Illness and the workplace: a study of physicians and employers

Seven million patients with work-related injuries are seen annually in the United States, the majority by primary care physicians. The number of such patients seen in a typical community practice may be significant but has never been studied. Most community-based physicians have little or no formal training in occupational health care. This study consisted of a survey of practicing physicians and major industrial employers in a city of 39,000 with a strong manufacturing base. The purpose was to assess physician skills, attitudes, and practices that might influence the optimal management of patients with work-related conditions, and to assess employer attitudes about this management. Eighty-three percent of physicians and 68% of employers responded to the written surveys. Low numbers of patients with work-related conditions were reported except by orthopedists and a neurologist. Few physicians communicated directly with employers, citing time and confidentiality as factors. Twenty-five percent were unaware of specific legal guidelines for such contact. Administrative and legal complexities were cited by 97% of the respondents as barriers to effective management of such cases. Eight percent of employers sought more contact with physicians, including site visits and more detailed work restriction guidelines. The education of primary care physicians may improve their understanding of work-related conditions and the optimal management and rehabilitation of these patients.