Fewer doctors are treating California’s injured workers, yet the typical injured worker is still getting care about as quickly as before — a combination RAND researchers describe as “somewhat of a puzzle” in a new report for the state. Access to Medical Care in California Workers’ Compensation: Recent Trends in Patient Access and Provider Participation, published in August 2026, is the first of four annual reports RAND will produce under Labor Code section 5307.2, which requires the DWC Administrative Director to contract for an independent annual study of injured workers’ access to medical treatment.
For the typical worker, access has held steady. The median time from injury report to a first evaluation and management visit has been one day since 2019 and remained one day in 2024, with a mean of 8.8 days. Nearly half of workers injured in 2024 (46%) had their first E&M visit on the day the employer reported the injury, 61% within one day, and 72% within three days. For physical medicine — physical therapy, chiropractic, and acupuncture — the median wait actually improved slightly, falling to 16 days in 2024 from 17 days in 2022 and 2023, though the mean ticked up marginally to 35.3 days. The report reads that split as a sign that the typical worker’s wait shortened while workers at the long tail of the distribution waited somewhat longer; the share whose first physical medicine visit came more than 30 days out held flat.
Regional differences in timeliness are substantial. Median time to a first physical medicine visit in 2024 ranged from 8 days in San Diego and 11 days in Los Angeles to 26 days in the Central Valley, 31 on the Central Coast, and 44 to 45 days in the North Sacramento Valley and North State-Shasta regions. Even so, median physical medicine wait times fell or held steady in every region where the change was statistically significant — not a picture of broadly deteriorating access.
The clearer negative trend is geographic. Statewide median driving distances rose modestly across most visit types, but the averages rose considerably more — mean distance to a first E&M visit climbed from 32.4 miles in 2022 to 41.3 in 2024, and to a first physical medicine visit from 36.2 to 46.0 miles — indicating that workers already traveling farther than most are now traveling farther still. Breaking that out by where workers live shows why: driving distances for E&M and physical medicine visits rose sharply for suburban and especially rural workers beginning around 2022, while distances for urban workers stayed relatively flat. Rural workers seeking behavioral health care have seen distances climb steadily since 2017. The report’s read is that access problems are emerging at the margins — concentrated among a minority of workers outside dense areas — without yet being widespread enough to move the statewide timeliness numbers.
Just under 75,000 individual providers billed for treating an injured worker in 2024, essentially unchanged from 2022 and 2023 (a 0.3% decline). But that stability conceals a meaningful compositional shift. Physician participation fell 1.5% between the 2022-23 average and 2024, chiropractors fell 2.1%, physical therapists 1.0%, and psychologists 4.6%, while nurse practitioners rose 11.2%, acupuncturists 9.2%, and physician assistants 4.5%. Declines among physicians were broad-based across specialties, including primary care (-5.1%), orthopedic surgery (-3.3%), other surgery (-2.8%), anesthesiology (-3.5%), physical medicine and rehabilitation (-4.0%), and neurology (-6.1%). Under stricter participation definitions requiring sustained involvement — treating at least 10 workers’ compensation patients in a year — the count actually rose slightly (+0.9%), suggesting the losses are concentrated among providers with marginal system involvement.
Comparing workers’ compensation against the broader health care market sharpens the concern. Physicians per 10,000 population in California’s general health care system grew 8.6% from 2020 to 2023, while physicians per 10,000 workers’ compensation patients fell 7.4% from 2020 to 2024. Under every participation threshold RAND tested, workers’ compensation physician supply lost ground relative to the general system.
Provider-to-patient ratios vary widely by region. In 2024, the Bay Area had 907 providers per 10,000 workers’ compensation patients and San Diego 817, while the Central Valley had 526 and the Inland Empire just 507. Among large regions, the Bay Area led on physicians specifically (580 per 10,000 patients) and the Inland Empire trailed badly (268).
The report’s most policy-relevant finding may be its attempt to separate workers’ compensation-specific problems from general medical shortages. Plotting each region’s workers’ compensation provider supply against its general health care provider supply produced a population-weighted correlation of 0.71, meaning roughly half of regional variation in workers’ compensation physician supply is predicted simply by how many physicians practice in that region overall. The Central Valley’s low workers’ compensation supply, on that measure, is largely a function of a broader physician shortage. But Los Angeles and especially the Inland Empire — defined here as Imperial, Orange, Riverside, and San Bernardino counties — have workers’ compensation provider participation well below what their general health care supply would predict, across multiple provider types and specialties. RAND flags this as an unexplained finding it plans to investigate in future reports, while noting the practical implication: policies aimed narrowly at boosting workers’ compensation participation likely have more room to work in the Inland Empire than in the Central Valley, where the binding constraint appears to be the overall supply of clinicians.
Telehealth adoption is highest in behavioral health and has risen recently, with the strongest uptake in the Central Coast and Central Valley — the same regions with low psychologist supply and long driving distances. RAND’s rough calculation treating at-home telehealth visits as zero driving distance found meaningfully lower average travel burden in both regions. The caveat is significant, though: telehealth cannot substitute for in-person care in physical medicine or surgical specialties, which are central to workers’ compensation, and telehealth use in orthopedic care has been declining since 2020 even among eligible services.
RAND frames the central puzzle directly: provider participation is flat or declining across most key provider types, yet patient-level access measures have largely held steady. One plausible explanation the report offers is that growing nurse practitioner and physician assistant participation has offset declining physician participation, particularly for initial E&M visits, which may in turn keep downstream physical medicine referrals moving. But advance practice providers cannot perform orthopedic surgery or deliver physical therapy — precisely the services where participation is falling. The question RAND poses for policymakers is how far provider participation can decline before measurable, widespread access problems emerge.
Future reports in 2027, 2028, and 2029 will update these baseline measures and take on structural features this first report deliberately deferred, including utilization review, Independent Medical Review, Independent Bill Review, and Medical Provider Networks — features that system participants have long argued add friction and discourage provider participation. A final report will synthesize findings and offer policy recommendations.