Physicians specialized in occ may not meet demand
Med school program cuts taking toll
Just when the business world is coming back around to the idea of on-site corporate medical offices, the supply of physicians specializing in occupational health may be choking itself out.
Much on-site health care once handled by teams of physicians and nurses gradually has became the responsibility of occupational health nurses, according to Tee Guidotti, MD, vice president of the American College of Environmental and Occupational Medicine (ACOEM). Now that employers are seeing the benefits of expanding the health services offered at work sites, the occupational medicine doctors might not be there to fill the demand.
While Guidotti says some of his colleagues in ACOEM fret that jobs once held by occupational and environmental medicine physicians are now in the hands of occupational health nurses, "it's not a question of choosing a nurse over a doctor."
Economics, he says, has shaped the fortunes of occupational medicine physicians, both in positive and negative ways.
The company doctor is (back) in
When companies started downsizing in earnest about 20 years ago, middle management positions were among the most commonly cut. Guidotti says those middle managers, by and large, influenced decisions about corporate medical department staffing. What disappeared with those positions, he theorizes, "were a lot of people who appreciated what occupational medicine could do for them."
In the ensuing years, decisions on employee health were based on economics. When deciding whether to keep some health care presence at the site or completely do away with on-site medical care, Guidotti says employers opted to cut costs by hiring occupational health nurses, thus providing care for employees without the cost of maintaining a clinic or occupational medicine team.
However, the current generation of managers has shown growing interest in the long-term value of occupational medicine and the benefits of offering physician services at the workplace, in addition to occupational nursing.
"We're finally getting some arguments about how occupational physicians enhance productivity and reduce risk and liability," he says.
Guidotti says ACOEM has noticed a reawakening of the corporate medical office — just as the supply pipeline of new occupational and environmental medicine physicians appears in danger of choking itself.
Supply may not meet demand
Occupational medicine can be viewed as a supply-driven specialty, Guidotti says, because the greater the presence of occupational medicine physicians, the more demand there is for their services. "Employers see we're adding value, and they say, 'I want that.'"
But Guidotti says his single biggest concern for his specialty is that although residents are getting good jobs, the market is favorable, and indicators are that the job market is favorable for occupational medicine physicians for the first time in a while, the discontinuation of training programs is threatening the supply.
"There is a constant pressure [for schools] to close small programs, and occupational medicine programs tend to be relatively small," he says.
"Accreditation agencies have a strong preference for large programs in fields like surgery, because large programs are preferable in some specialties, but if you apply that across the board and say that means small programs are substandard, then that hurts small programs."
While private occupational medicine practices can be lucrative, programs in large medical centers often suffer from lack of funding, he says, because they're not seen as large revenue generators.
To make inroads in the workplace, occupational health practitioners in all fields need to demonstrate their value, suggests Giudotti.
"Physicians and nurses need to take care of the fundamentals, show the value we add, and demonstrate our utility," he says. "There's no magic marketing or ad campaign. We just need to understand our ability and demonstrate our ability to take care of the workforce."
Susan Randolph, president of the American Association of Occupational Health Nurses, says polls taken by the group show that occupational health programs make the most positive impact when the occupational health professional understands the employer's needs and expectations.
"By knowing the executive management team's goals and perspectives, the occupational health staff will ultimately be better equipped to prove their true value and benefit within the workplace," she says.
[For more information, contact:
- Tee Guidotti, MD, vice president, American College of Occupational and Environmental Medicine; professor and chair, Department of Environmental and Occupational Health, George Washington University Medical Center, Washington, DC. Phone: (202) 994-1734.
- Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, president, American Association of Occupational Health Nurses. 2920 Brandywine Road, Suite 100, Atlanta, GA 30341. E-mail: [email protected].]
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