In September 2016, Horizon Occupational Health Solutions was awarded a contract to provide on-site medical services. For this contract, the client requested an on-site physician two days a week, bi-weekly, as well as a full time (40 hrs/wk) on-site nurse practitioner. These on-site resources would be tasked with day-to-day management of the clinic, all related medical assessments and back log of case management files. Both of these roles would also have an active involvement in the strategy for reduction of absenteeism rates.

Our Recommendations

Upon reviewing the customer’s scope of work and gaining a better insight into the remote environment in which these positions would operate, we decided to approach the client with an alternative solution that would better suit their needs. The solution would include a physician/physician assistant model given the uniqueness of the fit for the client needs.

In our  experience  working  with  this  model  and   that most physician assistants (PA)  working  with  us  have  military  experience,  we  knew   this   profile would understand the intricacies of working in a remote environment.

We also chose to approach the client with this model for the following reasons:

• PAs are trained in a medical model like physicians. Ex-military PAs in particular have significant occupational medicine experience. When supervised by a physician with a broad range of occupational medicine experience, an expanded scope of practice is provided for the management of occupational illness and injuries.
• PAs work under the license of a physician and are given a wide degree of autonomy by the supervising physician, within the physician’s scope of practice, which is of utmost importance in a remote setting.
• Core training for a PA requires Advanced Trauma Life Support (ATLS), Advanced Cardiac Life Support (ACLS) and treatment/assessment of acute, chronic or emergent injury/illness.

Within 6 weeks from the start of our program the physician services were no longer needed. The customer felt the services provided by the PAs were sufficient and meeting the mandate requirements resulting in an annual cost saving for the customer of approximately 240K.*

Additionally, absenteeism rates declined steadily every month following implementation of the PA model and measurable performance   indicators   were   seen   after    only three months. In fact, the absenteeism rate declined to 8.4%, lowest in 14 months. In the Reduction operating area, absenteeism fell to 5.9%, the first time in 14 months that a specific operating area saw rates below 6%. And lastly, 6 out of 7 operating areas saw a reduction in absenteeism rates from January to February 2017.

Through this program, several improved outcomes were observed. Firstly, injured or sick employees would visit the on-site PA instead of taking the time to go see a regular off-site clinic physician meaning that non-urgent cases could be treated immediately as opposed to requiring a trip off-site. The PA was then able to quickly assess the illness or injury in relation to the worker’s job functions as opposed to a generalized diagnosis often received in the public system. Each case was treated individually to determine best course of treatments with a focus on keeping employees working or returning to work faster.

Secondly, on-site PAs understand the work environment as well as the common injuries and risks of that particular environment so that when medical issues arose, they could be proactive in identifying and treating issues before they became chronic. Also, the PA knew alternatives to keeping the employee working such as modified duties.

Finally, through this program our client came out with support in building a culture of wellness – not an easy task on remote sites such as this! The Horizon PAs acted as a source of education and health promotion for safety and wellness on-site, they regularly met with HR and senior management to act as a champion for the continuous improvement of health programs and they acted as a resource for HR in understanding absenteeism claims.

All in all, the client need was filled and their expectations far exceeded. By allowing our experience team of medical professionals to assess the situation, provide recommendations, and carry out a plan of action that was best suited to the particular client needs, the best possible outcome was achieved.

*salary + travel of physician resource