What does a physical consist of?

A physical exam in occupational medicine includes medical history, vital signs, and assessment of body systems, augmented by work-related components associated with regulatory compliance, injury prevention, medical surveillance, and disability avoidance.

Getting the Right Work Physical

A general physician might answer the question, “What does a physical consist of?” with a list of body systems to be assessed and lab work to be done. An occupational health clinician is likely to address those aspects in a physical exam, too – while also going a step further by asking about the employee’s work environment and job requirements. A national occupational health organization with Concentra’s 40-year history and extensive clinical expertise will provide the right work physical for the work the employee needs to do.

Overview

In occupational medicine, clinicians address the needs of employers and their more than 130 million employees¹ across a hundred recognized industries² to help prevent and manage injury, illness, and disability in the workplace. They also help keep employers and workers in compliance with millions of federal and state regulations and laws. For them, the physical examination is a valuable element of the occupational medicine toolkit. Given the complexities of the specialty, you begin to see why a question, “What does a physical consist of?” needs a detailed response.

As a brief overview, we can look at work-related physical examinations in four categories, based on when they are done or the purpose they serve:

1. Physical exams performed before work begins
2. Regulated physical exams
3. Medical surveillance/hazardous substance exams (also regulated)
4. Return-to-work and fit-for-duty physical exams

Physicals before work begins include two major types. Pre-placement exams and functional capacity evaluations match physical capacity with requirements of the job.

Regulated physical exams can help keep employees compliant with industry/government requirements. This encompasses interstate commercial drivers of trucks and buses, commercial pilots, maritime workers, military, police officers, firefighters, and more.

Exams for medical surveillance (baseline/ongoing screening), exposure to bloodborne pathogen or hazardous substances, and respirator medical clearance/respirator fit tests are mandated by the federal Occupational Safety and Health Administration (OSHA) for worker health and safety to help prevent injury and monitor exposures.

Fitness-for-duty and return-to-work physical exams support the employer’s efforts to keep workforce health and safety awareness and fitness high over time. These exams can aid in averting repeated injury or illness, thus, helping to reduce workers’ compensation costs.

Now let’s answer the question – What does a physical consist of? – from a general perspective and then from the point of view of different employees.

What Does a Standard Physical Consist Of?

Prior to any physical examination, the employee completes a questionnaire to provide a comprehensive personal, occupational, and medication history. At Concentra, clinicians review the questionnaire and the employee’s test results as they conduct the physical exam and address any findings that may pose immediate risk to health or life.

If an employer has specific physical exam requirements, Concentra incorporates those elements in the exam. In general, the standard physical exam typically includes:

• Vital signs: blood pressure, breathing rate, pulse rate, temperature, height, and weight
• Vision acuity: testing the sharpness or clarity of vision from a distance
• Head, eyes, ears, nose and throat exam: inspection, palpation, and testing, as appropriate
• Gastrointestinal examination: may include any of inspection, auscultation (listening for bowel sounds), percussion (a special tapping technique to deduce any tenderness), or palpation (a touching technique using the clinician’s hand on the relevant body part, in this case, abdomen, to observe any muscle guarding, rigidity, or tenderness)
• Cardiovascular evaluation: general appearance, inspection of eyes (retinal arteries) and heartbeat, blood laboratory tests, and when required by regulations, electrocardiogram
• Respiratory assessment: respiratory rate, observation of skin appearance, breathing sounds and postures. Employees at workplaces required to have a respiratory protection program may also undergo respirator medical evaluation for respirator use.
• Musculoskeletal assessment: Muscles, bones, and joints are assessed by functional grouping using techniques of inspection, palpation, and manipulation (applying pressure or movement) while the clinician observes responses and reactions.
• Neuro exam: observation and testing or observation alone of mental awareness, motor function and balance, sensory response, and nerves/reflexes
• Skin and lymph node check:  skin tone/pallor and lymph nodes are inspected

Where Can Employees Get a Physical?

All of Concentra’s more than 520 community-based medical centers provide pre-placement, DOT, and surveillance exams, as well as drug testing and other occupational health services. To see where your employees can get a physical, go to our Location Finder  and enter your city, state or zip code in the search field.

How Long Do Physicals Take?

As a general rule of thumb, you can expect a standard physical examination to take about 45 minutes. More complex physical exams or exams that uncover a health issue that requires additional discussion or examination may run longer.

Click the physical exam category below  to go directly to a specific exam, if desired.

• New hire physicals
• DOT certification physicals
• Firefighter physicals
• Law enforcement officer physicals
• Physicals for workers with risk of hazardous substance exposure
• Physicals for employees returning to work after extended absence
• Business executive physicals

I’m a New Hire. What Does a Physical Consist Of?

Pre-placement/post-offer physical exams are designed to help ensure there is no health condition that could compromise the safety of the employee or others when performing the essential functions of the job description. These exams also seek to ensure essential job functions will not worsen any pre-existing medical condition.

If you have employees with physically demanding jobs, you may benefit from functional capacity evaluations to assess how well a new hire’s physical capacity aligns with the physical demands of those jobs. In this type of physical exam, the post-offer new hire will undergo a variety of brief physical tests to demonstrate capacity to lift, carry, and hold weighted objects at body height or higher. After the exam, Concentra clinicians will communicate with the employer regarding the employee’s results.

The value of functional capacity evaluations (also called human performance evaluations) is well supported by research, as seen in several studies cited in MDGuidelines®, the high-quality, evidence-based practice guidelines of the American College of Occupational and Environmental Medicine.3 Here are three significant examples:

• Researchers studied food production and manufacturing employees over employment periods of 3.5 to 6 years. They found that incidence of back injury was very low (3 percent) among employees who, in a functional capacity evaluation, demonstrated capability to perform the defined job description. Employees who did not demonstrate capability had a 33 percent incidence of back injury.
• In a statistical analysis combining the results of multiple studies, researchers looked at the impact of impact of pre-placement ergonomic screening tests on injury rate. They found that new hires who completed a battery of functional capacity tests satisfactorily had a 47 percent lower workers’ compensation injury rate. Job retention also was higher (by 21 percent) for employees who performed well on functional capacity tests versus those who did not, which could indicate that employees who are well-matched with job description requirements are more engaged, loyal, and happier in their work.
• In another study, researchers looked at the frequency and severity of musculoskeletal injury of employees who were screened in advance with those who weren’t. Over a period of almost three years:
  • There were significant reductions in the frequency and severity of musculoskeletal injuries in the screened employee population.
  • Meanwhile, unscreened applicants were 2.38 times more likely to experience an overexertion injury of the knee, shoulders, or back than screened hires and incur workers’ compensation claims cost more than four times higher than the employees who were screened.

My Employee Needs DOT Certification. What Does a Physical Consist Of?

Employees in “safety-sensitive transportation jobs,” as defined in U.S. Department of Transportation (DOT) regulations, are required to have regular physical exams performed by a certified medical examiner listed on the National Registry of Certified Medical Examiners, along with mandatory drug testing. Concentra DOT physical examinations and testing meet all requirements outlined in the Federal Motor Carrier Safety Administration’s Standard 49 CFR 391.41 (Physical Qualifications for Drivers).

Concentra has more than 1,200 certified medical examiners listed on the NRCME – at least one at each of our more than 520 community-based medical centers nationwide, so there is always one near you. Our certified medical examiners conduct each DOT physical to protect the well-being of commercial drivers, rule out any DOT disqualifying medical conditions , and help ensure safety on the roads. (Diabetes involving insulin treatment is no longer a disqualifying condition or one where an exemption is required when commercial drivers have properly controlled diabetes and a stable insulin regimen.)

Components of the DOT physical examination include:

• General appearance: The medical examiner makes note of a variety of factors, including obesity, abnormalities with posture, limps, tremors, or other conditions that might indicate an illness or other concern.
• Head and eyes: Eye charts are used to assess visual acuity (sharpness/clarity of vision from a distance) so a driver who normally wears corrective lenses may wear them during the exam. Contact lens wearers must be well adapted to them.
• Ears: The medical examiner notes any evidence of ear disease, such as Meniere’s disease or vertigo. Two tests of hearing may be used. Failing the first – a forced whisper test – means the medical examiner may administer an audiometric test. (An examiner may reverse the order of the two tests, but the driver must pass one to be certified.)
• Throat: The medical examiner looks for any deformities likely to interfere with breathing or swallowing.
• Heart: The medical examiner inspects for any current irregularities in heart function or evidence of an enlarged heart, congestive heart failure, or other cardiovascular disease. If the medical examiner determines an electrocardiogram is indicated, one may be performed.
• Blood pressure (BP): If a driver has hypertension and/or is being medicated for hypertension, recertification should occur more frequently than the standard once every 24 months.
  • A driver diagnosed with Stage 1 hypertension (BP is 140/90-159/99) may be certified for one year. At recertification, an individual with a BP equal to or less than 140/90 may be certified for one year; however, if his or her BP is greater than 140/90 but less than 160/100, a one-time certificate for three months may be issued.
  • A driver diagnosed with Stage 2 hypertension (BP is 160/100-179/109) should be treated and a three-month certification may be issued.
  • A driver with Stage 3 hypertension (BP is higher than 180 systolic and/or 120 diastolic pressure) requires immediate medical attention, and cannot be certified. When the condition resolves and the blood pressure decreases to 140/90, the driver can be certified at six-month intervals.
• Lungs: The medical examiner looks for any abnormality in chest wall expansion, respiratory rate, and breath sounds. In addition, they look for impaired respiratory function, shortness of breath or cyanosis (which is when the skin has a bluish cast due to poor circulation or oxygen supply). The medical examiner may require pulmonary function tests and/or chest X-rays, if indicated.
• Abdomen and viscera (internal organs in the main body cavity: The medical examiner will inspect for any weakness or tenderness in the abdominal wall, enlargement of the liver or spleen, and the presence of masses. Further testing and evaluation may be required if any abnormalities are found that might interfere with the safe operation of a commercial motor vehicle.
• Genitourinary examination: A urinalysis is required for assessment of protein, blood, and sugar levels. Elevated levels may indicate an underlying medical problem. The medical examiner is also required to check for hernias.
• Neuro exam: The medical examiner assesses the function of the brain and nervous system, with a focus on mental awareness, motor function and balance, sensory response, and reflexes. Impairment of equilibrium or abnormal neurological responses may require further testing to rule out a disqualifying condition. Any neurological condition is evaluated on the general nature and severity of the condition, the degree of limitation it presents, and the likelihood of progression to more limited function or sudden incapacitation.
• Spine and musculoskeletal exam: The medical examiner will assess the result of previous surgery and examine for any deformities, limitation of motion, and tenderness in muscles, bones, and joints before deciding whether additional testing/evaluation is needed.
• Extremities: This part of the exam notes any loss or impairment in function of legs, feet, toes, arms, hands, or fingers, as well as any deformities, atrophy, or paralysis that would interfere with operating a commercial motor vehicle.
• Laboratory and other testing: Based on the medical history and findings of the physical examination, the medical examiner may order additional lab work or tests.

Concentra DOT physicals are available as electronic physicals with the entire exam captured electronically to reduce the risk of documentation errors. Electronic capture enables easier, more efficient management of an employer’s DOT physicals across all business locations.

I am a Firefighter. What Does a Physical Consist Of?

The National Fire Protection Association (NFPA) has developed and routinely updates the Medical Evaluation of Candidates and Existing Members, as outlined in NFPA 1582, a host of regulations to protect these professionals in the performance of their job tasks. The NFPA has reported that firefighters not only face a high safety risk, day in and day out, but also are susceptible to hypertension, diabetes, high cholesterol, obesity, overexertion, stress, heart attacks, and cancer.4

The physical exam for firefighting candidates is conducted consistent with the requirements of NFPA Standard 1582, if the fire department chooses to follow this standard. NFPA Standard 1582 envisions candidates being able to show the strength and fitness to crawl or walk extensively, climb stairs/ladders while lifting and carrying heavy objects and wearing a self-contained breathing apparatus, and more.

Concentra has created physical conditioning procedures and performed job site analyses, physical fitness testing, and more for hundreds of fire departments nationwide, in compliance with local, state, and federal guidelines, including NFPA and International Association of Fire Fighters/International Association of Fire Chiefs (IAFF/IAFC) standards, to ensure that individuals in these positions are fit to perform their essential job functions.

The answer to the question, “What does a physical consist of?” in some respects is similar to other occupational physical exams. There is a medical history questionnaire, which includes medical, personal, occupational, and medication history. A Concentra clinician reviews the questionnaire and performs a comprehensive physical examination.

The exam seeks to determine if the candidate can perform essential job functions (examples are given below) and is free from any health conditions that could adversely affect job performance.

Examples of essential job tasks that are tested during a firefighter physical exam are:

• Lifting/carrying – simulates the height/weight of a fan, jaws of life, chain saw, or portable ladder
• Pushing/pulling – simulates pulling/carrying the hose off the truck to the scene/fire hydrant
• Upper body push/pull – simulates coupling the hoses to the hydrant/truck, using hand tools, and opening doors
• Climbing – simulates accessing the fire ladder to reach victims and climb stairs in structures

In addition, the candidate must demonstrate aerobic capacity, muscular strength and flexibility, and cardiovascular endurance.

Concentra clinicians have expertise beyond what you may find from other providers. First, Concentra maintains written protocols on all NFPA standards and ensures clinical team members have the appropriate certifications for perform audiograms and pulmonary function tests. Next, Concentra clinicians go through extensive occupational health care training specific to firefighters, enabling them to:

• Understand their physiological, psychological, and environmental demands
• Evaluate fire department candidates and employees to identify medical conditions that could affect their ability to safely respond to emergency operations
• Utilize the essential job task descriptions provided by the fire department to determine a candidate's or member’s medical certification
• Identify and report the presence of disqualifying medical conditions
• Inform the fire department chief or designee if/when a candidate or current member is assessed as medically fit to safely perform the essential job functions

The medical examination entails all elements required under NFPA 15825, including:

• Blood analysis
• Cancer screening
• Chest X-ray
• Electrocardiogram
• Hearing test (audiometric exam)
• Infectious disease screening
• Pulmonary function test
• Urinalysis
• Vision test

I am a Police/Law Enforcement Officer. What Does a Physical Consist Of?

Physical exams and pre-screenings help ensure police and law enforcement officers are physically, psychologically, and emotionally well-prepared for the rigors of their job, which can include adversarial situations, high physical demands, and crisis encounters.

Concentra has extensive experience working with hundreds of police departments and other law enforcement agencies across the country to help ensure their officers are fit to perform their essential job functions. Our physical examinations for police officers or candidates comply with all local, state, and federal guidelines, as well as each agency’s standards.

In addition, for safety-sensitive positions, Concentra performs a medical history and physical examination to detect any of the following conditions that may interfere with performance of essential job functions:

• Angina pectoris
• Asthma
• Cancer
• Heart health exam
• Cerebral vascular concerns
• Chest pains of unknown origin
• Contagious hepatitis or tuberculosis
• Chronic respiratory disease
• Diabetes
• Musculoskeletal exam
• Hearing
• Hypertension
• Hernia
• Liver or kidney dysfunction
• Migraine
• Paralysis
• Mental health history
• Seizure disorders
• Vision impairment

The clinician records the findings of the medical examination and describes any circumstance or condition that could limit the individual’s ability to perform the duties of a police officer. Infectious disease screenings and immunizations are completed, as needed, based on patient health history.

If I Have Employees Who Meet OSHA Regulations for Medical Surveillance, What Does a Physical Consist Of?

Concentra offers medical surveillance examinations for employees who may work with or be exposed to chemical, biologic, or physical substances that may present hazards. Services include a baseline surveillance exam, follow-up exam (for pesticides only), periodic surveillance examinations, biologic monitoring, and exit examinations upon leaving an employer. Each type of exposure has very specific requirements and regulations, so the precise content of what a physical consists of will vary by exposure.

Concentra provides physical exams that comply with regulatory requirements for a large number of exposures, including:

• OSHA Standard 1910.120 Hazardous waste operations and emergency response
• OSHA Standard 1910.134 Respiratory protection
• OSHA Standard 1910.1001 Asbestos exposure
• OSHA Standard 1910.1024 Beryllium
• OSHA Standard 1910.1030 Bloodborne pathogens
• OSHA Standard 1910.1053 Respirable crystalline silica

Under OSHA Standard 1910.134, employers are required to develop and implement a written respiratory protection program if airborne contaminants in the workplace exceed permissible exposure limits or employees are required to wear respirators to protect against hazardous respirable exposure.

For these examinations, Concentra uses the mandated OSHA Respirator Medical Clearance Evaluation Questionnaire. In addition, based on the employee’s responses, the evaluating clinician may conduct a follow-up exam and, if the exam indicates, ancillary tests (such as spirometry, resting electrocardiogram, or chest X-ray.

After the clinician reviews the questionnaire responses, performs a focused physical exam, and reviews test results, he or she will provide a written medical opinion to the employer addressing the employee’s ability to wear a respirator. Spirometry, EKG, and chest X-ray may be required at the discretion of the evaluating clinician.

Once an employee is medically cleared to wear a respirator, an employer may contract with Concentra for fit testing of any respirator with a negative or positive, tight-fitting facepiece to ensure an effective seal and performance. This test is done prior to initial use and whenever there is a change in the respirator or facepiece or change in the employee’s appearance that might affect fit. Fit testing is required by OSHA every 12 months.

If My Employee is Returning to Work After an Extended Absence, What Does a Physical Consist Of?

Return-to-Work Physical Exams

Concentra’s longstanding methodology and practices expedite employees’ safe and sustainable return to work. Our process includes immediate communication with the employer, careful job analysis, and a focus on avoiding or limiting an employee’s lost time from work.

During a return-to-work physical exam, in addition to a review of the employee’s medical history and existing documentation, the clinician performs a basic medical examination. The clinician determines if the employee is medically able to proceed with the functional performance evaluation. If the employee has a medical condition that precludes participation in a functional performance evaluation (e.g., recent back/knee/shoulder surgery, an active hernia, a cardiac condition), we require clearance from the employee’s personal physician prior to the functional test.

Once the employee has completed the required functional tests, the Concentra therapist documents a “pass/fail” result, and the results are given to the clinician. The clinician then combines the medical results with the functional test results to render an overall “pass/fail” result for the employee. In some cases, our examining clinician may require additional testing to render a medical decision. However, we do not conduct any additional testing without authorization by the designated employer contact.

Leave of Absence Assessments/Examinations

Concentra can provide leave-of-absence assessments/examinations to determine the cause, validity, extent, and permanency of a disability absence. The results report includes a list of limitations/restrictions, expected duration of those limitations/restrictions, and temporary/permanent accommodations needed.

Under the Family and Medical Leave Act (FMLA), a Certification of Health Care Provider form verifies that the employee’s health care provider signed the form to document that there is information to support the recommendation for time off work on an intermittent or continual basis.

Concentra's review process is as follows:

• Physician receives a completed FMLA form with medical records (via fax, mail, hand delivery, or email)
• Physician reviews form and contacts the employer for clarification or additional information
• Physician reviews form for completeness. Medical records are reviewed to support the medical necessity of the FMLA request (i.e., the establishment of a serious health condition as defined under the Act)
• If request is appropriate, physician provides supporting documentation If request is not appropriate, physician makes two attempts to contact the provider to discuss medical necessity

An employer or employer-assigned medical provider who has reason to doubt the validity of a medical certification may require the employee to obtain a second opinion at the employer's expense. Pending receipt of the second (or third) medical opinion, the employee is provisionally entitled to the benefits of the Act. Concentra’s physician would determine the need for the second opinion. Under the Act, the employer is permitted to designate the health care provider to furnish the second opinion, but the selected health care provider may not be employed on a regular basis by the employer. The employer may not regularly contract with or otherwise regularly utilize the services of the health care provider furnishing the second opinion unless the employer is located where access to health care is extremely limited. In these cases, Concentra would suggest the appropriate medical referral.

Do You Have an Exam for Business Executives? What Does a Physical Consist Of?

Concentra partners with employers to enhance their efforts to protect the health of top-level team members. We perform executive physicals to help determine an executive’s ability to meet the physical demands of their job.

Our process is comprehensive and begins with our clinician’s careful review of the executive’s medical history. This is followed by a thorough medical examination, which includes, but is not limited to, the following:

• Visual acuity and vital signs including, but not limited to, blood pressure and urine dip test
• Examination of head, eyes, ears, nose, and throat
• Evaluation of the respiratory system
• Evaluation of the cardiovascular system
• Gastrointestinal examination
• Musculoskeletal examination
• Skin and lymphatic examination
• Neurological examination

Executives have many demands on their time. As such, Concentra recommends they schedule an examination appointment in advance. This allows clinicians to perform all examination components required by the employer and to schedule any additional screenings or laboratory services.

When all physical testing, laboratory services, and screening studies are complete, a follow-up consultation is recommended. This allows the clinician to discuss test results with the executive, provide personalized guidelines, and make specific recommendations to help the executive maintain optimal health. Concentra clinicians also provide a written report to the executive.

 

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1. “Occupational Medicine,” American Medical Association, accessed July 18, 2019.
2. “Industries at a Glance,” Bureau of Labor Statistics, US Department of Labor, accessed July 26, 2019.
3. “Practice Resources: MDGuidelines®,” American College of Occupational and Environmental Medicine, accessed on July 26, 2019.
4. “Breaking Down Requirements for NFPA 1582https://www.worksitemed.com/breaking-down-nfpa-1582-requirements/,” Occupational Health in Motion, December 28, 2018. Accessed July 29, 2019.
5. “NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments,” National Fire Protection Association, 2018. Accessed on July 29, 2019.