Occupational Medicine

[Kelsey]

Hello all! Novice PA here looking to switch fields, very specialized right now, looking to slowly branch out.

 

How does a PA function in Occupational Medicine??

 

 

 

 

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[Reality Check 2]

Occupational covers everything from pre-employment physicals to injuries, DOT physicals and environmental monitoring.

PAs do the same thing as in any practice -manage patients.

suturing, burns, eye injuries, fractures, tons of back pain, repetitive motion injuries, inhalation injuries - you name it. Depends on location and types of businesses.

I went on tours of local businesses to see the environment and types of injuries. Had to learn more about PFTs and respiratory monitoring as well as exposures like cadmium, lead, PCBs, etc. Yearly blood work and testing for exposures. Audiology monitoring for sound protection.

LOTS of pressure from employers to force things sometimes. Have to know your state - does the employer have the right to contract and force one provider or is it patient choice like here in Washington.

Have to take DOT course and become certified. Fairly complex - see other threads here about DOT. 

So, lots to do - depends on the clinic - corporate like Concentra, hospital based outpatient, solo with concurrent Urgent Care.  Even on site for one employer. 

Hope that helped or at least expanded your info.

[CAAdmission]

Mostly, you slowly die inside dealing with people faking back pain because they want to live with society supporting them.

[Guest UVAPAC]

46 minutes ago, CJAdmission said:

Mostly, you slowly die inside dealing with people faking back pain because they want to live with society supporting them.

I would say that 25% have moderate-severe injuries requiring medical intervention of some kind

50% have injuries that will resolve with minimal/conservative treatment

25% are trying to game the system or despise their job/career and will do anything for a couple of paid days off

[Kelsey]

Mostly, you slowly die inside dealing with people faking back pain because they want to live with society supporting them.

Oh... gross. Haha.


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[Kelsey]

Occupational covers everything from pre-employment physicals to injuries, DOT physicals and environmental monitoring.
PAs do the same thing as in any practice -manage patients.
suturing, burns, eye injuries, fractures, tons of back pain, repetitive motion injuries, inhalation injuries - you name it. Depends on location and types of businesses.
I went on tours of local businesses to see the environment and types of injuries. Had to learn more about PFTs and respiratory monitoring as well as exposures like cadmium, lead, PCBs, etc. Yearly blood work and testing for exposures. Audiology monitoring for sound protection.
LOTS of pressure from employers to force things sometimes. Have to know your state - does the employer have the right to contract and force one provider or is it patient choice like here in Washington.
Have to take DOT course and become certified. Fairly complex - see other threads here about DOT. 
So, lots to do - depends on the clinic - corporate like Concentra, hospital based outpatient, solo with concurrent Urgent Care.  Even on site for one employer. 
Hope that helped or at least expanded your info.

Yes! Thank you!

So I’m getting the feeling it’s fairly repetitive? I’m trying to move away from that right now...


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[Cideous]

2 hours ago, CJAdmission said:

Mostly, you slowly die inside dealing with people faking back pain because they want to live with society supporting them.

HAHAHAHAHAHAHAHAHAHAHA!!!!!!

 

Coffee right out the nose!

 

Soooooooo my truth in this one sentence.

[BruceBanner]

It sucks. Balls.

It's a mix of acute injury, malingering, chronic overuse injury, somatoform disorders, DOT exams, and pre-employment physicals.

I did it for 2 years. You do get to do a lot of suturing, fracture care, and wound care depending on the population; but the number of back pain malingerers and non-English speakers will drive you to drinking.

You will constantly be at odds with the employer, the patient, and the insurer. No one really wins. Very few people get better or even want to get better. I have never been more angry and disillusioned with medicine than when I did occ med.

Proceed at your peril.

[Reality Check 2]

I have enjoyed Occ Med in the right setting with the right ideals.

Unfortunately, medicine has become customer service oriented instead of "do the right thing" oriented. Folks want to be "happy" and satisfied not actually deal with the realities of illness, disease and self management.

So, telling someone they do not pass their DOT due to uncontrolled HTN with proteinuria or an A1c of 10 - they hate you. It is not THEIR job - YOU are the one who "ended their career" - well, yeah, you ended it before they crashed into a busload of kids.

In all medicine their is a loss of self responsibility. Folks want cures, pills, magic and DONE. No one has time to be sick, no one can take off work - employers don't help.

So, Occ Med CAN be good - if you have admin that supports MEDICINE not FLUFF.

It can be repetitive but all medicine is. I do intense internal medicine at the VA and my life revolves around smoking, HTN, DM, CHF, COPD, PTSD and the like - each patient is different though and you have a chance to individualize their care.

Don't let all of us discourage you - but Occ Med has some issues as any other specialty does. Be prepared as you are doing.

[rev ronin]

15 hours ago, CJAdmission said:

Mostly, you slowly die inside dealing with people faking back pain because they want to live with society supporting them.

You know, I thought the same thing until I inherited a panel of sick, long term Occ Med patients.  I threw a few out for narcotic issues, one got caught by Labor and Industries on the roof of a job site while on time loss, but waay more than 90%, probably about 95%, have been no problem at all.

The faker ratio is probably a lot higher in the first few weeks.  Getting a couple weeks paid off work time surely sounds appealing.  But these folks, who have been on time loss for years, tend to pass multiple Functional Capacities Exams, with the anti-cheating measures built in, giving the best objective evidence of actual incapacity one can get in those circumstances.

Just last night a mid 30's year old patient of mine who was offered a pension turned it down for nothing more than another go 'round at the vocational process.  This person wants to become a paralegal, and hopefully help others who have gotten short shrift from the occupational medicine system.  That's basically the equivalent of finding a wallet with no ID and $50k cash and turning it into the police because 'it's the right thing to do.'

I wouldn't trade these patients away for anything.

[Kelsey]

You know, I thought the same thing until I inherited a panel of sick, long term Occ Med patients.  I threw a few out for narcotic issues, one got caught by Labor and Industries on the roof of a job site while on time loss, but waay more than 90%, probably about 95%, have been no problem at all.
The faker ratio is probably a lot higher in the first few weeks.  Getting a couple weeks paid off work time surely sounds appealing.  But these folks, who have been on time loss for years, tend to pass multiple Functional Capacities Exams, with the anti-cheating measures built in, giving the best objective evidence of actual incapacity one can get in those circumstances.
Just last night a mid 30's year old patient of mine who was offered a pension turned it down for nothing more than another go 'round at the vocational process.  This person wants to become a paralegal, and hopefully help others who have gotten short shrift from the occupational medicine system.  That's basically the equivalent of finding a wallet with no ID and $50k cash and turning it into the police because 'it's the right thing to do.'
I wouldn't trade these patients away for anything.

Wow, so you are really enjoying it? Share more?


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[rev ronin]

4 minutes ago, Kelsey said:

Wow, so you are really enjoying it? Share more?

I wouldn't call it enjoyable.  It's turned into a calling, more or less.  I don't see many acute patients, but if I do, I will own the case to the bitter end.  Now, I take the cases where someone else has cast these people away as incurable.  If I wanted to, I could do this all day every week, I'm afraid, because there are just that many injured workers who need the help, and most medical professionals can't be bothered.

As an Attending Provider, I will see each patient, typically monthly, but biweekly to bimonthly depending on need.  I refer to specialists, review their notes, order treatment, concur or disagree with any proposals.  I occasionally do exams, but these folks aren't changing work status often, so I don't submit useless 'activity prescription forms' unless something has changed.  I get paid to do paperwork, and when I sit down and do paperwork, I typically generate enough revenue to pay my salary.  Oh, as a PA I only get paid 90% of what an NP or MD/DO does.  Yes, you read that right--the NPs get more money than I do.  I can't do permanent impairment ratings, but my DO SP doesn't do them, either.

I get loggers, carpenters, mill workers, janitors, mechanics, sheet metal workers, office workers, fast food workers... oh, and cops, firefighters, and healthcare workers.  Most are men, probably 60/40 or 70/30, with a slightly more minority-heavy distribution than my typical family medicine patients.  Often have no other healthcare, sometimes medicaid which is useless, sometimes Medicare if they're already on social security disability.

These people all got legitimately injured at the job, to the best of my knowledge.  I wasn't there, I didn't witness it, but there's an adversarial system where it's the employer's prerogative to challenge the injury.  I do have the right to not endorse a report of accident if I don't believe it, but most people are able to tell me a coherent enough story.

I have gotten a guy who got fingers smashed under a pallet into surgery in 36 hours, which is amazing considering the glacial pace of the process as a whole, and therein lies the frustration: with an adversarial system, curative treatment i order can be challenged by the employer.  The "employer" in this case is typically a lawyer-heavy firm (a representative, to whom large companies outsource the abuse of their injured workers) who objects to everything possible to minimize costs, not caring that there are hurting human beings on the other end of their equation.  I have more respect for drug dealers who sell to middle school children, actually, because they actually provide some enjoyment to someone.

And, as we all know, treatment delayed is treatment denied.

The whole process is dehumanizing.  My patients lose their jobs, their friends, their families, and more.  I consider it an accomplishment that none of my patients (to the best of my knowledge) have killed themselves or their claim managers.

Sounds really uplifting, right?

These patients are human beings, men and women discarded by society as useless.  I am sometimes the last person left on earth who will listen and believe them.  I am holding on to their rope.  If I write "I agree" and sign the wrong paper, they are out, "able to return to work" when they can't, and cut off from whatever benefits or time loss payments they were receiving.

But when you're given hopeless cases, and get some of them to pension and others returning to work, it's your success too.

So all the malingerers get filtered out before they get to me: the system is too hard to stay on for any length of time unless you have a real issue.  I'm left with the people who have survived getting treated as malingerers and liars for a year or more, often closer to 5.

[d2305]

I got a sick feeling whenever I got a vocational rehabilitation patient to evaluate. 

[AlteredBeast]

On 4/11/2018 at 4:19 AM, CJAdmission said:

Mostly, you slowly die inside dealing with people faking back pain because they want to live with society supporting them.

Nail on the head.  I've seen some legit pathology in occ med but the majority was pretty much walmart medicine.

" I hurt my back so now I need to be on temporary disability until x date".

Then when you do see someone that actually needs help you have to fight the employer or whatever evil sith lord represents the employer to get the pt the care they need that you can't render yourself.  These patients generally actually want to return to work but can't and you get to hear about how they can't make ends meet now.........and it slowly (or quickly) rots your soul.  YMMV.

[sas5814]

I worked for about a year at an industry clinic in a place that was owned by the union. An employee could be off at 70% pay for 2 YEARS for a work related problem. It was a small but persistent population and a huge headache for the company...and therefore me.

As stated read other posts about DOT physicals. I'd rather come to work and, first thing every morning before I start, have someone kick my in the nards, rather than do DOT physicals again.

Your mileage may vary.

[Cideous]

22 hours ago, sas5814 said:

As stated read other posts about DOT physicals. I'd rather come to work and, first thing every morning before I start, have someone kick my in the nards, rather than do DOT physicals again.

Your mileage may vary.

ROFL, Exactly!