Dysfunctional Disabilty

Last  weekend I loaded the wife and kids into the car and made the long trip to the sprawling metropolis of Fort Covington, NY to spend Easter with family. While the kids watched Despicable Me (again) I listened to one of my favorite podcasts, This American Life. I highly recommend you take a listen to this episode which was dedicated to the disability system in the US.  If you are not into podcasts then you can read about the topic here. 

                This episode focused on Hale County Alabama where 1 in 4 adults are on disability. However, this problem is not isolated to one county in one state. States like West Virginia, Arkansas, Alabama and Kentucky all have over an 8% disability rate for 16-64 year olds.pm-gr-disability_states-616
The US pays disability benefits to over 14 million people each month and these numbers continue to grow. Not surprising the fastest growing sector of disability is from musculoskeletal disorders (33.8%, up from 8.3% in 1961). I am sure like me, many other physical therapists have seen firsthand how messed up the system is.
What was most interesting to me about the episode was the impact that politics, social ideals and economics had on the disability system. For instance, the unemployment rate makes headlines all the time, but you never hear about the disability rate. So it is a political advantage to move unemployed workers to disability (poof, the unemployment rate goes down). Also, states have to pick up the bill for welfare but the federal government pays for disability. As a result, states will hire consultants to contact people on welfare and attempt to get them qualified for disability.

               pm-gr-disabilityvswelfare-616 The episode further expands on this misalignment of incentives. Once on disability you are “punished” (disability benefits taken away) if you get better and/or get a job. As a result, very few people ever get off disability once approved. This got me thinking about the neuromatrix and pain. Imagine a patient with low back pain whose only source of income is a disability check and they have no job prospects. Getting better poses a huge threat and staying disabled and in pain may be the safer option. Maybe we need a questionnaire which measures the fear of getting better?

                If you get a chance check out the podcast or article and let me know what you think.


All Comments

  • Hey Adam,
    Funny that you just wrote about this as I read this podcast (for some reason I couldn’t get the podcast to work) last Thursday. I had a colleague show me initially and my first reaction was after seeing title, will this just piss me off!? ha!
    It is eye opening and definitely did not know that people on disability are not on unemployment numbers, quite decieving! I work in a rural area and has high rate of disability (low socioeconomics, no jobs, no education, etc) so it really hits home. I do recommend anyone working in our field to read or listen to this too. I hear it is a long process to get someone on disability, but it seems too easy around where I am and someone seems to just stamp ‘approved’ on every application!
    This model leads to a minimalist attitude and people just get by from what can be given to them. Where I am, young patients come in and say they are on disability just b/c their parents are (physical, not mental). But then they have smart phone and nails recently prepped. Ugh, its a downward spiral trend.
    Thanks for sharing this.

    Harrison Vaughan April 7, 2013 9:44 pm Reply
  • I’m new to your blog site but I want to tell you how much I’ve enjoyed reading the recent posts on FowardThinkingPT. This is a fascinating topic that we’ve talked about in my company many times. I have 14 clinics and we specialize in back and neck problems. We utilize neuromatrix education with our patients and have tremendous success. However, one of the biggest stumbling blocks we’ve encountered is not the pain science education with patients but the inability to change the “system” so to speak. We see chronic pain patients who have failed every traditional treatment, we take them through neuroscience education, and we start to see change. Where everything falls apart is the threat of losing guaranteed money in the form of disability. For many of these patients there is no incentive to return to work and this combined with the baggage many of them have already is a lethal combo.
    I attended a seminar last year where Michael Sullivan from McGill University in Canada was speaking regarding his PGAP approach with chronic pain and he had some really cool data (unpublished so far) in the U.S. social security and disability arena. They had managed to move the needle and get a small percentage of people off of permanent disability and they are working on publishing that data, hopefully soon.

    Galen April 10, 2013 10:51 am Reply

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