Finding Ways Around Managed Care, Part II

By Stephen R. Seater
Experts say that job stress has become America's #1 health problem. Acutely stressful situations in the workplace are known to cause, or at least exacerbate, such conditions as hypertension, heart attacks, panic attacks, etc. Physiologists tell us this is due to the excessive production of hormones associated with "fight or flight" responses.

A new class of job stress has recently attracted the attention of the media, along with attorneys, physicians, government agencies, and top management in many corporations. I am speaking of job- related injuries, especially repetitive stress injury (formerly called cumulative trauma injury).

Repetitive motion or stress injuries are not new. In 1700, the Italian physician Ramazzine discussed this class of injury in his Treatise on Diseases of Workers. Repetitive stress injury (RSI) refers to the development of various stages of carpal tunnel syndrome, which can be a painful and debilitating condition. According to a June 1996 article in USA Today, RSI cost U.S. and Canadian companies $12.6 billion in one year.

According to Paul J. Rosch, MD, president of the American Institute of Stress, "The seriousness of the (RSI) problem might have been anticipated by the results of a study reported in 1992, showing that such injuries had quadrupled between 1985 and 1989, affected 50-70 million American workers, and had become the fastest growing segment of job stress workers' compensation claims." Another study of 500 computer workers in a telephone company "found that almost 25% had complaints consistent with repetitive stress injury," says Rosch.

These statistics may be only the tip of the iceberg, according to Rosch. He says that meat packers experience 12 times more RSI than any other group of workers. This prompted the director of the enforcement division of the Occupational Safety and Health Administration to say that in some meat packing plants, almost 80 percent of workers are affected! A high incidence of RSI has also been documented in workers involved in automobile and boiler manufacturing, shipbuilding, pen and pencil repairs, metal furniture assembly, and various frozen food industries.

According to Dennis Downing, president of Future Industrial Technologies, "This is a national epidemic" that affects business and government agencies from coast to coast. "President Clinton addressed this problem in an interview on USA Today," says Downing. The president made clear his belief that employers have an obligation to prevent death and injury on the job. And, in fact, there is considerable legislation on the books to protect workers. This, along with lost productivity, has prompted many companies to seek solutions to RSI and other job related injuries.

Almost overnight, a new health care specialty has emerged. It is frequently called occupational health or industrial consulting, and includes people with various kinds of training, such as occupational medical physicians, industrial engineers, ergonomic specialists, and occupational and physical therapists. However, in my opinion, the professionals with the best training to act as industrial consultants are doctors of chiropractic. They possess the most expertise in neuromusculoskeletal conditions, can differentially diagnose, and emphasize prevention more so than treatment. Furthermore, I believe that numerous opportunities await doctors of chiropractic as industrial consultants. What is more, there are no insurance companies or managed care companies to contend with. Doctors of chiropractic are paid a fee for their work by the companies that hire them.

Dr. Ted Oslay is a chiropractor living in Illinois who actually gave up his practice to become a full time industrial consultant. Dr. Oslay has consulted with more than 40 major corporations in North America, Europe, and Japan. He sees the need for the chiropractic approach to help lower the costs of industrial injuries as simply enormous. "The window of opportunity is open, and it is open wide for chiropractors probably more than it has ever been before," Dr. Oslay says.

Dr. Joseph J. Sweere at Northwestern College of Chiropractic concurs with this assessment. He points out that about 90 cents of every workers' compensation dollar goes for neuromusculoskeletal injuries. Furthermore, he points out that doctors of chiropractic who wish to pursue this area of interest should not limit themselves solely to Fortune 500 companies. He emphasizes the fact that 85% of American workers are employed by companies with less than 100 employees.

FCER has long been interested in the idea of doctors of chiropractic capturing a significant market share in the industrial consulting market. To this end, FCER has funded a large-scale study at the Northwestern College of Chiropractic which compares chiropractic treatment of carpal tunnel syndrome with that of standard medicine. Results of this work, being carried out by Dr. Tom Davis, are expected to be published soon.

Michael Nelson, DC, tells of his work with a Toro Manufacturing. When he began working for this company, they had budgeted $1.2 million to cover work related injuries. Following Dr. Nelson's work, Toro's costs were down to $120,000 a year. Companies large and small will pay for these kinds of money saving services.

We often hear doctors of chiropractic saying, "This all sounds good, but how do you get started?" But chiropractors are consulting with industry. Patricia Bender, RN, DC, says that she simply started by talking with her patients who were injured while at work. Later, she began calling on the companies and discussing with their management personnel how she could help cut costs by preventing injuries. It worked and today her practice has a large industrial consulting component. Other chiropractors are working with companies specializing in injury prevention.

The chiropractic colleges have started to respond to this new market by offering postgraduate training in occupational health. A diplomate in occupational health is now available through the ACA's American Board of Occupational Health for those doctors wishing the most advanced training.

In closing, I would like to emphasize once again that industrial consulting is free of managed care hassles, nor will doctors of chiropractic who embrace this field have to contend with denials of payment and all the other unpleasantries involved with doing business with insurance companies. To succeed, doctors will have to polish their marketing and sales skills, but the potential market is huge and certainly worth the trouble. "Industry has a need and is looking for a solution," say Dr. Ted Oslay. "We as chiropractors understand the biomechanics and etiology of soft tissue better than any other health care profession and we are in a position to make a difference."

Stephen R. Seater, MA, CAE
Arlington, Virginia

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