by Judith Green-McKenzie, MD

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A new report published in a special supplemental issue of the Journal of Public Health Management and Practice focusing on the Health Resources and Services Administration’s (HRSA’s) Investment in Public Health looks at the factors contributing to the shortage of formally trained Occupational Physicians in the United States.

In “Outcomes of a Survey-Based Approach to Determine Factors Contributing to the Shortage of Occupational Medicine Physicians in the United States,” my colleagues and I set out to better understand reasons behind the shortage, and our findings are published in this special supplement.

The shortage, first described by the Institute of Medicine in 1991, persists despite the field having the lowest burnout of all medical specialties and one of the highest job satisfaction scores. Why is the diverse field of Occupational and Environmental Medicine (OEM) one of the best kept secrets in medicine?

Our research team surveyed three different groups in various stages of training: medical students, mid-career physicians, and graduates of the HRSA supported Train-in-Place Occupational Medicine Residency Program. The goal was to identify root causes of this shortage as voiced by these three groups and to suggest potential remedies.

Medical Students

Medical students indicated very little OEM exposure: 70% had no more than 1 lecture and 21% denied hearing of OEM at all, although competency in taking an OEM history is considered important for timely recognition of workplace illnesses, injuries, and exposures.

Mid-Career Physicians

Particularly compelling is our finding that only 21% of OEM practitioners recalled hearing of OEM as medical students, when most physicians choose a career specialty. Most became aware of OEM when already practicing in another field. This lack of awareness was not inconsequential: 38% believed that their career path would have been different had they been aware of OEM earlier and those aware of OEM during medical school were more likely to become OEM board-certified. The majority of physicians in OEM enter mid-career from another field.

Train-in-Place Program

Graduates of the novel Train-in-Place Program (TIP), created in 1997, reported that they would not have undertaken OEM training without a TIP program. Around half would not be eligible for their current job without OEM training. Most indicated that their compensation increased after TIP and strongly agreed that the TIP was important in helping them achieve their career goals. TIP residents work full time as OEM physicians at their approved clinical training site, supervised by an ABPM-certified physician.

Funding of OEM Residency Programs

Largely due to a lack of funding, only approximately half of Accreditation Council for Graduate Medical Education (ACGME) approved positions have been filled over the past decade. OEM residencies are not eligible for funding by the Centers for Medicare & Medicaid Services, as is the bulk of graduate medical education. OEM Residency Training Programs must apply for grant funding from the Health Resources & Services Administration and the National Institute for Occupational Safety and Health. Other sources are the Veteran’s Administration (VA), corporate donations, and scholarships. 

Potential Remedies

A short-term solution to the OEM specialist shortage is increasing availability of OEM Train-in-Place specialist training for mid-career physicians making a switch to OEM. A long-term solution to the OEM specialist shortage is greater visibility for the field in medical student education including relevant clinical clerkships. Mandated representation of OEM in the medical school curriculum would serve to educate students on its existence and importance earlier in their career, such that those with an interest in public health and population health, merged with clinical medicine, can make the choice sooner in their career. In general, increased and sustainable funding sources for OEM programs would provide the resources necessary to allow for the filling of ACGME approved positions. This action would almost double the number of residents with the ultimate outcome of helping to reduce the shortage of OEM physicians.

To learn more, read our research report, “Outcomes of a Survey-Based Approach to Determine Factors Contributing to the Shortage of Occupational Medicine Physicians in the United States” in a special supplemental issue of JPHMP, HRSA’s Investment in Public Health.