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Many good reasons have been given for providing an on-site clinic — primary and/or urgent care — for employees. Clearly, there can be physical health benefits, and often such a benefit is appreciated by employees.
But when Gabor Lantos, MD, MBA, P.Eng, an occ-health consultant in Toronto, considers the reasons for offering such a clinic, he drills down to one very specific dynamic: trust.
"It comes down to that one word," he says. "If you read the literature, whether on disability, absenteeism, or presenteeism management, there’s a lot of adversity [between employer and employee]. What a primary care clinic does is establish trust over a period of time."
Lantos says with most of his corporate clients, he provides on-site clinics that are occ-health focused. "But we also provide primary care — not family practice — and this has worked extremely well. The employers are satisfied because it is very cost-effective, and the employees like it because it is convenient, they don’t need to miss work [and lose money], and because they have confidence in us — in contrast to an unknown urgent clinic or ER."
Establishing a trusting relationship
Seeing individuals for non-occ issues establishes a trusting relationship, says Lantos. "If you have a service available, employees will start to use it, no matter what the existing climate is in the company," he says. "Employees will come in if they feel dizzy, have abdominal pains, if their doc is out of town — you name it."
By providing such a service, the first encounter with employees actually will be in pre-placement, he continues. "This gives you the opportunity to indicate there’s a caring employer, it allows the face to face establishment of a doctor-patient, nurse-patient, employer-employee relationship," Lantos observes.
A strong rapport can be established through the clinic, he adds. "So, when you need to ask questions, or if you call to see how they’re doing, you won’t get a bad reaction from them because you’re a management representative,’" he notes. "These things fall by the wayside; they realize over time that you are looking after their welfare, that you’re not taking sides. They acknowledge the fact that you call a spade a spade — that you are objective."
Lantos adds that he’s never had problems with any of the unions involved in such arrangements. "In fact, they become staunch supporters once they see it in action," he asserts.
Another benefit of an on-site primary care (or primary care-plus) clinic is that it can help strengthen your prevention efforts. "What everybody wants is early intervention, and this is what allows you to practice proactive prevention at the group or the individual level," Lantos asserts. "You know the employee’s medical history before anything ever happens. If they cut themselves, and you know they’re diabetic, you have to warn them they may be a slow healer, and you follow them more closely."
Because of the ongoing relationship, injury situations also are easier to deal with, he notes. "The employees don’t see you as a disability claims manager, but rather, as a specialist in occ-health who knows workplace issues and how relate to individual health. This makes you able to bridge the gap between the workplace and an employee’s individual work issue — something a specialist out in the community can’t do. When a neurologist writes light duty,’ people come to us; they know we’re the ones who can assign appropriate light duty."
What’s more, says Lantos, there’s no critical mass in terms of company size for setting up such a clinic. "You just go into the company, conduct a needs analysis, and come up with a suggestion that will prove to be cost-effective," he advises. "There are places where a nurse will go in a half day a week. In general, however, to make it worthwhile you usually need to have 200 or so employees. On the other hand, complex organizations with 40-50 people who, for example, deal with infectious disease issues — such as a research institute — will have a nurse go in one half-day a week, and I might go in once month."
The bottom line, he says, is if you set up such a clinic "as professionally and as objectively as humanly possible, it works out to be a win-win."
[For more information, contact:
• Gabor Lantos, MD, MBA, P.Eng, Occupational Health Management Services, Toronto. Telephone: (416) 410-5018. Fax: (416) 229-2669.]