Pre-employment medical exams: a prevention and support tool

A pre-employment medical is an overall health exam intended to document a candidate’s current health status and confirm their ability to fulfill their job requirements. The exam is performed by a team of healthcare providers such as a doctor, kinesiologist and nurse. These evaluations are a preventive way of identifying the risks to the candidate’s health of performing their workplace tasks.

Pre-employment exams allow companies to reduce their rates of absenteeism, injuries or work-related illnesses.

More than just preventing risks and accidents which may lead to serious complications, this exam helps employers better support their employees’ health and safety. When special conditions are identified and documented by the healthcare team, the employer can make arrangements to accommodate the candidate.

There are many advantages of incorporating a medical exam into the hiring process. Doing so helps prevent injuries and reduce absenteeism costs. Every dollar invested provides the organization with a positive return on investment. One dollar invested in prevention can save $14 in medical expenses [1] and provide a 37% reduction in the medical costs of injuries, including shoulder injuries. [2]

In Canada, costs associated with absenteeism drop by 30%-50% when employers add a pre-employment medical and implement an appropriate return-to-work program. [3]

When organizations consider their employees’ health and identify their personal conditions at the time of hiring, they naturally see positive effects for their operations, including:

• improved employee health;
• higher retention rate;
• increased productivity;
• reduced insurance costs.

A pre-employment medical may include a number of tests. It generally consists of a medical evaluation (general exam, vision and hearing) to detect any abnormalities or refer the candidate to their family doctor for follow-up or acknowledgement of care.

The medical may also include an assessment of functional movements, conducted by a kinesiologist, to measure the candidate’s strength, mobility and endurance. This analysis helps our professionals assess the risk of injury based on the job requirements, using a performance score determined in accordance with Canadian standards. This type of evaluation significantly reduces lower back injuries; candidates who fail the functional evaluation have a 33% incidence rate of back injuries, compared with 3% of candidates who pass it. [2]

Depending on the nature of the job and the employer’s health requirements, further tests may be added, such as a pulmonary function test, blood lead level, urinalysis or toxicology screening.

There are physical tests for jobs which require workers to remain seated for a long period, handle or carry weights such as tanker pipes, secure their loads and have physical endurance for vehicle vibrations.

The testing protocol for a heavy vehicle driver, with or without a tank trailer, may include:

• medical evaluation;
• functional movement evaluation by a kinesiologist;
• hearing test;
• full eye test;
• toxicology screening including urine alcohol testing;
• urinalysis using a dipstick to screen for specific conditions, such as diabetes or an infection.

The evaluation may be upgraded for candidates required to do “heavy labour”, meaning handling loads of 50-100 pounds without the use of a lift. An aerobic capacity test may be added to assess the candidate’s recovery capacity. Lastly, a gradual loading test may be performed to assess the quality of movements in a fatigue situation and its effect on the cardiovascular system during intensive, repetitive tasks.

Even for administrative positions, there are benefits to a pre-employment evaluation. Spending long hours sitting can reduce muscle tone. As well, some one-off tasks such as carrying a box of paper, may require physical effort. A functional medical evaluation can confirm that employees are able to respond to these occasional variations in the pace of work.

By considering employee health at the hiring stage and identifying individual conditions, organizations see positive impacts on their operations, including:

• improved employee health
• higher retention rates
• increased productivity
• reduced insurance costs

Companies which do not send candidates for pre-employment medicals may encounter expensive, dangerous situations. The cost of hiring an employee who is unsuitable or has safety risks is often greater than the cost of a pre-employment medical. A single accident may cause tens of thousands of dollars in expenses, not to mention the human consequences, which may also affect the organization’s performance. [3]

When an employee has an accident or work-related illness, Quebec’s Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST) allocates all costs to the employer, including income replacement, compensation for physical injury or death, healthcare services and rehabilitation. These events may also increase employers’ CNESST contributions in the long term.

When an employee without the necessary physical skills for their job joins a team, there can be serious consequences:

• drop in productivity;
• increased staff turnover;
• decreased engagement;
• increased risk of costly mistakes or incidents.

Recruiting the wrong person may cost up to 30%-40% of the employee’s annual salary, due to lost productivity and recruitment/training costs. [4]

With the aging population [5], the consequences of sedentary living [6], poor lifestyle habits, the rise in diagnoses such as diabetes and high blood pressure, the rise in musculoskeletal disorders [7] and mental health challenges [8], an employee’s ability to perform their tasks safely and effectively may evolve or deteriorate over time.

In this context, a periodic or on-the-job medical evaluation can be conducted. The goal is to confirm that an employee is still able to meet their job requirements. The exam may repeat some or all of the parts of the pre-employment medical to assess whether workplace risks are under control and whether the environment is still safe for all staff.