OMA Proposes a Novel Model for Managing Medical Issues in Employee Return-to-Work

This is a post that invites discussion about a position paper published by the Ontario Medical Association that is of relevance to employers, disability insurers and employer and employee advisors.

The OMA is the doctors’ association in Ontario, and health policy is part of its mandate. In March 2009, the OMA published a revised version of its longstanding policy paper on return to work issues. “The Role of the Primary Care Physician in Timely Return to Work” has been published for over a year and a half, but it seems not to have received much attention in the human resources management and legal communities to date.

Through its paper, the OMA outlines the challenges increasingly being borne by primary care physicians who are asked by employees and employers to assist with return-to-work management. It explains that primary care physicians are hard-pressed to provide effective support for timely return-to-work because employers often expect significant input without sufficient information about job responsibilities and without paying for the kind of deep investigation and diagnosis that is required to give a good input. Moreover, the OMA suggests that primary care physicians do not necessarily have the training (nor the inclination, perhaps) to participate in the return-to-work process in an effective manner.

To address these challenges, the OMA proposes an approach involving much deeper engagement by employee health care providers – either primary care physicians or occupational medicine specialists. To wit, it recommends employee health care providers take on the role of “timely return-to-work coordinator,” a role that is framed as the provision of health care (to employees) yet one that the OMA also suggests should be funded by employers.

The OMA-proposed model should be understood as significantly different from a very common return-to-work model in which employee health care providers are asked only to provide objective medical evidence (and not an opinion) for assessment by the employer itself, often with the assistance an occupational medicine specialists who are retained and paid as an employer advisors. In this common model, the employer and its medical advisor have very strong knowledge of the relevant position duties and work environment, but have limited access to medical information. The issue of access to employee medical information is often litigated, and though employers may lawfully demand access to information that is “necessary” for accommodation and return-to-work purposes, many still feel they are charged with making difficult return-to-work decisions with inadequate knowledge.

The OMA model is logical and seems like a simple solution to a significant challenge for many employers: engage the doctor who the patient trusts and who has all the information, pay the doctor for getting engaged and trust the doctor to encourage the right outcome. Yes, the doctor has a primary duty to the employee as his or her health care provider, but that duty ought not conflict with the employer’s interest because, as the OMA explains, a return to regular functionality is a de facto primary treatment objective. Hence, the OMA suggests that physicians must “Support and encourage the patient to participate in a timely-return-to work program.”

Do you think the OMA proposal is sound? Is the potential for conflict too high to make the model workable? Is it worth a shot given the limits of the current model? Have you had positive or negative experience with this novel form of engagement? What are the barriers to adoption, and how can they be overcome? These questions are worth discussing.

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