What's the go with Rehab in the US?
Our first ever multimedia feature! An interview with Mary Harris, US disability management professional, exploring the three key challenges facing RTW in the US.
Transcript below, in case your office computer will not play YouTube.
Mary Harris is a Return to Work specialist, with a Masters degree in Vocational Rehabilitation and is a Certified Rehabilitation Counsellor (CRC).
Mary's experience across systems and roles in the US gives her a rich understanding of the challenges and complex interactions in return to work. In this interview we ask Mary about the key challenges of return to work management in the US.
| MW: | Hi Mary, thanks for joining us today. We really appreciate your time and for us to get some insights as to what’s happening in the United States in terms of rehabilitation. |
| MH: | Well, it is great to see you too, Mary. And I appreciate the opportunity to share some of how we do return to work here in America-- |
| MW: | Excellent. |
| MH: | —from the viewpoint of a seasoned professional, anyway. |
| MW: | Thank you. Mary, can you tell us what you see is the top three challenges facing rehabilitation in the United States? |
| MH: | Yes. In fact, I was discussing this with some of my colleagues and we have narrowed it down to more than three but we'll start with the top three, and they would be a lack of employer involvement would be number one. There are also some issues with the medical provider and also the agendas that each party of a claim brings with them, would be the three top concerns. |
| MW: | Okay. Well, can you tell us a little bit more about them? What do you mean when you say lack of workplace involvement? |
| MH: | I sure can. I believe that this is set up by the time the employee files a claim against the employer. it sets up an adversarial relationship, and adding to that is a very clear—or a lack of clear and consistent information on how to do return to work, and so what ends up is opinions are all over the place and nobody knows what’s going on. |
| MW: | In Australia about 15 years ago it was decided that rehab needed to be workplace based and an active involvement with the workplace and so we had a return to work co-ordinator positioned really identified and developed, and it's modified over the years but it's been quite stable. Do you see that as an option in the States? Do some workplaces have a designated person, and do you see it being developed more generally? |
| MH: | Yes, they do. The larger employers will have somebody who is doing disability management. they don’t know it’s called return to work but somebody is in place doing that. You don’t see it very often, however, in the medium-sized to smaller employers but I believe that will change especially if those employers have higher incident rates of injury. |
| MW: | So Mary, you mention that the situation can become adversarial. How well is the workplace not involved with managing work injuries or disability generally? |
| MH: | They're not involved because they don’t know how to be involved, and they hand this responsibility then over to the insurer and you don’t always know that the claims representative has knowledge about what the employer has to offer in light duty. |
| MW: | And maybe they lose some of those key ingredients that make a difference, like what's the employee-employer relationship. If you’re at the workplace you can get a sense of that, but if you're distant as the insurer you might be oblivious to that? |
| MH: | Definitely. |
| MW: | Is that what happens? |
| MH: | Definitely. Yeah. |
| MW: | Yeah. Okay, so that’s—so workplace based rehab is not a key platform in the States? |
| MH: | No. |
| MW: | What was your second key area of concern? |
| MH: | Medical provider. Nothing personal. (Laughing) You’re an exception and we do have exceptions, definitely. You know, but most often you'll see people who come in with notes from their GPs and they have no idea what jobs does this patient of theirs is performing nor do they have a clear understanding of disability in the workplace. I don’t believe it's taught to doctors unless they specialize and so what you get is doctors who don’t know how to write work restrictions and that—I see that being a bigger problem with the time that's wasted. For example, it's hard to reach a medical provider and by the time you do to ask them, "What do you mean by 'light duty unknown amount of time’?" two or three days has gone by and so it just really stalls the process. So that's the problem with the medical providers. Plus they want to advocate for their patient and so they end up letting the patient drive the discussion on return to work. |
| MW: | It's interesting. The first discussion about the workplace involvement. It sounds like it’s quite a contrast if you talk to many people here. I think they would say the same thing about medical practitioners or health practitioners in general, and of course underpinning that there are very little studies and the poor doctor is grappling with something that, you know, is out of their field of vision. So we're on the same page with you, I think. |
| MH: | Okay. |
| MW: | The third challenge? |
| MH: | The competing interests that come in with each party of the claim and the longer the claim goes the more parties come in and so... And too often those interests supersede the goal of returning to work. In fact that almost becomes [gestures] a moot point. Their agendas are very different but they all have to do with entitlement and money. For example, the employers are looking at their bottom line, they need to stay in business so they look at that part, I think, more than the value bringing this person back to work. And the employee is also losing some money and they’re not happy about that and besides their boss is a jerk. And then, you know, you have the insurers who have to keep their eye on cost containment so they’re trying to see where they can cut, and when the lawyers get involved return to work becomes a bargaining chip. |
| MW: | We say— |
| MH: | As an adjunct to the legal system. |
| MW: | We say in the medical arena if somebody's in intensive care and they have six lines going into their body then the chance of them surviving goes down, and the more lines you have going into the body—intravenous, nasal, gastric, etc, etc—the less likely they are to survive. And it sounds like you’re saying the same thing. The more people involved— |
| MH: | Yes. |
| MW: | You know? It just kind of goes up. |
| MH: | Yes. |
| MW: | The worse the chances are. |
| MH: | Yeah. |
| MW: | Yep. |
| MH: | It's a great analogy. Definitely. |
| MW: | And Mary, of the sort of more difficult cases, what's the sort of typical number of people involved? |
| MH: | Well you have the employee, the employer, the rehab professional, at least one doctor, the insurer, and then the attorneys at least two, and their experts. Ten. |
| MW: | Ten? |
| MH: | I mean in the worst case scenario. |
| MW: | Yeah, yeah. So and the worker, I suppose, is really just sort of sitting in this room of conversations—virtual room of conversations and reports and different language often. |
| MH: | Yes, yes. |
| MW: | So, Mary, interesting array of challenges you have. Do you see any bright lights on the horizon? |
| MH: | We do, we do. We see a lot more education happening and organization developments toward the efforts of changing perception and establishing some good return to work guidelines for everybody. And of course to help that along there's a change that's brought on by the inability of the system to be sustained by the way it is currently. |
| MW: | What do you mean by that? |
| MH: | Kind of a push comes to shove. Financially it's not feasible to keep the system as it is. |
| MW: | So it's not so bad that things have to change, is that what you're saying? |
| MH: | Yes, in many states it's getting to crisis-level. |
| MW: | Really, it's that bad? |
| MH: | Yes. |
| MW: | Oh, okay. We worry about our system here but I don’t think most people would say it's at crisis-level, although I think if you listen to a few employees and the awful things that have been done to them— |
| MH: | Yes, yes. |
| MW: | —you really might consider it is that way, yes. |
| MH: | Definitely. But it’s more of a financial crisis, and that's really what drives things, I guess. |
| MW: | Yes. We don’t have a financial crisis but we could say we have a moral imperative to improve the system here because it's not helping many people who really need assistance in a difficult time. |
| MH: | I think that all goes hand-in-hand, actually. When you answer one, others are sure to follow. |
| MW: | Yes. True leadership. If you deal with the underlying issues then, as you say, the financial issues will follow suit. |
| MH: | Right. |
| MW: | Well, it's been fabulous talking to you today. Really appreciate your time and hopefully we'll chat again in the future. |
| MH: | I'd love to. Thanks Mary. Keep up the good work! |
| MW: | Cheers! |
| MH: | Bye-bye. |