Workers’ compensation (comp) makes up 20 percent of the general orthopaedist’s practice, 65 percent of a hand surgeon’s practice, and 90 percent of the independent medical examiner’s practice.

Although orthopaedists have unique training in diagnosing and treating musculoskeletal conditions, their formal training in the sciences of epidemiology, biomechanics, ergonomics, impairment evaluation, disability management, workplace prevention, and medical-legal testimony has been limited. For this reason, the AAOS annually sponsors “Occupational Orthopaedics and Workers’ Compensation: A Multidisciplinary Perspective.” This year, the course will be held in early November in Chicago.

Treatment outcomes
Is treating the workers’ comp patient different than treating a local athlete? In both cases, the final outcome measure of success is whether the patient returned to the same job—to the same employer/position or the same sport/position. But patients can differ in their level of motivation to return to work or sport. This motivation issue can sometimes make treating the workers’ comp patient difficult for physicians.

Know the rules
State and federal laws governing workers’ comp and determining compensability (legislative criteria), how and which treatments are allowed (treatment guidelines), and employer requirements are rapidly changing. Because more than 50 percent of workers will have an occupational injury during their careers, orthopaedists who treat work-related injuries must understand how these programs work and how these programs will affect their patients and their practice.

The advent of federal healthcare reform is placing new attention on legislated health care and injury prevention in the workplace—topics that are not taught during residency training.

Measuring up
Physicians who treat workers’ comp patients may find it difficult to know how they are being judged. Insurance carriers and employers assess physicians based on four factors: how the physician determines causation; how the physician provides medical treatment for the injured worker; the physician’s ability to provide early and safe return-to-work options; and the physician’s “Disability Duration,” which is the employee’s actual length of time off work.

Disability duration
Disability durations are now tracked and reported for each physician and collected as a composite. This creates a “report card” for each physician, even if the physician is unaware that he or she is being “graded.” These report cards can then be used to measure a physician’s disability durations compared to the national “average.”

What to do
Outcomes based on successful return to work have been supported by the AAOS, the American Medical Association, the American College of Occupational and Environmental Medicine, the California Orthopaedic Association, and others. To decrease disability durations and increase a patient’s chances of successfully returning to work, orthopaedic surgeons need to develop additional communication and negotiation skills. Filling the knowledge gap with continuing education courses remains the key to improving occupational orthopaedics and the associated benefits to the injured worker and society.

The AAOS course, “AAOS Occupational Orthopaedics & Workers’ Compensation: A Multidisciplinary Perspective,” is designed to provide fresh perspectives on treatment options, patient care management, and strategies for handling both nonmedical and medical issues associated with treating workers’ compensation patients. This year’s course will also focus on musculoskeletal imaging techniques and interpretation. For more information, visit www.aaos.org/courses

J. Mark Melhorn, MD, is the course director for the AAOS course “Occupational Orthopaedics & Workers’ Compensation: A Multidisciplinary Perspective.”