September 21, 2026 | Sacramento, CA — MedLegalNews.com — California’s workers’ compensation system is facing renewed attention over its provider shortage after a new RAND study found that the number and distribution of health care professionals participating in workers’ compensation vary substantially across the state. The report, released August 27 by the California Department of Industrial Relations (DIR) and Division of Workers’ Compensation (DWC), is the first of four annual studies examining access to medical care for injured workers. Rather than finding a statewide deterioration in access for the typical injured worker, RAND identified a more complicated picture in which overall participation has remained relatively stable while physician participation, regional provider supply, and travel distances have developed important disparities.
The findings make the provider shortage issue particularly relevant to workers’ compensation administrators, physicians, attorneys, employers, and injured workers because access depends on more than the total number of professionals practicing in California. A provider may be available somewhere in the state without being reasonably accessible to a worker who needs treatment close to home. RAND examined data from 2017 through 2024 and evaluated both patient-level access and provider supply, including differences by specialty and geography. The resulting baseline provides regulators with a framework for tracking whether the provider shortage becomes more pronounced as future annual reports measure changes in participation and access.
Provider Shortage Emerges Through Changing Physician Participation
The RAND study found that nearly 75,000 individual providers supplied some care to injured workers through California’s workers’ compensation system in 2024. That number has remained broadly stable, but the composition of the participating workforce has changed. RAND reported that participation shifted away from physicians, chiropractors, physical therapists, and psychologists and toward advanced practice providers, including nurse practitioners and physician assistants. The number of participating physicians declined across several specialties, including primary care, orthopedic surgery, other surgery, anesthesiology, physical medicine and rehabilitation, and neurology.
This distinction matters when evaluating a provider shortage. A stable overall provider count does not necessarily mean that the system has maintained the same clinical capacity. If physician participation declines while other provider categories increase, the total number of participating professionals can remain relatively unchanged even as the availability of particular specialties shifts. RAND reported that the number of providers treating at least 10 workers’ compensation patients annually increased slightly between 2022–23 and 2024, suggesting that measures of sustained participation can produce a somewhat different picture than a simple count of every provider with one paid bill line.
The study also compared workers’ compensation physician supply with physician supply in California’s general health care system. That comparison provides another important dimension to the provider shortage discussion. From 2020 to 2023, the general health care system experienced an 8.6% increase in physicians per 10,000 California residents. By contrast, the workers’ compensation system experienced a 7.4% decrease from 2020 to 2024 in physicians per 10,000 workers’ compensation patients under the study’s broadest participation measure. The periods are not identical, but RAND used the comparison to show that physician participation in workers’ compensation has not kept pace with broader physician supply.
Regional Provider Gaps Complicate Injured-Worker Access
Geography is another major component of the provider shortage identified by RAND. The report found that provider-to-patient ratios varied significantly among California’s DWC regions. In 2024, the Central Valley had approximately 526 providers per 10,000 workers’ compensation patients, while the Inland Empire had approximately 507. By comparison, the Bay Area had approximately 907 providers per 10,000 patients and San Diego had approximately 817. These differences indicate that an injured worker’s ability to locate a participating provider can depend substantially on where the worker lives.
The geographic findings are particularly significant because the provider shortage is not distributed evenly throughout the state. RAND found that the Inland Empire had the lowest physician-to-patient ratio among the large regions, at approximately 267.9 physicians per 10,000 workers’ compensation patients, while the Bay Area had the highest large-region ratio at approximately 579.8. The Central Valley and Inland Empire also consistently appeared toward the lower end of provider ratios across multiple provider categories. For injured workers who require specialized treatment, a lower regional supply may translate into fewer nearby options even when statewide provider numbers appear relatively stable.
At the same time, the report cautions against treating every low provider ratio as proof of a workers’ compensation-specific provider shortage. RAND found that regional differences in workers’ compensation provider supply were associated with differences in provider supply in the general health care system. In other words, some areas with fewer workers’ compensation providers also have fewer health care providers generally. This distinction is important for policymakers because it suggests that some access problems may reflect broader workforce conditions rather than a problem unique to workers’ compensation.
Rural and Suburban Workers Face Longer Travel Distances
The relationship between a provider shortage and actual patient access becomes clearer when travel distance is considered. RAND found that statewide median access remained relatively stable for the typical injured worker with an accepted specific injury claim. The median time to the first evaluation and management visit has remained at one day since 2019, while the median time to the first physical medicine visit declined slightly from 17 days in 2022–23 to 16 days in 2024. These findings do not indicate a broad statewide deterioration in timeliness.
However, the same report identified growing travel distances for injured workers living in suburban and rural areas. Driving distances for evaluation and management and physical medicine visits increased in those areas, particularly among rural workers, while distances for urban workers remained comparatively stable. RAND also found regional differences in timeliness, with the Central Valley reporting a median 26 days to the first physical medicine visit and the Central Coast reporting 31 days, compared with a statewide median of 16 days in 2024. This creates a more nuanced picture of the provider shortage, where the problem may be less visible in statewide averages but more consequential for particular communities.
Longer travel does not automatically establish that a worker could not obtain appropriate treatment. RAND specifically noted that travel distance can reflect factors other than insufficient access, including provider preferences or perceived differences in quality. Nevertheless, persistent increases in travel distances can serve as an indicator that local provider capacity deserves continued monitoring. For workers recovering from musculoskeletal injuries, surgery, neurological conditions, or other occupational injuries, repeated long-distance travel can add practical burdens to treatment. A regional provider shortage therefore can affect the real-world accessibility of care even when statewide measures of appointment timeliness remain stable.
Physician Participation Matters for Specialized Workers’ Compensation Care
The provider shortage discussion also needs to account for the type of medical care required. Workers’ compensation patients do not all need the same services, and access to a primary care provider does not necessarily resolve a need for orthopedic surgery, physical medicine and rehabilitation, behavioral health, neurology, or another specialty. RAND found recent declines in participating physicians across multiple specialties, including a 6.1% decrease in neurology participation, a 5.1% decrease in primary care participation, a 4.0% decrease in physical medicine and rehabilitation, and a 3.3% decrease in orthopedic surgery between 2022–23 and 2024.
For workers’ compensation professionals, those changes can raise questions about network adequacy, referral patterns, treatment continuity, and the practical availability of specialists. A numerical provider shortage in a specialty may be more consequential than a modest decline in the overall provider population because specialized treatment cannot always be substituted by another category of clinician. The issue can become especially important when an injured worker requires sequential care, such as evaluation followed by physical medicine, diagnostic services, specialist consultation, or behavioral health treatment. Regional availability can influence how easily that sequence occurs.
The report also highlights a shift toward advanced practice providers. Nurse practitioners increased by 11.2% and physician assistants by 4.5% between 2022–23 and 2024, while participating physicians declined 1.5%. Acupuncturists increased 9.2%, while chiropractors, physical therapists, and psychologists also experienced declines. These changes do not by themselves establish inadequate care, but they demonstrate that the workers’ compensation provider workforce is evolving. Monitoring a provider shortage therefore requires looking at provider mix, specialty availability, patient volume, geography, and sustained participation rather than relying solely on the number of individual providers appearing in billing data.
Provider Shortage Could Affect Treatment Planning and Claims Administration
A provider shortage can also have implications beyond the initial appointment. Workers’ compensation treatment frequently involves continuing care, referrals, utilization review, medical documentation, and coordination among multiple professionals. If an appropriate specialist is difficult to locate, delays or additional travel may affect the practical administration of a claim even when the underlying regulatory requirements have not changed. The RAND report does not conclude that provider supply is causing widespread treatment delays, but it identifies regional differences that warrant continued observation.
The findings may therefore become relevant to medical provider networks, claims administrators, employers, and attorneys evaluating whether workers have meaningful access to appropriate care. A low provider ratio should not automatically be treated as evidence that a particular claim cannot be adequately managed. At the same time, repeated difficulty locating an appropriate provider, long travel distances, or limited specialty participation can provide important context when assessing an injured worker’s treatment experience. The provider shortage issue is consequently connected to both system-level policy and individual claim administration.
RAND’s methodology also provides useful limitations for interpreting the findings. Provider participation was primarily measured using medical billing information, with a provider counted as participating when the individual appeared as the rendering provider on at least one workers’ compensation bill line during a service year. The researchers also examined stricter measures based on annual payments or the number of workers’ compensation patients treated. Medical-legal-only services were excluded from the provider participation analysis, meaning providers acting solely as Qualified Medical Evaluators were not counted as participating medical-care providers.
California Will Have More Data to Track Provider Shortage Trends
The August report is only the beginning of a longer monitoring process. DIR described the RAND study as the first of four annual reports designed to track injured workers’ access to medical care and the factors influencing that access. Because the initial study establishes a baseline, future reports can provide additional evidence about whether the provider shortage is becoming more concentrated in particular specialties or geographic regions, whether provider participation changes over time, and whether longer travel distances persist.
That longitudinal approach will be important because a single year of data cannot establish a permanent statewide trend. The current evidence instead shows a system in which access for the median injured worker has remained generally stable while provider composition and geographic access have changed. The provider shortage question is therefore not simply whether California has enough providers in total. It is whether the workers’ compensation system has an adequate distribution of providers with the specialties, locations, and sustained participation necessary to meet injured workers’ treatment needs.
For injured workers, the most immediate concern may be whether appropriate care is available within a reasonable distance and within a clinically appropriate timeframe. For physicians and other health care professionals, participation trends may raise questions about the factors affecting willingness or ability to treat workers’ compensation patients. For claims administrators and policymakers, the RAND findings provide a data-based starting point for evaluating regional differences without assuming that every disparity represents the same underlying problem. The continuing annual studies should help clarify whether the current provider shortage signals a temporary shift in provider composition or a longer-term challenge for California’s workers’ compensation medical-care system.
Conclusion
California’s provider shortage issue is more complex than a simple statewide count of physicians or other health professionals. The RAND report shows that total workers’ compensation provider participation remained relatively stable through 2024, but physician participation declined across several specialties while advanced practice provider participation increased. At the same time, provider-to-patient ratios differed substantially between regions, with the Inland Empire and Central Valley among the areas reporting lower overall ratios.
The report does not conclude that California is experiencing a universal breakdown in access to workers’ compensation medical care. Instead, it identifies a system where statewide median measures can remain stable while rural, suburban, and lower-supply regions experience greater travel burdens and where specialty participation can change over time. Continued monitoring will be necessary to determine whether these patterns develop into broader access problems. For California’s workers’ compensation system, the provider shortage question will increasingly depend on whether the right providers remain available in the places where injured workers need them.
The official source for this report is the California Department of Industrial Relations. Read the DIR report on workers’ compensation medical access and provider participation.
Subscribe to MedLegalNews.com for continuing coverage of California workers’ compensation medical access, provider participation, DWC developments, medical treatment standards, and other medical-legal issues affecting the workers’ compensation system.
🔗 Read More from MedLegalNews.com:
- California Court Addresses Workers’ Compensation Insurance Policy Cancellation
- California Supreme Court Issues Important Workers’ Compensation Reconsideration Decision
- California MTUS Hip and Groin Guidelines Change Workers’ Compensation Treatment Standards
- Critical California MTUS Ankle Foot Guidelines Take Effect in 2026
- Critical Workers Compensation Medical Care Access Findings for California in 2026
FAQs: California Workers’ Compensation Provider Shortage
What does the RAND report say about California’s provider shortage?
The RAND report found that nearly 75,000 individual providers participated in California’s workers’ compensation system in 2024, with total participation remaining relatively stable. However, participation shifted away from physicians and several other provider groups toward nurse practitioners, physician assistants, and acupuncturists. RAND also found that workers’ compensation physician supply per 10,000 patients declined between 2020 and 2024 while general physician supply increased during the comparable period.
Which California regions have the lowest provider supply?
RAND found that the Central Valley had approximately 526 providers per 10,000 workers’ compensation patients in 2024, while the Inland Empire had approximately 507. Among large regions, the Inland Empire also had the lowest physician-to-patient ratio, at approximately 267.9 physicians per 10,000 workers’ compensation patients.
Does the provider shortage mean California workers are experiencing widespread treatment delays?
Not according to the statewide median measures in the RAND study. The median time to the first evaluation and management visit remained one day, while the median time to the first physical medicine visit was 16 days in 2024. However, RAND found increased travel distances in rural and suburban areas and significant regional differences in access, indicating that some injured workers may face greater practical barriers.
Will California continue studying workers’ compensation provider shortages?
Yes. The August 2026 RAND report is the first of four annual studies examining access to medical care and provider participation in California’s workers’ compensation system. Future reports are expected to provide additional information about changes in provider supply, geographic access, specialty participation, and other factors affecting injured-worker access.