Letters to The Editor
To the Editor: We appreciate the comments of both Drs Smith and Sheedy about our article.1 Their insights support our contention that the discipline of occupational-environmental preventive medicine (OEPM) should promptly discuss fundamental assumptions and options. For example, (1) both letters emphasize “mid-career” transfers into occupational medicine, and we concur that facile programs are needed that assure high-quality training. Dr Smith also supports reaching medical students. We concur. Does the frequency of mid-career changes reflect our failure to effectively reach students sufficiently early and effectively? Does the current structure of residency training, without an effective Postgraduate Year 1 (PG-1), impede our efforts? These are questions raised, and we hope that the specialty addresses them decisively. Dr Smith also emphasizes the compelling need to address the real world of clinical practice. Again, we concur. This is among the specialty’s biggest challenges. Should greater priority be given to early or mid career efforts? (2) Both commentators describe commitments made by trainees in both traditional and nontraditional residencies. A specialty-wide discussion is whether these commitments are equivalent and sufficient. Also, are there enough highly motivated mid-career physicians to support many more nontraditional and distance learning programs? Is the public’s health better served by educating a smaller number of intensively trained specialists, or by improving the skills of generalists who treat occupational patients? (3) Both correspondents emphasize “quality” of training. The letters appear to differentiate activities that are “academic” or “esoteric” from “real world” and “musculoskeletal,” Both academic and practical aspects of care are essential components of optimal training programs in any specialty. Comprehensively trained specialists must have a broad appreciation of public health as well as clinical perspectives; specialists must recognize “rare” as well as mundane disorders. (4) One of our correspondents may imply that meeting the requirements of the Accreditation Council for Graduate Medical Education (ACGME), American Board of Preventative Medicine (ABPM), and the Council on Education for Public Health (CEPH) is adequate; we feel that our discipline (and all disciplines) must provide decisive input to these bodies to facilitate their standard setting, in order to be relevant and to serve the highest quality of care.
Our article addressed general issues rather than specific institutional programs. We are also pleased that one of our correspondents expressed strong loyalty to several specific programs. Program and specialty loyalty are also of public benefit and essential to a strong discipline. Our article was about differences between possible training modalities. We assume, but do not know with certainty, that program loyalty will not vary among training modalities, provided that equivalent efforts are required and an equivalent certification is provided.
Finally, Dr Smith’s letter asks, “… Are we really willing to act?” We hope our profession’s answer is “yes.”
Philip Harber, MD, MPH
University of California, Los Angeles
Alan Ducatman, MD, MSc
West Virginia University
1. Harber P, Ducatman A. Training pathways for occupational medicine. J Occup Environ Med.