Medical Exams: A Driver of Work Force Wellness

April 1, 2009
Keeping employees safe is crucial for any organization, and common sense tells us that a healthy work force ultimately makes for a stronger business.

Creating an environment of wellness isn't a simple proposition, especially for employers with large, dispersed work forces. A proactive wellness program, however, can be within reach. A growing number of businesses are finding that one of the best wellness tools available is one they already have in place: their existing, OSHA, Americans with Disabilities Act (ADA) or U.S. Department of Transportation (DOT)-mandated medical examination program.

Many companies see medical exams as no more than a necessary regulatory obligation. But mandated exams can be much more than just a compliance issue. Often times, these exams are the first time an individual has seen a doctor in years. And while the primary role is to determine a person's ability to do a job safely, the exams also provide the chance to identify medical conditions or potential health habits that significantly can impact health and well-being. Medical surveillance, fitness-for-duty or pre-placement exams can be the first step for an individual to make better health decisions.

Not adapting to the changing needs of workers is an all-too-common business mistake. As many companies experience an aging work force, workers may be doing the same tasks they did when they were younger, but their lifestyle and physical condition may have changed. Just knowing what kind of prescription medication a given patient/employee is taking can be crucial to making sure they are safe in the workplace.


Exam programs also can be a good foundation for future wellness initiatives. One clear benefit to combining the two is that employers can make more informed wellness decisions tailored to their specific work force's health needs. It's very difficult to design an effective wellness plan without an accurate baseline of health issues workers are facing or health patterns seen across a particular employee population.

Recently, a Fortune 1000 transportation company requested a breakdown of the reasons employees were not automatically being cleared to perform safety-sensitive duties. The company was aware of its aging work force, but it didn't have a sense of its population's overall health profile, what programs were needed or what to focus on to make a difference in the long-term stability and productivity of its work force.

Working in partnership across the country with its medical exam provider, the company was able to receive an aggregate analysis of its work force health information and discovered that a significant number of employees were overweight and had heart disease and diabetes (see Chart A). As a result of this analysis, the company was able to make an informed decision to create a wellness program that targeted those and other health conditions. The scope of the exam program allowed them to focus on longer-term employee health.

Following up exams with a wellness program can be a great way to improve health. Exams can be used to amass and graph health-related information of an employee population to give an employer the data needed to make the best choice for its particular work force. A centralized exam program also can aid in educating employees about the importance of tracking their own health condition, including risk assessment, prevention, early detection and intervention.


Making sure that all of your workers are in compliance with OSHA, DOT or ADA can be a major challenge for any company. Regulations and standards change, new employees are added or existing workers move into a different age bracket. Many employers fear that adding a wellness element on top of these compliance requirements simply would be too complex and difficult to manage. However, partnering with a work force health expert can eliminate many of these concerns and add long-term benefits beyond just compliance.

Compliance issues can be tricky and exam programs require robust processes, systems and protocols to ensure employee safety while protecting patient confidentiality. Selecting an experienced health partner who understands these mandates, keeps up with ever-changing regulations and offers best practices is essential. These partnerships help to not only achieve total work force medical compliance, but also to minimize legal risk and streamline health care costs and administrative time in the process.

In addition to the easily identifiable compliance regulations, there are some requirements that can be more subtle and even harder to track across a large work force. Mandates like records-retention or past-exam expiration dates especially can be tough on companies where the working population is spread out across multiple locations. Ideally, any business with a national work force has one point of contact to develop and mange its health program.


Without a centralized approach to work force health, it's hard for employers to maintain a consistently excellent compliance record. However, there are advantages to centralizing a health program that go beyond compliance. A centralized strategy also gives an employer the ability to see larger trends, either regionally or for an entire employee population. In addition, with one uniform program companies can be sure that their workers are getting the same level of care no matter where a particular office is located. Having a centralized approach to employee health gives businesses a level of quality control that they just can't get otherwise.

Without a centralized program, organizations often rely on multiple examiners to collect data and administer medical exam programs. This method doesn't give employers a consistent approach to medical clearance or a uniform view of the health of their work force, and it even can result in inconsistent medical results, meaning that some people with medical conditions could be given a medical clearance incorrectly and wind up working unsafely.

A unified approach to work force health also can be a matter of economics. The longer a team is waiting to get medically cleared, the more revenue a business loses. Whether it means getting new hires into compliance, recertifying existing workers or making appropriate occupational changes and accommodations, acting quickly is essential. Companies with a centralized medical exam program have the capacity to conduct large numbers of exams in a short time frame and therefore, qualify workers much more quickly.


One of the most common mistakes that large employers make, especially during times of economic uncertainty, is to make short-term concessions without thinking through the long-term consequences. And the wellness of employees shows up as both a direct and indirect cost savings: increased productivity, fewer sick days, even fewer workers' compensation claims. Businesses pay for wellness one way or another, and savvy employers know proactive wellness initiatives pay in the long run.

If an exam program is done right and is based on the profile of the work force, it will help maximize a company's health care spending. The cost of health care has been consistently between 7 and 15 percent in recent years, much higher than general inflation. Studies have shown that when designed properly, wellness programs can reduce the escalation of health care costs to between zero and 2 percent.

Mergers and acquisitions also frequently prove to be troublesome for companies that piecemeal their exam programs. The large-scale and immediate compliance issues that these mergers create can be chaotic. Having a centralized exam program already in place makes these business changes much easier to manage.

This model also gives employers the ability to scale quickly if needed. When the government created the Transportation Security Administration, it had to recruit, qualify and hire thousands of new workers, which also meant that there were thousands of physical-assessment tests, medical evaluations and drug screenings that all needed to be done quickly, consistently and in locations across the country. Without a medical examination partner who could provide the personnel, medical equipment and supplies needed to make that happen, it's unlikely that this important federal agency could have met those obligations.


When choosing a company to administer an exam or wellness program, there are a few universal considerations. Does the company know and fully understand all of the components, including the changing regulatory climate? Do they have physicians who not only can administer the exams but have the expertise to provide oversight and serve as consultants? If your company has multiple locations and a dispersed work force, does the potential partner have the ability to serve all of them with a consistent and unified approach? If you are currently creating a wellness program, does your health partner have the experience to make it one in which that employees actually want to participate?

It's been said that you can mandate exams but not wellness. Still, that doesn't mean you can't use your exam program to promote and encourage wellness in new and more effective ways. It often can be the first step to a healthier and more productive company, with smarter utilization of every health care dollar.

Jim Mitchell is executive vice president and Dr. Ellen Kessler is the associate medical director for Comprehensive Health Services Inc. (

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