WCRI Panel Explores Shifting Dynamics in Medical Workforce and Workers’ Compensation

At the Workers’ Compensation Research Institute (WCRI) Annual Conference in Phoenix yesterday, researchers presented findings on how changes in the medical workforce are impacting workers’ compensation systems across the United States. The presentation highlighted significant shifts in who provides care to injured workers and what these changes mean for claim outcomes.

The panel began by addressing widespread concerns about healthcare provider shortages that have been amplified during the pandemic. While headlines frequently highlight physician burnout, hospital vacancies, and limited access to care—particularly in rural areas—the researchers presented data showing more nuanced trends.

Contrary to initial assumptions, the absolute number of primary care physicians has slightly increased from 2010 to 2021 (from about 30 to 32 physicians per county). However, when population growth is accounted for, the per capita number of physicians has actually declined. This decline is occurring alongside growing demand for medical services due to an aging population and increased prevalence of chronic conditions.

Meanwhile, the healthcare system has seen dramatic growth in advanced practitioners:

• Physician assistants increased from 17 to 30 per 100,000 population by 2022
• Nurse practitioners increased even more dramatically, from about 30 to 86 per 100,000 population
• Overall, the number of nurse practitioners increased by 115% during the study timeframe

So, what does this all mean for the workers’ compensation industry? Well, this was, after all, a report from the Workers’ Compensation Research Institute, so they did not disappoint.

The researchers analyzed more than six million workers’ compensation claims to examine who provided the initial evaluation and management services. Their findings revealed a significant transformation in care delivery:

• In 2013, physicians provided 81% of first office visits for injured workers
• By 2022, physicians provided only 60% of first office visits
• Nurse practitioners increased their share from 5% to 16% of first visits
• Physician assistants increased from 11% to 22% of first visits

This shift was even more pronounced in rural areas, where by 2022, only 54% of visits were to physicians (compared to 61% in urban areas). Nurse practitioners now provide 26% of all visits in rural areas versus 14% in urban areas, reflecting their ability to practice independently in many jurisdictions.

The data also revealed changing patterns in how providers collaborate during workers’ compensation claims:

• In 2013, 58% of claims involved only physicians providing evaluation and management services
• By 2022, this dropped to just 37% of claims
• Claims where physicians worked alongside nurse practitioners or physician assistants increased from 15% to 25%
• Cases where nurse practitioners and physician assistants were the only providers increased from 7% to 19%

So, you might ask, what does all this mean? How did it affect outcomes? Turns out WCRI had that covered as well.

The researchers conducted empirical analysis to examine relationships between local provider availability and various claim outcomes, controlling for important claim characteristics.

The findings indicated that a 40-provider increase in nurse practitioners per county (representing the average growth observed) led to:

• A 22% increase in the share of first visits to nurse practitioners
• Small decreases in visits to physicians (2%) and physician assistants (5%)
• A modest 3% increase in time to first evaluation and management visit
• No significant changes in the share of claims with major surgery or early MRI
• No significant changes in medical payments or indemnity payments per claim
• A 5.5% increase in disability duration for claims with more than five weeks of disability

Interestingly, the researchers found that hospital-based vacancies for physicians and nurses did not explain pandemic-related changes in outcomes, despite concerns about provider shortages.

The panel concluded that workers’ compensation patients are increasingly likely to be treated by nurse practitioners instead of physicians, with the availability of different types of local providers being an important factor in these treatment patterns. However, these workforce changes had relatively little impact on most claim outcomes, with the exception of slightly longer times to first visits and somewhat longer disability durations.

It should also be noted that some of the increase in disability durations may be attributable to regulatory environments, especially where NP’s or PA’s are not authorized to release patients back to work. That point was mentioned by the panel, but there was no specific data presented on that specific concept.

The findings suggest that while the composition of the medical workforce serving injured workers is changing significantly, with advanced practitioners playing a growing role, this transition has not substantially disrupted the workers’ compensation system in terms of costs or most care delivery metrics. This is an important point, as many in our industry see Nurse Practitioners and Physician Assistants as critical in countering the overall shortage of primary care providers. 

The timing of this session was excellent, as it provided solid information for an upcoming webinar, “The Point,” scheduled at WorkCompCollege.com, which is specifically looking at this very topic. WCRI has been invited to participate in that program and will definitely have great content to contribute. That webinar will be May 20, 2025, so please watch this space for registration opportunities.