Medical specialists’ willingness to accept workers’ compensation patients has been trending downward in a number of states over the past 10 years. This is due to two major factors: increased regulatory burdens and declines in specialist fees. This commentary, written by Dr. Steven E. Levine, a board certified internist and neurologist at UCLA Medical Center, examines these trends and the implications for several states, particularly for California. Dr. Levine predicts that a thorough inversion of the distribution of fees away from specialists, as is currently under consideration in California, without significantly increasing overall payments, will result in markedly reduced access to specialty care for injured workers.