Unemployment and health: physicians' role

Unemployment has been documented to have detrimental impacts on a person's mental, physical and social well being. When unemployment or being out of work is due to injury or sickness, the effects are compounded by mental and social factors. In an effort to prevent prolonged unemployment due to injury or sickness, changes were made to existing disability income supplement plans to redirect their focus from basic income support to active employment measures. This is intended to reduce individual's dependency on financial assistance and encourage individuals to take personal responsibility for getting back to work. The various disability insurance plans require primary care physicians to provide opinion and participate in the recovery and safety return to work of injured or sick persons. The physician approach to medical care of the injured/sick person with employment problems should focus on return to work as a goal of treatment. The patient should be seen as part of a social or environmental system and not as an isolated individual. The physician has a significant role to play in the diagnosis, determining functional abilities and participation in the return to work plan. The physician positive participation, not only provides an intrinsic cost saving value in insurance costs, but more important, helps patients maintain gainful employment. Work often helps in regaining health. Many factors are involved in a return to work outcome and physicians need to know how to identify and track the factors that facilitate or impede return to work. The challenge for the physician is to utilize the available resources to facilitate the recovery and communicate with other parties involved in the return to work process. This paper discusses the disability insurance plans in Canada and the community expectations from physicians dealing with patients who are out of work because of injury or sickness. It is acknowledged that primary care physicians' skills are not adequate in this area and that there is a need for continuing medical education to prepare them for this new role. Relevant topics should be introduced in medical curricula.