“You work that you may keep pace with the earth and the soul of the earth. For to be idle is to become a stranger unto the seasons and to step out of life’s procession.”

— Kahlil Gibran

As the pandemic slows down, mandates lift and augmented unemployment support tapers, many have returned to work. However, access to care when injured is increasingly inadequate. Several of the larger clinics offering occupational medicine have either closed, downsized or moved far from town.

Decades ago the people of Hawaii established an important social contract: When our workers become injured, they are entitled to reasonable and necessary medical care. The system in place is, at its foundation, a good one, but without access, benefits are constrained.

At Manakai o Malama, the largest facility in town that cares forinjured workers, the phone is ringing off the hook, and in response we continue to add providers to meet this quickly escalating need. Manakai offers medical providers including primary care, occupational medicine, neurology and naturopathic medicine, physical therapy, occupational therapy, psychology and a sleep lab, all of which are covered by all health insurances. It also offers acupuncture, massage therapy, naturopathic medicine and typically chiropractic. The latter four services are covered well by workers’ compensation insurance. Care is delivered in a team-based, multidisciplinary format.

Under workers’ compensation insurance in Hawaii, as appropriate, injured workers are entitled to up to 15 visits for each of the following services within the first 60 days without prior authorization: care by a medical provider including naturopathic medicine, physical therapy, occupational therapy, acupuncture, massage therapy and chiropractic. X-rays and medication also do not require prior authorization. After 60 days, authorization becomes necessary for the above services. Authorization is also always required for any specialty consultations, additional diagnostic studies such as MRI and any surgery. The exception is emergency care.

Prior to the pandemic, unemployment in Hawaii was among the lowest in the country at under 4%. At the height of pandemic restrictions, with the visitor industry at a near standstill in April and May 2020, unemployment peaked at well over 20%. However, as of September 2021 the unemployment rate was back to 6.6% but, unusually, behind the seasonally adjusted national average of 4.8%.

What is counterintuitive is that even though the unemployment rate is much higher than pre-pandemic levels, there are probably a lot more jobs out there now, and many more employers are struggling to fill positions. Why? Some of us who found ourselves out of work during COVID-19 were not that eager to return once positions opened back up. We have known for years from the occupational medicine literature that if someone is off work for six weeks or more, the chances of them ever returning to work are significantly reduced. Many now prefer the freedom that comes from managing with less. Others have found work in the gig economy. Some now have off-grid income, without the constraints of an employer and, with that, the ability to skirt taxes. There are also those still holding out for a better wage.

Lack of adequate access to occupational medicine for injured workers results in pain and suffering. Without timely health care, the ability to return to work also may be delayed. This harms the workers’ incomes and their families. There is also fallout for employers who may have to do without valuable employees for longer. This is especially difficult if there are lots of unfilled positions to begin with. Ultimately, lack of access to care for injured workers also contributes to the supply chain disruption, which negatively affects the Hawaii economy.

Whether formal or informal, to work is a sacred honor. In consideration for our toil, we earn a livelihood that places food on the table, keeps a roof over our heads and enables us to care for our loved ones. Work is an opportunity for creative expression, for service to the world we live in, and should involve a fair wage for the goods and services we provide. It also should include access to occupational health care when injured.

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Ira Zunin, a practicing physician, is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Serv­ices Inc. His column appears the first Wednesday of each month. Submit questions to info@manakaiomalama.com or check out manakaiomalama.com.