Welcome to the ROEP (Runde
Occupational and Environmental Physicians, P.C.) medical clinics web
page. We are dedicated to improving the health and safety of workers in
mid-Missouri. To this end, we are providing this web page to disseminate
information and to obtain information about the needs of mid-Missouri
businesses and communities.
What is occupational and
environmental medicine? The ultimate goal of occupational and
environmental medicine (OEM) is the prevention of disease and injury. It
not only requires mastery of medicine but also epidemiology, toxicology,
industrial engineering, behavioral sciences, history and law. The key to
detecting occupational illness is to suspect the diagnosis, and the diagnosis
of work-related illness hinges principally on the quality of the occupational
and environmental history.1
According
to the American College of Graduate Medical Education (ACGME), the principal
concerns of occupational medicine are a) the workers, b) the
workplace, c) information management, and d) administration. This allows the OEM specialist to organize,
implement, and assess activities designed to promote the health and well-being of
workers and to enhance the capability to deal with relevant regulatory, legal,
and industrial relations organizations.2,a
Occupational diseases mimic those
due to other causes. For this reason, they are often not correctly
diagnosed by the busy primary care provider.
Likewise, these providers may
incorrectly attribute symptoms to a workplace exposure. This can be due
to an incomplete occupational history, incomplete understanding of work-related
illnesses and/or poor knowledge of the workplace itself.
The specialist in occupational
medicine is trained in the early recognition of work-related illnesses and may
conduct a walk-through of the work environment to ensure the proper diagnosis
has been reached.
You can check out an editorial in
the Journal of Occupational Medicine on the question, "What is
environmental medicine?" (Journal of Occupational Medicine,
vol. 32, No. 11, November 1990. "What Is Environmental
Medicine?", A.M. Ducatman.)
Environmental medicine is very
closely related to occupational medicine since occupational hazards are
frequently environmental hazards (e.g. heat stress, barotrauma)
and environmental toxic exposures are similar to (or arise from) industry (e.g.
pollution).
The OEM
Specialist
Physicians (MDs, DOs) undergo at
least three years of postgraduate training. This training includes:
One
clinical year where the physician receives further medical training in primary
care. Many OEM specialists have had more than one year of additional
clinical experience.
A
master's in public health (MPH) or its equivalent. Some OEM specialists
pursue the doctoral equivalent rather than a master's degree.
A
"practicum" year where the trainee is supervised in an occupational
medicine practice. This can be in an industrial clinic or a clinic
external to an industrial setting. In some programs, this year is spent
in occupational safety / health research.
The American Board of Preventive Medicine
certified 1800 physicians between 1955 and 1990. However, it has been
estimated that 4600-6700 OEM specialists are needed. Each year, only
60-70 board-eligible physicians are produced by residency programs.1
The shortage of specialists in OEM has been somewhat ameliorated by those who
have been trained in short-courses on OEM -- and by others with no training in
occupational or environmental medicine whatsoever.
A community-based survey found that
the public identified physicians as one of the most trusted but least informed
sources of information about the risks of chemical exposure. According to
surveys, the majority of medical schools place minimal emphasis on occupational
/ environmental medicine.1 This was attributed to a lack of
OEM faculty and an overcrowded curriculum. Only half of the medical
schools specifically teach occupational medicine and 30% require up to four (4)
hours in the pre-clinical years. Approximately 40% offer a variety of
elective courses or clerkships. Since these are usually in the clinical
years, they are taken by only a handful of students.1
As with other medical specialties,
two important conclusions must be reached:
The
four-year medical school curriculum is too short to fully equip physicians with
the skills needed to safely and adequately address occupational and
environmental health and safety issues. The suggestion that "any
physician" can adequately fill the need is contradicted by available
evidence.
Since
most physicians will nevertheless care for patients who are working, occupational
medicine should be a basic component of the medical school curriculum.
Occupational medicine needs to be integrated into the traditional courses
throughout the four years.3
OSHA has suggestions on how to
choose an OEM professional to best serve your needs. (click
here)
Notes:
a To assist in the early
recognition of work-related problems, the National
Institute of Occupational Safety and Health (NIOSH) has established
priorities in the research of occupational safety and health issues via
the National Occupational
Research Agenda (NORA).
References
1 WN Rom, editor. Environmental
& Occupational Medicine, 3rd ed. Philadelphia:
Lippincott-Raven, 1998.
2 ACGME
website.
3 Goldman RH, Rosenwasser S, Armstrong
E. Incorporating an environmental/occupational medicine theme into the
medical school curriculum. Journal of Occupational &
Environmental Medicine 1999 Jan;41(1):47-52.