The challenge of ensuring injured workers have access to quality medical care is becoming increasingly complex across the United States.

As populations grow and physician participation in workers’ compensation decreases, states are grappling with how to maintain high standards of care while improving access. Texas’s innovative approach to workers’ compensation offers valuable insights into potential solutions.

Greg Gilbert, a senior executive at one of the nation’s largest occupational health providers, recently shared his perspective on these challenges in a recent conversation on the Forecasting Success Podcast:

“The data shows from the AMA that there’s an access issue. They’re not graduating enough physicians. There’s not enough of them out there to treat,” Gilbert noted

The President of the AMA recently sounded the alarm on this in a national address, and according to recent data from the Association of American Medical Colleges (AAMC), these shortages may be getting worse.

According to the AAMC report, the U.S. faces a projected shortage of between 13,500 and 86,000 physicians within 12 years.

This shortage may become particularly acute in workers’ compensation with the treatment of occupational injuries, where the system has traditionally been very physician-focused.

The Texas Advantage

Texas has proven particularly effective in addressing these challenges. Texas is unique in that it does not mandate employers to carry workers’ compensation insurance coverage.

Instead, Texas employers have three options:

• Opt-in to Workers’ Compensation – Texas innovation and competition has created one of the best-performing workers’ compensation systems in America.

• Opt-in to QCARE – A responsible Texas injury benefit program that delivers better medical outcomes, improved benefits and cost savings, and meets 10 essential standards to earn the QCARE designation.

• Opt-Out – May not meet industry standards for the QCARE designation or provide any injury benefits.

This freedom enables competitive innovation unique to Texas’ system, and has enabled it to become one of the most respected, high-performing programs in America.

As Gilbert explains in his appearance on Forecasting Success,

“We treat a ton of non-subscriber patients in Texas… We find our non-sub clients are really open to doing good things and allowing the doctor to practice medicine, but holding us accountable.” 

This balance of flexibility and accountability has enabled providers to maintain high standards, like those specified by the QCARE designation, while adapting to market realities.

The Texas model offers several advantages in addressing these challenges:

• Treatment Flexibility: Injury benefit programs programs can adapt quickly to emerging solutions like telemedicine, particularly valuable for behavioral health services where access issues are acute.
• Market-Driven Innovation: Free market competition helps attract quality providers by removing unnecessary administrative burdens while maintaining high standards of care.
• Practical Solutions: The model allows for pragmatic approaches to using mid-level practitioners like nurse practitioners and physician assistants when appropriate, while ensuring physician oversight where needed.

Gilbert notes that his company’s treatment model remains consistent whether treating patients covered under workers’ compensation or an injury benefit program, emphasizing that quality care is paramount in both systems. However the flexibility of Texas’ system can allow for more efficient delivery of that care.

Looking Forward

The solution to physician access challenges requires a multi-faceted approach. Texas’s model demonstrates how market-based solutions, regulatory flexibility, and innovative care delivery models can work together.

As Gilbert notes, 

“Practically, what we’re seeing now in multiple states is that because of that, we’re getting delays in treatment… The discussion we had… was how do we open up our minds and thought process with the new world and the lack of access and our unique system in workers’ compensation?”

 Texas’s success in maintaining quality care while adapting to these challenges offers valuable lessons for other states. By allowing market competition based on reimbursement and removing unnecessary red tape, while maintaining appropriate oversight, Texas continues to lead the way in ensuring injured workers receive timely, quality care.

As states continue to grapple with physician access challenges, Texas’s balanced approach offers a proven framework for maintaining quality while improving access to care.

Through innovation, flexibility, and market-based solutions, Texas demonstrates that it’s possible to adapt to changing healthcare realities while ensuring injured workers receive the care they need.