Primary care physicians’ learning needs in returning ill or injured workers to work

Primary care or front-line physicians play an important role in helping ill and injured workers stay at work or return to work (RTW). Positive and encouraging messages from physicians are associated with better RTW outcomes; patients who receive information about injury prevention, pain management and work accommodation are more likely to return to work.

However, many physicians feel uncomfortable assessing patients’ functional abilities or limitations following a work-related injury or illness. This scoping review sets out to identify physicians’ learning needs or training gaps when it comes to returning ill or injured workers to work.

In this scoping review, the research team conducted a systematic search for peer-reviewed journal articles published between 2016 and 2021. The search turned up 44 English-language studies that were focused on general practitioners, residents, fellows, primary care physicians and family doctors. The studies were conducted in the United States, Canada, the United Kingdom, Ireland, Norway, Finland, Sweden, Denmark, Netherlands, Belgium, Germany, Australia and Israel.

Learning needs were found in four key areas: 1) administrative tasks, 2) attitudes and beliefs, 3) specific knowledge, and 4) awareness of services and tools.

1) Administrative tasks: Physicians need to learn how to manage the paperwork required by patients’ workplaces, insurance providers and medical evaluators; how to communicate with the parties and stakeholders involved in a compensation claim process; and how to collaborate or coordinate services with workplace representatives, allied health-care providers and caregivers.

2) Attitudes and beliefs: Physicians need greater awareness about the attitudes and beliefs they may hold that stem from biases based on patients’ race, gender, socioeconomic status or from a culture of blaming patients (e.g., for lacking motivation to return to work). Physicians also need greater clarity about their role in the workers’ compensation process. Some studies in the review also found a lack of confidence among physicians at times leading doctors to be reluctant or refuse to treat injured workers.

3) Specific knowledge: Physicians have gaps in several knowledge areas related to return to work. These include: capacity assessments, environmental exposures, prognosis after certain conditions and injuries, as well as care related to specific populations such as adolescents and pregnant workers.

4) Awareness of services and tools: Physicians need greater awareness of relevant services for injured or ill workers and of available tools to help them manage patients with work-related injuries or illnesses.

The list of learning needs identified in the scoping review underscores the need to provide medical education to frontline primary care providers on return to work and staying at work. Practitioners who may benefit from a curriculum on these subjects include practitioners in family medicine, general medicine, emergency medicine, rehabilitation medicine, as well as nurse practitioners and allied health-care professionals.

A strength of this scoping review was its use of recommended methodologies to avoid bias in the searches, selection and synthesis of data.

A weakness of the review was its scope, which was limited to studies published since 2016.

The wide number of countries from which the literature was found is both a weakness and a strength. It is a weakness because there may be issues specific to jurisdictions and health systems. However, it may be a strength because common challenges were found despite national differences.