The silent struggle: GPs and the workers’ compensation system
By Dr Steven Kaye. This article was originally published in the RACGP's newsGP on 29 October 2024. Click here to read the full article and related commentary.
Image: pixabay.com, Creative Commons Licence
When workers are injured or ill as a result of work, we as GPs play a pivotal role in supporting them back to optimum function and employment.
Supporting injured workers and their families and facilitating their return to good meaningful work has been a personal passion throughout my career.
I have long advocated for system improvements and standardisation of scheme administration to better support and encourage GP participation in this valuable and rewarding work.
Currently, I work with the university sector delivering education for medical trainees on supporting injured workers.
Handling an overwhelming 80–90% of cases, our role as GPs extends far beyond initial assessments and certificates of capacity, encompassing ongoing care, coordination with specialists, allied health, employers and insurance companies, and facilitation of return-to-work processes.
However, it is not without its challenges.
The current system often fails to recognise the complexity and importance of this work, with impacts for both our profession and the patients we’re supporting.
Acknowledging these challenges is vital as a first step to improving the workers compensation system for better patient outcomes and to encourage more GPs to participate.
At the core of effective social insurance systems lie trust and cooperation.
These fundamental values are critical in addressing the challenges.
Challenge one: Time constraints and financial pressures
One of the most significant hurdles we face interacting with the workers’ compensation system is the conflict between the time required for proper patient care and the financial realities of being a GP.
The current fee-for-service model encourages a high-volume, quick-turnover approach to patient care.
However, a thorough initial review of a workers’ compensation patient typically requires at least 30 minutes – a Level C (item 37) or D (item 44) long consultation.
This time investment is crucial for understanding the nature of the injury, its impact on the worker’s ability to perform their job and developing an appropriate treatment and return-to-work plan.
Unfortunately, the current system does not adequately compensate GPs for this additional time and effort, creating a disincentive for thorough, quality care.
Challenge two: Lack of clear guidance and communication
We often find ourselves navigating a complex workers’ compensation system without clear guidance on what is expected.
There seems to be a disconnect between what the system wants and what is feasible within the constraints of our practice.
For instance, the system may expect unfettered rapid access to GPs by workplaces, a focus on return-to-work outcomes, without providing a supportive framework to achieve this or ready access to allied health services, which is often not possible due to high demand, particularly in mental health.
This lack of clear guidance leads to frustration and inefficiencies, as we struggle to meet unclear or unrealistic expectations.
Challenge three: System-induced psychosocial distress
The workers’ compensation system, with its inherent delays and disputes, often inadvertently contributes to increased psychosocial distress among injured workers.
This systemic issue creates a cascading effect that significantly impacts GP consultations.
As workers navigate the complex and sometimes frustrating claims process, they may experience heightened anxiety, stress, and demoralisation.
Consequently, consultations become longer and more complex, requiring a higher level of skill to manage patients who are often frustrated or disheartened by their experiences with the system.
These extended consultations demand that we not only address the physical aspects of the work-related injury but also manage the psychological toll of dealing with the compensation process itself.
Effective GPs must employ advanced communication skills and empathy to reassure patients, explain delays, and maintain a therapeutic alliance despite system-induced setbacks.
This additional layer of care, while crucial for the worker’s overall wellbeing, is rarely recognised or compensated adequately within the current fee structure.
The increased emotional labour and time investment required from GPs in these situations further strains their already limited resources.
Challenge four: Administrative burden and payment delays
The administrative load associated with workers’ compensation cases is significantly higher than that of regular patient care.
GPs and the practice team often spend considerable time navigating paperwork, communicating with insurers, and following up on treatment approvals.
This increased administrative burden takes time away from patient care and adds stress to already busy practices.
Moreover, many GP practices report significant delays in receiving payments from insurers for workers’ compensation cases.
These delays can stretch into months, forcing practices to allocate valuable staff resources to chase outstanding payments.
This not only impacts the financial stability of practices but also creates a disincentive for GPs to take on workers’ compensation cases.
Challenge five: Software and technology limitations
There are known software and technology limitations within practice software which can add complexity and limits the ease with which we can share information with relevant insurers.
This lack of tailored software and interoperability is an impediment to effective and efficient practice.
Challenge six: Mental health referrals and expertise
The current model of care for mental health issues in workers’ compensation cases often involves direct referrals to psychologists, some of whom may lack experience with compensation claims, potentially leading to suboptimal outcomes.
As GPs we often have long-standing relationships with our patients and a comprehensive understanding of their health history but are not adequately utilised in this process.
Challenge seven: Workload and quality of care
The most experienced and skilled GPs in managing workers’ compensation cases often find themselves overwhelmed with work.
This creates a paradoxical situation where these doctors are less available, while those with less experience or interest in workers’ compensation may be more accessible.
This scenario is counterproductive to the goal of providing high-quality care and achieving optimal return-to-work outcomes.
Challenge eight: Cultural and linguistic diversity
The current system does not adequately address the needs of culturally and linguistically diverse (CALD) workers.
There is a lack of matching services to ensure that injured workers can communicate effectively with their healthcare providers, potentially leading to misunderstandings, misdiagnoses, and suboptimal treatment plans.
Challenge nine: Limited collaboration with allied health professionals
Effective treatment of work-related injuries often requires a multidisciplinary approach.
However, many of my colleagues report limited opportunities for collaborative care discussions with allied health professionals, particularly psychologists.
The lack of consistent feedback from these professionals hinders our ability to provide coordinated, comprehensive care to injured workers.
The way forward: Potential benefits of addressing these challenges
Addressing these challenges could yield significant benefits for all stakeholders involved:
- Improved patient outcomes: By allowing GPs the time and resources, including appropriate remuneration, to provide thorough, quality care, injured workers are more likely to receive appropriate treatment, leading to better health outcomes and faster return-to-work times.
- Cost efficiency: While initially requiring greater investment, addressing these challenges could lead to long-term cost savings. Proper initial assessments and treatment plans can prevent the escalation of injuries and reduce the likelihood of prolonged disability.
- Enhanced system efficiency: Clear guidelines, improved communication, and streamlined administrative processes would reduce frustration and inefficiencies, allowing all parties to focus on what matters most – the health and recovery of the injured worker.
- Increased GP participation: By making workers’ compensation cases more manageable and financially viable for GPs, more doctors may be willing to take on these cases, increasing access to care for injured workers.
- Better utilisation of GP expertise: GPs have a unique perspective on their patients’ overall health and work capacity. Leveraging this knowledge more effectively could lead to more tailored and successful return-to-work strategies.
- Improved collaboration: With streamlined service and coordinated support, secondary mental health conditions will be reduced.
- Improved mental health outcomes: By addressing the challenges in mental health referrals and treatment, the system could better support workers with both physical and psychological injuries, potentially reducing the duration and severity of these often-complex cases.