Letters to The Editor
To the Editor: The article by Philip Harber, MD, MPH, and Allen Ducaman, MD, MSc, “Training Pathways for Occupational Medicine,” in the April 2006 issue of the Journal1, highlights what has been a concern of minefor some time. I have asked three former presidents of the American College of Occupational & Environmental Medicine about the issue of “Where are the new occupational medicine providers coming from?” I received thoughtful responses from all of them but never an answer to the question. They are all astute men but they are also astute politicians.
As I go to my local and regional meetings of occupational medicine providers, I frequently see the “usual suspects.” The same faces—the same older, aging faces. As I am planning to attend my 25th reunion of my medical school classmates this August, I have to count myself as one of them.
It is time for my colleagues to face the reality that we have made educational pathways perhaps too difficult for physicians interested in occupational medicine as a midcareer change to become board-certified.
Too many purported practitioners of “occupational medicine” are really family practitioners or generalists who practice urgency care and learn through experience how to treat occupational injuries and develop their knowledge of the workers’ compensation system in the state they are operating in. This is clearly inadequate.
Additionally, it appears, for the majority of us who do occupational medicine on a daily basis, the focus of occupational medicine residencies seems to be far too academic and focusing on the very rare occupational disorders that an experienced occupational medicine provider in a secondary or tertiary referral center will only see a few times in his or her career. More training in psychosocial issues that affect the workplace and a strong basis of understanding musculoskeletal medicine appear to be more appropriate fields of study and practical experience than some of the more esoteric pneumoconioses.
Also quite remiss is our engagement and involvement with medical students early in their clinical training and having regular seminars for second-year and third-year medical students to expose them to occupational medicine to generate interest in the discipline as a career choice.
I am grateful to Drs Harber and Ducaman for highlighting this issue in the journal; however, as I consider my potential successor at a busy, successful, and pure occupational medicine practice, I worry that I will not be able to find an occupational medicine practitioner board-certified in the field who is possessing the right skill set. My fervent hope is this article will focus the discussion within our specialty and we will act on easing the training required for physicians in other disciplines to transition to occupational medicine and raising interest in medical students to consider occupational medicine as a primary career path. Otherwise, we may find our field with a handful of academic practitioners and too many undertrained providers who learn occupational medicine by “trial and error” without having a firm grounding in occupational medicine’s history and the extensive wealth of knowledge occupational medicine practitioners benefit from. Drs Harber and Ducaman outline the issues, but are we really willing to act?
Eric S. Smith, MD
Journal of Occupational & Environmental Medicine
1. Harber P, Ducatman A. Training pathways for occupational medicine. J Occup Environ Med