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Improving the physician role in evaluating work ability and managing disability: a survey of primary care practitioners

Purpose : In the US health care system, most work-related issues are addressed by primary care practitioners (PCP's). Prior investigations of PCP's have focused on disability claims, whereas evaluations of work status and work capacity are more common. This study was conducted to identify challenges and opportunities for improvement in this area from a physician perspective. Methods : A validated survey was mailed to a random sample of 423 Massachusetts PCP's, with a 43% response rate. Results : On average, PCP's were requested to provide opinions regarding work ability in 9% (range, 1-100%) of all visits, about half of which involved non-work-related conditions. Their assessments were largely based on patient input and observations; direct communication with employers was rare. Only 6% agreed that PCP's should not have a role in facilitating safe return to work (RTW). However, 25% believed they had little influence over disability outcomes. While patient-specific factors were viewed as significant barriers to providers' efforts to successfully encourage RTW, lack of alternative work at the workplace was seen as the most significant problem. Conclusions : Evaluations of work status and work ability are common PCP activities, but little formal training has been provided in this area. Rehabilitation professionals can have a significant role through provider education, developing improved systems for communication with employers, and encouraging employers to provide more alternative duty assignments.