The field of occupational health has been a piece of the workers’ compensation puzzle for a very long time. Even so, it remains a lesser known specialty area even to the health care community — an issue that has limited the number of practitioners entering the field.

For injured employees, that means less access to the specialized care and clinical knowledge that could speed recovery and get them back to work quickly and safely.

“The specialty of occupational and environmental medicine is not well known or well understood. Even in the medical community, there are many physicians who have never heard of occupational and environmental medicine,” said Dr. John Anderson, chief medical officer for Concentra.

“Few physicians have had exposure to occupational medicine in the course of their training,” said Anderson. Practitioners who enter the field from a background of family practice, internal medicine or emergency medicine typically have had no opportunity to work in an occupational health facility.

Exacerbating the issue, the number of occupational health residency programs has declined over the past 20 years, and the number of residents in each program is limited.

There are now only about 2,000 occupational medicine specialists in the United States for a population of 129 million full-time employees. Making matters even worse, an average of 250 occupational physicians are retiring every year.

A Different Way to Educate

The very real and growing need for more practitioners with specialized occ-health expertise is a key motivator behind Concentra’s Occupational Health University (OHU).

Conceived in 2017 and launched in March of this year, OHU is part of an active effort to invest in Concentra clinicians. While Concentra has a very strong orientation program focused on return to work, regulatory areas, and employer and payor relations, completion of the OHU curriculum will provide graduates with a higher level of more specialized knowledge and skills they can apply to the benefit of employers and employees.

Dr. John Anderson, chief medical officer, Concentra

The OHU program was developed under the clinical leadership of Dr. Anderson on the medical side, as well as Concentra’s vice presidents of medical operations, Dr. Barry Magnus and Dr. Lisa Figueroa. The therapy side was developed under the leadership of Giovanni Gallara, senior vice president, national therapy and ancillary services director, and Mark Glover, vice president of therapy services.

The Concentra Learning Team, under the direction of Amy Barbour and Amy Kidder, strategically designed OHU with a unique, immersive approach to build advanced occ-health knowledge upon a clinician’s foundational knowledge.

The learning experience in OHU is enhanced through more active engagement in exercises with peers, patients and employers versus the traditional passive completion of online modules. This approach has already proven to be very successful, and OHU participants are finding deeper meaning in their work, their relationships and patient results.

In 2018, the learning team brought in Mary Heartfield, Sr. Instructional Designer, to lead design and begin to identify critical knowledge gaps and opportunities for improvement in the training of occupational health practitioners.

The coursework they developed is rigorous and targeted at the facets of the specialty that few practitioners would learn outside of an occupational medicine residency.

OHU’s 100-level curriculum, for example, includes a comprehensive look at the microcosm of occupational health — a guide to building relationships with employees, employers and the insurance industry.

The 200- and 300-levels involve practical brass tacks of areas such as medical surveillance and advanced-level projects that participants design and work with their mentors to develop.

The curriculum has been carefully planned to ensure that upon completion of all three levels, “our clinicians will feel that they really have a solid background and understanding of this area of medicine in order to be more effective and more confident in its practice,” said Anderson.

“It’s not intended to replace a residency program,” he said. “It’s a staged curriculum with an intense focus on those elements of occupational medicine that differentiate it from group health and result in consistently superior clinical outcomes.”

Concentra’s learning team members are available to OHU students for support and guidance throughout their educational journey and provide ample opportunity for feedback on the student experience.

“The learning team meets regularly with the students, and they’re getting both informal and formal feedback from the participants,” said Anderson. “We’re in the nascent stages of the coursework,” he said, but “the feedback has been very positive,” even in the face of the unexpected challenges of completing the curriculum in the current pandemic environment.

There are 22 clinicians currently in OHU’s inaugural class, including physicians, advanced-practice clinicians and physical therapists. The class is expected to graduate in September 2020. Applications are currently being reviewed for acceptance into the program in the fall of 2020, and 300 proposals will be reviewed in February 2021 for acceptance into the spring 2021 class.

Functional Restoration Goes Beyond Healing

An important area of focus for Concentra OHU students is the application of the biopsychosocial model of care, Anderson explained, an area that’s not broadly understood or taught outside of occupational medicine and workers’ compensation.

“Medical school and post graduate training are focused on the biological model. But the biopsychosocial model takes into consideration many other nuances that will help clinicians manage a case more effectively and achieve the best possible clinical outcomes,” he said.

“We’ve been refining this approach to the care of injured employees for over 40 years and have incorporated it successfully into our clinical model.

“A subtle but important difference between the traditional care provided in group health versus our occupational health model centers around the goal of the care,” said Anderson. “Under the biological model, a physician might say, ‘You have this wound or injury, expect it to take this amount of time to heal. Go home, stay off work and let it heal.’

“In our world, that doesn’t work. Applying Concentra’s care model, when working with an employee with that same type of injury, we’re going to figure out — together — how we can manage this while enabling the employee to retain their job, their income and their productivity, because all of those things affect careers and futures.

“The social and psychological implications of lost time are pretty much lost, if you will, on clinicians who are thinking about the biological model. Using a biopsychosocial approach decreases needless disability, lost productivity, lost time, and decreases the total cost of the case,” he added.

Clinicians who finish OHU training will have a much greater appreciation for the consequences of decisions they make regarding the employee’s work status. Students completing OHU’s program will also understand the importance of helping injured employees understand that a major part of their recovery, regardless of how complicated their injury is, requires their active participation in restoring function, and that includes returning to work as quickly as possible with a minimum of lost time.

Measurable and Meaningful Results

As more practitioners complete the curriculum, Anderson believes consistency of care and adherence to Concentra’s clinical care model will be elevated to even greater heights.

The results will be measurable, with the benefit of 30-plus metrics designed to quantify clinical outcomes each graduate achieves.

“We have an entire department dedicated to clinical analytics and quality that focuses on our clinical outcomes,” said Anderson. “We will be able to isolate the graduates of the program and do comparative analysis of their past and future outcomes.

“It’s been quite a journey for us. And we’re excited to be able to look at and analyze the results and outcomes of the clinicians who are engaged in this program right now,” he added.

OHU’s specialized training allows practitioners to feel more confident in their ability to provide top-notch effective care and affords them a deeper level of understanding of every facet of workplace injury management.

“In essence we’re training them to have even greater value in the occupational health arena,” he said. “I think it will improve career satisfaction for those clinicians who complete the program because it will raise their level of skill and confidence and lead to even higher levels of patient care,” he said. &