A frustrated PA I interviewed recently told me a story that really burns me on two levels:

  1. Inconsistency and discontinuity in urgent care practice
  2. Bad worker’s compensation return to work policy

And a 3rd is probably lack of management support for a rational clinical decision.


The story went something like this:

A worker was seen for a worker’s compensation low back injury by his supervising physician and owner of the urgent care center on a Thursday.  He was kept off duty from work, although his job did not require significant lifting, and was given a follow up appointment for the following Monday.

This PA was on duty on Monday and saw the patient.  When asking how the patient felt he said “fine, no more pain” and his examination revealed that he could touch his palms to the floor and had no physical limitations.  So the PA said “great, I’ll let you get back to work.”

But the worker said “Oh, no I can’t return to work yet, I have to be out for 8 days!”  (In order to collect time loss under this perverse disincentive rule for Connecticut worker’s comp).  The PA dutifully explained that the decision to return to work is made solely on the basis of fitness for duty as indicated by the current history and physical examination, and unfortunately cannot be done on the basis of his time loss compensation.

Angered, the patient demanded to be seen by the initial physician.  The PA explained the situation to the owner/physician, who then went to see the patient.  He came back to the PA and said he had returned the patient to work….next week!

So this poor PA was devastated for the reasons 1-3 above, to say nothing of a possible insurance fraud issue this raises as well.  It is quite likely the patient may not have needed any time off work at all and could have been treated as “first aid” and not OSHA-recordable.

It is little wonder that this PA is interviewing for a new position.  This lack of adherence to sound return to work philosophy and communication with client employers is not only unethical and poor practice, it has also led to an exodus of clients from this practice, according to the PA.

PAs:  What frustrates you about your supervising physicians?

Worker’s Comp Posts:

Three Ways to Lose Your Occmed Clients

When the Boss Wants to Play Doctor