Rand: Stable Access, Decreasing Provider Participation a 'Puzzle'

Monday, August 31, 2026 | 0

Rand said in a new report that contradictory findings about provider participation trends and access to care in California's workers' compensation system "pose somewhat of a puzzle."

"We found flat or slightly declining participation for individual providers overall in workers’ compensation, which included declines in participation among key provider types (physicians, chiropractors and psychologists) and physician specialties (primary care, orthopedic surgeons and other surgeons) with substantial workers’ compensation participation," Rand said. "Yet with the exception of some recent increases in distance traveled by patients (especially in rural and suburban areas), patient-level measures of access have largely been stable over the study period, suggesting that there have not been substantial changes at the statewide level in the prevalence of access problems for the categories of care examined in this report."

Rand reports that the median time to the first evaluation and management visit has remained at one day after the report of injury since 2019. The median time to the first physical medicine visit was down slightly in 2024 at 16 days compared to 17 days during a baseline period of 2022 and 2023.

While median travel distances increased slightly, Rand said the uptick was modest. However, the report also found geographic differences in changes to average distances traveled for treatment.

Distances traveled for E&M and physical medicine increased in both suburban and rural areas since 2022. And the distance that rural workers traveled to receive behavioral health care has increased steadily since 2017.

"Taken together, these findings indicate that while access to care for the median injured worker has remained stable, access may be more difficult for a minority of cases, particularly in suburban and rural areas," Rand said. "The recent increases in distance traveled may suggest increasing access challenges, but these changes have not become widespread enough to affect timeliness of care for the typical worker."

The report also identified a change in provider participation mix even while the total number of providers remained relatively steady.

"Overall, the total number of providers participating in California workers’ compensation remained essentially stable between 2022-23 and 2024, declining by 0.3% (from 74,747 in 2022 and 74,871 in 2023 to 74,599 in 2024)," Rand reports. "However, this stability masked meaningful shifts in the composition of the provider workforce. The most notable trend was a shift from physicians (-1.5% change), chiropractors (-2.1% change), physical therapists (-1.0% change) and psychologists (-4.6% change) toward nurse practitioners ( 11.2% change) and physician assistants (4.5% change), as well as acupuncturists (9.2% change)."

Rand speculated that increasing participation by nurse practitioners and physician assistants may have helped offset declining physician participation, particularly in ensuring timely access to evaluation and management and physical medicine visits.

"However, advanced practice professionals may be limited in their ability to provide some types of care — most notably physical therapy and surgery — that are widespread in workers' compensation," Rand said. "The critical question is whether and when declining provider participation will result in widespread and measurable access problems for injured workers."

Rand also identified additional questions for policymakers to consider, including regional disparities in provider supply and why provider participation in workers' compensation is lower than what would be expected in Los Angeles and the Inland Empire, given the overall number of providers in the general health care system in those regions.

Other patterns that Rand said deserve attention include the divergence between stable median access measures and increasing travel distance for workers in rural and suburban areas, the structural shift in the provider workforce and the concentration of care among a smaller number of providers.

The report, "Access to Medical Care in California Workers' Compensation," is the first in a four-part series covering medical care provided from 2017 through 2024.

A copy of the report is here.