ReedGroup, Ltd. (Ms. Wizner and Dr. Gaspar); Boston Medical Center and Boston University School of Medicine, MA (Dr. Berenji); Webility Corporation, Wayland, MA (Dr. Christian). Dr. Harrell is an independent researcher, San Diego, CA. kerri.wizner@mdguidelines.com
Ms. Wizner and Dr. Gaspar are employees of ReedGroup, Ltd., which publishes disability duration guidelines and the American College of Occupational and Environmental Medicine evidence-based medical treatment guidelines.
Drs. Harrell, Berenji, and Christian reported no potential conflict of interest relevant to this article.
Improving the timeliness and quality of your guidance on work disability lessens the impact of health problems on patients’ lives and livelihoods.
› Set appropriate expectations for the patient at the start of any episode of work disability: Estimate the course of functional recovery over time and the total duration of life–work disruption. A
› Include detailed activity prescriptions in the treatment plan, with stepwise progression over time toward full recovery. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented evidence, case series
References
All clinicians who have patients who are employed play an essential role in work disability programs—whether or not those clinicians have received formal training in occupational health. A study found that primary care clinicians are asked to provide guidance about work activities in nearly 10% of their patient encounters; however, 25% of those clinicians thought they had little influence over work disability outcomes.1
In this article, we explain why it is important for family physicians to better manage work disability at the point of care, to help patients return to their pre-injury or pre-illness level of activity.
Why managing the duration of work disability matters
Each year, millions of American workers leave their jobs—temporarily or permanently—because of illness, injury, or the effects of a chronic condition.2 It is estimated that 893 million workdays are lost annually due to a new medical problem; an additional 527 million workdays are lost due to the impact of chronic health conditions on the ability to perform at work.3 The great majority of these lost workdays are the result of personal health conditions, not work-related problems; patients must therefore cope with the accompanying disruption of life and work.
Significant injury and illness can create a life crisis, especially when there is uncertainty about future livelihood, such as an income shortfall during a lengthy recovery. Only 40% of the US workforce is covered by a short-term disability insurance program; only 10% of low-wage and low-skill workers have this type of coverage.4 Benefits rarely replace loss of income entirely, and worker compensation insurance programs provide only partial wage replacement.
In short, work disability is destabilizing and can threaten overall well-being.5
Furthermore, the longer a person remains on temporary disability, the more likely that person is to move to a publicly funded disability program or leave the workforce entirely—thus, potentially losing future earnings and self-identity related to being a working member of society.6-8
Most of the annual cost of poor health for US employers derives from medical and wage benefits ($226 billion) and impaired or reduced employee performance ($223 billion).3 In addition, temporarily disabled workers likely account for a disproportionate share of health care costs: A study found that one-half of medical and pharmacy payments were paid out to the one-quarter of employees requiring disability benefits.9
