DIP Ep 649: What is Occupational and Environmental Medicine?

Uh you ask medical students, you ask other physicians like, Hey do have you heard of ACMED and they say, uh no, I've never heard of it before. Uh which is kinda strange, uh, because honestly it's probably one of the best hidden gems in all of medicine. Um it's a great field, uh it's very good, very intellectually stimulating, um, has a lot of flexibility. So I want to talk about it just to increase awareness of this field.

Um this is actually what I what I what I'm training in as well. I am an occupational and environmental medicine uh resident. All right, so um let's go ahead and uh hit hit through this, right? So first things first, right, let's get right to it.

Uh so what's the length of this training? Well the thing is the classic thin for most people is uh you have one year of preliminary something, right? So either like one year of internal medicine or one year of uh transitional year or one year of prelim surgery or whatever.

And then the actual re Ocmed residency is two years, right? So kind of like anesthesia where you do like a year of something, like an intern year, and then you go into like anesthesia for three years. Uh this one is an intern year and then you go into occupational and environmental medicine for for two years.

Right. And one thing I will probably mention here is that quite a number of people in occupational medicine, uh, there are people that switch out of another field in medicine, right? And then they move on to occupational and environmental medicine. Right. So Um so generally as long as you have an intern year, then you should be good. Then you have uh uh two years of of residence.

Right. There's even this uh I believe it's called a complementary pathway where uh say for example you let's say you have like an MPH for whatever reason and you've done like two years of residency. Then there are quite a number of programs that will just put you through a one-year program, like almost like a fellowship in a sense, and you're able to challenge the occupational medicine boards and become a board surgeon.

Right. Um so uh again your intern year is pretty much like any intern year, right? So what is the actual residency like? What is an occupational and environmental medicine residency?

Well basically you have like an MPH, like a masters in public health for about eight ish months of the residency, right? And it's typically paid for by the program that you're doing the residency with. And then the rest you have your clinical rotations, right? So You'll have uh clinical rotations in things like uh cardiology, uh pulmonology, neurology.

Um occupational medicine clinics, urgent care, addiction medicine, orthopaedic surgery. Uh you'll have some occupational safety and health administration uh rotations, so OSHA rotation. Um, sports medicine rotations, emergency medicine rotations, VA rotations, employee health rotations. uh emergency preparedness rotations. There's lots of variability in programs, but most programs tend to have the MPH and most of these core rotations that I'm talking talking about.

And one thing I'm gonna say about many of these rotations is that they are outpatient rotations. Probably about 80 to 90 percent of the rotations you do in residency are primarily outpatient, right? So now a question many people may ask is Divine, what exactly do you do in occupational medicine? Well, there's actually a lot of variation, right? There's a lot of variation, right? So you can work in an occupational health clinic.

Um you can work in an employee health clinic, you can hand you you you handle workplace injuries, you do Department of Transportation Physicals, right? So all these uh CDL drivers, these commercial truck truck drivers. Um, do you think that he can drive without uh getting like uh

uh like a detailed medical evaluation. Uh no they can't, right? Uh basically every two years, that's like the maximum amount of time you can get. You do need to get evaluated by somebody that is probably an Ocmed physician. uh that you know determines your you know your fitness for being able to do the job, you know, and things like that. Right. So or people that work in safety sensitive positions, right? So say for example like pilot.

uh for example, uh people that work in safety sensitive positions The vast majority of these people are evaluated by occupational medicine physicians, right? Uh, immigration examinations, those are done by people called civil surgeons. Um those are very detailed medical exams. That's gonna be done by an occupational medicine physician. Uh there are many occupational medicine physicians that work in the Veterans Affairs Administration, the VA.

Um so all these things like respiratory fit testing, fitness for duty, right? Like is a person fit to perform certain jobs. Uh that's done by occupational medicine physicians, corporate medicine, right? So say for example, you can be an occupational medicine physician and you can be an executive at a at a plant or something like that, like a manufacturing plant or whatever.

And you're basically the one that determines, okay, this is how the workplace should be set up, this is this, this is that, um, so that workers don't get injured, right? This is how we make sure that we're keeping with OSHA requirements and things like that. Um And they they also manage a lot of exposures, right? So, um, you know, like I know many of many people think that this is just stuff that you read from first aid, but things like silica Uh things like lead, things like beryllium.

Uh people do get exposed to those stains. Things like radon, things like asbestos, millions of people, believe it or not, every year get exposed to those stains, right? So occupational medicine physicians are the ones that are knowledgeable in okay, how do we do medical surveillance? for these exposures, how do we screen people for diseases related to these exposures? And what do we do for these people? Right. So um that's again largely done by occupational medicine physicians.

Um, so doing things like workers compensation, disability examinations, that's also done by occupational medicine. Environmental health, toxicology that's done by occupational medicine. Return to work. So let's say, for example, a person had a heart attack, you know, and um They have uh you know, you know, they've they had a cardiac cath and everything and they're about to return to work.

Um well who does that return to work evaluation if they are fit to come back to work or not? That's gonna be done by an occupational medicine physician, right? Um so again, um making a workplace less hazardous. Fitness for duty evaluations, toxicology, right? All these environmental exposures like an oil spill and all those things. Again.

Many occupational medicine physicians handle things like that, right? The medical aspects of those things, right? Um, disaster preparedness, emergency preparedness. public health work, medical surveillance exams, medical legal work, right? A lot of Ocmed physicians do consulting, uh where they do like medical legal work, right? Uh or even like another

Crazy it's not even crazy, like it's pretty common, right? So say for example you have like a big facility, right? So let's say you have like a uh car company, like a Toyota facility that employs a thousand people. Uh many times these places are gonna have like an on-site clinic. Uh who do you think manages that on-site clinic? It's typically gonna be an occupational medicine uh physician, right? Um literally scratching the surface of what.

an occupational medicine physician does, right? There's even some of these like very niche jobs, right? So like for example, like you can have like these national labs uh or like uh nuclear facility or whatever. And again, who do you think is in charge of managing workplace injuries at those places?

or monitoring workers for like radiation injury and things like that is going to be an occupational medicine physician. It's a very specialized field of medicine. It's broad, but it's also very specialized. That's one way I I would probably describe occupational medicine. It's broad, but it's very, very specialized. It's broad, but it's also very very specialized, right? It is probably one of the

In fact, I'll I'll probably judge this as being one of the most flexible fields in all of medicine, right? And the thing is, many times in occupational medicine, you can do your primary job. And then do a lot of other supplemental things. Like you can do a lot of consulting work. You can be a medical review officer where you review drug tests and things like that. Right. So there's a lot of things that you can do.

Right. So now what's the pay like? Uh the pay is very strongly com I'll save on average. On average for On average. right, uh like on average is very comparable to internal medicine, if not somewhat higher than internal medicine. Okay. Is very, very comparable to internal medicine and I'll say probably in many cases uh quite a bit higher than internal medicine.

you know, quite a bit higher than internal medicine. Um and for those that are in corporate medicine, the salary can approach that of a sub specialist in a like specialty like anesthesia, right? So

Again, if you know what an anesthesiologist makes, a person that's doing corporate medicine uh in occupational medicine can make that much, if not even more, right? And the thing is the job market is pretty good, right? So again, if you want a salary range is between like above internal medicine to sub specialists we

an anesthesiologist or a radiologist, right? So it pays pretty well. And the job market is pretty good, right? The thing is there are lots of people retiring. Literally lots of people retiring and there's not a lot of people entering the field. Um in fact I think the most current figures are that about thirty-five people nationwide are currently training in occupational medicine.

35 people nationwide are currently training occupational medicine. And a lot of people in the field are old and they're retiring. Right? They're old and they're they're retiring.

Right. Um there's not a lot of people in training. There's about twenty training programs nationwide. Um there's about twenty training programs are nationwide, right? And one thing I think I want to mention here that's actually like a very nice perk of occupational medicine, of occupational and environmental medicine, OEM. is that many of the insurance squibbles that many people worry about in other disciplines, it is very, very minimal.

mostly non existent, right? So all these things like prior off, um so prior authorizations, uh Medicare problems, uh I those you don't even think you basically don't even think about those in in occupational medicine. Right. And then what's the schedule like? What's the schedule like? Well, in a residency There is phenomenal work-life balance, right? Um most of the time your work is gonna be like nine to four, nine to five from Monday to Friday. That's it. Um you

Basically, never work weekends. Um, and that's pretty much what your job will also look like. Although, again, it depends on the job you get, but I'll say that. For probably like 95 to 99% of occupational medicine, like real-world jobs. Uh that's kind of how the schedule is. Right.

Who is this for? Who is this for? Well, um, what are some things I will say you should kind of keep in mind if you're a person that is thinking of occupational medicine? Well, number one, you should be a person that has an uh attention to detail, right? So you you need to be a person that has

good attention to detail, right? You need to be a person that is very flexible, right? It's a very flexible field. And again, anything could come let's say you work at an on-site clinic at a big manufacturing facility.

Anything could come through the door, right? Uh it could be a bone fracture. It could be something where you need to refer them to the emergency room, right? It could be something where you need to stabilize them and then refer them out, right? So you you need to be very flexible. There's a lot of flexibility even just in terms of career, right? Uh you also need to be a person that he likes outpatient medicine, right?

A lot of the work you do is outpatient medicine if you're involved in clinical occupational medicine. And I guess let me maybe comment on this flexibility aspect of things, right? So you can actually do pure 100% clinical occupational medicine. But you can also do occupational medicine that is like a hundred percent administrative. Like a hundred percent administrative, policy work, public health work, like nothing clinical. If you if if that's what

Right to your boat, you can absolutely do that. You can absolutely do that. You can absolutely do that. Um and then it also has uh it's also a discipline that I will say again, largely a mix of clinical and policy slash administrative slash public health work. Right. Uh again, you're basically a person that is working to make a workplace safer. And you're I I like to think of it as like you're essentially like the internate. slash emergency medicine physician off the workplace.

You're the internist slash the emergency medicine physician of the workplace. That is a gross oversimplification, but there's many other things uh in fact let me say you're probably like the internist. the family medicine doctor and the

Emergency medicine physician of the workplace. Well, let maybe let me break that down. Like, why do I say that? So the thing is, the emergency medicine angle is a workplace injury that arises obviously is gonna be an acute problem, right? You're going to manage those. And then, uh, from the internal medicine perspective, right, you have to consider many things in evaluating a person's fitness for duty, right? So say for example, if a person is a truck driver, right? If a person is a truck driver

You need to evaluate their cardiovascular systems, you need to evaluate their respiratory systems, you need to evaluate their neurologic systems, right? Before you say, Okay, I'm going to certify you to work to I'm gonna give you a a medical card to be able to work for two years as a CDL driver, right? As a commercial truck driver. Um you have to consider many things, right? Like for example, um when I do DOT physicals, right? Department of Transportation Physics.

I have to evaluate the patient, like, okay, wait, does this person have obstructive sleep apnea? Does this person have high blood pressure? What is this person's vision like?

What is this person's hearing like? Uh does this person have a murmur? Does this person have a seizure disorder? You need to know quite a bit about general medicine to make the right determination. Because the thing is, if you make the wrong decision, you can kill a lot of people. That's the truth, right? So say for example you g grant a medical card to a commercial driver

And you'll y you know, you didn't do a proper evaluation and things like that. You didn't think through things. You grant the person a medical card and then the person goes out, you know, they're driving their truck and then they they fall asleep on the job, right? Or they're impaired or they have a seizure or whatever.

Right. If you have a commercial truck accident, you're probably gonna kill tons of people, right? You're probably gonna kill tons of people, you're gonna cause significant damage, right? So Uh that's the internal medicine aspect of things like the hey I gotta think about many things.

Right. And then the family medicine part of things, uh slash preventive medicine part of things is like surveillance, right? So say for example, a person works in construction, right? And let's say, you know, they're like a people that build countertops and things like that. well those people are going to be exposed to

A lot of silica, right? So the thing is you need to be the one because those people they they have medical surveillance exams where basically like every three years they come in for a medical evaluation if they meet certain criteria.

So you typically work with a company to see like okay does this person meet the criteria for evaluation? Okay, how frequently should this person be evaluated? What should be the content of the exams? Like this person is probably gonna get spirometry, this person is gonna get a chest x-ray and it's gonna be read in a very specific way.

There's like a bunch of things you need to be cognizant of, right? So that's like the medical surveillance, almost like the preventive medicine aspect of of uh of uh occupational and environmental medicine. Right? Uh and you're gonna be a Outra coisa que eu vou dizer é You know, a characteristic you should probably have if you're interested in Ocmed is

You need to be willing to talk with people, right? Talk with people, educate people. Uh, that's something you need to be willing to do because it's a people specialty. You're going to be talking with people a lot. Right. And then you also need to be a person that is willing to work uh with autonomy, right?

So not necessarily having people breathing down your neck. Again, you probably will have bosses or whatever. But the thing is in many settings, in many situations, you're kind of the lone ranger, right? There are some times that in the military, you have an occupational medicine physician and you're the only Ocmed doc on the bait. Right. Uh you're the one that has to basically handle uh Most the workplace injuries, the fitness for duty evaluations and things like that.

Right. And you also need to be a person that is a leader, right? Leadership, leadership, leadership. Right. Many occupational medicine physicians are in leadership positions, especially if you're in corporate medicine, you're probably gonna be on the in in some settings you can actually be like an executive in the company, like the vice president of something, right? Uh you know, you'll you see like a large healthcare system and and things like that, right? And um you know

You also need to generate quite a number of reports, right? So you need to be a person that is you know, well versed in writing, right? You have a diversity of uh diversity of interests. If you're a person that has a diversity of interests, right, uh, and again a person that values work-life balance, right? So like for example, you know, many of you that listen to those podcasts.

Uh you know that um I'm a I'm a Christ follower, you know, I'm a person that, you know, I love to go to church on Sundays and I like to make podcasts that, you know, prepare people for the USMLE exam. Um you know I have many interests outside of classical medicine, right? Occupational medicine is a great field for a person that has that kind of

uh orientation, right? If you're a person that has a family, right? Again, it's a great field for physicians that have families, right? So it's a really great field. And you know, I I think I may have even neglected to talk about uh some other things that are done, right? Like employee health.

Right, like these employee health clinics you find at like the VA or at a hospital or whatever. Uh again, who do you think runs those employee health clinics? It's gonna be an occupational environmental medicine physician in many cases. Right. So um if you're interested in this field, I will encourage you um just do some research on it. Right. Um I will probably, God willing, in the future, make some other podcasts.

Excuse me. Uh make some other podcasts uh relating to occupational medicine um in the future, God willing, we'll see. But um I'm really s surprised by how how little people know about this. Um so again it's something to consider if you're applying for uh for uh you know for residency, it is certainly something to consider. Um it's certainly something to consider. It's certainly something to consider. I think uh many people, if more people knew about this field.

I have a feeling that more people would go into this field, right? There are many people that were family medicine physicians, they were internal medicine physicians, they were surgeons. Burnt out in their fields and they switched to occupational environmental medicine. Right. So uh just something to think about.

And there I guess also some sister specialties that are in uh related to occupational medicine, like uh preventive medicine is another separate residency. That's probably like a whole other podcast. Um, and then aerospace medicine is another residency. That's like a whole other podcast. Those people tend to work at like NASA or SpaceX or, you know, things things like that.

So I'm gonna go ahead and stop here. Uh again, if you love the way I teach, you love the way I make integrations, uh you will love the uh the classes that I offer. I also offer one on one tutoring and all that stuff. So um and I have these podcasts on Apple, Google and Spotify. And I have a YouTube channel, Divine Intervention, USMLE podcast and videos that you should check out. Um, there's tons of videos there, right? And um

Uh I also have another website called Divine Intervention Life Lessons.com. Divine Intervention Life Lessons.com. Again, many of you know I'm a Christ follower. So every week I post like one or two podcasts where from a biblical perspective.

I uh address a life lesson. Right. Uh there's actually I think like three hundred and eighty-nine podcasts on there uh now. Um and there's actually an Apple podcast, uh, you know, called the Divine Intervention Life Lessons uh podcast. So thank you for listening to me today. Again, I really, really think more med students. And I'm really trying to raise more more more and more awareness.

of occupational environmental medicine. That's literally what I'm uh being trained in now. That's what I'm gonna be doing for a living after I'm done with training, right? So I think it's a really great field, something that is not considered by many people, but I want to try to bring more eyes. and more ears to our field. Uh because again it's a it's a really great field. Again I know you may sound like I'm really glazing the field but I promise you it.

It's that good. In fact I think I'm probably with this podcast like heavily underselling. occupational medicine, but you should really dig into it. You you'll be quite shocked at what you will discover. So I will see you uh God willing episode six hundred and fifty. That's a nice round number. But have a wonderful rest of your day. Uh God bless you and bye for now. Thank you.