Myth busting: Occupational medicine
By: Brenden Matus, M.D., MPH, WorkWell Occupational Medicine
Brenden Matus, M.D., MPH, practices occupational medicine at WorkWell Occupational Medicine in Aurora, Colorado. He sat down with Pinnacol to share his experience with some of the most common myths around practicing occupational medicine.
Q: How did you get into the field of occupational medicine?
A: I had a rotation with one of my senior residents who was interested in occupational medicine. He was at the tail end of his training for internal medicine, but wasn't overly enthused with the long-term outlook. I was getting into the same realm. He started telling me about it when I was voicing some of my concerns. I started reading more about it and it sounded, at least on paper, like a really, really interesting sort of mix of some primary care, but you also get plenty of specialty exposure with a whole different population of patients. The icing on the cake is the business office hours. Within medicine it's hard to find something where you actually have some protected time and are not expected to work weekends and nights, which is pretty huge with quality of life and work-life balance.
Q: A common concern among providers is “We don't understand the rules.” What has been your experience with this concern?
A: In most of my previous exposure and then in training, a lot of folks don't actually go through formal occupational medicine residency. They're stumbling into it and they find out they do kind of like it and slowly transition. I obviously have a little different outlook because part of my training was dealing with these different areas that other doctors are concerned about, such as the paperwork. For me it's normal. That's part of how the gig works. Within Colorado, we have our M164 form. That's probably the biggest routine paperwork you have to do, but it's not that big of a deal. You can fill it out pretty quickly, you can bill for it, and it’s in the fee schedule.
Q: What about getting paid in occupational medicine? How does the financial aspect of it work out?
A: Because of the fee schedule, you know everything you know you're going to get paid for each visit. You can get paid for documentation. You can actually schedule appointments a little bit longer and have more time with the patients, as opposed to a primary care provider, where you're only expecting a percentage reimbursement per visit. There are plenty of things in primary care you're not even getting paid for, and you're having to do it on your own time and kind of hustle. Earlier this week I had an inch of medical records to review. I let my office manager know I'm going to need some time and we blocked it out on the schedule. We can bill for the medical record review. It's very easy to get protected time, reserved time at the very least, and to get paid for specific activities.
Q: What are some of the biggest challenges for you in occupational medicine?
A: The intersection of occ med with primary care such as when an injured worker comes in with a physical injury and a pre-existing mental health disease. That can become a big difficulty because you can't really fully manage pre-existing conditions. It's very well documented and researched you're going to have delayed recovery if you have untreated mental illness at the same time. We try to cover the mental health disease to a certain extent and Pinnacol is usually pretty helpful as far as following the treatment guidelines. As example, we can make reasonable referrals to get a psychologist on board early to make sure we're monitoring the whole person. We as occ med providers don't need to do anything specific with the disease. We need to get the patient back to work and participating in life; but they're depressed, they're anxious, they don't like their job, and they have other stressors in life we can't control. Those are my more difficult cases. That's not the majority, but you try to help them out as much as you can. It could get to the extent where it’s the primary care provider's job to treat ongoing mental health problems.
Q: Is there anything you picked up when you first got into occupational medicine that was a surprise to you?
A: As far as lawyers go, it has been a learning process to some degree because you're insulated when you're a resident because you're not considered the authorized treating provider. You talk with your attending, you try to get some sense of it, but you're not really necessarily directly in the meetings. You don't have to interact or call them on the phone. When I got my first letter about having to speak with a lawyer, I was pretty stressed about it and concerned. Then you go through the process and it's not that big of a deal. It's relaying information I've already documented many times. Very rarely are you actually interacting with attorneys or getting into the legal aspect. I think that's by far the minority of patients. Those tend to be the more complicated cases, the long-standing cases, the recurrent cases. If there are questions of causality, compensability, that kind of stuff you can definitely become part of it, but it doesn't affect the direct medical care we offer or provide. There are very few things that are legitimately a reason to worry.
Q: What advice would you give to a primary care physician who's considering accepting workers' compensation cases?
A: Don't be afraid it's going to be this insurmountable thing. Certainly, there are going to be a few new pieces, but you can learn along the way. There are a ton of similarities, and the differences aren't that dramatic. It's hard to make a dramatic mistake like, "Oh, I filled out a piece of paper wrong." You can fix most of the administration problems in time. The rest of it is just medical care, which everyone's used to. If you get into the higher-level stuff, you won't see workers' compensation patients on a regular basis unless you tailor your practice or you're a sub-specialist within occupational medicine.
Q: Is there anything else you think would be helpful to other physicians to know that we haven't already talked about?
A: Most of occupational medicine can be done within the confines of eight to five, Monday through Friday, which is really nice. Anything serious, concerning, needs immediate workup, you've still got the entire rest of the medical system right next door. The patient will come back to you after. That type of stuff is nice.
Dr. Matus received his Bachelor of Science in biochemistry from Andrews University in Berrien Springs, Michigan, and his Master of Public Health, Medical Epidemiology, from Loma Linda University. He earned his Doctor of Medicine in May 2014 and completed his occupational medicine residency in 2017 under the tutelage of his co-worker Dr. Paul Ogden. His interests include hiking, camping, anything involving water or mountains, and visiting with friends.