What is Occupational and Environmental Medicine?
Saturday, September 9th, 2006What is Occupational and Environmental Medicine?
Occupational and environmental medicine is perhaps the most wide ranging of all medical specialties. It is the medical specialty devoted to prevention and management of occupational and environmental injury, illness and disability, and promotion of health and productivity of workers, their families, and communities.
Many physicians may not realize that occupational and environmental medicine is a specialty of challenge and opportunity. Because the majority of the population is employed, the need for specialists in the field continues to grow. Regardless of the particular aspect of medical practice a physician finds most interesting — diagnosis, internal or family medicine, psychiatry, surgery, epidemiology, toxicology, forensic medicine, administration, preventive medicine — occupational and environmental medicine can encompass them all.
Today, the complexity and pervasiveness of modern industrial processes afford occupational and environmental medicine physicians the opportunity to address work site and environmental concerns and such community health and policy issues as atmospheric pollution, product safety, health promotion, and benefits value management. The term “environmental medicine” has also recently been used to describe this growing, challenging, modern medical specialty. Environmental medicine has been defined as the branch of medical science that addresses the impact of chemical and physical stressors on individuals and groups. Both occupational and environmental medicine use similar skills and focus on the recognition and prevention of hazardous exposures.
Occupational and environmental medicine belongs to the future. It offers unlimited challenges and its interests are so broad that within its scope a physician can satisfy special concerns in academic research, administration, hospital practice, private practice, or any of the other aspects of medical practice. Occupational and environmental medicine requires high professional standards and maintenance of professional competence in an ever-expanding medical/scientific arena.
The field of occupational and environmental medicine is not static. The demand for trained occupational and environmental physicians in private industry, education, and government agencies far exceeds the supply, and the need continues to grow.
Practice Settings
The extent of medical services an organization provides depends on its size and complexity. These services may be provided by full- or part-time physicians, private physicians, group practice physicians, or physicians in private clinics devoted to occupational and environmental medical practice. Types of services and operations include the following:
Large Industry with Multi-plant Operation
This service is usually headed by a vice president of medical affairs or corporate or general medical director. The chief medical officer may be a senior executive. Duties at this level are largely administrative and include formulating company medical/environmental policy and overall supervision of company health programs and research. Each major facility normally has its own medical director or plant physician, a number of staff physicians, perhaps some part-time specialists, a nursing staff, toxicologists, industrial hygienists, and ancillary or paramedical personnel.
Medium-sized Companies
Most organizations with 1,000 or more employees offer medical services. These services depend on the size of the staff and equipment provided.
Small Companies
Many small companies employ physicians on a part-time basis. Such physicians may be engaged in the private practice of occupational medicine and may be employed on a part-time basis by more than one company. Some small companies make arrangements with local clinics or hospitals to provide their medical services; others engage the services of private physicians who may be “on call.”
Hospital-based Occupational and Environmental Medicine Programs
This is a rapidly developing area; hospitals are now offering occupational health services to client industries. Services usually start with rapid treatment of injuries and communication of the return-to-work status to the client industry. Services may expand to the full range of occupational and environmental health services.
Private Practice/Consulting
This is another rapidly expanding option. Private practice physician groups may offer services such as physical examinations, program design, health promotion, epidemiologic studies, and hazard consultation. Many occupational and environmental physicians also serve as consultants to industry.
Government Agencies
With the enactment of major occupational health, safety, and environmental laws, the federal and state governments take an active role in studying occupational and environmental health concerns, enforcing rules, and communicating risk analyses to the public. Physicians are employed by these agencies to bring scientific expertise to the field. In addition, opportunities exist in government through the National Institute for Occupational Safety and Health (NIOSH) and more recently through the medical office of the Occupational Safety and Health Administration (OSHA). In some cases, unions and consulting practices may offer openings.
Academics
The occupational and environmental physician’s responsibilities in academics may include clinical hospital practice, consultation, and teaching. The unique clinical case variety and opportunity for research are combined with industrial, governmental, and labor consultation. The wide variety of research opportunities gives more flexibility than other disciplines.
Personal Advantages
In addition to the professional satisfaction of applying one’s medical skill to maintaining the employee population health at a high level, occupational and environmental medicine offers several important personal advantages:
Regular Hours
Most occupational and environmental physicians have a regular workweek related to the clinic or industry work schedule.
Salary
For salaried physicians, income is stable from month to month and relieves the physician of the details involved in staffing, operating an office, and collecting fees. Although salaries vary, they are favorable compared with other similar medical practices. Starting salaries depend upon experience, qualifications, and the nature of responsibilities. There are regional variations in most organizations; the salary scale provides for merit increases on a regular basis and promotional opportunities as well. ACOEM’s recent Compensation and Benefits Study found that the average annual salary for occupational and environmental physicians in 2002 was $188,000.
Facilities
For physicians employed by an organization such as industry or government, the provision of medical facilities, equipment, and office space by management removes the necessity for a large capital outlay on the part of the individual physician in setting up practice.
Insurance
Most employers provide group life insurance, pensions, accident and sickness disability insurance, paid vacations, and expense-paid trips to medical meetings and conferences. They also provide malpractice insurance for their full-time physicians. Some even make similar provisions for part-time and fee-for-service physicians when they perform services for the company.
Other Benefits
Many organizations also support additional postgraduate training and research and encourage their physicians to join medical school faculties and obtain hospital staff appointments. Anticipated changes in the current health care system are less likely to have a major impact on the practice of occupational medicine than on other specialties.
Qualifications of the Occupational and Environmental Medicine Physician
The major role of the occupational and environmental physician is to evaluate the interaction between work and health. The most effective way of gaining the education and qualifications to assume these responsibilities is to complete an occupational medicine residency training program. Because a residency program is not a realistic option for physicians entering the field in mid-career, educational opportunities are now available to enable a transition into a specialty that requires not only clinical and scientific knowledge, but interpersonal skills, diplomacy, and sensitivity to a variety of interests in order to practice effectively. The clinical occupational and environmental physician responsible for employee health must:
have a general knowledge of worksite operations and be familiar with the toxic properties of materials used by employees as well as the potential hazards and stressors of work processes;
be qualified to determine an employee’s physical and emotional fitness for work;
be capable of diagnosing and treating occupational and environmental diseases and competently handling injuries;
possess knowledge of rehabilitation methods; health education techniques; sanitation; workers’ compensation laws; local, state, and federal regulatory requirements; and the systems for maintaining medical records; and
be able to organize and manage the delivery of health services.
The occupational and environmental physician must communicate with and inspire confidence in people on all levels. In addition to administering the medical program and supervising medical personnel, he or she must work as part of a business organization and understand both management’s and labor’s problems. He or she must maintain the confidentiality of the physician/patient relationship. For research positions, training in epidemiology, toxicology, biostatistics, and psychology is important.
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