Careers in Occupational and Environmental Medicine was prepared by ACOEM to introduce interested physicians to the field of occupational and environmental medicine. For educational purposes only, the Careers brochure may be reproduced in whole or in part without charge, so long as ACOEM is notified and proper recognition given to the College. Call the ACOEM Communications Department at 847/818-1800 if you have any questions.

Careers in Occupational and Environmental Medicine

Founded in 1916, the American College of Occupational and Environmental Medicine (ACOEM) is the world's largest organization of occupational and environmental physicians dedicated to promoting and protecting the health of workers through preventive services, clinical care, research, and educational programs. To achieve this goal, the College provides courses and an annual conference, newsletters, the Journal of Occupational and Environmental Medicine, and numerous other services, including publication of career-related information.

This publication is intended to introduce physicians to the exciting and challenging world of occupational and environmental medicine (OEM). It outlines the opportunities available in occupational and environmental medicine and provides information to physicians entering the field.

What 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.

More than a quarter of a century ago, an editorial in the Journal of the American Medical Association defined occupational medicine as "a specialty field of medicine concerned with: 1) the appraisal, maintenance, restoration, and improvement of the health of the worker through the application of the principles of preventive medicine, emergency medical care, rehabilitation, and environmental medicine; 2) the promotion of a productive and fulfilling interaction of the worker with his work through the application of the principles of human behavior; and 3) the active application of the social, economic, and administrative needs and responsibilities of both the worker and the work community." This definition emphasizes the importance of a medical practice recognized since the days of Hippocrates (460-377 BC).

Occupational medicine was previously identified as "industrial medicine." This term was used when heavy industry (e.g., lumbering, automobile manufacturing, mining, railroads, steel manufacturers, etc.) employed physicians to provide acute medical and surgical care for employees. By 1945, medical programs had spread to business organizations with a predominance of clerical and service employees. Large banks, insurance companies, mercantile establishments, etc., could not be described as industrial; therefore, the broader designation of "occupational medicine" came into common use. Occupational medicine achieved specialty status from the American Board of Preventive Medicine (ABPM) in 1955.

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.

Need for Occupational and Environmental Physicians

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.

According to a National Academy of Sciences Report (Rosenstock L, et al. Occupational and environmental medicine: meeting the growing needs for clinical services. N Engl J Med. 1991; 325:924-927), occupational and environmental medicine specialists are needed for three critical roles -- educator, researcher, and clinical consultant. Considerable other opportunities also exist for the well-trained occupational physician. According to the Institute of Medicine (IOM) subcommittee on physician shortage in occupational and environmental medicine, there currently is a dearth of 3,100 to 5,500 physicians.

Entering the Field of Occupational and Environmental Medicine

Physicians can enter occupational and environmental medicine through two primary routes: 1) after residency or fellowship training in occupational and environmental medicine; or 2) from another clinical discipline such as internal, family, or emergency medicine. Other specialties that provide background for occupational and environmental medicine practice include surgery, orthopedics, and rehabilitation medicine.

Opportunities for occupational and environmental medicine practice depend primarily on the physician's educational experience. For example, residency-trained physicians are frequently recruited to develop and implement an occupational health program at a hospital or clinic setting or to join established clinical groups. Occupational and environmental physicians are also needed by corporations, group practices, hospitals, consulting firms, and educational institutions. Federal and state government service offers additional opportunities for careers in occupational and environmental medicine. Epidemiologic, toxicologic, and clinical research is performed in government facilities, academic institutions, corporate research centers, and on a contract basis, usually by government or industry. Compensation is favorable compared with other types of non-procedural medical practice.

Physicians who enter occupational and environmental medicine from another medical specialty, often at mid-career, usually begin by working a few hours a week at a local plant site. These activities may expand to include service to other organizations or to be fully employed by a major corporation in a large, medium-sized, or small company.

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.

To help you in your career choice, ACOEM makes available an on-line Career Center that features links, and tips to help you achieve success in each stage of your occupational and environmental medicine career.

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 2006 Compensation and Benefits Study found that the average annual salary for occupational and environmental physicians was $209,000.
• 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.

ACOEM Competencies

In 2008, ACOEM updated its "Occupational and Environmental Medicine Competencies," a set of competencies for occupational and environmental physicians. Occupational and environmental medicine comprises a spectrum of competencies ranging from those of the general practitioner to those of a highly trained specialist. Occupational and environmental physicians vary in the nature of their practices and their practice settings. While a gastroenterologist in Paris and one in Detroit may perform very similar tasks on a routine basis, the practices of two occupational and environmental medicine physicians in Detroit alone may be completely different. As a result, it is not practical to define a "core" set of competencies for this field of medicine. Those competencies considered core for the occupational and environmental medicine generalist who primarily manages occupational injuries and fitness-for-duty issues may be very different from those considered to be core for the occupational and environmental medicine specialist who serves as a consultant on health issues of populations of workers or communities with environmental concerns. Thus, ACOEM's Panel to Define the Competencies of Occupational and Environmental Medicine has served to define a more comprehensive "menu" of competencies rather than the core.

Postgraduate Education in Occupational and Environmental Medicine

Postgraduate education in occupational and environmental medicine may take different forms. The following are a few of the opportunities available:

Formal Training Programs
Formal residency training in occupational medicine is accomplished over a three-year period of study and training. The first year is spent in an internship, either through a preventive medicine residency, one of the primary care specialties, or a transitional program. For those with board qualification in internal or family medicine, the latter two years serve as a fellowship. The second and third years are spent in an accredited occupational medicine residency. Either sequentially or concomitantly, the occupational medicine resident takes didactic courses in epidemiology, biostatistics, environmental and work physiology, toxicology, industrial hygiene, ergonomics, mental health, health services administration, and public health, which leads to a Master of Public Health (MPH) or equivalent degree.

During the second and third year, the resident spends "practicum" time in various occupational health settings (corporations, plants, clinics, government agencies, university consulting clinics, or research organizations) gaining hands-on experience in occupational medicine. The third year must include at least four months of direct occupational medical care in a company. This year is often served at a field facility approved for this purpose as an occupational medical facility, frequently one in a corporation or government program. With this training, the resident can make application to sit for the board examination in occupational medicine given annually by the American Board of Preventive Medicine (ABPM).

A current list of residency programs accredited by the American Council for Graduate Medical Education that offer graduate training in occupational and environmental medicine can be obtained from ACOEM. Support for residency and fellowship training is available through NIOSH, the National Institutes of Health, industry grants, and the ACOEM scholarship grant program, the Occupational Physician Scholarship Fund.

Other training alternatives include:

Short Courses
Many universities conduct short courses (from three days to three weeks duration) in which specific subjects relating to occupational and environmental medical practices are offered. One-year courses in occupational medicine are also available in schools of public health.

ACOEM Sessions, and Courses
ACOEM offers scientific sessions and courses on subjects directly related to the practice of occupational and environmental medicine. Sessions are held at the annual spring American Occupational Health Conference (AOHC). Continuing medical education offerings are also provided to College members at state and regional component society meetings.

To enrich physicians' understanding of issues related to the specialty of occupational and environmental medicine, ACOEM has created professional development courses in four areas. These courses are presented at the College's annual meeting and at other times during the year at locations throughout the country. Courses include, but are not limited to the following (for a complete list of courses, visit the ACOEM web site at http://www.acoem.org/courses.aspx):

• Basic Curriculum in Occupational Medicine: A Survey of the Essentials (Segments 1, 2, and 3). This series of three two-day courses teaches the fundamental principles and scope of occupational and environmental medicine. Each segment is self-contained and provides practical information useful to the OEM physician in managing the clinical, regulatory, and administrative functions of an OEM practice at a primary care level.
• Medical Review Officer Training Courses. ACOEM offers three types of medical review officer (MRO) courses to instruct physicians on how to understand and comply with drug testing and MRO requirements: the two-day Comprehensive Course; the one and one-half-day Fast Track Course; and the one-day Refresher Course. These courses can help occupational and environmental medicine physicians prepare to take the MRO certification examination offered by the Medical Review Officers Certification Council (MROCC).
• Impairment and Dis/Ability Evaluation Courses. With workers' compensation, disability, personal injury, and other claims on the rise, insurer attorneys, employers, and governmental agencies are seeking experienced, third-party evaluators to provide quality independent medical evaluations (IMEs) and perform impairment evaluations. To fill this growing need, ACOEM offers two courses that enable participants to become skilled evaluating physicians -- the two-day "Evaluating Impairment -- Use of the AMA Guidelines" course and the two-day "Advanced Topics" course. These courses can help occupational and environmental medicine physicians prepare to take the IME certification examination offered by the American Board of Independent Medical Examiners (ABIME).
• Occupational Medicine Board Review Course. This two-day course explains the contents and requirements of the American Board of Preventive Medicine (ABPM) examination in occupational medicine. It covers all topics relevant to the exam's occupational medicine section and provides test-taking strategies and sample questions.

Scholarships

The Occupational Physicians Scholarship Fund (OPSF) provides stipends to worthy physicians to cover their occupational and environmental medicine residency positions. The Fund was established in to help alleviate the shortage of properly trained and skilled occupational physicians. OPSF will assist qualified individuals, capable of making a significant contribution in this field, to pursue a well-rounded residency education in occupational medicine. It is the goal of OPSF to provide financial support to residents in occupational medicine, in order that they become certified specialists able to practice in a broad range of settings. Applicants to any occupational medicine residency training program approved by the Accreditation Council for Graduate Medical Education are eligible to apply for scholarship funding. Support for residency and fellowship training is available through NIOSH, the National Institutes of Health, and industry grants.

Certification

For physicians who have chosen to devote the major part of their careers to the study and practice of occupational medicine, there is specialty certification. The occupational medicine certification examination is conducted annually by the American Board of Preventive Medicine (ABPM). The examination is a one-day written examination given in late fall of each year. It is a multiple choice examination, with the morning portion covering the core knowledge of preventive medicine and the afternoon portion covering either aerospace medicine, occupational medicine, or public health and general preventive medicine.

Membership in ACOEM

ACOEM is presently more than 5,000 members strong. Membership in a component society of the College (local chapter) is required (only those international members located in areas with no component society are exempt). Membership in special interest sections is also a benefit of ACOEM membership.

• Active membership is open to physicians who have an interest in field of occupational and environmental medicine.
• Fellowship, the College's highest designation, is available to physicians certified by the ABPM or another medical specialty board or who -- have other documented expertise in occupational and environmental medicine; have been ACOEM members for three years; have been engaged in the practice of occupational and environmental medicine on a full-time basis for three years; and have accumulated a total of 200 points awarded by ACOEM for various professional activities.
• Student/Resident membership is available to interns, residents, and other physicians who are taking postgraduate work in occupational and environmental medicine.
• Associate membership is available to non-physicians who have attained a doctorate-level degree of PhD, ScD, DrPH, or EdD in occupational and environmental health discipline.

ACOEM Publications

The official publication of ACOEM is the monthly Journal of Occupational and Environmental Medicine (JOEM). Internationally recognized and peer-reviewed, JOEM brings to member and non-member subscribers reports of current occupational and environmental medical practice and research. Each issue features the latest research, literature reviews, and a forum for information exchange through editorials and letters to the editor. Special issues have addressed key topics such as cancer surveillance, benefits value assurance, and the effects of over-the-counter medications on work capacity. Other important sources of information available through the College include:

• ACOEM E-News. Published 12 times a year, this electronic newsletter keeps members updated on all College activities.
• MRO Update. Published 10 times a year, the Update provides medical review officers (MROs) and other providers of workplace drug and alcohol testing services with information on state and federal regulations.
• CDME Review. Published quarterly, the Review keeps commercial driver medical examiners up-to-date regarding issues involved in certifying the medical fitness of more than 8 million commercial drivers.
• Occupational Medicine Practice Guidelines. ACOEM’s Guidelines are the gold standard in effective treatment of occupational injuries and illnesses. They are intended to help improve or restore the health of those workers who incur occupationally related illnesses or injuries. ACOEM’s are the only evidence-based guidelines that focus on returning employees to work within 90 days of an injury or illness.
• Committee Reports/Guidelines. The College periodically issues guidelines or special reports on issues of importance to those entering or already practicing occupational and environmental medicine.

ACOEM Annual Meetings

Scientific papers presented at the College's annual meeting are directed toward the dissemination of knowledge of current research and activities in the field.