yeah,
(25:06):
that's basically what I'mtrying to educate them on.
And we do talk about triage aswell and try to find appropriate
resources there and help ourclients vet the different
providers in that space.
Whether it is, you know, Ialways feel it with the nurse
triage systems.
Start with your carrier, seewhat they have, because
(25:30):
sometimes the carriers aren'tgoing to charge a fee, it's just
rolled into the premium package, right, but then maybe that
program isn't as robust as theclient would like.
So maybe that's when we startto look at outside third-party
vendors.
But beyond that, you know, thisis something we talk about in
claim reviews also, when we haveboth our client and the claims
(25:54):
adjuster present, also, when wehave both our client and the
claims adjuster present.
And if I see a pattern wheretreatment is being delayed
because an adjuster is denyingtreatment because of the doctor
not submitting the right form,the RFA or whatever it is, then
I like to take a step back andlook at it logically and then
(26:18):
discuss should we just, you know, go ahead and honor the
doctor's request from themedical report they provided?
If the rationale is there?
Why do we have to go throughall this rigmarole?
And you're just, you'reprolonging the injured worker's
disability and being out of worklonger, which is affecting
(26:39):
everybody.
It's affecting our you know ourclients business as well, and
so that plays into it.
But yeah, these are the thingsagain that we like to discuss
and claim reviews and try to bereally creative in our strategy.
You know, there's other timeswhere an adjuster might be
really insistent on a claimanttreating within the medical
(27:03):
provider network.
But what if the injured workeris in a remote area and there
are no providers within areasonable geographical distance
?
So that's when we've got tolook at do we want to go outside
the provider network?
It's not the injured worker'sfault that they can't find care
within the network.
So then sometimes we discussnurse case managers.
(27:24):
You know they can be reallyhelpful if there's a delay in
treatment and coordinating care,and they can also help bridge
the gap in communication issuesbetween the different parties.
So we talk about that strategyas well.
Speaker 3 (27:41):
So one final question I'm curious how would you, what
kind of advice would you, giveto an injured worker?
How would what's the best wayfor them to advocate for
themselves when they're perhapssee themselves in a situation
where they're not getting themedical care that they're
supposed to be getting?
Speaker 2 (27:59):
The best advice I can give is to really be their own
advocate and maybe pretend likethey're trying to help their
elderly parents.
You know we often are better atadvocating for our loved ones
than we are for ourselves.
(28:22):
So what would you do if yourelderly sick mother or father is
not able to get treatment orthey're not getting treatment
authorized and they're notgetting responses from the
insurance company or the doctor?
You step in for them and youescalate issues.
So for injured workers, theycan go back to their employer
for help.
They can go to their adjuster.
(28:43):
Really, the adjuster is thefirst person they can talk to
and a lot of times there'smiscommunication between
adjusters and doctors and it'sno one's fault.
It's maybe the injured workerjust went to a medical
appointment and the doctor tellsthem verbally I want you to
have an MRI, and the injuredworker expects that MRI to be
(29:05):
authorized immediately.
Well, what if the adjusterdoesn't have that information
yet?
They often don't because thedoctor can tell the injured
worker verbally what theyrecommend, but then they have to
put it in a report and thattakes time for the doctor and
that's often delayed.
So that's another thing is likeif the injured worker can just
get on the phone with theadjuster, don't go out and get
(29:27):
an attorney.
That's not going to help,that's just going to delay
everything and make the problemworse.
And you know, call the adjuster.
If you can't get through to theadjuster, call your employer,
escalate it to the next level.
Speaker 3 (29:41):
Yeah, communication is key in all points of this
from every direction.
It's all about communication,for sure, and Debbie, we were
talking.
You said that you know havingtalked about this has kind of
prompted you to do some research, to perhaps write an article
about the physician shortage.
Where are you?
(30:01):
Have you been published?
Where have your articles been,if people want to look you up
and read some more about otherthings that you've written on?
Speaker 2 (30:08):
So people can go to.
They can either look me up onLinkedIn Debbie Hammer, woodruff
Sawyer.
They can either look me up onLinkedIn, debbie Hammer,
woodruff Sawyer, or they canlook at our website,
woodruffsawyercom and find ourinsights blog and then do a
search by name or by area.
Claims is one of those areasand usually people can find my
(30:30):
articles there, either on ourblog, our insights blog, or on
LinkedIn.
Speaker 3 (30:35):
You have incredible insights and I really appreciate
you coming on and being with us.
It's such a pleasure to talk toyou and I hope you come back
again in a couple weeks, months,maybe another time over the
summer.
You may get back with us.
Speaker 2 (30:47):
Thank you so much, Todd.
Speaker 1 (30:50):
Thanks for listening to REA Audio.
I hope we opened up your braina bit and helped you be better
at what you do.
Please follow us on Spotify,apple Podcasts, stitcher, amazon
Music or wherever you get yourpodcasts.
If you have input orsuggestions, email Todd at
reemployabilitycom.
Be grateful and have afantastic rest of your week.
How do you get better at what you do?
Speaker 2 (00:02):
Time management assistance.
Speaker 3 (00:03):
AI.
Speaker 2 (00:03):
Webinars Mentors.
Open platforms like CourseraLive and virtual Live training,
live course Live training.
Speaker 1 (00:07):
Live course, live training Live training Live
training, live training, livetraining, live training, live
training, live training, livetraining, live training, live
training.
Speaker 3 (00:26):
Whoa, tell me a little bit about what you've
been up to.
You've been a guest with REAAudio a couple times in the past
.
We've done some webinarstogether and I just so
appreciate your take on thingsand kind of your position on
things.
You're able to take some ofthese work comp issues that we
talk about and go really deep onthem, and so I'm really glad
(00:48):
that you've come back as a guestand really interested in what
you're up to now.
Debbie at Woodruff Sawyer.
Speaker 2 (00:53):
Great, yeah, thanks, todd.
Thanks for having me on again.
I love your show and I lovebeing on and talking about all
of these important issues andgoing into deep dives and so
yeah, so let's see where can Istart.
You know, I know you'refamiliar with my background a
little bit.
I've been in workers' comp forabout 35 years.
(01:19):
I've been with Woodruff Sawyerfor 19 of those years and what I
do at Woodruff Sawyer is I'm aclaims consultant and advocate
for our clients.
I'm basically a liaison betweenour clients and their claims
adjusters on the carrier side,and I get involved anywhere from
(01:39):
the onboarding process when wehave a new client or we have a
client who is changing carriers,and I get the team together to
make sure that we've got specialhandling instructions in place
and everybody understands themand is comfortable with them to
then getting involved in claimoversight and management.
(02:01):
I help out with reservestrategy, settlement strategy,
return to work strategy.
As you know, I have someclients who are involved with
re-employability and yournot-for-profit programs, and so
basically, we have claim reviewswith our clients and meetings
to discuss statuses and actionplans on the open claims.
(02:22):
And then we also get involvedwith, or I get involved with
XMOD projections to help ourclients with forecasting and
budgeting, understanding wheretheir premium might lay on the
next year, based on their claims, and so that's basically what I
do here.
Speaker 3 (02:41):
There's a lot of things that are involved with
what you do.
Obviously, do you work inspecific industries, or is there
a specific type of client thatyou work with at Woodruff Shore?
Speaker 2 (02:53):
Not really.
We have some claims consultantshere who are a little bit more
specialized in their focus.
We have someone who does a lotof construction accounts and
then we have people who areinvolved in tech accounts.
I tend to be sort of themulti-practice person here.
(03:15):
I have a lot of different areasand I love that.
I love being able to handleconstruction accounts, and then
I have a handful of tech riskmanagement very large deductible
accounts or accounts that areself-insured, and that's very
different from working onsmaller accounts who are on, say
, a guaranteed cost program andthere's different strategies
(03:38):
involved.
And I love working with thedifferent personalities, with
different types of clients small, large and whatever their
industry area is.
It's it makes it more fun and Ithink I learn more as well Just
seeing how different types ofcompanies and industries handle
things differently, and that's,you know, that's really
(04:01):
interesting to me.
That's really interesting to me.
Illuminating.
Speaker 3 (04:04):
And I'm sure you learn, right, that's one of the
things I like about being ableto travel and talk to our
clients that are in verydifferent industries is that you
can learn so much just fromlearning what one organization
does and you can then help, kindof be a resource to other
people as you talk to, even indifferent industries, right?
A lot of best practices goacross industries and I'm sure
(04:30):
through your experiences and thetime that you've been there.
Speaker 2 (04:32):
You've been able to absorb a lot of things and share
that information with yourclients, haven't you?
Absolutely, Completely agreewith you on that?
Speaker 3 (04:35):
So what are you seeing as trends now in workers'
comp as you're talking to yourclients?
Are there specific things thatare creeping up that maybe
you've seen creep up in yearspast, or new things happening
that are starting to kind ofdraw your attention to?
Speaker 2 (04:50):
So one of the things our team has been talking about
lately is an uptick in physicianshortages in workers' comp, and
that has got me reallyinterested in why why that's
occurring and where is itoccurring.
Is it geographically specificor is it type of specialty?
(05:15):
So there's a lot going on withthat and, you know, I think
there's a lot of interestingreasons and maybe a convergence
of factors that are all causingthis.
Speaker 3 (05:28):
So if we step back for a second, can you explain a
little bit?
And it may seem obvious, but ifyou could just kind of lay out
like how does that negativelyimpact a claim and from a you
know, risk manager standpointsomebody who is trying to keep
their X mod as low as possibleand trying to move claims to
closure as quickly as possibleand safely as possible and get
(05:50):
their employees back to work anddo all the right things how
does a physician shortage affectthat?
Speaker 2 (05:57):
So I think it affects both injured workers and
employers negatively, and themost significant impact is going
to be felt by the employeesbecause they need to rely on
prompt and effective medicalcare to recover from their
injuries and return to work.
(06:18):
Without an adequate number ofphysicians that are willing to
provide treatment, employees areforced to wait longer for
appointments, they getinadequate or, in some cases, no
care at all.
And the other thing I find isthe lack of quality care can
result in misdiagnosis andinappropriate treatment for the
(06:39):
wrong condition.
I've seen cases where aninjured employee was provided
physical therapy for theirshoulder and then it turns out
much later that the problem wasactually not the shoulder at all
but a herniated disc in theneck, causing radiating pain
down the upper extremity.
That could have been caughtearly on if there had been
(07:01):
proper triage, diagnostics andspecialty consultation.
So that's one area, and I thinkyou know that it's important to
note that the delay intreatment is also affecting not
just the injured worker'sphysical recovery but their
financial stability and theirmental health.
(07:21):
So many employees are unable toreturn to work for extended
periods.
It puts their livelihoods atrisk and you know it can lead to
long-term disability, prolongedsuffering chronic pain and then
a feeling of hopelessness andfrustration starts to set in.
So that's the other thing we'vebeen seeing.
Related is and there's manyreasons for this not just the
(07:45):
physician shortage, but the morecomplex an injury is and lack
of care and all these otherfactors it can lead into site
claims.
So we have seen another.
You know another problem there.
That's probably the subject ofanother conversation.
Speaker 3 (08:03):
Yeah, yeah, I mean, it is all connected.
So are you seeing more peoplejust not get the treatment that
they need, or are they gettingtreatment from you know, like I
know myself, I've gone to.
I got a new doctor a couple ofyears ago and I've never seen
him.
I always see the EA, which isfine, she's wonderful, she's
(08:25):
super nice, she seems veryknowledgeable.
I'm in pretty good health, sothat's okay.
But it's not just in workers'comp, right?
I'm in Florida and there's alot of people here and I've seen
it too.
Growing up as a kid we went tothe local doctor.
His office was in the firstfloor of an old house, right,
great guy.
His office was in the firstfloor of an old house, right,
great guy.
Family doctor.
(08:45):
But now it seems like it's allcorporately owned, or you're
going to an urgent care orsomething like that.
So you know, I've seen it justin my own, in my own life.
And so in work comp and forpeople that might not understand
this at this point, in mostcases I am asked to go to a
specific doctor by my employer.
(09:07):
Is that correct?
Speaker 2 (09:08):
Yes In workers' compensation.
If you are injured, you wouldbe directed, if it's handled
appropriately like it should be,to an occupational physician,
not your personal care physician.
That is true in, as far as Iknow, all states across the
country.
There's varying regulations anddifferences there across states
(09:33):
.
But yeah, employees do not seetheir personal care doctors and
workers comp anywhere.
Speaker 3 (09:40):
They're not supposed to.
Right, they're not supposed to,but why is that?
And why is that?
They're not supposed to?
Right, they're not supposed to,but why is that?
Speaker 2 (09:45):
That is just the way that the system is set up, so
that there is cost containmentand there's medical control.
I don't know that that meansthat there isn't medical control
and cost containment outsidethe work comp system, but work
comp is just a unique area ofspecialty, and so the whole
(10:07):
reason behind having medicalprovider networks is to control
costs and control the system andbe balanced and fair for both
employers and their injuredworkers.
Speaker 3 (10:24):
So do you feel like this lack or the physician
shortage is due to physiciansjust not wanting to get into the
workers comp world, or is it anissue of, like, fewer
physicians coming out of schoolnow?
Speaker 2 (10:39):
I think it's a lot of different reasons and it's
interesting.
I mean, I could talk a longtime on this and you can feel
free to cut me off?
Speaker 3 (10:50):
No, not at all, it's interesting.
Speaker 2 (10:52):
So I think again there's multiple reasons and
they are all converging at once.
One of the things that peopledon't talk about much in comp in
terms of the physician shortageis how there's a domino effect
from the Dobbs decision, whichoverturned Roe v Wade.
So obviously this has decreasedstudent motivation to pursue
(11:16):
medical careers in the OBGYNarea.
But did anybody think thisdecision would be so far
reaching as to extend toworkers' comp medical care?
And the link is the Dobbsdecision decreased student
motivation to apply to medicalschools in states with severely
(11:37):
restrictive abortion rights, forexample the Midwestern, central
and Southern states that weknow of and in turn, this has
reduced medical schoolenrollment and residency
training, leading to the lack ofavailability of practicing
physicians in those states.
So the most significant impactfrom my research has been on
(11:59):
family medicine and emergencyroom care, which affects
treatment for occupationalinjuries, especially when severe
injuries require an emergencyroom visit.
And then there's other areas ofmedicine that have been
affected by this as well,including occupational and
orthopedic specialty care.
(12:19):
So, essentially, physiciandemographics and workforce
patterns have shifted as aresult of this.
But, aside from the Dobbsdecision, the physician shortage
has already been in the makingfor decades because of shifting
demographics.
For other reasons, due to acombination of population growth
(12:41):
, we have an aging population.
Due to a combination ofpopulation growth, we have an
aging population.
We have an aging, nearretirement physician workforce
that is experiencing burnout.
So there's now a higherpercentage of the population
being older the baby boomers,including those older working
physicians, entering theirtwilight years and having
(13:02):
greater and more varied medicalneeds.
And I just want to go back towhat you said.
You know the physician burnout.
Why people are not entering themedical field is because of red
tape.
So and this is both inoccupational and
non-occupational medicinethere's more medical practice
(13:23):
and patient care regulations.
There's more insurance andadministration regulations.
So people enter the medicalprofession to care for patients,
not complete time-consumingreports, right?
So for many physicians, theadministrative hurdles outweigh
the financial and professionalrewards of providing direct care
(13:45):
and advocacy for patients.
The other problem isreimbursement rates.
Reimbursement rates are lessthan they used to be and they
are less in workers' comp thanthey are for general, you know,
non-occupational practice.
There's significantly morephysician regulations in
workers' comp.
(14:05):
And, getting back to what wewere talking about earlier, that
is because the system'sdesigned to be fair and balanced
and protect both injuredworkers and employers and to
contain the costs.
But yeah, there's definitelymore.
There's utilization reviewguidelines, evidence-based
(14:27):
treatment guidelines In workers'comp.
Doctors must provide detaileddocumentation about injury
causation and permanentdisability A lot of complex
factors in workers' comp that wejust don't see on the
non-occupational side.
So there's just a lot ofbureaucracy and legalities that
(14:51):
don't help attract and retainphysicians to the field.
Speaker 3 (14:56):
Yeah, and you know, I feel like just that going to
see a doctor now is muchdifferent than what it used to
be, as I recall the just thewhole appointment process and
this is outside of the work compworld, right, this is just
personal experience, you know, Iremember full physicals and you
(15:17):
know more of the experience ofa doctor was less about what
they're seeing in the blood testand more about what you're
actually feeling andexperiencing.
And I feel like it's changed.
And again, I'm not a doctor.
If I was a doctor, I wouldn'tbe doing this interview right
now, right, but I feel like it'sbecome again.
(15:38):
This is just personalexperience, less personal and it
is, and I would imagine, evenso, in a work comp atmosphere,
when there is so much more redtape, so much more reporting
that has to be done, it isalmost like an assembly line and
there's not that personal care,right.
Speaker 2 (15:59):
Yeah, that's a good analogy.
It's an assembly line.
Speaker 3 (16:02):
Yeah, that's a good analogy.
It's an assembly line.
Yeah, so what's being done toovercome this in the short term
from a work comp perspective?
Speaker 2 (16:11):
Well, I think that there's a lot that needs to be
done.
I'm not sure what's actuallybeing done but, I think that
this is a collective effort.
It has to be.
It can't just be one singlegroup alone.
I think that insurers,employers and healthcare
(16:32):
providers, as well aspolicymakers, need to come
together to collaborate and findsolutions, and starting with
employers.
I think that many of them areunprepared.
When an employee suffers aninjury, they don't know where to
direct their employees fortreatment.
Maybe they don't even have theeducation and the knowledge to
(16:54):
know that the treatment can'thappen with that employee's
personal care physician, that ithas to be through a provider
network.
So I think that employers needto be proactive and work with
their carriers up front toobtain provider listings prior
to injuries occurring, so thatthey can educate their workforce
(17:16):
.
If you get injured, here iswhere you go, here is where you
access medical providers forworkers' comp injuries.
So that's one thing I think.
Long term, I feel I'm reallyinto wellness, that whole field,
and I see a connection betweenwellness and workers' comp, and
(17:36):
I know that wellness is hotright now.
I wish more employers wouldconsider offering robust
wellness programs, because theycan reduce the risk of injuries
in the first place, they canreduce the severity of injuries
when they happen and that isgoing to reduce the strain on
workers' comp.
(17:57):
So I think that's one area.
Nurse triage services is anotherpopular area.
I think that can be effective.
These nurse triage services areoffered through either work
comp carriers A lot of them arestarting at their own in-house
program or third-party vendors,and these nurses can assist in
(18:21):
proper diagnosis at the time ofinjury and help determine the
best medical care.
A lot of times they canestablish that an injury is not
severe as initially thought andthat the injury really may only
require over-the-counter orat-home treatment and avoid the
need to find a doctor altogether.
Telehealth is another goodoption, and not in all cases,
(18:45):
but sometimes we find thatinjuries that used to be
required to be evaluated by anin-person physician could be
addressed by telehealth and orby a physician assistant.
You know that can improve theappropriateness of treatment
based on accurate diagnostictesting and referrals to
(19:07):
specialty consultations.
I think on the carrier side,what insurers can do and allow
(19:27):
greater leniency for adjustersto approve medical treatment and
diagnostics and related to that, another possibility is to
amend the Request for TreatmentAuthorization form, the RFA
requirements.
Now, not all states have this.
California is a big one thatrelies on this designated
(19:49):
mandated form.
Doctors are required to submitit to the claims adjusters when
they make a recommendation fortreatment, but some of these
doctors aren't even aware of theexistence of the form, so part
of that solution is to traindoctors.
But, at the same time, why notallow doctors to make a request
(20:10):
using their standard medicalreport form, as long as they
provide the rationale for thetreatment right?
And many doctors are doing thisalready, but adjusters are
denying treatment because therequest isn't made on a specific
form in a specific format.
So some of these things likethe carriers will push back and
(20:32):
say, well, this is ourregulation, you know we have to
do this, and sometimes that'strue.
So some of these things maytake legislative reform before
insurers can make changes.
And I would say one more thingfor insurers is investing in
technology such as electronicmedical records and automated
(20:57):
claim processing platforms, youknow, to help speed up the
system, reduce administrativeoverhead, using integrated
platforms that allow physiciansto quickly submit claims to
check on the status of theirreimbursements, communicate with
the adjusters.
(21:18):
California's Division ofWorkers' Comp e-form system.
This is a state rather than aninsurer system, but it's a
unique shared online portalwhich integrates with insurer
claim management platforms, sothat is something that can help
reduce the burden on you knowthe administrative burden on
(21:39):
physicians.
Speaker 3 (21:41):
Yeah, Okay, this is just pulling right out of the
thin air.
What do you think about anational work comp system rather
than 50 individual ones?
Speaker 2 (21:50):
I have not reflected on that before, todd.
You know you talk about all thedifferent jurisdictions.
Speaker 3 (21:57):
I mean, I understand how it was set up.
I've done I understand, know,100 years ago, when workers work
comp was set up, you know, withall the right intentions, and
it was a much different worldthen, right.
But we work in all 50 stateshere at reemployability and so
we have 50 different bona fidejob offer letters that we sent
(22:18):
out, so that it's everything isjurisdictionally in line with
what it's supposed to be.
And you talk about therequirements of California
versus the requirements of astate like Florida, where we are
, and you talk about red tapeand just doing what makes sense.
It seems like sometimes there'sso many things that hold us up
(22:40):
that could so benefit humanbeings that we hold up because
and I understand we want to makesure that the right thing's
being done and people are beingtaken care of and that there's
less fraud than than could be.
Right, that this, as you, asyou pull back restrictions, the
more opportunity there is forhuman beings to be human beings
(23:01):
and fraud to creep up and peopletake advantage of the system.
But but at the end of the day,it seems like what you're saying
is it's red tape on the side ofthe doctors that is prohibiting
them from doing what they'resupposed to be doing, and it's
red tape on the side of theinsurance adjusters that are
prohibiting them from being ableto do.
(23:21):
What seems like the right thingto do is if we could come
together and just kind of freethat up.
It seems like we'd be doing alot of good for a lot of
different people.
Speaker 2 (23:31):
I think in theory, that is an awesome idea.
Speaker 3 (23:35):
I'm not sure.
Let you and I get together anddo it.
What do you say?
We?
Speaker 2 (23:40):
need to come up with something, todd to help our
legislators across the country.
Yeah, that would definitelyhelp streamline, for sure.
Speaker 3 (23:51):
So what about tips and tricks?
You had mentioned some thingsthat you talked to I'm sure you
talked to your clients about, totry to smooth this issue out a
little bit.
Are those mainly the focusesthat you use with your clients
when they're trying to overcomethese hurdles of the physician
shortage?
Speaker 2 (24:11):
Yeah, I would just say, going back to what I said
about what employers can do,that's part of my job is to try
to educate them barriers claimaccount manager to discuss what
their medical provider networklooks like and ask for provider.
(24:41):
You know physician panels ineach of the employer.
You know my client'sgeographical location so that
they can make sure to educatetheir employees before the
renewal date, because you knowthey're going to have an injury
on day one and they're not goingto know what to do.
They're going to be scrambling.
So it's about proactivemeasures and education and yeah,
(25:06):
that's basically what I'mtrying to educate them on.
And we do talk about triage aswell and try to find appropriate
resources there and help ourclients vet the different
providers in that space.
Whether it is, you know, Ialways feel it with the nurse
triage systems.
Start with your carrier, seewhat they have, because
(25:30):
sometimes the carriers aren'tgoing to charge a fee, it's just
rolled into the premium package, right, but then maybe that
program isn't as robust as theclient would like.
So maybe that's when we startto look at outside third-party
vendors.
But beyond that, you know, thisis something we talk about in
claim reviews also, when we haveboth our client and the claims
(25:54):
adjuster present, also, when wehave both our client and the
claims adjuster present.
And if I see a pattern wheretreatment is being delayed
because an adjuster is denyingtreatment because of the doctor
not submitting the right form,the RFA or whatever it is, then
I like to take a step back andlook at it logically and then
(26:18):
discuss should we just, you know, go ahead and honor the
doctor's request from themedical report they provided?
If the rationale is there?
Why do we have to go throughall this rigmarole?
And you're just, you'reprolonging the injured worker's
disability and being out of worklonger, which is affecting
(26:39):
everybody.
It's affecting our you know ourclients business as well, and
so that plays into it.
But yeah, these are the thingsagain that we like to discuss
and claim reviews and try to bereally creative in our strategy.
You know, there's other timeswhere an adjuster might be
really insistent on a claimanttreating within the medical
(27:03):
provider network.
But what if the injured workeris in a remote area and there
are no providers within areasonable geographical distance
?
So that's when we've got tolook at do we want to go outside
the provider network?
It's not the injured worker'sfault that they can't find care
within the network.
So then sometimes we discussnurse case managers.
(27:24):
You know they can be reallyhelpful if there's a delay in
treatment and coordinating care,and they can also help bridge
the gap in communication issuesbetween the different parties.
So we talk about that strategyas well.
Speaker 3 (27:41):
So one final question I'm curious how would you, what
kind of advice would you, giveto an injured worker?
How would what's the best wayfor them to advocate for
themselves when they're perhapssee themselves in a situation
where they're not getting themedical care that they're
supposed to be getting?
Speaker 2 (27:59):
The best advice I can give is to really be their own
advocate and maybe pretend likethey're trying to help their
elderly parents.
You know we often are better atadvocating for our loved ones
than we are for ourselves.
(28:22):
So what would you do if yourelderly sick mother or father is
not able to get treatment orthey're not getting treatment
authorized and they're notgetting responses from the
insurance company or the doctor?
You step in for them and youescalate issues.
So for injured workers, theycan go back to their employer
for help.
They can go to their adjuster.
(28:43):
Really, the adjuster is thefirst person they can talk to
and a lot of times there'smiscommunication between
adjusters and doctors and it'sno one's fault.
It's maybe the injured workerjust went to a medical
appointment and the doctor tellsthem verbally I want you to
have an MRI, and the injuredworker expects that MRI to be
(29:05):
authorized immediately.
Well, what if the adjusterdoesn't have that information
yet?
They often don't because thedoctor can tell the injured
worker verbally what theyrecommend, but then they have to
put it in a report and thattakes time for the doctor and
that's often delayed.
So that's another thing is likeif the injured worker can just
get on the phone with theadjuster, don't go out and get
(29:27):
an attorney.
That's not going to help,that's just going to delay
everything and make the problemworse.
And you know, call the adjuster.
If you can't get through to theadjuster, call your employer,
escalate it to the next level.
Speaker 3 (29:41):
Yeah, communication is key in all points of this
from every direction.
It's all about communication,for sure, and Debbie, we were
talking.
You said that you know havingtalked about this has kind of
prompted you to do some research, to perhaps write an article
about the physician shortage.
Where are you?
(30:01):
Have you been published?
Where have your articles been,if people want to look you up
and read some more about otherthings that you've written on?
Speaker 2 (30:08):
So people can go to.
They can either look me up onLinkedIn Debbie Hammer, woodruff
Sawyer.
They can either look me up onLinkedIn, debbie Hammer,
woodruff Sawyer, or they canlook at our website,
woodruffsawyercom and find ourinsights blog and then do a
search by name or by area.
Claims is one of those areasand usually people can find my
(30:30):
articles there, either on ourblog, our insights blog, or on
LinkedIn.
Speaker 3 (30:35):
You have incredible insights and I really appreciate
you coming on and being with us.
It's such a pleasure to talk toyou and I hope you come back
again in a couple weeks, months,maybe another time over the
summer.
You may get back with us.
Speaker 2 (30:47):
Thank you so much, Todd.
Speaker 1 (30:50):
Thanks for listening to REA Audio.
I hope we opened up your braina bit and helped you be better
at what you do.
Please follow us on Spotify,apple Podcasts, stitcher, amazon
Music or wherever you get yourpodcasts.
If you have input orsuggestions, email Todd at
reemployabilitycom.
Be grateful and have afantastic rest of your week.
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