According to the U.S. Department of Labor, businesses spend $170 billion a year on costs associated with occupational injuries and illnesses, which greatly impacts their profitability.
My job as a certified physician assistant (PA-C) in occupational medicine is to help keep employees healthy and save employers money. It requires a commitment to evidence-based medicine and a strong background of clinical education and experience.
Employers need safe, cost-effective, objective ways to evaluate potential employees’ physical abilities to identify those not suited for the position they seek. As a certified PA, I render a medical judgment that allows employers to make those decisions.
The post-offer physical exam
Post-offer physical exams are done after an applicant has been offered a job to determine whether individuals are physically capable of performing essential job functions without risk to themselves or others. We strive to place and maintain employees in an occupational environment adapted to their physiological and psychological capacities.
As a PA in occupational medicine, I must have detailed knowledge of occupational and health conditions. I need to be familiar with the work environment and assess a person’s ability to work in that environment without experiencing an injury. This process can protect the potential employee from predictable injury and save the employer money by preventing an injury and keeping workers’ compensation premiums low.
My patients trust me, in part, due to my familiarity with what they do. I have toured multiple industrial facilities, including foundries, transformer companies and plastics manufacturers, which gives me a clear understanding of the various positions applicants are seeking. For instance, I’m familiar with what a tool and die maker or CNC (computer numerically controlled) machine operator does and the physical demands of those jobs.
Pre-employment physicals are important in establishing a baseline of someone’s personal health condition, such as back pain or carpal tunnel syndrome. If an employee experiences an injury at work, we have a well-documented exam of their baseline before the injury. This helps us know how to manage their conditions and return them to that baseline. It can also provide essential information when incidents do occur and decisions need to be made as to whether an injury was work-related or not.
The first step to reducing risk is through “bread and butter medicine” — a thorough physical exam and detailed medical history. Applicants fill out a health questionnaire, and I conduct a more thorough line of questioning. This enables me to better evaluate any personal health conditions that may affect their performance or safety.
Not too long ago, a man applying for a carpenter position came to his physical exam wearing a heart monitor and a knee brace. According to his health questionnaire, he had no health problems. When I inquired about the heart monitor, he admitted to having atrial fibrillation — a heart condition whereby the heart beats irregularly and fast, which can cause dizziness, fainting or stroke. When I asked about the knee brace, he reported it was for his knee surgery he had two weeks ago. After my evaluation and review of his job description I was able to determine his medical conditions posed a direct threat to his safety and others.
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Detecting what’s real in Workers’ Compensation claims
Certified PAs are vital in the Workers’ Compensation area. When evaluating a work-related injury, gathering all of the correct data is essential. In most states, including the one in which I work, PAs are not permitted to determine final causation of an injury. However, by establishing a strong working relationship with a knowledgeable supervising physician, I can gather the information and work collaboratively with him to determine causation.
The process of determining whether an injury is work-related is like detective work. For example, I once evaluated a man who came in with symptoms of hand pain, numbness and tingling. He claimed to have developed bilateral carpal tunnel by using vibratory hand tools during his three months of employment. His health history included high blood pressure, high cholesterol and diabetes (a strong risk factor for developing carpal tunnel). The patient alleged that he used these hand tools “repetitively” and “all day long.” His employer’s safety representative was able to help me quantify how much time he was actually using hand tools — 42 seconds per day. Nerve testing confirmed carpal tunnel; however, it was my opinion that 42 seconds per day over a three-month time period was not sufficient “exposure” to develop carpal tunnel on both sides. Gathering a thorough history — and working with employers’ safety representatives to collect all necessary data — are imperative to a thorough assessment of workplace injuries and determining causation.
Quality care is another priority. Throughout the post-offer physical process, the patients and I discuss wellness and prevention. I also encourage early reporting of injuries. Early reporting can limit the severity of the injury, increase the effectiveness of treatment and minimize the likelihood of disability. It can also enable employers to identify work areas or tasks where injuries are more frequent or severe and make adjustments.
In occupational medicine, some PAs also work at on-site clinics, providing services such as wellness checks and conducting immunization clinics. On-site PAs can assess employees’ symptoms before they become an injury and evaluate and manage injuries as soon as they occur.
Employing PAs to perform the post-offer physical exams, assess workers’ comp claims or deliver care at on-site clinics are ways companies can provide quality care to employees in a cost-effective manner and a reason that certified PAs are increasing in numbers as valued resources on the occupational medicine health care team.
Alicia Kelch is a certified physician assistant in Wisconsin. She is employed by U.S. HealthWorks, an urgent care and occupational healthcare provider that employs 200 PAs — in addition to physicians — at 190 freestanding medical clinics and 32 on-site clinics in 20 states.
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