586
STATEMENT* ON
The Health Manpower Situation in Occupational Medicine BY
THE NEW YORK ACADEMY OF MEDICINE DEFINITION
OF
OCCUPATIONAL MEDICINE
OCCUPATIONAL MEDICINE iS concerned with the prevention of disease, the maintenance and promotion of health among employed persons in their group setting, the community's health as it is affected by industry, and the consumers' health as affected by industrial products. Occupational medicine involves clinical medicine, toxicology, epidemiology, and administrative expertise. The Council on Medical Education and Hospitals of the American Medical Association (A.M.A.) in June 1955 authorized certification of specialists in occupational medicine by the American Board of Preventive Medicine. ASSESSMENT OF NEED
The importance of occupational medicine has been highlighted during the last six years by the enactment of such national and state legislation as the Occupational Safety and Health Act of 1970 and the Toxic Substances Control Act of 1976. Such activity in the political arena undoubtedly reflects the growing economic influence of health-related factors in the production costs of most industries; these health-related factors include workmen's compensation, consumer protection, health-care benefits, disability pay, and disability retirement benefits. A 1974 survey by the Conference Boardt of companies employing 500 or more people in the United States (29 million employed persons out of 84 million) indicates that about 20 million employees are covered by organized programs staffed by full-time or part-time physicians. Another *Approved by the Committee on Medical Education of the New York Academy of Medicine December 9, 1976 and by the Council March 23, 1977. tlndustry Roles in Health Care, New York, The Conference Board, Inc., 1974, chap. 3, pp. 20-25. Address for reprint requests: Committee on Medical Education, the New York Academy of Medicine, 2 East 103rd Street, New York, N.Y. 10029.
Bull. N. Y. Acad. Med.
HEALTH MANPOWER IN OCCUPATIONAL MEDICINE
587
five million are served by programs staffed solely by nurses, and the remaining four million have no organized occupational health service. The occupational health services provided for the 55 million employed persons not included in the survey are not known. According to the A.M.A. Profile of Medical Practice for 1973, * 2,374 physicians listed their principal professional activity as occupational medicine, a total far below the 5,400 physicians with appropriate training which the National Institute of Occupational Safety and Health (N.I.O.S.H.) estimated would be required in 1973. The obligations imposed by the 1976 Toxic Substances Control Act will almost certainly escalate the needs imposed by the 1970 Occupational Safety and Health Act upon which the 1973 N.I. O.8. H. estimates were based. Therefore, there can be little doubt that, in addition to a real deficit in trained occupational health specialists, some deficiency probably exists in the qualifications of many practicing physicians who spend a significant proportion of their time in the field. RECOMMENDATIONS
The Academy recommends that a number of steps be addressed to the deficit in physicians adequately trained in occupational medicine: 1) At the undergraduate level career counselors should be encouraged to point out the needs and opportunities in this field to premedical students. 2) At the medical school level a recognized center for occupational medicine issues should exist as a section or institute within the department of preventive medicine, staffed by practicing occupational physicians, nurses, toxicologists, and industrial hygienists employed by industry, unions, or governmental agencies. Because experience has shown that formal allocation of periods of instruction in occupational medicine are not productive, the services of the specialists described above should be utilized in teaching rounds, seminars, and conferences conducted by the major clinical services. The importance of a patient's occupational history and potential environmental hazards and their control thus could be integrated into clinical teaching concerned with primary care and family practice, which includes the traditional departments of medicine, psychiatry, surgery, obstetrics and gynecology, and their subspecialties. 3) At the level of postdoctoral medical education the occupational health faculty should participate in residency programs in family practice, *Profile of Medical Practice. Chicago, Amer. Med. Assoc., 1973, Table 2, p. 8.
Vol. 53, No. 6, July-August 1977
588
N. Y. ACADEMY OF MEDICINE
medicine, surgery, and other specialties. Because most practicing physicians have various degrees of interaction with occupational medicine, residents in all specialties would benefit from a greater awareness of occupational disease and the ethical, managerial, and economic issues involved. 4) Graduate schools of public health and environmental health sciences or both should continue to develop programs to attract the admittedly small number of young physicians who decide to make occupational medicine a full-time career. 5) A postgraduate program of occupational health training should receive support to enable practicing physicians to earn board eligibility in four years. Such programs initially would require financial subsidy by industry, unions, or government, but ultimately would become self-sustaining. Such programs would enable physicians in mid-career, who already may be practicing clinical medicine in an industrial setting, to develop the additional knowledge and skill needed to practice bona fide occupational medicine to the greater benefit of society and themselves. Many of those completing such training would undoubtedly become certified in occupational medicine by the American Board of Preventive Medicine. 6) Occupational medicine should become part of continuing programs of medical education in the traditional fields of clinical practice. The recent enactment of PL-94-484, which commits the federal government to support occupational health training and the creation of 10 regional training centers (with a grant of $5 million in 1977, $8 million in 1978, and $10 million in 1979), undoubtedly will do much to make the goals outlined above financially attainable. Particularly commendable is that portion of the law which specifies that financial support for residencies in occupational medicine shall be maintained at a level equal to that given to residencies in other medical specialties. Generous as this governmental support is, there will still be a need for additional funding of certain types of experimental training efforts (e.g., the postgraduate occupational health training program) which could be provided by industry or union sources. The most important factor, however, in making any training program for occupational health effective is the attitude adopted by medical leaders. Without their intellectual support and active cooperation, successful attainment of the objectives outlined in this statement is doubtful.
Bull. N. Y. Acad. Med.
STATEMENT* ON
The Health Manpower Situation in Occupational Medicine BY
THE NEW YORK ACADEMY OF MEDICINE DEFINITION
OF
OCCUPATIONAL MEDICINE
OCCUPATIONAL MEDICINE iS concerned with the prevention of disease, the maintenance and promotion of health among employed persons in their group setting, the community's health as it is affected by industry, and the consumers' health as affected by industrial products. Occupational medicine involves clinical medicine, toxicology, epidemiology, and administrative expertise. The Council on Medical Education and Hospitals of the American Medical Association (A.M.A.) in June 1955 authorized certification of specialists in occupational medicine by the American Board of Preventive Medicine. ASSESSMENT OF NEED
The importance of occupational medicine has been highlighted during the last six years by the enactment of such national and state legislation as the Occupational Safety and Health Act of 1970 and the Toxic Substances Control Act of 1976. Such activity in the political arena undoubtedly reflects the growing economic influence of health-related factors in the production costs of most industries; these health-related factors include workmen's compensation, consumer protection, health-care benefits, disability pay, and disability retirement benefits. A 1974 survey by the Conference Boardt of companies employing 500 or more people in the United States (29 million employed persons out of 84 million) indicates that about 20 million employees are covered by organized programs staffed by full-time or part-time physicians. Another *Approved by the Committee on Medical Education of the New York Academy of Medicine December 9, 1976 and by the Council March 23, 1977. tlndustry Roles in Health Care, New York, The Conference Board, Inc., 1974, chap. 3, pp. 20-25. Address for reprint requests: Committee on Medical Education, the New York Academy of Medicine, 2 East 103rd Street, New York, N.Y. 10029.
Bull. N. Y. Acad. Med.
HEALTH MANPOWER IN OCCUPATIONAL MEDICINE
587
five million are served by programs staffed solely by nurses, and the remaining four million have no organized occupational health service. The occupational health services provided for the 55 million employed persons not included in the survey are not known. According to the A.M.A. Profile of Medical Practice for 1973, * 2,374 physicians listed their principal professional activity as occupational medicine, a total far below the 5,400 physicians with appropriate training which the National Institute of Occupational Safety and Health (N.I.O.S.H.) estimated would be required in 1973. The obligations imposed by the 1976 Toxic Substances Control Act will almost certainly escalate the needs imposed by the 1970 Occupational Safety and Health Act upon which the 1973 N.I. O.8. H. estimates were based. Therefore, there can be little doubt that, in addition to a real deficit in trained occupational health specialists, some deficiency probably exists in the qualifications of many practicing physicians who spend a significant proportion of their time in the field. RECOMMENDATIONS
The Academy recommends that a number of steps be addressed to the deficit in physicians adequately trained in occupational medicine: 1) At the undergraduate level career counselors should be encouraged to point out the needs and opportunities in this field to premedical students. 2) At the medical school level a recognized center for occupational medicine issues should exist as a section or institute within the department of preventive medicine, staffed by practicing occupational physicians, nurses, toxicologists, and industrial hygienists employed by industry, unions, or governmental agencies. Because experience has shown that formal allocation of periods of instruction in occupational medicine are not productive, the services of the specialists described above should be utilized in teaching rounds, seminars, and conferences conducted by the major clinical services. The importance of a patient's occupational history and potential environmental hazards and their control thus could be integrated into clinical teaching concerned with primary care and family practice, which includes the traditional departments of medicine, psychiatry, surgery, obstetrics and gynecology, and their subspecialties. 3) At the level of postdoctoral medical education the occupational health faculty should participate in residency programs in family practice, *Profile of Medical Practice. Chicago, Amer. Med. Assoc., 1973, Table 2, p. 8.
Vol. 53, No. 6, July-August 1977
588
N. Y. ACADEMY OF MEDICINE
medicine, surgery, and other specialties. Because most practicing physicians have various degrees of interaction with occupational medicine, residents in all specialties would benefit from a greater awareness of occupational disease and the ethical, managerial, and economic issues involved. 4) Graduate schools of public health and environmental health sciences or both should continue to develop programs to attract the admittedly small number of young physicians who decide to make occupational medicine a full-time career. 5) A postgraduate program of occupational health training should receive support to enable practicing physicians to earn board eligibility in four years. Such programs initially would require financial subsidy by industry, unions, or government, but ultimately would become self-sustaining. Such programs would enable physicians in mid-career, who already may be practicing clinical medicine in an industrial setting, to develop the additional knowledge and skill needed to practice bona fide occupational medicine to the greater benefit of society and themselves. Many of those completing such training would undoubtedly become certified in occupational medicine by the American Board of Preventive Medicine. 6) Occupational medicine should become part of continuing programs of medical education in the traditional fields of clinical practice. The recent enactment of PL-94-484, which commits the federal government to support occupational health training and the creation of 10 regional training centers (with a grant of $5 million in 1977, $8 million in 1978, and $10 million in 1979), undoubtedly will do much to make the goals outlined above financially attainable. Particularly commendable is that portion of the law which specifies that financial support for residencies in occupational medicine shall be maintained at a level equal to that given to residencies in other medical specialties. Generous as this governmental support is, there will still be a need for additional funding of certain types of experimental training efforts (e.g., the postgraduate occupational health training program) which could be provided by industry or union sources. The most important factor, however, in making any training program for occupational health effective is the attitude adopted by medical leaders. Without their intellectual support and active cooperation, successful attainment of the objectives outlined in this statement is doubtful.
Bull. N. Y. Acad. Med.
